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A patient with ST segment elevation in several electrocardiogram (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which of the following questions should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy?
- A. Do you take Aspirin on a daily basis?
- B. What time did your chest pain begin?
- C. Is there any family history of heart disease?
- D. Can you describe the quality of your chest pain.
Correct Answer: B
Rationale: Fibrinolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI), so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information also will be needed, but it will not be a factor in the decision about fibrinolytic therapy.
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Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which of the following actions should the nurse take next?
- A. Palpate the radial pulses bilaterally.
- B. Assess the feet for peripheral edema.
- C. Auscultate for a pericardial friction rub.
- D. Check the cardiac monitor for dysrhythmias.
Correct Answer: C
Rationale: The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient's symptoms.
The nurse is caring for a patient with hyperlipidemia who has a new prescription for colestipol. Which of the following nursing actions is best when giving the medication?
- A. Administer the medication at the patient's bedtime.
- B. Have the patient take this medication with an Aspirin.
- C. Encourage the patient to take the colestipol with a sip of water.
- D. Give the patient's other medications 2 hours after the colestipol.
Correct Answer: D
Rationale: The bile acid sequestrants interfere with the absorption of other drugs, and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colestipol may increase the incidence of gastrointestinal adverse effects such as heartburn. An increased fluid intake is encouraged for patients taking the bile acid sequestrants to reduce the risk for constipation. For maximum effect, colestipol should be administered with meals.
The nurse is providing teaching to a patient about the use of atenolol in preventing anginal episodes. Which of the following patient statements indicate that the teaching has been effective?
- A. It is important not to suddenly stop taking the atenolol.
- B. Atenolol will increase the strength of my heart muscle.
- C. I can expect to feel short of breath when taking atenolol.
- D. Atenolol will improve the blood flow to my coronary arteries.
Correct Answer: A
Rationale: Patients who have been taking β-blockers can develop intense and frequent angina if the medication is suddenly discontinued. Atenolol decreases myocardial contractility. Shortness of breath that occurs when taking β-blockers for angina may be due to bronchospasm and should be reported to the health care provider. Atenolol works by decreasing myocardial oxygen demand, not by increasing blood flow to the coronary arteries.
Which of the following approaches to preventing a recurrence of sudden cardiac death is the most common?
- A. Long-term Aspirin therapy
- B. Implantable cardioverter-defibrillator
- C. Administration of amiodarone
- D. Continuous Holter monitoring
Correct Answer: B
Rationale: The most common approach to preventing a recurrence is the use of an implantable cardioverter-defibrillator (ICD). Research has shown survival rates are better with an ICD than with drug therapy alone. Drug therapy with amiodarone may be used in conjunction with an ICD to decrease episodes of ventricular dysrhythmias. Continuous monitoring will not prevent a recurrence. Aspirin will not prevent a recurrence of SCD.
The nurse is administering a fibrinolytic agent to a patient with an acute myocardial infarction. Which of the following assessments should cause the nurse to stop the drug infusion?
- A. Bleeding from the gums
- B. Surface bleeding from the IV site
- C. A decrease in level of consciousness
- D. A non-sustained episode of ventricular tachycardia
Correct Answer: C
Rationale: The change in level of consciousness indicates that the patient may be experiencing intracranial bleeding, a possible complication of fibrinolytic therapy. Bleeding of the gums and prolonged bleeding from IV sites are expected adverse effects of the therapy. The nurse should address these by avoiding any further injuries, but they are not an indication to stop infusion of the fibrinolytic medication. A non-sustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective.