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Exam 1: Angina & Myocardial Infarction (NCLEX) Questions and Answers Containing 97 terms with Certified Answers 2024.
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A client admitted for uncontrolled hypertension and chest pain was started on a daily diuretic two days ago upon admission, with prescriptions for a daily basic
metabolic panel. The client’s potassium level this morning is 2.7 mEq/L. Which action should the nurse take next? A. Notify the healthcare provider that the potassium level is above normal B. Notify the healthcare provider that the potassium level is below normal C. No action is required because the potassium level is within normal limits D. Hold the client’s morning diuretic dose - Answer: B A client arrives at the emergency room complaining of chest pain and dizziness. The client has a history of angina. The healthcare provider prescribes an ECG and lab tests. A change in which component of the ECG tracing should the nurse recognize as the client actively having a myocardial infarction? A. QRS complex B. ST segment C. P wave D. R wave - Answer: B A client who had a MI receives 15 mg of morphine sulfate for chest pain. 15 minutes after receiving the drug, the client complains of feeling dizzy. What action should the nurse take?
The healthcare provider prescribes Nitroglycerin ointment to be applied topically every 8 hours for a client who was admitted for chest pain and a MI. Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment? "I may experience: A. A headache B. Increased BP readings C. A slow Pulse rate D. Confusion - Answer: A The most common SE of Nitro is a headache. Additional cardio SE are tachycardia, hypotension and dizziness not confusion. A client is admitted to the ER with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication? A. Gabapentin B. Midazolam C. Alprazolam D. Aspirin - Answer: D
Early administration of aspirin in the setting of acute MI has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, can be lifesaving. A client admitted for uncontrolled hypertension and chest pain was prescribed a low sodium diet and started on furosemide (Lasix). The nurse should instruct the client to include which foods in the diet? A. cabbage B. Liver C. Apples D. Bananas - Answer: D A client who had several episodes of chest pain is scheduled for an exercise ECG. Which explanation should the nurse include when teaching the client about this procedure? A. "This is a noninvasive test to check your heart's response to physical activity".
Elevated ST segments are an early typical finding after a MI, because of altered contractility of the heart. Flattened or depressed T waves indicate hypokalemia. Absence of P waves occurs in atrial and ventricular fibrillation Q waves may become distorted with conduction or rhythm problems but they do not disappear unless cardiac standstill occurs. A pregnant woman develops chest pain and is found to be in atrial fibrillation. Which medication would be appropriate to prescribe for this client? A. Warfarin B. Heparin C. Aspirin D. Atenolol - Answer: B Heparin is the only one of the medications that would be used for this problem and does not cross the placental barrier. Warfarin, atenolol and aspirin cross the placenta and are distributed in breast milk, leading to potential fetal death, neonatal hemorrhage, or intrauterine death. A client with a coronary occlusion is experiencing chest pain and distress. What is the primary reason that the nurse should administer oxygen to this client?
A. Prevent dyspnea B. Prevent cyanosis C. Increase oxygen concentration to heart cells D. Increase oxygen tension in the circulating blood - Answer: C Administration of oxygen increases the transalveolar oxygenngradient, which improves the efficiency of the cardiopulmonary system; this increases the oxygen supply to the heart. Increased oxygen to the heart cells will improve cardiac output, which may or may not prevent dyspnea. Pallor, not cyanosis, is usually associated with MI. Although administrating oxygen will increase oxygen tension in the circulating blood, it is not specific to heart cells, which are hypoxic when there is a MI. The nurse caring for a client admitted for chest pain and a MI is preparing to apply nitroglycerin ointment. Before applying, the nurse should: A. Assess the client's pulse rate B. Prepare the site with an alcohol swab C. Remove ointment previously applied D. Expect the client to be relieved of pain within 20 minutes - Answer: C Before applying the nitro ointment, the nurse should remove the previous ointment. If the previously applied ointment is not removed, the client could
A) Angina is relieved with nitroglycerin and rest. B) Angina can be fatal. C) MI pain always radiates to the left arm or jaw. D) MI pain cannot be treated. - Answer: A The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action? A) Dilating just the coronary arteries B) Decreasing the blood pressure C) Increasing contractility of the heart D) Dilating arteries and veins - Answer: D The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information must the nurse include? A) Limit exercise to 30 minutes twice per week. B) Avoid alcohol consumption.
C) Monitor intake and output. D) Report skin flushing to the physician. - Answer: B What does the nurse include in the teaching plan for a client receiving a beta blocker for treatment of angina? A) Discontinue drug if heart rate <60. B) Do not discontinue drug abruptly. C) Exercise heart rate should be 110-120. D) Monitor for hyperglycemia. - Answer: B The nurse recognizes that calcium channel blockers prescribed for treatment of angina exert their effect by: A) Increasing preload. B) Decreasing afterload. C) Positive chronotropic effect. D) Positive inotropic effect. - Answer: B Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased
D) Educate the client about his symptoms - Answer: B Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised. Medical treatment of coronary artery disease includes which of the following procedures? A) Cardiac catherization B) Coronary artery bypass surgery C) Oral medication therapy D) Percutaneous transluminal coronary angioplasty - Answer: C Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.3. Oral medication administration is a noninvasive, medical treatment for coronary artery disease.
Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments. Which of the following is the most common symptom of myocardial infarction (MI)? A) Chest pain B) Dyspnea C) Edema D) Palpitations - Answer: A Which of the following blood tests is most indicative of cardiac damage? A) Lactate dehydrogenase B) Complete blood count (CBC) C) Troponin I D) Creatine kinase (CK) - Answer: C Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Lactate
Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and nitro are also used to treat MI, but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI What is the most common complication of an MI? A) Cardiogenic shock B) Heart failure C) arrhythmias D) Pericarditis - Answer: C Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI. Toxicity from which of the following medications may cause a client to see a green-yellow halo around lights?
A) Digoxin B) Furosemide (Lasix) C) Metoprolol (Lopressor) D) Enalapril (Vasotec) - Answer: A Which of the following types of angina is most closely related with an impending MI? A) Angina decubitus B) Chronic stable angina C) Noctural angina D) Unstable angina - Answer: D Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months. Which of the following conditions is the predominant cause of angina? A) Increased preload B) Decreased afterload
Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed. Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking? A) Sit the client down B) Get the client back to bed C) Obtain an ECG D) Administer sublingual nitroglycerin - Answer: A The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. An ECG can be obtained after the client is sitting down. After the ECGm sublingual nitro would be administered. When the client's condition is stabilized, he can be returned to bed. A client admitted with angina compains of severe chest pain and suddenly becomes unresponsive. After establishing unresponsiveness, which of the following actions should the nurse take first? A) Activate the resuscitation team
B) Open the client's airway C) Check for breathing D) Check for signs of circulation - Answer: A Immediately after establishing unresponsiveness, the nurse should activate the resuscitation team. The next step is to open the airway using the head-tilt, chin-lift maneuver and check for breathing (looking, listening, and feeling for no more than 10-seconds). If the client isn't breathing, give two slow breaths using a bag mask or pocket mask. Next, check for signs of circulation by palpating the carotid pulse. The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following? A) Obtaining an infusion pump for the medication B) Monitoring BP q4h C) Monitoring urine output hourly D) Obtaining serum potassium levels daily - Answer: A IV nitro infusion requires an infusion pump for precise control of the medication. BP monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion.
