Nokea
Family members bring a patient to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data?
- A. The symptoms indicate angina and should be treated as such
- B. The symptoms indicate a pulmonary etiology rather than a cardiac etiology
- C. The symptoms indicate an acute coronary episode and should be treated as such
- D. Treatment should be determined pending the results of an exercise stress test
Correct Answer: C
Rationale: Angina and MI have similar symptoms and are considered the same process, but are on different points along a continuum. That the patients symptoms are unrelieved by rest suggests an acute coronary episode rather than angina. Pale cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be initiated immediately regardless of diagnosis.
You may also like to solve these questions
A 48-year-old man presents to the ED complaining of severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU?
- A. Begin ECG monitoring
- B. Obtain information about family history of heart disease
- C. Auscultate lung fields
- D. Determine if the patient smokes
Correct Answer: A
Rationale: The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored; life-threatening arrhythmias are the leading cause of death in the first hours after an MI. Obtaining information about family history of heart disease and whether the patient smokes are not immediate priorities in the acute phase of MI. Data may be obtained from family members later. Lung fields are auscultated after oxygenation and pain control needs are met.
The nurse working on the coronary care unit is caring for a patient with ACS. How can the nurse best meet the patients psychosocial needs?
- A. Reinforce the fact that treatment will be successful
- B. Facilitate a referral to a chaplain or spiritual leader
- C. Increase the patients participation in rehabilitation activities
- D. Directly address the patients anxieties and fears
Correct Answer: D
Rationale: Alleviating anxiety and decreasing fear are important nursing functions that reduce the sympathetic stress response. Referrals to spiritual care may or may not be appropriate, and this does not relieve the nurse of responsibility for addressing the patients psychosocial needs. Treatment is not always successful, and false hope should never be fostered. Participation in rehabilitation may alleviate anxiety for some patients, but it may exacerbate it for others.
A patient with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The patient is admitted to the cardiac critical care unit after the PTCA. For what complication should the nurse most closely monitor the patient?
- A. Hyperlipidemia
- B. Bleeding at insertion site
- C. Left ventricular hypertrophy
- D. Congestive heart failure
Correct Answer: B
Rationale: Complications of PTCA may include bleeding at the insertion site, abrupt closure of the artery, arterial thrombosis, and perforation of the artery. Complications do not include hyperlipidemia, left ventricular hypertrophy, or congestive heart failure; each of these problems takes an extended time to develop and none is emergent.
The ED nurse is caring for a patient with a suspected MI. What drug should the nurse anticipate administering to this patient?
- A. Oxycodone
- B. Warfarin
- C. Morphine
- D. Acetaminophen
Correct Answer: C
Rationale: The patient with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta-blocker, and other medications, as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.
The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors would the nurse list that can be controlled or modified?
- A. Gender, obesity, family history, and smoking
- B. Inactivity, stress, gender, and smoking
- C. Obesity, inactivity, diet, and smoking
- D. Stress, family history, and obesity
Correct Answer: C
Rationale: The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled.