Nokea
Following an acute myocardial infarction, a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response, which of the following assessment data would indicate that the exercise level should be decreased?
- A. BP changes from 118/60 to 126/68 mm Hg.
- B. Oxygen saturation drops from 100% to 98%.
- C. Heart rate increases from 66 to 90 beats/minute
- D. Respiratory rate goes from 14 to 22 breaths/minute.
Correct Answer: C
Rationale: A change in heart rate of more than 20 beats or more indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in oxygen saturation, are normal responses to exercise.
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The nurse is evaluating the outcomes of pre-operative teaching with a patient scheduled for a coronary artery bypass graft (CABG) using the internal mammary artery. Which of the following patient statements indicates that additional teaching is needed?
- A. I will have incisions in my leg where they will remove the vein.
- B. They will circulate my blood with a machine during the surgery.
- C. I will need to take an Aspirin a day after the surgery to keep the graft open.
- D. They will use an artery near my heart to bypass the area that is obstructed.
Correct Answer: A
Rationale: When the internal mammary artery is used there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective.
The nurse is admitting a patient to the emergency department with severe chest pain and gives the following list of medications taken at home to the nurse. Which of the following medications has the most immediate implications for the patient's care?
- A. Sildenafil
- B. Furosemide
- C. Diazepam
- D. Captopril
Correct Answer: A
Rationale: The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of sudden death caused by vasodilation. The other home medications also should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment.
The nurse is assessing a patient who has chest pain is to the emergency department and all the following diagnostic tests are prescribed. Which of the following tests should the nurse arrange to be completed first?
- A. Electrocardiogram (ECG)
- B. Computed tomography (CT) scan
- C. Chest x-ray
- D. Troponin level
Correct Answer: A
Rationale: The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that reperfusion therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion. Troponin levels will increase after about 3 hours. Data from the CT scan and chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing a myocardial infarction (MI).
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.
Which of the following causes is the most common cause for sudden cardiac death?
- A. Ventricular tachycardia
- B. Aortic stenosis
- C. Hypertrophic cardiomyopathy
- D. Angina
Correct Answer: A
Rationale: Acute ventricular dysrhythmias (e.g., ventricular tachycardia, ventricular fibrillation) cause the majority of cases of SCD. Less commonly, SCD occurs because of a primary left ventricular outflow obstruction (e.g., aortic stenosis, hypertrophic cardiomyopathy) or extreme slowing of the heart (bradycardia).