Nokea
Which of the following information about a patient who has been receiving fibrinolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?
- A. No change in the patient's chest pain
- B. A large bruise at the patient's IV insertion site
- C. A decrease in ST segment elevation on the electrocardiogram (ECG)
- D. An increase in cardiac enzyme levels since admission
Correct Answer: A
Rationale: Continued chest pain suggests that the fibrinolytic therapy is not effective and that other interventions such as percutaneous coronary intervention (PCI) may be needed. Bruising is a possible adverse effect of fibrinolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST segment elevation indicates that fibrinolysis is occurring and perfusion is returning to the injured myocardium. An increase in cardiac enzyme levels is expected with reperfusion and is related to the washout of enzymes into the circulation as the blocked vessel is opened.
You may also like to solve these questions
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 is caring for a patient who was admitted the previous day to the coronary care unit with an acute myocardial infarction. Which of the following information should the nurse include in the teaching plan for the patient?
- A. Typical emotional responses to AMI
- B. When patient cardiac rehabilitation will begin
- C. Discharge drugs such as Aspirin and β-blockers
- D. The pathophysiology of coronary artery disease
Correct Answer: B
Rationale: Early after an AMI, the patient will want to know when resumption of usual activities can be expected. At this time, the patient's anxiety level or denial will prevent good understanding of complex information such as coronary artery disease (CAD) pathophysiology. Teaching about discharge medications should be done when the time for discharge is closer. The nurse should support the patient by decreasing anxiety rather than discussing the typical emotional response to myocardial infarction (MI).
The nurse is caring for a patient who has had severe chest pain for several hours and a diagnosis of possible acute myocardial infarction. Which of the following prescribed laboratory tests should the nurse monitor to help determine the diagnosis?
- A. Homocysteine
- B. C-reactive protein
- C. Cardiac-specific troponin
- D. High-density lipoprotein (HDL) cholesterol
Correct Answer: C
Rationale: Troponin levels increase about 3-12 hours after the onset of myocardial infarction (MI). The other laboratory data are useful in determining the patient's risk for developing coronary artery disease (CAD) but are not helpful in determining whether an acute MI is in progress.
The nurse is administering a fibrinolytic agent to a patient with an acute myocardial infarction. Which of the following assessments should cause the nurse to stop the drug infusion?
- A. Bleeding from the gums
- B. Surface bleeding from the IV site
- C. A decrease in level of consciousness
- D. A non-sustained episode of ventricular tachycardia
Correct Answer: C
Rationale: The change in level of consciousness indicates that the patient may be experiencing intracranial bleeding, a possible complication of fibrinolytic therapy. Bleeding of the gums and prolonged bleeding from IV sites are expected adverse effects of the therapy. The nurse should address these by avoiding any further injuries, but they are not an indication to stop infusion of the fibrinolytic medication. A non-sustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective.
The nurse is assessing a patient who has chest pain is to the emergency department and all the following diagnostic tests are prescribed. Which of the following tests should the nurse arrange to be completed first?
- A. Electrocardiogram (ECG)
- B. Computed tomography (CT) scan
- C. Chest x-ray
- D. Troponin level
Correct Answer: A
Rationale: The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that reperfusion therapy can begin as quickly as possible. ECG changes occur very rapidly after coronary artery occlusion. Troponin levels will increase after about 3 hours. Data from the CT scan and chest x-ray may impact the patient's care but are not helpful in determining whether the patient is experiencing a myocardial infarction (MI).