Nokea
Which of the following information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction?
- A. The pain increases with deep breathing.
- B. The pain has persisted longer than 30 minutes.
- C. The pain worsens when the patient raises the arms.
- D. The pain is relieved after the patient takes nitroglycerin.
Correct Answer: B
Rationale: Chest pain that lasts for 20 minutes or more is characteristic of an acute myocardial infarction. Changes in pain that occur with raising the arms or with deep breathing are more typical of pericarditis or musculoskeletal pain. Stable angina is usually relieved when the patient takes nitroglycerin.
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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 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 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 is 3 days post myocardial infarction and the patient states, 'I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned' Which of the following responses should the nurse make?
- A. Where are you planning to go for your vacation?
- B. What do you think caused your chest pain episode?
- C. Sometimes plans need to change after a heart attack.
- D. Recovery from a heart attack takes at least a few weeks.
Correct Answer: B
Rationale: When the patient is experiencing denial, the nurse should assist the patient in testing reality until the patient has progressed beyond this step of the emotional adjustment to MI. Asking the patient about vacation plans reinforces the patient's plan, which is not appropriate in the immediate post-MI period. Reminding the patient in denial about the MI is likely to make the patient angry and lead to distrust of the nursing staff.
The nurse is caring for a patient who has recently started taking crestor who reports all of these symptoms to the nurse. Which of the following finding is most important to communicate to the health care provider?
- A. Generalized muscle aches and weakness
- B. Skin flushing after taking the medications
- C. Dizziness when changing positions quickly
- D. Nausea when taking the drugs before eating
Correct Answer: A
Rationale: Muscle aches and weakness may indicate myopathy and rhabdomyolysis, which have caused acute renal failure and death in some patients who have taken the statin medications. These symptoms indicate that the rosuvastatin may need to be discontinued. The other symptoms are common adverse effects when taking niacin, and although the nurse should follow up with the patient, they do not indicate that a change in medication is needed.