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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.
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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.
Which of the following information given by a patient admitted with persistent stable angina will help the nurse confirm this diagnosis?
- A. The patient rates the pain at a level 3-5 (0-10 scale)
- B. The patient states that the pain 'wakes me up at night.'
- C. The patient says that the frequency of the pain has increased over the last few weeks.
- D. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.
Correct Answer: D
Rationale: Persistent stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina.
The nurse will suspect that the patient with stable angina is experiencing an adverse effect of the prescribed metoprolol if which of the following findings are assessed?
- A. The patient is restless and agitated.
- B. The blood pressure is 190/110 mm Hg.
- C. The patient complains about feeling anxious.
- D. The cardiac monitor shows a heart rate of 45.
Correct Answer: D
Rationale: Patients taking β-adrenergic blockers should be monitored for bradycardia. Because this category of medication inhibits the sympathetic nervous system, restlessness, agitation, hypertension, and anxiety will not be adverse effects.
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 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.