Nokea
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.
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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.
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.
The nurse is providing teaching to a patient about the use of atenolol in preventing anginal episodes. Which of the following patient statements indicate that the teaching has been effective?
- A. It is important not to suddenly stop taking the atenolol.
- B. Atenolol will increase the strength of my heart muscle.
- C. I can expect to feel short of breath when taking atenolol.
- D. Atenolol will improve the blood flow to my coronary arteries.
Correct Answer: A
Rationale: Patients who have been taking β-blockers can develop intense and frequent angina if the medication is suddenly discontinued. Atenolol decreases myocardial contractility. Shortness of breath that occurs when taking β-blockers for angina may be due to bronchospasm and should be reported to the health care provider. Atenolol works by decreasing myocardial oxygen demand, not by increasing blood flow to the coronary arteries.
The nurse is caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having percutaneous coronary intervention and the nurse obtains these assessment data. Which of the following data indicate the need for immediate intervention by the nurse?
- A. Pedal pulses 1+
- B. Heart rate 100 beats/minute
- C. Blood pressure 104/56 mm Hg
- D. Chest pain level 8 on a 10-point scale
Correct Answer: D
Rationale: The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse.