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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).
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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.
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.
The nurse is caring for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) who is receiving heparin. Which of the following information explains the purpose of the heparin?
- A. Platelet aggregation is enhanced by IV heparin infusion.
- B. Heparin will dissolve the clot that is blocking blood flow to the heart.
- C. Coronary artery plaque size and adherence are decreased with heparin.
- D. Heparin will prevent the development of new clots in the coronary arteries.
Correct Answer: D
Rationale: Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.
The nurse is caring for a patient with hyperlipidemia who has a new prescription for colestipol. Which of the following nursing actions is best when giving the medication?
- A. Administer the medication at the patient's bedtime.
- B. Have the patient take this medication with an Aspirin.
- C. Encourage the patient to take the colestipol with a sip of water.
- D. Give the patient's other medications 2 hours after the colestipol.
Correct Answer: D
Rationale: The bile acid sequestrants interfere with the absorption of other drugs, and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colestipol may increase the incidence of gastrointestinal adverse effects such as heartburn. An increased fluid intake is encouraged for patients taking the bile acid sequestrants to reduce the risk for constipation. For maximum effect, colestipol should be administered with meals.
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.