Nokea
An ED nurse is assessing an adult woman for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female patients? Select all that apply.
- A. Shortness of breath
- B. Chest pain
- C. Anxiety
- D. Numbness
- E. Weakness
Correct Answer: D,E
Rationale: Although these symptoms are not wholly absent in men, many women have been found to have atypical symptoms of MI, including indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among patients of all ages and genders.
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The nurse is participating in the care conference for a patient with ACS. What goal should guide the care teams selection of assessments, interventions, and treatments?
- A. Maximizing cardiac output while minimizing heart rate
- B. Decreasing energy expenditure of the myocardium
- C. Balancing myocardial oxygen supply with demand
- D. Increasing the size of the myocardial muscle
Correct Answer: C
Rationale: Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the patient with ACS. Treatment is not aimed directly at minimizing heart rate because some patients experience bradycardia. Increasing the size of the myocardium is never a goal. Reducing the myocardiums energy expenditure is often beneficial, but this must be balanced with productivity.
The nurse providing care for a patient post PTCA knows to monitor the patient closely. For what complications should the nurse monitor the patient? Select all that apply.
- A. Abrupt closure of the coronary artery
- B. Venous insufficiency
- C. Bleeding at the insertion site
- D. Retroperitoneal bleeding
- E. Arterial occlusion
Correct Answer: A,C,D,E
Rationale: Complications after the procedure may include abrupt closure of the coronary artery and vascular complications, such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion, as well as acute renal failure. Venous insufficiency is not a postprocedure complication of a PTCA.
A nurse has taken on the care of a patient who had a coronary artery stent placed yesterday. When reviewing the patients daily medication administration record, the nurse should anticipate administering what drug?
- A. Ibuprofen
- B. Clopidogrel
- C. Dipyridamole
- D. Acetaminophen
Correct Answer: B
Rationale: Because of the risk of thrombus formation within the stent, the patient receives antiplatelet medications, usually aspirin and clopidogrel. Ibuprofen and acetaminophen are not antiplatelet drugs. Dipyridamole is not the drug of choice following stent placement.
The nurse is caring for an adult patient who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina?
- A. Ineffective breathing pattern related to decreased cardiac output
- B. Anxiety related to fear of death
- C. Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)
- D. Impaired skin integrity related to CAD
Correct Answer: C
Rationale: Ineffective cardiopulmonary tissue perfusion directly results in the symptoms of discomfort associated with angina. Anxiety and ineffective breathing may result from angina chest pain, but they are not the causes. Skin integrity is not impaired by the effects of angina.
The public health nurse is participating in a health fair and interviews a patient with a history of hypertension, who is currently smoking one pack of cigarettes per day. She denies any of the most common manifestations of CAD. Based on these data, the nurse would expect the focuses of CAD treatment most likely to be which of the following?
- A. Drug therapy and smoking cessation
- B. Diet and drug therapy
- C. Diet therapy only
- D. Diet therapy and smoking cessation
Correct Answer: D
Rationale: Due to the absence of symptoms, dietary therapy would likely be selected as the first-line treatment for possible CAD. Drug therapy would be determined based on a number of considerations and diagnostics findings, but would not be directly indicated. Smoking cessation is always indicated, regardless of the presence or absence of symptoms.