‼️FINAL ACS‼️

Question 1

Which ECG finding is most indicative of a STEMI?
A. T wave inversion in lead V1 only
B. ST depression in two non-contiguous leads
C. ST elevation in two contiguous leads
D. A prolonged PR interval

Answer 1

Correct Answer: C. ST elevation in two contiguous leads
Rationale: ST elevation in at least two contiguous leads indicates myocardial injury and is a hallmark of STEMI.

Question 2

Which medication should be administered first for a patient presenting with ACS and chest pain?
A. Heparin
B. Nitroglycerin
C. Atorvastatin
D. Aspirin

Answer 2

Correct Answer: D. Aspirin
Rationale: Chewable aspirin is given immediately to inhibit platelet aggregation and reduce clot progression.

Question 3

Troponin levels in a patient with an MI typically rise within how many hours?
A. 1–2 hours
B. 4–6 hours
C. 10–12 hours
D. 24 hours

Answer 3

Correct Answer: B. 4–6 hours
Rationale: Troponin I and T levels rise within 4–6 hours, peak at 10–24 hours, and remain elevated for 10–14 days.

Question 4

What symptom is most typical of a myocardial infarction in women?
A. Crushing chest pain
B. Jaw pain and diaphoresis
C. Epigastric pain and fatigue
D. Palpitations and cyanosis

Answer 4

Correct Answer: C. Epigastric pain and fatigue
Rationale: Women may present with atypical symptoms like fatigue, dyspnea, and epigastric discomfort.

Question 5

A patient with chest pain and ST depression is diagnosed with:
A. STEMI
B. NSTEMI
C. Pericarditis
D. Ventricular fibrillation

Answer 5

Correct Answer: B. NSTEMI
Rationale: NSTEMI presents with ST depression and/or T wave inversion without ST elevation.

Question 6

What is the primary goal of treatment in STEMI patients within the first 90 minutes?
A. Pain control
B. Prevent heart failure
C. Restore perfusion
D. Reduce fever

Answer 6

Correct Answer: C. Restore perfusion
Rationale: Prompt reperfusion with PCI or thrombolytics within 90 minutes is critical to minimize infarct size.

Question 7

Which pharmacologic agent is used for chest pain unrelieved by nitroglycerin?
A. Morphine
B. Metoprolol
C. Lisinopril
D. Heparin

Answer 7

Correct Answer: A. Morphine
Rationale: Morphine is used for pain unrelieved by nitroglycerin; it also reduces cardiac workload.

Question 8

Which condition is suggested by a new pathologic Q wave on an ECG?
A. Pericarditis
B. Myocardial infarction
C. Atrial fibrillation
D. Left bundle branch block

Answer 8

Correct Answer: B. Myocardial infarction
Rationale: A new Q wave indicates necrosis from a completed infarct, often seen post-STEMI.

Question 9

Unstable angina is characterized by:
A. Predictable exertional chest pain
B. Pain that is relieved by rest
C. Chest pain that occurs at rest or with minimal exertion
D. A normal ECG

Answer 9

Correct Answer: C. Chest pain that occurs at rest or with minimal exertion
Rationale: Unstable angina is unpredictable and often occurs at rest, indicating worsening ischemia.

Question 10

Which lab result would most definitively differentiate between unstable angina and NSTEMI?
A. Elevated WBC
B. CK-MB elevation
C. Elevated cardiac troponin
D. Hypokalemia

Answer 10

Correct Answer: C. Elevated cardiac troponin
Rationale: Elevated troponins are seen in NSTEMI but not in unstable angina.

Question 11

Which action is part of the initial nursing assessment for suspected ACS?
A. Administering insulin
B. Applying compression stockings
C. Obtaining a 12-lead ECG
D. Giving a high-fiber diet

Answer 11

Correct Answer: C. Obtaining a 12-lead ECG
Rationale: A 12-lead ECG should be performed within 10 minutes of arrival to identify STEMI or ischemia.

Question 12

The goal of IV nitroglycerin in ACS treatment is to:
A. Increase preload and afterload
B. Improve coronary blood flow and reduce chest pain
C. Slow the heart rate
D. Prevent thrombus formation

Answer 12

Correct Answer: B. Improve coronary blood flow and reduce chest pain
Rationale: IV NTG reduces myocardial oxygen demand by decreasing preload and afterload.

Question 13

Which patient is most likely experiencing a silent MI?
A. 48-year-old woman with anxiety
B. 72-year-old man with osteoarthritis
C. 60-year-old man with chest trauma
D. 68-year-old patient with diabetes

Answer 13

Correct Answer: D. 68-year-old patient with diabetes
Rationale: Diabetics may have neuropathy that blunts pain perception, leading to silent MIs.

Question 14

What is the purpose of administering atorvastatin during ACS care?
A. Reduce inflammation
B. Lower glucose levels
C. Promote clotting
D. Dilate coronary arteries

Answer 14

Correct Answer: A. Reduce inflammation
Rationale: High-dose statins reduce cholesterol and stabilize plaques, lowering inflammation in ACS.

Question 15

Which symptom indicates right ventricular infarction?
A. Pulmonary crackles
B. Jugular vein distention
C. Orthopnea
D. Peripheral cyanosis

Answer 15

Correct Answer: B. Jugular vein distention
Rationale: JVD, hepatic engorgement, and peripheral edema are signs of right ventricular failure.

Question 16

In ACS care, MONA stands for:
A. Metoprolol, Oxygen, NSAIDs, Anticoagulants
B. Morphine, Oxygen, Nitroglycerin, Aspirin
C. Magnesium, Oxygen, Nitroglycerin, Atropine
D. Morphine, Omeprazole, Nitroglycerin, Acetaminophen

Answer 16

Correct Answer: B. Morphine, Oxygen, Nitroglycerin, Aspirin
Rationale: MONA is the emergency acronym for chest pain relief and myocardial perfusion.

Question 17

What is a priority nursing diagnosis for a patient with STEMI?
A. Risk for infection
B. Impaired physical mobility
C. Decreased cardiac output
D. Impaired urinary elimination

Answer 17

Correct Answer: C. Decreased cardiac output
Rationale: Impaired perfusion from MI results in decreased cardiac output, requiring immediate attention.

Question 18

Reperfusion therapy in a STEMI patient is successful when:
A. Chest pain worsens
B. Troponin levels decrease immediately
C. ST segments return to baseline
D. Bradycardia develops

Answer 18

Correct Answer: C. ST segments return to baseline
Rationale: Normalization of the ST segment is the most reliable sign of reperfusion success.

Question 19

Which of the following patients is not eligible for thrombolytic therapy?
A. STEMI with chest pain <12 hours
B. NSTEMI patient
C. STEMI in rural setting without PCI
D. STEMI within 30 minutes of ED arrival

Answer 19

Correct Answer: B. NSTEMI patient
Rationale: Thrombolytics are contraindicated in NSTEMI because of partial occlusion and higher bleeding risk.

Question 20

Which medication prevents platelet aggregation in ACS?
A. Lisinopril
B. Aspirin
C. Furosemide
D. Digoxin

Answer 20

Correct Answer: B. Aspirin
Rationale: Aspirin inhibits thromboxane A2, reducing platelet aggregation and clot growth.

Question 21

What is the main reason for drawing serial cardiac biomarkers?
A. Rule out diabetes
B. Monitor potassium levels
C. Track infection
D. Confirm myocardial damage over time

Answer 21

Correct Answer: D. Confirm myocardial damage over time
Rationale: Biomarkers like troponin peak and decline in a predictable pattern post-MI.

Question 22

Which electrolyte imbalance increases the risk for lethal dysrhythmias in MI?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia

Answer 22

Correct Answer: B. Hypokalemia
Rationale: Low potassium levels increase the risk for PVCs, VT, and VF in cardiac patients.

Question 23

A nurse notes a holosystolic murmur in a patient with a recent MI. What should the nurse suspect?
A. Aortic stenosis
B. Mitral regurgitation from papillary muscle rupture
C. Pericarditis
D. Tricuspid valve prolapse

Answer 23

Correct Answer: B. Mitral regurgitation from papillary muscle rupture
Rationale: A new loud systolic murmur post-MI can signal mechanical complications like valve rupture.

Question 24

The infarcted tissue after MI is replaced with scar tissue by how many weeks?
A. 1 week
B. 2 weeks
C. 4 weeks
D. 6 weeks

Answer 24

Correct Answer: D. 6 weeks
Rationale: Healing and scar tissue replacement occurs by 6 weeks post-infarction.

Question 25

Why are beta-blockers given after an MI? A. Increase HR and BP B. Enhance cardiac contractility C. Reduce myocardial oxygen demand D. Promote diuresis

Answer 25

Correct Answer: C. Reduce myocardial oxygen demand Rationale: Beta-blockers reduce heart rate, BP, and contractility to preserve myocardium.

Question 26

Which action is appropriate during thrombolytic therapy administration? A. Administer IM injections after starting infusion B. Monitor for signs of bleeding C. Delay starting IV lines D. Encourage early ambulation

Answer 26

Correct Answer: B. Monitor for signs of bleeding Rationale: Thrombolytics increase bleeding risk; invasive procedures should be done beforehand.

Question 27

What complication should be most closely monitored after PCI? A. GI upset B. Pulmonary embolism C. Stent thrombosis D. Asthma attack

Answer 27

Correct Answer: C. Stent thrombosis Rationale: The most serious risk post-PCI is stent thrombosis, which can lead to reinfarction.

Question 28

Why is morphine beneficial in ACS beyond pain control? A. Promotes hyperventilation B. Causes vasodilation and reduces preload C. Raises blood pressure D. Increases O2 demand

Answer 28

Correct Answer: B. Causes vasodilation and reduces preload Rationale: Morphine reduces cardiac workload by decreasing preload, HR, and oxygen demand.

Question 29

What should the nurse assess first in a patient complaining of chest pain? A. Blood glucose B. Urine output C. Vital signs and ECG D. Capillary refill

Answer 29

Correct Answer: C. Vital signs and ECG Rationale: Vital signs and a 12-lead ECG are immediate priorities for chest pain assessment.

Question 30

Which symptom indicates left ventricular dysfunction post-MI? A. Clear lung sounds B. Dyspnea and crackles C. Bradycardia D. Leg cramps

Answer 30

Correct Answer: B. Dyspnea and crackles Rationale: Left ventricular failure leads to pulmonary congestion, reflected by dyspnea and crackles.

Question 31

acs med order (from notes)

Answer 31

Aspirin, nitro, O2, morphine?