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What is the primary consideration when preparing to administer thrombolytic therapy to a patient who is experiencing an acute myocardial infarction (MI)?
- A. History of heart disease.
- B. Sensitivity to aspirin.
- C. Size and location of the MI.
- D. Time since onset of symptoms.
Correct Answer: D
Rationale: Thrombolytic therapy is most effective when administered within a few hours of symptom onset.
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The nurse is giving digoxin to a client. What is the most important parameter to check before administration?
- A. Heart rate
- B. Blood pressure
- C. Respiratory rate
- D. Oxygen saturation
Correct Answer: A
Rationale: Step 1: Digoxin is primarily used to treat heart conditions.
Step 2: Heart rate is crucial as digoxin can affect the heart rhythm.
Step 3: Monitoring heart rate ensures safety and effectiveness of digoxin.
Step 4: Blood pressure, respiratory rate, and oxygen saturation are important but not as directly impacted by digoxin.
What is a condition where the heart muscle becomes abnormally enlarged, thickened, or stiffened, often leading to heart failure?
- A. Cardiomyopathy
- B. Pericarditis
- C. Aortic stenosis
- D. Mitral valve prolapse
Correct Answer: A
Rationale: The correct answer is A: Cardiomyopathy. Cardiomyopathy is a condition characterized by abnormal enlargement, thickening, or stiffening of the heart muscle, which can lead to heart failure. This condition directly affects the heart muscle itself, causing it to function improperly. Pericarditis (B) is inflammation of the pericardium, the outer lining of the heart, not the heart muscle. Aortic stenosis (C) and Mitral valve prolapse (D) involve issues with heart valves, not the heart muscle itself. Therefore, A is the correct choice as it directly addresses the abnormal changes in the heart muscle leading to heart failure.
The client has a prescription for sublingual nitroglycerin. What is the nurse's instruction for how to take this medication during an episode of chest pain?
- A. Take one tablet every 5 minutes, up to three tablets.
- B. Take one tablet every hour until the pain subsides.
- C. Take two tablets immediately if chest pain occurs.
- D. Take one tablet with a full glass of water.
Correct Answer: A
Rationale: The correct answer is A. Sublingual nitroglycerin is taken under the tongue to quickly relieve chest pain. The nurse should instruct the client to take one tablet every 5 minutes during an episode of chest pain, up to a maximum of three tablets. This is because nitroglycerin works rapidly to dilate blood vessels and improve blood flow to the heart, helping to relieve angina symptoms. Taking one tablet every hour or two tablets immediately may not provide adequate relief and could lead to an overdose. Taking the tablet with water is unnecessary as the medication is absorbed through the mucous membranes under the tongue.
Which term refers to a condition where the blood supply to part of the heart muscle is blocked, often referred to as a heart attack?
- A. Myocardial infarction
- B. Arrhythmia
- C. Stroke
- D. Aneurysm
Correct Answer: A
Rationale: The correct answer is A: Myocardial infarction. Myocardial infarction refers to the condition where the blood supply to part of the heart muscle is blocked, leading to tissue damage or cell death. This is commonly known as a heart attack. It is crucial to understand that arrhythmia (B), stroke (C), and aneurysm (D) are different medical conditions that do not specifically involve the blockage of blood flow to the heart muscle. Arrhythmia is an irregular heartbeat, stroke is the interruption of blood supply to the brain, and an aneurysm is a bulge in a blood vessel. Therefore, the correct term for a condition involving a blocked blood supply to the heart muscle is myocardial infarction.
Which test measures the electrical activity of the heart and can detect arrhythmias and other heart conditions?
- A. Electrocardiogram (ECG or EKG)
- B. Chest X-ray
- C. MRI
- D. CT scan
Correct Answer: A
Rationale: The correct answer is A: Electrocardiogram (ECG or EKG). An ECG measures the electrical activity of the heart, detecting arrhythmias and other heart conditions by recording the heart's electrical impulses. This test is non-invasive and provides valuable information about the heart's function. Chest X-ray (B) primarily shows the heart's size and shape, not electrical activity. MRI (C) and CT scan (D) are imaging tests that provide detailed anatomical images but do not directly measure heart electrical activity.