Nokea
The nurse is providing teaching to a patient who has a prescription for transdermal nitroglycerin patches. The patient asks the nurse how often they should remove the previously applied patch. Which of the following information is the basis for the nurse's response?
- A. Every 4 hours while awake
- B. Every 6 hours around the clock
- C. Every 12 hours
- D. Remove at bedtime
Correct Answer: D
Rationale: NTG patches should be applied in the am and removed at bedtime to prevent tolerance.
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The nurse is caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction. After the patient has recovered, which of the following information should the nurse teach the patient?
- A. That sudden cardiac death events rarely reoccur
- B. About the purpose of outpatient Holter monitoring
- C. How to self-administer low-molecular-weight heparin
- D. To limit activities after discharge to prevent future events
Correct Answer: B
Rationale: Holter monitoring is used to determine whether the patient is experiencing dysrhythmias such as ventricular tachycardia during normal daily activities. SCD is likely to recur. Heparin will not have any effect on the incidence of SCD, and SCD can occur even when the patient is resting.
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.
The nurse is admitting a patient to the emergency department with severe chest pain and gives the following list of medications taken at home to the nurse. Which of the following medications has the most immediate implications for the patient's care?
- A. Sildenafil
- B. Furosemide
- C. Diazepam
- D. Captopril
Correct Answer: A
Rationale: The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of sudden death caused by vasodilation. The other home medications also should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment.
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).
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.