Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 60: Management of Clients with Myocardial Infarction
MULTIPLE CHOICE
1. After instructing a client with stable angina, the nurse would evaluate that the client has a
proper understanding of the condition when the client says
a. “My chest pain can occur if I overexert myself.”
b. “Angina pain usually feels like being stabbed with a knife.”
c. “If I have chest pain, then I’m probably having another heart attack.”
d. “Each time I have angina, my heart is damaged.”
ANS: a
When fixed blockages are present in the coronary arteries, conditions that increase myocardial
oxygen demand (e.g., physical exertion, emotion, exposure to cold) may precipitate episodes of
angina.
DIF: Cognitive Level: Application
TOP: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity
REF: Text Reference: 1702
2. A client admitted for angina reports experiencing pain of long duration while at rest and also
early in the morning. The nurse would recognize this pattern as
a. unstable angina.
b. nocturnal angina.
c. variant angina.
d. angina decubitus.
ANS: c
Variant angina (Prinzmetal’s angina) is chest discomfort that is similar to classic angina but is of
longer duration and may occur while at rest. These attacks tend to happen in the early hours of
the day.
DIF: Cognitive Level: Application
REF: Text Reference: 1704
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
3. When instructing a client in the proper administration of sublingual nitroglycerin (NTG), the
nurse would include in the teaching plan that the client should
a. store NTG tablets in the refrigerator.
b. repeat the dosage every 5 minutes for three times if pain is not relieved.
c. assess blood pressure for reactive hypertension after each dose.
d. take an aspirin before each dose of NTG.
ANS: b
Chapter 60: Management of Clients with Myocardial Infarction
2
NTG tablets should be stored at room temperature. If the pain is not relieved after three NTG
tablets, each taken 5 minutes apart, the client should take an aspirin and notify the physician.
DIF: Cognitive Level: Application
REF: Text Reference: 1706
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
4. After a myocardial infarction (MI), a client is receiving continuous intravenous (IV) infusion
and has a Swan-Ganz catheter to measure hemodymanic parameters. On assessing a
pulmonary capillary wedge pressure (PCWP) of 24 mm Hg, the nurse initially would
a. observe for clinical manifestations of respiratory depression.
b. monitor the client’s blood pressure.
c. reduce the rate of the IV infusion.
d. notify the physician.
ANS: c
The elevated PCWP indicates fluid volume overload. The IV infusion should be slowed initially,
the breath sounds assessed, and the physician notified.
DIF:
REF:
TOP:
MSC:
5.
a.
b.
c.
d.
Cognitive Level: Analysis
Text Reference: 1721, Nursing Care Plan;
Nursing Process Step: Intervention
NCLEX: Physiological Integrity
As an appropriate breakfast menu for a client with angina, the nurse would suggest
bran flakes with skim milk, apple slices, and orange juice.
scrambled eggs, whole-wheat toast, and prune juice.
oatmeal with skim milk, one bacon slice, and hot tea.
French toast with syrup, grapefruit half, and skim milk.
ANS: a
A high-fiber diet not only may prevent constipation and other intestinal tract ailments, but also
may decrease the number and severity of anginal attacks. Diets high in fiber may also lower
serum cholesterol and triglyceride levels.
DIF: Cognitive Level: Application
REF: Text Reference: 1707
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
6. A client presents to the emergency department complaining of chest pain that began 2 hours
earlier; the client’s electrocardiogram (ECG) is consistent with acute myocardial infarction.
The nurse would know that the standard remedy at this time is
a. lidocaine.
b. verapamil.
c. streptokinase.
d. diazepam.
ANS: c
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Chapter 60: Management of Clients with Myocardial Infarction
3
Clinicians treat acute MI with medications that lyse (dissolve) the clot that forms part of the
blockage of the coronary artery. Thrombolytic therapy includes streptokinase, urokinase, tissue
plasminogen activator (t-PA, alteplase), anisoylated plasminogen-streptokinase activator
complex (APSAC, anistreplase), urokinase plasminogen activator, and the newest agent,
reteplase. To be most effective, thrombolytic agents must be given within 3 to 6 hours after the
onset of chest pain.
DIF:
REF:
TOP:
MSC:
7.
a.
b.
c.
d.
Cognitive Level: Application
Text Reference: 1713, 1714, Integrating Pharmacology Box;
Nursing Process Step: Assessment
NCLEX: Physiological Integrity
The nurse would explain to a client that the most common site for MI is the
posterior wall of the left ventricle.
anterior wall of the left ventricle near the apex.
inferior (diaphragmatic) surface.
anterior wall of the right ventricle.
ANS: b
The most common site for myocardial infarction is the anterior wall of the left ventricle near the
apex. Infarction of the anterior left ventricle results from thrombosis of the descending branch of
the left coronary artery.
DIF: Cognitive Level: Knowledge
REF: Text Reference: 1708
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
8. Four hours after the onset of pain from an MI, the nurse would expect an increase in the
definitive laboratory study result, which is
a. leukocyte count.
b. lactate dehydrogenase (LDH).
c. alkaline phosphatase (ALP).
d. CK-MB.
ANS: d
Serum levels of CK-MB, an isoenzyme of creatine kinase (CK) found primarily in cardiac
muscle, increase 3 to 6 hours after the onset of chest pain, peak in 12 to 18 hours, and return to
normal levels in 3 to 4 days. Although the other laboratory values will increase, the levels will
not rise as quickly as CK-MB and are not specific for myocardial muscle damage.
DIF: Cognitive Level: Application
REF: Text Reference: 1711
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
9. After administering a thrombolytic agent to a client experiencing an acute MI, the nurse
would record that the medication has been effective when the client experiences
a. elevated serum alkaline phosphatase.
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Chapter 60: Management of Clients with Myocardial Infarction
4
b. relief of anxiety.
c. presence of frequent PVCs.
d. return of blood pressure to baseline.
ANS: c
Successful reperfusion of the coronary arteries is evidenced by return of the ECG changes to
normal; relief of chest pain; presence of reperfusion dysrhythmias, usually sudden onset of
frequent premature ventricular contractions (PVCs) or short runs of PVCs; and a rapid, early
peak of CK-MB isoenzyme (washout).
DIF:
REF:
TOP:
MSC:
10.
a.
b.
c.
d.
Cognitive Level: Analysis
Text Reference: 1714, Integrating Pharmacology Box;
Nursing Process Step: Assessment
NCLEX: Physiological Integrity
When caring for a client immediately after an MI, the nurse’s first priority would be
relief of pain.
monitoring for presence of dysrhythmias.
prevention of embolism.
relieving client’s apprehension.
ANS: a
The first 6 hours after the onset of pain is the crucial time frame for the salvage of the
myocardium. Pain control is a priority, usually with IV morphine. Continued pain is a
manifestation of myocardial ischemia. Pain also stimulates the autonomic nervous system and
preload, increasing myocardial demands.
DIF: Cognitive Level: Analysis
REF: Text Reference: 1719
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
11. When the nurse notes a run of four premature ventricular contractions (PVCs) on the monitor
of a client with a recent MI, the nurse would
a. continue observation, watching for a run of six PVCs or more.
b. notify the physician immediately.
c. administer nitroglycerin.
d. change ECG leads.
ANS: a
The nurse should notify the physician if more than six PVCs occur per minute and the client is
symptomatic.
DIF: Cognitive Level: Analysis
REF: Text Reference: 1714
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
12. The nursing action that would most help to prevent cardiogenic shock in a client after a
myocardial infarction is
Elsevier items and derived items © 2005 by Elsevier Inc.
Chapter 60: Management of Clients with Myocardial Infarction
a.
b.
c.
d.
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administering lidocaine as ordered.
maintaining the client flat in bed.
limiting fluid intake.
administering morphine for pain.
ANS: d
Shock can be prevented with rapid relief of pain and with sufficient IV fluids to prevent
circulatory collapse.
DIF: Cognitive Level: Application
REF: Text Reference: 1716
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
13. When the immediate post-MI client complains about the soft, high-fiber diet, the nurse would
inform the client that the pupose of such a diet is to
a. maintain bowel health to decrease gas.
b. create a high-bulk, soft stool to minimize Valsalva’s maneuver.
c. lower cholesterol levels.
d. promote easy digestion.
ANS: b
The stool, being soft, does not require that the client perform Valsalva’s maneuver during
evacuation, which causes bradycardia and decreases cardiac output.
DIF:
REF:
TOP:
MSC:
Cognitive Level: Analysis
Text Reference: 1723, Nursing Care Plan;
Nursing Process Step: Intervention
NCLEX: Physiological Integrity
14. For a 40-year-old client who wants to be more active the first 24 hours after an MI, the nurse
could safely suggest that the client
a. use the bedside commode for bowel movements.
b. take a bath in the shower.
c. ambulate in the hall.
d. perform gentle isometric exercises.
ANS: a
The client should be on complete bed rest for the first day or so after MI, with use of the bedside
commode for bowel movements. Most clients receive a 2-gram sodium diet. The client who is
nauseated can have a liquid diet for the first 24 hours.
DIF:
REF:
TOP:
MSC:
Cognitive Level: Analysis
Text Reference: 1723, Nursing Care Plan;
Nursing Process Step: Intervention
NCLEX: Physiological Integrity
15. In the discharge teaching plan for a client after MI, the nurse would include that the client
should
Elsevier items and derived items © 2005 by Elsevier Inc.
Chapter 60: Management of Clients with Myocardial Infarction
a.
b.
c.
d.
6
resume sexual intercourse in 3 months.
begin walking for short periods every day.
take 1 aspirin every 8 hours as ordered.
continue previous lifestyle when ready.
ANS: b
The physician may allow sexual intercourse 4 to 8 weeks after an MI. The nurse should
encourage frequent walks; the walking program aims for a goal of 2 miles in less than 60
minutes. After an acute MI, many clients are instructed to take 1 aspirin daily.
DIF: Cognitive Level: Application
REF: Text Reference: 1727
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
16. The nurse would remind a client that the cause of sudden death after myocardial infarction is
usually
a. dysrhythmias.
b. congestive heart failure.
c. myocardial ischemia.
d. stroke.
ANS: a
Dysrhythmias are the major cause of death after an MI (40% to 50% of deaths). Ectopic rhythms
arise in or near the borders of intensely ischemic and damaged myocardial tissues.
DIF: Cognitive Level: Knowledge
REF: Text Reference: 1716
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
17. The nurse would explain to a client that increased levels of troponin T, the enzyme indicating
myocardial damage, are evident within
a. 1 to 2 hours after MI pain has started.
b. 3 to 6 hours after MI pain has started.
c. 7 to 9 hours after MI pain has started.
d. 10 to 12 hours after MI pain has started.
ANS: b
Troponin T is similar to CK-MB, and levels increase within 3 to 6 hours after pain has started;
this is more accurate than LDH in confirmation of the acute MI. The level remains elevated for 2
to 3 weeks.
DIF: Cognitive Level: Comprehension REF: Text Reference: 1711
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
18. For a client whose resting pulse rate is 71 per minute, the nurse would check the client’s
pulse to ensure that during post-MI activities, the client’s heart rate does not exceed
1. 89 beats/min.
Elsevier items and derived items © 2005 by Elsevier Inc.
Chapter 60: Management of Clients with Myocardial Infarction
2. 96 beats/min.
3. 101 beats/min.
4. 112 beats/min.
ANS: a
The post-MI activity of a client should not cause the pulse to rise above 25% of the resting heart
rate: 71  0.25 = 17.75; 71 + 17.75 = 88.75, or 89 beats/min.
DIF: Cognitive Level: Analysis
REF: Text Reference: 1718
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2005 by Elsevier Inc.
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