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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).
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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.
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 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.
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.
To assist the patient with coronary artery disease (CAD) in making appropriate dietary changes, which of the following nursing interventions will be most effective?
- A. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary.
- B. Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes.
- C. Assist the patient to modify favourite high-fat recipes by using polyunsaturated oils when possible.
- D. Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet.
Correct Answer: C
Rationale: Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences. The highest percentage of calories from fat should come from polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the patient with a list alone is not likely to be successful in making dietary changes. Removing saturated fat from the diet completely is not a realistic expectation. Telling the patient about the increased risk without assisting further with strategies for dietary change is unlikely to be successful.