Nokea
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.
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The nurse is providing teaching to a patient with persistent stable angina about how to use the prescribed short-acting and long-acting nitrates. Which of the following patient statements indicates that the teaching has been effective?
- A. I will put on the nitroglycerin patch as soon as I develop any chest pain.
- B. I will check the pulse rate in my wrist just before I take any nitroglycerin.
- C. I will be sure to remove the nitroglycerin patch before using any sublingual nitroglycerin.
- D. I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.
Correct Answer: D
Rationale: The patient should sit down before taking the nitroglycerin to decrease cardiac workload and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin. Although the nurse should check blood pressure before giving nitroglycerin, patients do not need to check the pulse rate before taking nitrates.
Which of the following information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?
- A. No change in the patient's chest pain
- B. A large bruise at the patient's IV insertion site
- C. A decrease in ST segment elevation on the electrocardiogram (ECG)
- D. An increase in cardiac enzyme levels since admission
Correct Answer: A
Rationale: Continued chest pain suggests that the fibrinolytic therapy is not effective and that other interventions such as percutaneous coronary intervention (PCI) may be needed. Bruising is a possible adverse effect of fibrinolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST segment elevation indicates that fibrinolysis is occurring and perfusion is returning to the injured myocardium. An increase in cardiac enzyme levels is expected with reperfusion and is related to the washout of enzymes into the circulation as the blocked vessel is opened.
The nurse is caring for a patient who has had an acute myocardial infarction and the patient asks the nurse about when sexual intercourse can be resumed. Which of the following responses by the nurse is best?
- A. Most patients are able to enjoy intercourse without any complications.
- B. Sexual activity uses about as much energy as climbing two flights of stairs.
- C. The doctor will discuss sexual intercourse when your heart is strong enough.
- D. Holding and cuddling are good ways to maintain intimacy after a heart attack.
Correct Answer: B
Rationale: Sexual activity places about as much physical stress on the cardiovascular system as climbing two flights of stairs. The other responses do not directly address the patient's question, or may not be accurate for this patient.
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).
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.