Nokea
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.
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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).
The nurse is caring for a patient who has had severe chest pain for several hours and a diagnosis of possible acute myocardial infarction. Which of the following prescribed laboratory tests should the nurse monitor to help determine the diagnosis?
- A. Homocysteine
- B. C-reactive protein
- C. Cardiac-specific troponin
- D. High-density lipoprotein (HDL) cholesterol
Correct Answer: C
Rationale: Troponin levels increase about 3-12 hours after the onset of myocardial infarction (MI). The other laboratory data are useful in determining the patient's risk for developing coronary artery disease (CAD) but are not helpful in determining whether an acute MI is in progress.
The nurse is caring for a patient who was admitted the previous day to the coronary care unit with an acute myocardial infarction. Which of the following information should the nurse include in the teaching plan for the patient?
- A. Typical emotional responses to AMI
- B. When patient cardiac rehabilitation will begin
- C. Discharge drugs such as Aspirin and β-blockers
- D. The pathophysiology of coronary artery disease
Correct Answer: B
Rationale: Early after an AMI, the patient will want to know when resumption of usual activities can be expected. At this time, the patient's anxiety level or denial will prevent good understanding of complex information such as coronary artery disease (CAD) pathophysiology. Teaching about discharge medications should be done when the time for discharge is closer. The nurse should support the patient by decreasing anxiety rather than discussing the typical emotional response to myocardial infarction (MI).
The nurse is providing teaching to a patient about use of sublingual nitroglycerin. Which of the following patient statements indicates that the teaching has been effective?
- A. I will put the nitroglycerin tablet under my tongue if I get chest pain.
- B. I like fresh salmon and I will plan to eat it more often.
- C. I will miss being able to eat peanut butter sandwiches.
- D. I can have a cup of coffee with breakfast if I want one.
Correct Answer: A
Rationale: Sublingual nitroglycerin is taken by placing the tablet under the tongue to relieve chest pain. The other statements relate to dietary preferences and do not indicate understanding of nitroglycerin use.
The nurse is caring for a patient who has recently started taking crestor who reports all of these symptoms to the nurse. Which of the following finding is most important to communicate to the health care provider?
- A. Generalized muscle aches and weakness
- B. Skin flushing after taking the medications
- C. Dizziness when changing positions quickly
- D. Nausea when taking the drugs before eating
Correct Answer: A
Rationale: Muscle aches and weakness may indicate myopathy and rhabdomyolysis, which have caused acute renal failure and death in some patients who have taken the statin medications. These symptoms indicate that the rosuvastatin may need to be discontinued. The other symptoms are common adverse effects when taking niacin, and although the nurse should follow up with the patient, they do not indicate that a change in medication is needed.