MI Flashcards
(44 cards)
The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction(MI)?
a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels
b. Depressed ST-segment on ECG and elevated total CPK
c. Depressed ST-segment on ECG and normal cardiac enzymes
d. Q wave on ECG with normal enzymes and troponin levels
ANS: A
ST segment elevation and elevated cardiac enzymes are seen in Q wave MI.
A patient presents to the emergency department (ED) with chest pain that he has had for the past 2 hours. He is nauseous and diaphoretic, and his skin is dusky in color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question?
a. Emergent pacemaker insertion
b. Emergent percutaneous coronary intervention
c. Emergent thrombolytic therapy
d. Immediate coronary artery bypass graft surgery
ANS: A
The goals of management of AMI are to dissolve the lesion that is occluding the coronary artery and to increase blood flow to the myocardium. Options include emergent percutaneous intervention, such as angioplasty, emergent coronary artery bypass graft surgery, or thrombolytic therapy if the patient has been symptomatic for less than 6 hours. No data in this scenario warrant insertion of a pacemaker.
While instructing a patient on what occurs with a myocardial infarction, the nurse plans to explain which process?
a. Coronary artery spasm.
b. Decreased blood flow (ischemia).
c. Death of cardiac muscle from lack of oxygen (tissue necrosis).
d. Sporadic decrease in oxygen to the heart (transient oxygen imbalance).
ANS: C
Acute myocardial infarction is death (tissue necrosis) of the myocardium that is caused by lack of blood supply from the occlusion of a coronary artery and its branches.
The nurse is examining the ECG of a patient who has just been admitted with a suspected myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary occlusion? 1 Sinus tachycardia 2Pathologic Q wave 3Fibrillatory P waves 4Prolonged PR interva
ANS: 2
The presence of a pathologic Q wave, which often accompanies ST segment elevation myocardial infarction (STEMI), is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.
A patient with three-vessel coronary artery disease has a random blood sugar level of 197 mg/dL. The laboratory reports show the presence of cardiac-specific troponin I (cTnI) and cardiac-specific troponin T (cTnT) markers. The nurse identifies that which intervention will benefit the patient? 1 Placement of drug-eluting stents 2 Coronary surgical revascularization 3Percutaneous coronary intervention 4Intraaortic balloon pump (IABP) therapy
ANS: 2
Coronary surgical revascularization helps restore the blood flow to the heart by replacing new blood vessels around existing blockages. This procedure is best for a patient with diabetes and three-vessel disease, because it helps improve perfusion to the myocardial muscle. A patient with confirmed myocardial infarction needs the placement of drug-eluting stents via cardiac catheterization. Percutaneous coronary intervention is a first line of treatment for a patient with definitive electrocardiogram changes and positive cardiac markers. Intraaortic balloon pump (IABP) therapy is used to treat severe left ventricular dysfunction.
A patient is recovering from an uncomplicated myocardial infarction (MI). Which instructions will the nurse include when discussing physical activity?
1”Start out with 30-minute sessions.”
2”Be sure to perform physical activity at least twice a week.”
3”Physical activity should be regular, rhythmic, and repetitive.”
4”Your heart rate during exercise should only go up to 30 beats over your resting heart rate.
ANS: 3
Physical activity should be regular, rhythmic, and repetitive, using large muscles to build up endurance (e.g., walking, cycling, swimming, rowing). Physical activity sessions should be at least 30 minutes long. Instruct the patient to begin slowly at personal tolerance (perhaps only 5 to 10 minutes) and build up to 30 minutes. Encourage the patient to perform physical activity on most days of the week. Activity intensity is determined by the patient’s heart rate. If an exercise stress test has not been performed, the heart rate of the patient recovering from an MI should not exceed 20 beats/minute over the resting heart rate.
A patient reports heaviness and burning sensation in the substernal and retrosternal region. Assessment findings include a fasting blood glucose of 190 mg/dL and blood pressure of 145/90 mm Hg. The nurse recognizes that which other finding indicates sympathetic nervous system stimulation? 1 Jugular venous distention 2 Abnormal S3 and S4 sounds 3 Ashen, clammy, and cool skin 4 Shortness of breath and anxiety
ANS: 3
A patient with heaviness and burning sensation in the substernal and retrosternal region may be having a myocardial infarction (MI) and stimulation of the sympathetic nervous system. This condition may trigger the production of catecholamines, which promote glycogen release, diaphoresis, and vasoconstriction of peripheral blood vessels. Because of this, the patient’s skin may appear ashen, clammy, and cool to the touch. Jugular vein distention and abnormal S3 and S4 sounds are caused by ventricular dysfunction. Shortness of breath and anxiety may not necessarily be caused by sympathetic nervous system stimulation.
The nurse assesses a patient with diabetes who reports shortness of breath, neck pain, and hypoglycemic symptoms. The patient’s blood pressure is 130/86 mm Hg, heart rate is 102 beats/minute, respiratory rate is 24 breaths/minute, and the fingerstick blood glucose is 136 mg/dL. The nurse recognizes that the patient may be experience
1 Myocardial infarction
2 Late-stage diabetic ketoacidosis
3 Early-onset diabetic ketoacidosis
4 Hyperosmolar hyperglycemic nonketotic syndrome
ANS: 1
Signs and symptoms of a myocardial infarction (MI) include shortness of breath, neck pain, and cool, clammy skin. Although cool, clammy skin may resemble a hypoglycemic reaction, when found along with shortness of breath and neck pain it is very specific for an MI. The patient is not experiencing a complication of diabetes (ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome). The blood glucose is close to normal, and further diagnostics would be required to determine a diabetic complication. Only cool, clammy skin is indicative of hypoglycemia.
During the 48 hours after a myocardial infarction, a nurse should assign the highest priority to monitoring the patient for: 1 Dysrhythmias 2 Anxiety and fear 3 Metabolic acidosis 4 Medication side effects
ANS: 1
The nurse must be most alert for dysrhythmias, which may signal another MI or impending complications. The nurse should also be alert for increased anxiety, which may cause pain and lead to a secondary infarction. Anxiety and fear are highly likely but secondary in importance to monitoring the patient for dysrhythmias. Metabolic acidosis and reactions to new medications are not likely but should still be included as part of overall assessment of the patient.
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication? 1 Dehydration 2 Paralytic ileus 3 Atrial dysrhythmias 4 Acute respiratory distress syndrome
ANS:C
Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first three days following CABG surgery. Although dehydration, paralytic ileus, and acute respiratory distress syndrome could occur, they are not common complications.
For which problem is percutaneous coronary intervention (PCI) most clearly indicated? 1 Chronic stable angina 2 Left-sided heart failure 3Coronary artery disease (CAD) 4Acute myocardial infarction
ANS: 4
PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD normally are treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure, such as left-sided heart failure.
The nurse reviews the prescriptions for cardiac markers for a patient who is suspected of having a myocardial infarction (MI). Because of its limited use in diagnosing an MI, the prescription for which cardiac marker should be questioned by the nurse? 1 Myoglobin 2Creatine kinase-MB (CKMB) 3Cardiac-specific troponin I (cTnI) 4Cardiac-specific troponin T (cTnT)
ANS: 1
Myoglobin is a serum cardiac marker that is released into the circulation two hours after a myocardial infarction (MI). Myoglobin’s role in diagnosing MI is limited because it lacks cardiac specificity. Creatine kinase-MB (CKMB) levels begin to rise about six hours after MI, are specific to myocardial cells, and help quantify myocardial damage. Cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI) are highly specific indicators of MI.
The nurse assesses a patient who has been administered the tissue-type plasminogen activator alteplase for an acute myocardial infarction. Which assessment finding is the highest priority and should be reported to the primary health care provider immediately?
1 Anorexia
2 Hematuria
3 Oral temperature of 100.4° F (38° C)
4 Occasional premature ventricular contractions
ANS: 2
Alteplase is a proteolytic enzyme that digests threads and other substances in the blood, including clotting factors, thereby causing hypercoagulability of the blood and possibly bleeding, which is evidenced by blood in the urine. Anorexia and increased temperature are not issues directly related to this drug. Alteplase may cause premature ventricular contractions, which should be monitored, but this is usually not a problem because the drug has a short half-life.
A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that subsequently were attributed to ST segment elevation myocardial infarction (STEMI). What complication of myocardial infarction (MI) should the nurse anticipate? 1 Unstable angina 2 Cardiac tamponade 3 Sudden cardiac death 4 Cardiac dysrhythmias
ANS: 4
The most common complication after MI is dysrhythmias, which are present in 80 percent of patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.
Heart disease in women is manifested by a variety of subtle signs. Which sign is typically seen in women?
a. Fainting
b. Chest pain
c. Dizziness
d. Fatigue
ANS: D
Women frequently experience fatigue with heart disease. Many women do not even experience chest pain. Fainting and dizziness are not typical signs of heart disease in women.
The drug alteplase (t-PA) is given to the patient with a myocardial infarction (MI). The nurse is aware the drug will:
a. dissolve the obstruction in the coronary artery.
b. dilate vessels to relieve pain.
c. strengthen cardiac contraction.
d. increase cardiac output.
ANS: A
Alteplase (t-PA) is a thrombolytic drug that will dissolve the clot if given within 12 hours of the MI.
The nurse counsels a patient that the administration of thrombolytic drugs would be contraindicated in the patient who is:
a. hypotensive.
b. being treated for a bleeding ulcer.
c. presently taking warfarin (Coumadin).
d. prone to asthma attacks.
ANS: B
Thrombolytic agents are contraindicated in people with uncontrolled hypertension, GI bleeds, recent intracranial or intraspinal surgery, or aneurysm because of threat of excessive bleeding.
Following a cardiac catheterization with coronary angiography, the physician writes an order to increase the patients fluid intake. The nurse knows that increasing the fluid intake is ordered for what reason?
a. Reducing the nausea related to the dye absorption
b. Maintaining adequate blood pressure and perfusion
c. Diluting the urine to prevent kidney damage
d. Making up for fluid lost during the angiogram
ANS: C
The dye used in a cardiac catheterization with coronary angiography is excreted through the kidneys and may cause damage to the kidneys. Fluid is encouraged to dilute urine to prevent kidney damage
The patient in the emergency room with a myocardial infarction (MI) becomes pale, diaphoretic, and hypotensive and complains of feeling cold. The nurse recognizes that these signs are which post-MI complication?
a. Cardiogenic shock
b. Pleural effusion
c. Ventricular fibrillation
d. Pulmonary embolus
ANS: A
Cardiogenic shock is characterized by all the signs mentioned. Cardiogenic shock is a medical emergency.
Following patient teaching regarding a scheduled minimally invasive direct coronary artery bypass (MIDCAB), the nurse determines the need for further instruction when the patient makes which statement?
a. It frightens me to think that my heart will be stopped during surgery.
b. This surgery bypasses my artery that is blocked, and replaces it with sections of a vein or artery taken from another part of my body.
c. This surgery will hopefully control my angina since nothing else we have tried has worked.
d. I may come out of surgery with vessels removed from my legs.
ANS: A
The MIDCAB procedure is less invasive than the traditional coronary artery bypass graft (CABG) procedure and does not require the patient be placed on the heart-lung machine due to stopping the heart for an extended period. Both procedures are used to treat angina that has not responded to more conservative treatment and utilize either the mammary artery or sections of the saphenous vein for the graft.
The nurse is aware that a positive diagnosis of a myocardial infarction (MI) is based on which diagnostic test results? (Select all that apply.)
a. Electrocardiographic (ECG) changes in the QRS complex
b. Elevation of low-density lipoprotein (LDH)
c. Elevation of troponin levels
d. Elevated white blood cell (WBC) count
e. Elevated T wave
ANS: A, C, E
Elevation of enzymes and altered QRS patterns are positive for diagnosis of MI. Elevation of T wave and WBC count, although present, are not specific to MI formation.
Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)?
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.
ANS: B
Chest pain that lasts for 20 minutes or more is characteristic of AMI. 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.
After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective?
a. I can expect indigestion as a side effect of nitroglycerin.
b. I can only take the nitroglycerin if I start to have chest pain.
c. I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin.
d. I will help slow down the progress of the plaque formation by taking nitroglycerin.
ANS: C
The emergency medical services (EMS) system should be activated when chest pain or other symptoms are not completely relieved 5 minutes after taking one nitroglycerin. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse). Gastric upset is not an expected side effect of nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis.
A patient with a nonST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin?
a. Platelet aggregation is enhanced by IV heparin infusion.
b. Heparin will dissolve the clot that is blocking blood flow to the heart.
c. Coronary artery plaque size and adherence are decreased with heparin.
d. Heparin will prevent the development of new clots in the coronary arteries.
ANS: D
Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.
