EAQ Wk3 Ch33 Acute Coronary Disease
1.A patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB).
Which steps are involved in the procedure? Select all that apply.
1. Some correct answers were not selected
2. A robot is used to replace the mitral valve.
3. Small incisions are made between the ribs.
4. Cardiac catheterization is performed during the procedure.
5. A mechanical stabilizer is placed to immobilize the operative site.
6. A thoracoscope or robotic assistance is used to free the internal mammary artery.
Rationale: MIDCAB offers patients with disease of the left anterior descending or right coronary artery an approach
to surgical treatment that does not involve a sternotomy and cardiopulmonary bypass (CPB). It involves several
small incisions between the ribs to dissect the internal mammary artery (IMA) with a thoracoscope or with robotic
assistance. The heart is then slowed or stopped temporarily with adenosine, which is assisted by a mechanical
stabilizer to immobilize the operative site. The IMA is then sutured to the coronary artery. A robot is used to replace
the mitral valve during robot assisted cardiothoracic surgery. Trans myocardial laser revascularization involves
cardiac catheterization. Mechanical stabilizers are used on a beating heart during off-pump coronary artery bypass.
2. The nurse is caring for a patient 24 hours after the patient was diagnosed with ST-segment-elevation myocardial
infarction (STEMI). For which complication of myocardial infarction (MI) would the nurse monitor this patient?
1. Unstable angina
2. Cardiac tamponade
3. Sudden cardiac death
4. Cardiac dysrhythmias
Rationale : The most common complication after MI is dysrhythmias, which are present in 80% of patients.
Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and
sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period
following an MI would not be characterized as sudden cardiac death.
3. Which artery is most commonly used for coronary bypass grafts?
1. Radial
2. Gastroepiploic
3. Inferior epigastric
4. Internal mammary
Rationale Bypass graft surgery involves the replacement of blood vessels that transport blood between the aorta and
the blocked coronary artery. The internal mammary artery (IMA) is the most common artery used for bypass graft.
The long-term patency rate for an IMA graft is greater than 90% after 10 years. Procedures involving the radial,
gastroepiploic, or inferior epigastric artery have a comparatively short-term patency rate. p. 716
5.
A patient receives morphine sulfate to relieve chest pain. For which adverse effects would the nurse monitor the
patient? Select all that apply.
Bradypnea
Dysrhythmia
Bradycardia
Hypotension
Decreased ejection fraction
Rationale : Morphine sulfate is prescribed to patients with chest pain. Morphine acts as a vasodilator; it decreases
cardiac workload, contractility, and BP. The nurse should monitor for signs of bradypnea and hypotension to avoid
myocardial ischemia and infarction. The nurse should monitor dysrhythmias and bradycardia in a patient receiving
docusate. Morphine sulfate does not directly affect ejection fraction; indirectly, improved oxygenation will lead to
more effective cardiac pumping.
6.
In which location would a myocardial infarction (MI) occur due to blockage of the right coronary artery?
Inferior wall
Anteroseptal
Anterolateral
Anterior wall
Rationale Blockage of the right coronary artery may result in an inferior wall MI because the right coronary artery
supplies blood to the inferior wall of the heart. Damage to one or more other coronary arteries may result in
anteroseptal and anterolateral MIs. Anterior wall infarctions result from blockages in the left anterior descending
artery.
7. A patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB).
Which steps are involved in the procedure? Select all that apply. Some correct answers were not selected
A robot is used to replace the mitral valve.
Small incisions are made between the ribs.
Cardiac catheterization is performed during the procedures.
A mechanical stabilizer placed to immobilize the operative site.
A thoracoscope or robotic assistance is used to free the internal mammary artery.
Rationale MIDCAB offers patients with disease of the left anterior descending or right coronary artery an approach
to surgical treatment that does not involve a sternotomy and cardiopulmonary bypass (CPB). It involves several
small incisions between the ribs to dissect the internal mammary artery (IMA) with a thoracoscope or with robotic
assistance. The heart is then slowed or stopped temporarily with adenosine, which is assisted by a mechanical
stabilizer to immobilize the operative site. The IMA is then sutured to the coronary artery. A robot is used to replace
the mitral valve during robot assisted cardiothoracic surgery. Trans myocardial laser revascularization involves
cardiac catheterization. Mechanical stabilizers are used on a beating heart during off-pump coronary artery bypass.
p. 716
8.
A patient who survived an episode of sudden cardiac death (SCD) is recovering in the intensive care unit (ICU).
Which intervention would the nurse anticipate to prevent a recurrence?
Drug therapy with β-blocker
Coronary artery bypass graft (CABG)
Percutaneous coronary intervention (PCI)
Implantable cardioverter-defibrillator (ICD)
Rationale
The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD
improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD.
A CABG is not necessary.
9.
The nurse assesses a patient who has been diagnosed with papillary muscle dysfunction. Which observation
supports the patient’s diagnosis?
S 3 heart sound
Murmur at the cardiac apex
Crackles in bilateral lung bases
Deep sound at the lower left sternal border
Rationale: Papillary muscle dysfunction occurs if the papillary muscles attached to the mitral valves are involved in
infarction. A patient may have papillary muscle infarction if a murmur is heard upon auscultation at the cardiac
apex. The presence of S and S sounds of the heart and crackles in breath sounds indicate heart failure. The deep
sound heard at the lower left sternal border upon auscultation indicates acute pericarditis.
10. A patient tells the nurse, "I had severe chest pain six days ago." Which cardiac biomarker will be most helpful
in determining whether the patient had a myocardial infarction at the time the patient experienced chest pain?
Troponin
Myoglobin
Homocysteine
Creatine kinase (CK
Rationale Troponin is a serum cardiac marker that is detectable in the blood up to two weeks after myocardial injury
and is used to diagnose a myocardial infarction. Troponin has two subtypes: cardiac-specific troponin T (cTnT) and
cardiac-specific troponin I (cTnI). Serum levels of cTnT and cTnI increase 4 to 6 hours after the onset of myocardial
injury, peak at 10 to 24 hours, and return to baseline over 10 to 14 days. Myoglobin is a protein found in skeletal and
cardiac muscle. It is a sensitive indicator of early myocardial injury but is not specific for cardiac muscle; therefore,
it is not used to diagnose a myocardial infarction. Murmur at the cardiac apex Crackles in bilateral lung bases Deep
sound at the lower left sternal border 3 4 Troponin Myoglobin Homocysteine Creatine kinase (CK). It is a sensitive
indicator of early myocardial injury but is not specific for cardiac muscle; therefore, it is not used to diagnose a
myocardial infarction. Myoglobin peaks and returns to normal in 3 to 15 hours. Homocysteine is a protein. High
levels of homocysteine may indicate an increased risk for coronary artery disease. It is not used to diagnose
myocardial infarction. CK levels begin to rise about 6 hours after an MI, peak at about 18 hours, and return to
normal within 24 to 36 hours.
11. The nurse is caring for a patient having a myocardial infarction. The health care provider prescribes an IV
infusion of alteplase. Which intervention would the nurse include during the administration of this medication?
Monitor for changes in neurologic status.
Assess BP for orthostatic changes.
Apply a pressure dressing to IV insertion sites.
Start additional IV lines after alteplase infusion has begun.
Rationale Assessment for changes in neurologic status is the priority nursing intervention because this may indicate
a cerebral bleed during the thrombolytic infusion. Monitoring BP for orthostatic changes is necessary with the use of
short-acting nitrates. Application of a pressure dressing to the IV insertion site is not done unless evidence of
bleeding is noted. Additional IV therapy lines should be inserted before the alteplase begins. Perform all other
invasive procedures before giving the thrombolytic agent to reduce the risk for bleeding.
12. A patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB). Which steps are
involved in the procedure? Select all that apply
A robot is used to replace the mitral valve.
Small incisions are made between the ribs.
Cardiac catheterization is performed during the procedure.
A mechanical stabilizer is placed to immobilize the operative site.
A thoracoscope or robotic assistance is used to free the internal mammary artery
Rationale MIDCAB offers patients with disease of the left anterior descending or right coronary artery an approach
to surgical treatment that does not involve a sternotomy and cardiopulmonary bypass (CPB). It involves several
small incisions between the ribs to dissect the internal mammary artery (IMA) with a thoracoscope or with robotic
assistance. The heart is then slowed or stopped temporarily with adenosine, which is assisted by a mechanical
stabilizer to immobilize the operative site. The IMA is then sutured to the coronary artery. A robot is used to replace
the mitral valve during robot assisted cardiothoracic surgery. Trans myocardial laser revascularization involves
cardiac catheterization. Mechanical stabilizers are used on a beating heart during off-pump coronary artery bypass.
13. A patient is recovering from an uncomplicated myocardial infarction (MI). Which instructions will the nurse
include about physical activity?
"Start out with 30-minute sessions."
"Be sure to perform physical activity at least twice a week."
"Physical activity should be regular, rhythmic, and repetitive."
"Your heart rate during exercise should only be 30 beats over your resting rate."
Rationale Physical activity should be regular, rhythmic, and repetitive, using large muscles to build up endurance
(e.g., walking, cycling, swimming, rowing). Physical activity sessions should be at least 30 minutes long. Instruct
the patient to begin slowly at personal tolerance (perhaps only 5 to 10 minutes) and build up to 30 minutes.
Encourage the patient to perform physical activity on most days of the week. Activity intensity is determined by the
patient's heart rate. If an exercise stress test has not been performed, the heart rate of the patient recovering from an
MI should not exceed 20 beats/min over the resting heart rate.
14. The nurse is caring for a patient 24 hours after the patient was diagnosed with ST-segment-elevation myocardial
infarction (STEMI). For which complication of myocardial infarction (MI) would the nurse monitor this
patient?
Unsatble Angina
Cardiac tamponade
Sudden cardia death
Cardiac dysrhythmias
Rationale The most common complication after MI is dysrhythmias, which are present in 80% of patients. Unstable
angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden
cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an
MI would not be characterized as sudden cardiac death. p. 720
15. Which artery is most commonly used for coronary bypass grafts?
Radial
Gastroepiploic
Inferior epigastric
Internal mammary
Rationale Bypass graft surgery involves the replacement of blood vessels that transport blood between the aorta and
the blocked coronary artery. The internal mammary artery (IMA) is the most common artery used for bypass graft.
The long-term patency rate for an IMA graft is greater than 90% after 10 years. Procedures involving the radial,
gastroepiploic, or inferior epigastric artery have a comparatively short-term patency rate. p. 716 Radial
Gastroepiploic Inferior Epigastric Internal mammary 6/13/2021 El
16. The nurse is preparing an initial care plan for a patient who presents with chest pain. Which is the priority
nursing intervention?
Monitoring the patient’s cardiac rhythm
Discussing the losses associated with chronic illness
Encouraging verbalization of feelings, perceptions, and fears
Advising the patient to avoid heavy meals and extreme weather conditions
Rationale A patient with chest pain may have acute coronary syndrome. The priority is to stabilize the patient,
determine the plan of care, and prevent complications. Ongoing care should include continuous electrocardiogram
(ECG) monitoring. The nurse should help the patient with anxiety and stress to work on the losses due to chronic
illness to prevent sudden depression-related cardiac workload, but that is not the highest priority. A patient with
chronic stable angina is advised to avoid heavy meals and extreme weather to reduce the probability of symptoms,
and this may be appropriate. The nurse should encourage verbalization of feelings, perceptions, and fears that
increases workload on heart but that is not a higher priority than monitoring for life-threatening dysrhythmias
17. The nurse teaches a student nurse about acute pericarditis. Which statement made by the student nurse
indicates effective learning?
"I should massage the patient’s chest region to relieve symptoms."
"The patient’s pain can be relieved by sitting in the forward position."
"Acute pericarditis should be treated immediately by IV heparin."
"Treatment of acute pericarditis involves mitral valve repair or replacement."
Rationale Acute pericarditis is an inflammation of the pericardium that may occur within two to three days of
acute myocardial infarction. The patient’s chest pain is relieved after sitting in the forward position. The pain may
return after a change in position or inspiration. Massaging the chest region may aggravate the symptoms. IV heparin
is given to a patient with an unstable thrombus or coronary artery spasm. Papillary muscle dysfunction treatment
involves mitral valve repair or replacement. Acute pericarditis treatment involves nonsteroidal anti-inflammatory
agents, aspirin, and corticosteroids.
18. A patient with acute coronary syndrome (ACS) receives a prescription for niacin to treat hyperlipidemia. The
nurse observes another care provider giving information about the medication to the patient. Which item
included in the education would the nurse question?
"Most side effects subside with time."
"Take the drug on an empty stomach."
"A side effect is flushing in the upper torso and face."
"Decreased liver function may occur with high doses."
Rationale The drug should be taken with food. Side effects include flushing and pruritus in the upper torso and face,
as well as gastrointestinal (GI) disturbances. Most side effects subside with time. Decreased liver function may
occur with high doses.
19. A patient who is being discharged from the hospital after acute coronary syndrome will be participating in
cardiac rehabilitation. Which information will the nurse provide about the early recovery phase of
rehabilitation?
" Activity level depends on severity of angina or myocardial infarction (MI).
Therapeutic lifestyle changes should become lifelong habits.
Activity level is increased gradually with supervision and with electrocardiogram (ECG) monitoring
The focus will be on management of chest pain, anxiety, dysrhythmias, and other complications.
Rationale In the early recovery phase after the patient is dismissed from the hospital, the activity level is increased
gradually under supervision and with ECG monitoring. In the first phase of recovery, activity is dependent on the
severity of the angina or MI. The late recovery phase includes therapeutic lifestyle changes that become lifelong
habits. In the first phase of recovery attention is focused on the management of chest pain, anxiety, dysrhythmias,
and other complications.
20. A patient with Prinzmetal’s angina who takes a short-acting nitrate reports feeling dizzy while changing
positions. Which prescription would the nurse anticipate?
Esmolol
Morphine sulfate
IV heparin
IV fluid bolus
Rationale Prinzmetal’s angina is treated with short-acting nitrates, such as nitroglycerin. Orthostatic hypotension is a
common side effect of nitroglycerin because of the depletion of body fluid volume. Therefore, the patient may be
administered IV fluid bolus. β-blockers such as esmolol can lead to hypotension, which may further worsen the
patient’s condition. IV heparin is administered to a patient undergoing thrombolytic therapy; heparin is not
suggested for a patient with Prinzmetal’s angina. Morphine sulfate is the drug of choice for chest pain during angina
that is unrelieved by nitroglycerin
21. A patient reports heaviness and burning sensation in the substernal and retrosternal region. Which assessment
finding would indicate sympathetic nervous system stimulation?
Jugular venous distention
Abnormal S 3 and S 4 sounds
Ashen, clammy, and cool skin
Shortness of breath and anxiety
Rationale A patient with heaviness and burning sensation in the substernal and retrosternal region may be having a
myocardial infarction (MI) and stimulation of the sympathetic nervous system. This condition may trigger the
production of catecholamines, which promote glycogen release, diaphoresis, and vasoconstriction of peripheral
blood vessels. Because of this, the patient’s skin may appear ashen, clammy, and cool to the touch. Jugular vein
distention and abnormal S and S sounds are caused by ventricular dysfunction. Shortness of breath and anxiety may
not necessarily be caused by sympathetic nervous system stimulation.
22. Which clinical manifestations in a patient with chest pain are associated with myocardial infarction (MI)? Select
all that apply.
Flushing
Ashen skin
Diaphoresis
S 3 or S 4 heart sounds
Nausea and vomiting
During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased
sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and
vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy as a result of this
response. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S and S heart
sounds. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Skin is ashen
and clammy rather than flushed. Pg719
23. The nurse is caring for a patient one month after the patient had a myocardial infarction. The patient is
hospitalized with a three-day history of chest pain, joint pain, and a body temperature of 101° F (38.3° C). The
patient’s lab results include a white blood cell count of 15,000/mcL and an erythrocyte sedimentation rate of 30
mm/hr. Which condition would the nurse suspect?
Pneumonia
Hiatal hernia
Dressler syndrome
Ventricular aneurysm
Rationale Dressler syndrome is pericarditis that develops four to six weeks after myocardial infarction. This
syndrome is caused by an antigen-antibody reaction to the necrotic myocardium, and the patient may experience
pericardial pain, fever, and arthralgia. Laboratory findings of an elevated white blood cell count and sedimentation
rate also indicate Dressler syndrome. Note that the normal level of white blood cells is 10,000/cc and the normal
range of sedimentation rate is 0 to 22 mm/hr for men and 0 to 29 mm/hr for women. Pneumonia and hiatal hernia
can cause chest pain that requires emergency management. Ventricular aneurysm results from thinning of
myocardial wall during contraction.
24. A patient with angina states, "I walked to the bathroom. While I was having a bowel movement, I started having
the worst chest pain ever. It was similar to the pain I had at home. The pain went away rather quickly." Which
further subjective assessment data would the nurse obtain?
What precipitated the pain?"
"Has the pain changed this time?"
"In what location did you feel the pain?"
"Please rate the pain on a scale from 0 to 10."
Rationale Using PQRST, the assessment data not volunteered by the patient is the radiation (R) of pain, the area in
which the patient felt the pain and if it radiated. The precipitating event (P) was going to the bathroom and having a
bowel movement. The quality (Q) of the pain was "like before I was admitted," although a more specific description
may be helpful. Severity (S) of the pain was the "worst chest pain ever," although an actual number may be needed.
Timing (T) is supplied by the patient describing when the pain occurred and that the patient had had this pain
previously.
25. A patient is admitted to the intensive care unit in stable condition with a diagnosis of myocardial infarction.
Which common medications will be used to treat this condition? Select all that apply.
Diuretics
Stool softeners
Prophylactic antibiotics
Dual antiplatelet therapy
IV nitroglycerin
Low -molecular-weight heparin (LMWH)
After an MI, the patient may be predisposed to constipation because of bed rest and opioid drugs. Stool softeners
(e.g., docusate sodium [Colace]) prevent straining and the resultant vagal stimulation from the Valsalva maneuver.
Vagal stimulation produces bradycardia and can provoke dysrhythmias. Drug therapy for myocardial infarction
includes IV nitroglycerin, dual antiplatelet therapy (e.g., aspirin and clopidogrel), and systemic anticoagulation with
either LMWH given subcutaneously or IV unfractionated heparin, which are the initial drug treatments of choice for
acute coronary syndrome (ACS). Diuretics and prophylactic antibiotics are not appropriate at this time. pp. 725-726
26. The nurse is caring for a patient who survived sudden cardiac death (SCD) caused by a lethal ventricular
dysrhythmia. Which tests will likely be prescribed to monitor the effectiveness of drug treatment? Select all that
apply.
24-hour Holter monitoring
Implantable cardiac monitor
MRI
Signal-averaged electrocardiogram (ECG)
Electrophysiologic study (EPS) under fluoroscopy
Because most SCD patients have lethal ventricular dysrhythmias associated with a high recurrence rate, they are
closely monitored to assess when they are most likely to have a recurrence and to determine which drug therapies
are most effective for them. This monitoring may include 24-hour Holter monitoring, implantable cardiac monitor,
signal-averaged ECG, and an EPS done under fluoroscopy. MRI is not used to monitor for lethal dysrhythmias.
27. For which problem is percutaneous coronary intervention (PCI) initially indicated?
Chronic stable angina
Left-sided heart failure
Acute myocardial infarction
Coronary artery disease (CAD)
Rationale PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and
CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of
heart failure, such as left-sided heart failure. 712
28. The nurse is examining the electrocardiogram (ECG) of a patient who has just been admitted with a suspected
myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary
occlusion?
Sinus tachycardia
Pathologic Q wave
Fibrillatory P waves
Prolonged PR interval
The presence of a pathologic Q wave, which often accompanies ST-segment-elevation myocardial infarction
(STEMI), is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial
fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.
29. The nurse provides information about thrombolytic therapy to a group of student nurses. Which statement made
by a student nurse indicates the need for further teaching?
Significant head trauma within the past three months is a relative contraindication."
"A symptom of major bleeding with thrombolytic therapy is an increase in heart rate (HR)."
"The goal is to give the thrombolytic within 30 minutes of the patient’s arrival to the emergency department."
"The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the
electrocardiogram (ECG)."
Rationale Significant closed-head or facial trauma within the past three months is an absolute contraindication due
to increased risk of bleeding; the benefit does not outweigh the risk. Signs and symptoms of bleeding during
thrombolytic therapy include a drop in BP, increase in HR, sudden change in the patient’s mental status, and blood
in the urine or stool. Treatment of ST-segment-elevation myocardial infarction (STEMI) with thrombolytic therapy
aims to limit the infarction size by dissolving the thrombus in the coronary artery and reperfusing the heart muscle
rapidly. The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the ECG.
29.A patient with a history of unstable angina reports a sudden onset of retrosternal chest heaviness and tightness,
fatigue, shortness of breath, and nausea. Which actions would the nurse take? Select all that apply.
Obtain a 12-lead electrocardiogram (ECG).
Administer sublingual nitroglycerin.
Place the patient in a supine position.
Apply high-flow oxygen by face mask.
Auscultate for a pericardial friction rub.
Rationale Initial management of the patient with chest pain includes the following: Obtain a 12- lead ECG and start
continuous ECG monitoring. Position the patient in an upright, not supine, position unless contraindicated, and
initiate oxygen by nasal cannula (not high-flow by face mask) to keep oxygen saturation above 93%. Establish an IV
route to provide an access for emergency drug therapy. Give sublingual nitroglycerin and aspirin (chewable).
Morphine sulfate is given for pain unrelieved by nitroglycerin (NTG). Auscultating for a pericardial friction rub is
not an appropriate action.
1. Which type of medication may be prescribed for a patient with an ejection fraction (EF)
of 25%?
β-adrenergic blocker
Calcium channel blocker
Angiotensin-converting enzyme (ACE) inhibitor
Lipid-lowering agent
Rationale Patients with chronic stable angina who have an EF of 40% or less should take an
ACE inhibitor indefinitely, unless contraindicated. These drugs result in vasodilation and
reduced blood volume. They also prevent ventricular remodeling and prevent the progression of
heart failure in the patient. Lipid-lowering agents reduce low density cholesterol and triglyceride
levels in the blood. β-adrenergic blockers decrease myocardial oxygen demand by reducing heart
rate, BP, and contractility. Calcium channel blockers are prescribed to decrease BP in patients
with β-blocker intolerance and Prinzmetal’s angina.
2. The nurse provides a student nurse with information related to management of a
patient following cardiac catheterization. Which intervention would the nurse explain is
the specific responsibility of the nurse, rather than that of assistive personnel (AP)?
Recording vital signs
Monitoring neurovascular changes
Asking the patient about comfort measures
Assisting with oral hygiene, hydration, and meals
Rationale The nurse is responsible for monitoring changes in neurovascular status or bleeding.
AP take vital signs. All members of the health care team can address measures that will make the
patient more comfortable. AP assist with oral hygiene, hydration, meals, and toileting
3. Cardiac biomarker levels are being evaluated for a patient who is suspected of having a
myocardial infarction (MI). Which biomarker lacks specificity for diagnosing an MI?
Myoglobin
Creatine kinase-MB (CK-MB)
Cardiac-specific troponin I (cTnI)
Cardiac-specific troponin T (cTnT)
Rationale Myoglobin is a serum cardiac marker that is released into the circulation within two
hours after an MI. Myoglobin’s role in diagnosing MI is limited because it lacks cardiac
specificity. Creatine kinase-MB (CK-MB) levels begin to rise about six hours after an MI, are
specific to myocardial cells, and help quantify myocardial damage. Cardiacspecific troponin T
(cTnT) and cardiac-specific troponin I (cTnI) are highly specific indicators of MI.
4. Which therapy would the nurse anticipate administering for emergency care of a patient
with a suspected myocardial infarction (MI)
Oxygen, nitroglycerin, aspirin, and morphine
Aspirin, nitroprusside, dopamine, and oxygen
Nitroglycerin, lorazepam, oxygen, and warfarin
Oxygen, furosemide, nitroglycerin, and meperidine
Rationale The American Heart Association's guidelines for emergency care of the patient with
chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These
interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload,
and prevent further platelet aggregation. Furosemide, meperidine, nitroprusside, dopamine,
lorazepam, and warfarin may be used later in the patient's treatment.
5. The nurse provides a list of health-promoting regular physical activity examples to a
patient with coronary artery disease (CAD). Which activity would the nurse include on
the list?
Painting while seated
Performing carpentry
Jogging (7 to 8 miles per hour)
Brisk walking (3 to 4 miles per hour)
Rationale Physical activity improves the physiologic functioning and psychologic well-being of
a patient with acute coronary syndrome. Therefore the nurse should encourage the patient to
walk at a rate of 3 to 4 miles per hour. Painting while seated is a low-energy activity. Carpentry
and running at 7 miles per hour are high-energy activities for a patient with acute coronary
syndrome
6. The nurse is caring for a patient 24 hours after the patient was diagnosed with STsegment-elevation myocardial infarction (STEMI). For which complication of myocardial
infarction (MI) would the nurse monitor this patient?
Unstable angina
Cardiac tamponade
Sudden cardiac death
Cardiac dysrhythmias
Rationale The most common complication after MI is dysrhythmias, which are present in 80% of
patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac
tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from
cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as
sudden cardiac death.
7. The nurse is providing teaching to a patient recovering from a myocardial infarction
(MI). In which way would the nurse plan for resumption of sexual activity to be
discussed?
Delegated to the health care provider
Discussed along with other physical activities
Avoided because it would be embarrassing to the patient
Accomplished by providing the patient with written material
Rationale Although some nurses may not feel comfortable discussing sexual activity with
patients, it is a necessary component of patient teaching. It is helpful to consider sex as a
physical activity and to discuss or explore feelings in this area when other physical activities are
discussed. The discussion of sexual activity should not be delegated to the health care provider or
avoided because of embarrassment. Although providing the patient with written material is
appropriate, it should not replace a verbal dialogue that can address the individual patient's
questions and concerns.
8. The nurse is reviewing a plan of care for emergency treatment of a patient with chest
pain. Which item listed on the plan would the nurse question?
Give a high-dose statin medication.
Give 162 to 325 mg aspirin (chewable).
Start O by nasal cannula to keep O saturation above 93%.
Instruct the patient to do coughing and deep-breathing exercises
Rationale Rapid diagnosis and providing treatment to a patient with acute coronary syndrome
help to preserve cardiac muscle function. The initial treatment is to manage chest pain; therefore
the patient needs to rest and limit activities (including breathing exercises) for 12 to 24 hours.
The nurse should make sure that the oxygen saturation stays at an acceptable level by initiating
supplemental oxygen. Aspirin is part of the antiplatelet therapy. Statins are lipid-lowering drugs.
They block synthesis of cholesterol and increase low-density lipoprotein receptors in the liver.