Nokea
The nurse is caring for a patient with angina who has been prescribed propranolol. Which of the following parameters should the nurse assess to determine whether the drug is effective?
- A. Decreased blood pressure and apical pulse rate
- B. Fewer complaints of having cold hands and feet
- C. Improvement in the quality of the peripheral pulses
- D. The ability to do daily activities without chest discomfort
Correct Answer: D
Rationale: Because the medication is ordered to improve the patient's angina, effectiveness is indicated if the patient is able to accomplish daily activities without chest pain. Blood pressure (BP) and apical pulse rate may decrease, but these data do not indicate that the goal of decreased angina has been met. The non-cardioselective β-blockers can cause peripheral vasoconstriction, so the nurse would not expect an improvement in peripheral pulse quality or skin temperature.
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A patient with ST segment elevation in several electrocardiogram (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which of the following questions should the nurse ask to determine whether the patient is a candidate for fibrinolytic therapy?
- A. Do you take Aspirin on a daily basis?
- B. What time did your chest pain begin?
- C. Is there any family history of heart disease?
- D. Can you describe the quality of your chest pain.
Correct Answer: B
Rationale: Fibrinolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI), so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information also will be needed, but it will not be a factor in the decision about fibrinolytic therapy.
Which of the following information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction?
- A. The pain increases with deep breathing.
- B. The pain has persisted longer than 30 minutes.
- C. The pain worsens when the patient raises the arms.
- D. The pain is relieved after the patient takes nitroglycerin.
Correct Answer: B
Rationale: Chest pain that lasts for 20 minutes or more is characteristic of an acute myocardial infarction. Changes in pain that occur with raising the arms or with deep breathing are more typical of pericarditis or musculoskeletal pain. Stable angina is usually relieved when the patient takes nitroglycerin.
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.
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.
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).