Nokea
Four days after having a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with all the daily activities, saying, 'I don't understand how to care for myself' Based on this information, which of the following nursing diagnoses is appropriate?
- A. Ineffective health management related to insufficient knowledge
- B. Activity intolerance related to physical deconditioning
- C. Ineffective denial related to ineffective coping strategies
- D. Social isolation related to insufficient personal resources
Correct Answer: A
Rationale: The patient data indicate ineffective health management related to lack of knowledge of disease process, and care after discharge. The other nursing diagnoses may be appropriate for some patients after an MI, but the data for this patient do not support denial, activity intolerance, or social isolation.
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Which of the following information given by a patient admitted with persistent stable angina will help the nurse confirm this diagnosis?
- A. The patient rates the pain at a level 3-5 (0-10 scale)
- B. The patient states that the pain 'wakes me up at night.'
- C. The patient says that the frequency of the pain has increased over the last few weeks.
- D. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.
Correct Answer: D
Rationale: Persistent stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina.
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 caring for a patient with newly diagnosed Prinzmetal's (variant) angina and has a prescription for amlodipine. Which of the following information is accurate about amlodipine?
- A. Reduce the 'fight or flight' response
- B. Decrease spasm of the coronary arteries
- C. Increase the force of myocardial contraction
- D. Help prevent clotting in the coronary arteries
Correct Answer: B
Rationale: Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., amlodipine, nifedipine) are a first-line therapy for this type of angina. Platelet inhibitors, such as Aspirin, help prevent coronary artery thrombosis, and β-blockers decrease sympathetic stimulation of the heart. Medications or activities that increase myocardial contractility will increase the incidence of angina by improving oxygen demand.
The nurse is administering IV nitroglycerin to a patient with a myocardial infarction (MI). Which of the following actions should the nurse take to evaluate the effectiveness of the medication?
- A. Check blood pressure.
- B. Monitor apical pulse rate.
- C. Monitor for dysrhythmias.
- D. Ask about chest discomfort.
Correct Answer: D
Rationale: The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand. The nurse also will monitor heart rate and BP and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective.
Which of the following electrocardiogram (ECG) changes is most important for the nurse to communicate to the health care provider when caring for a patient with chest pain?
- A. Frequent premature atrial contractions (PACs)
- B. Inverted P wave
- C. Sinus tachycardia
- D. ST segment elevation
Correct Answer: D
Rationale: The patient is likely to be experiencing an ST-segment-elevation myocardial infarction (STEMI) and immediate therapy with percutaneous coronary intervention (PCI) or fibrinolytic medications is indicated to minimize the amount of myocardial damage. The other ECG changes also may suggest a need for therapy, but not as rapidly.