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The nurse is caring for a patient with newly diagnosed Prinzmetal's (variant) angina and has a prescription for amlodipine. Which of the following information is accurate about amlodipine?
- A. Reduce the 'fight or flight' response
- B. Decrease spasm of the coronary arteries
- C. Increase the force of myocardial contraction
- D. Help prevent clotting in the coronary arteries
Correct Answer: B
Rationale: Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., amlodipine, nifedipine) are a first-line therapy for this type of angina. Platelet inhibitors, such as Aspirin, help prevent coronary artery thrombosis, and β-blockers decrease sympathetic stimulation of the heart. Medications or activities that increase myocardial contractility will increase the incidence of angina by improving oxygen demand.
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The nurse is developing a health teaching plan for a 60-year-old man with the following risk factors for coronary artery disease (CAD). Which of the following risk factors should the nurse focus on when teaching the patient?
- A. Family history of coronary artery disease
- B. Increased risk associated with the patient's gender
- C. High incidence of cardiovascular disease in older people
- D. Elevation of the patient's serum low density lipoprotein (LDL) level
Correct Answer: D
Rationale: Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient's LDL level. Decreases in LDL will help reduce the patient's risk for developing CAD.
The nurse obtains the following data when caring for a patient who experienced an acute myocardial infarction 2 days previously. Which of the following information is most important to report to the health care provider?
- A. The patient denies ever having a heart attack
- B. The cardiac-specific troponin level is elevated.
- C. The patient has occasional premature atrial contractions (PACs)
- D. Crackles are auscultated bilaterally in the mid-lower lobes.
Correct Answer: D
Rationale: The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme (ACE) inhibitors for the patient. Elevation in cardiac troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI.
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.
Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which of the following actions should the nurse take next?
- A. Palpate the radial pulses bilaterally.
- B. Assess the feet for peripheral edema.
- C. Auscultate for a pericardial friction rub.
- D. Check the cardiac monitor for dysrhythmias.
Correct Answer: C
Rationale: The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient's symptoms.
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.