Question 1

A patient admitted to the coronary care unit (CCU)with an ST-segment-elevation myocardial infarction (STEMI)is restless and anxious.The blood pressure is 86/40 and heart rate is 123.Based on this information,which nursing diagnosis is a priority for the patient?

Accepted Answer

A)  Acute pain related to myocardial infarction 
B)  Anxiety related to perceived threat of death 
C)  Stress overload related to acute change in health 
D)  Decreased cardiac output related to cardiogenic shock

Question 2

A patient with ST-segment elevation in three contiguous electrocardiographic (ECG)leads is admitted to the emergency department (ED)and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI).Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?

Accepted Answer

A)  "Do you have any allergies?" 
B)  "Do you take aspirin on a daily basis?" 
C)  "What time did your chest pain begin?" 
D)  "Can you rate your chest pain using a 0 to 10 scale?"

Question 3

When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG)surgery using the internal mammary artery,the nurse determines that additional teaching is needed when the patient says which of the following?

Accepted Answer

A)  "They will circulate my blood with a machine during the surgery." 
B)  "I will have small incisions in my leg where they will remove the vein." 
C)  "They will use an artery near my heart to go around the area that is blocked." 
D)  "I will need to take an aspirin every day after the surgery to keep the graft open."

Question 4

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI)and percutaneous coronary intervention the previous day.Teaching for this patient would include

Accepted Answer

A)  when cardiac rehabilitation will begin. 
B)  the typical emotional responses to AMI. 
C)  information regarding discharge medications. 
D)  the pathophysiology of coronary artery disease.

Question 5

After receiving change-of-shift report about the following four patients,which patient should the nurse assess first?

Accepted Answer

A)  39-year-old with pericarditis who is complaining of sharp, stabbing chest pain 
B)  56-year-old with variant angina who is to receive a dose of nifedipine (Procardia) 
C)  65-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge 
D)  59-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)

Question 6

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement,the nurse obtains the following assessment data.Which data indicate the need for immediate action by the nurse?

Accepted Answer

A)  Heart rate 102 beats/min 
B)  Pedal pulses 1+ bilaterally 
C)  Blood pressure 103/54 mm Hg 
D)  Chest pain level 7 on a 0 to 10 point scale

Question 7

In preparation for discharge,the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates.Which patient statement indicates that the teaching has been effective?

Accepted Answer

A)  "I will check my pulse rate before I take any nitroglycerin tablets." 
B)  "I will put the nitroglycerin patch on as soon as I get any chest pain." 
C)  "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue." 
D)  "I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin."

Question 8

Following an acute myocardial infarction (AMI),a patient ambulates in the hospital hallway.When the nurse is evaluating the patient's response to the activity,which assessment data would indicate that the exercise level should be decreased?

Accepted Answer

A)  Blood pressure (BP) changes from 118/60 to 126/68 mm Hg. 
B)  Oxygen saturation drops from 99% to 95%. 
C)  Heart rate increases from 66 to 92 beats/minute. 
D)  Respiratory rate goes from 14 to 20 breaths/minute.

Question 9

A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten).The nurse should teach the patient that the primary purpose of captopril is to

Accepted Answer

A)  lower heart rate. 
B)  control blood glucose levels. 
C)  prevent changes in heart muscle. 
D)  reduce the frequency of chest pain.

Question 10

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI).What is the purpose of the heparin?

Accepted Answer

A)  Heparin enhances platelet aggregation. 
B)  Heparin decreases coronary artery plaque size. 
C)  Heparin prevents the development of new clots in the coronary arteries. 
D)  Heparin dissolves clots that are blocking blood flow in the coronary arteries.

Question 11

After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat),which patient statement indicates that the teaching has been effective?

Accepted Answer

A)  "I can expect some nausea as a side effect of nitroglycerin." 
B)  "I should only take the nitroglycerin if I start to have chest pain." 
C)  "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart." 
D)  "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."

Question 12

Diltiazem (Cardizem)is ordered for a patient with newly diagnosed Prinzmetal's (variant)angina.When teaching the patient,the nurse will include the information that diltiazem will

Accepted Answer

A)  reduce heart palpitations. 
B)  decrease spasm of the coronary arteries. 
C)  increase the force of the heart contractions. 
D)  help prevent plaque from forming in the coronary arteries.

Question 13

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI).Which laboratory test should the nurse monitor to help determine whether the patient has had an AMI?

Accepted Answer

A)  Myoglobin 
B)  Homocysteine 
C)  C-reactive protein 
D)  Cardiac-specific troponin

Question 14

Which electrocardiographic (ECG)change is most important for the nurse to report to the health care provider when caring for a patient with chest pain?

Accepted Answer

A)  Inverted P wave 
B)  Sinus tachycardia 
C)  ST-segment elevation 
D)  First-degree atrioventricular block

Question 15

Three days after experiencing a myocardial infarction (MI),a patient who is scheduled for discharge asks for assistance with hygiene activities,saying,"I am too nervous to take care of myself." Based on this information,which nursing diagnosis is appropriate?

Accepted Answer

A)  Ineffective coping related to anxiety 
B)  Activity intolerance related to weakness 
C)  Denial related to lack of acceptance of the MI 
D)  Disturbed personal identity related to understanding of illness

Question 16

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI)2 days previously.Which information is most important to report to the health care provider?

Accepted Answer

A)  The troponin level is elevated. 
B)  The patient denies ever having a heart attack. 
C)  Bilateral crackles are auscultated in the mid-lower lobes. 
D)  The patient has occasional premature atrial contractions (PACs).

Question 17

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse.Which medication has the most immediate implications for the patient's care?

Accepted Answer

A)  Sildenafil (Viagra) 
B)  Furosemide (Lasix) 
C)  Captopril (Capoten) 
D)  Warfarin (Coumadin)

Question 18

A few days after experiencing a myocardial infarction (MI)and successful percutaneous coronary intervention,the patient states,"I just had a little chest pain.As soon as I get out of here,I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make?

Accepted Answer

A)  "What do you think caused your chest pain?" 
B)  "Where are you planning to go for your vacation?" 
C)  "Sometimes plans need to change after a heart attack." 
D)  "Recovery from a heart attack takes at least a few weeks."

Question 19

After reviewing information shown in the accompanying figure from the medical records of a 43-year-old,which risk factor modification for coronary artery disease should the nurse include in patient teaching?

Accepted Answer

A)  Importance of daily physical activity 
B)  Effect of weight loss on blood pressure 
C)  Dietary changes to improve lipid levels 
D)  Ongoing cardiac risk associated with history of tobacco use

Question 20

A patient who has recently started taking pravastatin (Pravachol)and niacin (Nicobid)reports the following symptoms to the nurse.Which is most important to communicate to the health care provider?

Accepted Answer

A)  Generalized muscle aches and pains 
B)  Dizziness when changing positions quickly 
C)  Nausea when taking the drugs before eating 
D)  Flushing and pruritus after taking the medications

Exam 34: Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious.The blood pressure is 86/40 and heart rate is 123.Based on this information,which nursing diagnosis is a priority for the patient?

When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery,the nurse determines that additional teaching is needed when the patient says which of the following?

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day.Teaching for this patient would include

After receiving change-of-shift report about the following four patients,which patient should the nurse assess first?

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement,the nurse obtains the following assessment data.Which data indicate the need for immediate action by the nurse?

In preparation for discharge,the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates.Which patient statement indicates that the teaching has been effective?

Following an acute myocardial infarction (AMI) ,a patient ambulates in the hospital hallway.When the nurse is evaluating the patient's response to the activity,which assessment data would indicate that the exercise level should be decreased?

A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten) .The nurse should teach the patient that the primary purpose of captopril is to

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) .What is the purpose of the heparin?

After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat) ,which patient statement indicates that the teaching has been effective?

Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina.When teaching the patient,the nurse will include the information that diltiazem will

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI) .Which laboratory test should the nurse monitor to help determine whether the patient has had an AMI?

Which electrocardiographic (ECG) change is most important for the nurse to report to the health care provider when caring for a patient with chest pain?

Three days after experiencing a myocardial infarction (MI) ,a patient who is scheduled for discharge asks for assistance with hygiene activities,saying,"I am too nervous to take care of myself." Based on this information,which nursing diagnosis is appropriate?

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously.Which information is most important to report to the health care provider?

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse.Which medication has the most immediate implications for the patient's care?

A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention,the patient states,"I just had a little chest pain.As soon as I get out of here,I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make?

After reviewing information shown in the accompanying figure from the medical records of a 43-year-old,which risk factor modification for coronary artery disease should the nurse include in patient teaching?

A patient who has recently started taking pravastatin (Pravachol) and niacin (Nicobid) reports the following symptoms to the nurse.Which is most important to communicate to the health care provider?