Week 2: Dysrhythmias and CAD

Question 1

A patient in the coronary care unit develops ventricular fibrillation. Which of the following actions should the nurse take first?

1. Perform defibrillation.
2. Initiate cardiopulmonary resuscitation.
3. Prepare for synchronized cardioversion.
4. Administer IV antidysrhythmic medications per protocol.

Answer 1

2. Ventricular Fibrillation results in Unresponsive, pulseless and apneic state. If not treated rapidly, death will result
   Requires immediate cardiopulmonary resuscitation and advanced cardiac life support measures with the use of defibrillation and definitive medication therapy

Question 1

A patient has a diagnosis of acute myocardial infarction, and his cardiac rhythm is sinus bradycardia with six to eight premature ventricular contractions (PVCs) per minute. The pattern that the nurse recognizes as the most characteristic of PVCs is which of the following?

1. An irregular rhythm
2. An inverted T wave
3. A wide, distorted QRS complex
4. An increasingly long PR interval

Answer 1

3. PVCs

Question 2

A patient’s cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/minute. If the bradycardia is symptomatic, which of the following findings should the nurse expect the patient to exhibit?

1. Palpitations
2. Hypertension
3. Warm, flushed skin
4. Shortness of breath

Answer 2

4.

Question 3

What is an EKG?

Answer 3

Graphic tracing of electrical impulses produced by the heart. Waveforms represent activity of charged ions across cell membranes of myocardial cells

Question 4

How does a normal rhythm electrical cycle move through the heart?

Answer 4

SA node, Atrial myocytes, AV node, AV bundle, Bundle branches, Purkinje fibres, Ventricular myocytes

Question 5

Which plane of the heart do precordial leads view?

Answer 5

The 6 chest leads (precordial leads) (V1-V6)provide a horizontal view of the heart

Question 6

The nurse instructs a patient about modifiable risk factors for coronary artery disease. Which statements indicate that teaching has been effective? (Select all that apply)

1. I should stop smoking to reduce my risk of heart disease
2. Restricting my activity reduces the onset of heart disease
3. I should drink alcohol because this prevents hearts disease
4. There is not much that can be done to prevent heart disease
5. Obesity is a risk actor that I can change to reduce the onset of heart disease

Answer 6

1, 5

Question 7

A patient is prescribed lovastatin (Mevacor) for hyperlipidemia. What should the nurse instruct the patient about this medication?

1. Abstain from alcohol use while taking this drug
2. Take the drug with meals to minimize gastric distress
3. Promptly report muscle pain or tenderness to the physician
4. Consume a diet that includes no more than 20% of calories from saturated fat.

Answer 7

3. Lovastatin is a first line drug for treating hyperlipidemia and can cause myopathy. All patients should be instructed to report muscle pain and weakness or brown urine, which is an indication of muscle breakdown.

Question 8

The nurse is caring for a patient with stable angina. Which assessment finding would be consistent with this medical diagnosis?

1. Persistent ECG changes
2. Increasing nocturnal pain
3. Correlation between activity level and pain
4. Evidence of impaired cardiac output such as weak peripheral pulses.

Answer 8

3. Stable angina is the most common and predictable form of angina. It occurs with a predictable amount of activity or stress and usually occurs when the work of the heart is increased by physical exertion, exposure to the cold, or by stress.

Question 9

The nurse is caring for a patient with acute coronary syndrome. Which nursing diagnosis should be the priority for this patient?

1. Anxiety related to unknown outcome of disorder
2. Decreased cardiac output related to myocardial ischemia
3. Ineffective Health Maintenance related to lack of knowledge about coronary heart disease
4. Ineffective tissue perfusion: cardiopulmonary related to underlying coronary heart disease

Answer 9

4. Acute coronary syndrome is a dynamic state in ehich coronary blood flow is acutely reduced, but not fully occluded. Myocardial cells are injured by acute ischemia that redults. The most important goal of care is to reestablish tissue perfusion through the use of medication or surgery.

Question 10

The nurse is caring for a patient recovering from a coronary angioplasty with stent placement. Which intervention is a priority for the patient at this time?

1. Securing chest tubes to bedding
2. Maintaining leg extension on the affected side
3. Discontinuing intravenous lines when taking oral fluids
4. Treating chest pain with intravenous morphine as needed

Answer 10

2. The cardiac catheter used to insert the stent is usually inserted via the femoral artery, a large, high-pressure vessel. The leg is maintained in extension for a prescribed period after the procedure to reduce the risk of bleeding, hematoma formation, or clot formation at the insertion site.

Question 11

The nurse is planning care for a patient with acute myocardial infarction. What goals should the nurse use to guide this patient’s care? (Select all that apply)

1. Relieve chest pain
2. Prevent complications
3. Reduce blood viscosity
4. Decrease cardiac workload
5. Reduce myocardial damage

Answer 11

1,2,4,5

Immediate treatment goals for the patient with an acute myocardial infarction are to reduce chest pain, myocardial damage, decrease cardiac workload, and prevent complication. Blood viscosity is not implicated in the development of an acute MI, but plays a role in peripheral vascular resistance.

Question 12

The nurse is determining nursing diagnoses appropriate for a patient scheduled for fibrinolytic therapy. Which nursing diagnosis would a priority for this patient?

1. Anxiety
2. Ineffective protection
3. Risk for powerlessness
4. Ineffective health maintenance

Answer 12

2. Fibrinolytic therapy, administered to restore myocardial perfusion, disruts the clotting cascade and can lead to potentially serious bleeding. Establishing bleeding precautions is vital to preserve physiologic integrity. The diagnosis Ineffective protection would be the priority for this patient.

Question 13

The nurse is reviewing laboratory results for a patient admitted with acute chest pain. Which laboratory value should cause the nurse the most concern?

1. AST 65 units/L
2. CK 320 units/L
3. Hematocrit 35%
4. APTT 35 seconds

Answer 13

2. Creatine kinase is an important enzyme for celar function found principally in cardiac and skeletal muscle and the brain. CK levels rise rapidly with damage to these tissues, appearing in the serum 4-6 hours after an acute MI, peaking within 12-14 hours and then declining. The CK level correlates with the size of the infarction; the greater the amount of infarcted tissue, the higher the serum CK level.

AST is a liver enzyme

Question 14

Which patient(s) are most at risk for developing coronary artery disease? Select-all-that-apply:*
A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer.
B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day.
C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction.
D. A 29 year old that has type I diabetes.

Answer 14

B,C,D

Question 15

A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:*
A. Unstable angina
B. Variant angina
C. Stable angina
D. Prinzmetal angina

Keeping the patient in question 4 in mind: What type of diagnostic tests will the physician most likely order (at first) for this patient to evaluate the cause of the patient’s symptoms? Select-all-that-apply:*
A. EKG
B. Stress test
C. Heart catheterization
D. Balloon angioplasty

Answer 15

C
A, B,

Question 16

A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction?*
A. absent Q wave
B. QRS widening
C. absent P-wave
D. ST segment elevation

Answer 16

D

Question 17

A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix (anti platelet). What important information will you include in the patient’s teaching? Select-all-that-apply:*
A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure.
B. A normal side effect of this medication is a dry cough.
C. Avoid green leafy vegetables while taking Plavix.
D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.

Answer 17

A, D

Question 18

A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next?*
A. Take another dose of Nitroglycerin in 5 minutes.
B. Call 911 immediately
C. Lie down and rest to see if that helps with relieving the pain
D. Take two doses of Nitroglycerin in 5 minutes

Answer 18

B

Question 19

A 67 year old woman with a history of CAD comes in with chest pain.
Her EKG shows premature atrial contraction
What are two reasons the nurse would insert and IV line?

Answer 19

In those with heart disease, PACs can be a warning of more serious dysrhythmias and her condition could quickly progress
Nurse would initiate to have IV access in case of cardiac arrest, for bolus fluid administration, and for administration of IV nitroglycerin (NTG) or other medications as needed.

Question 20

Explain the purpose of administering an aspirin tablet for patients experiencing acute coronary syndrome. Why is “non–enteric-coated” aspirin specified? What would be a contraindication to administering aspirin?

Answer 20

Aspirin is effective in reducing mortality in MI due to its antiplatelet action

An enteric coating slows down the availability of aspirin, and in this case, it is desirable for the medication to be rapidly absorbed for rapid availability in the bloodstream.

Chewing the tablet also enhances the absorption.

Contraindications:
allergy to aspirin
active major bleeding or major bleeding within the past 2 weeks,
hemorrhagic stroke
active or recent gastric bleeding, ulcer disease,
acute bronchospasm

Question 21

Lipitor is prescribed for a patient with a high cholesterol level. As the nurse, how do you educate the patient on how this drugs works on the body?*
A. Lipitor increases LDL levels and decreases HDL levels, total cholesterol, and triglyceride levels.
B. Lipitor decreases LDL, HDL levels, total cholesterol, and triglyceride levels.
C. Lipitor increases HDL levels, total cholesterol, and triglyceride levels.
D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.

Answer 21

D

Question 22

A patient taking Zocor (statin) is reporting muscle pain. You are evaluating the patient’s lab work and note that which of the following findings could cause muscle pain?*
A. Elevated potassium level
B. Elevated CPK (creatine kinase level)
C. Decreased potassium level
D. Decreased CPK (creatine kinase level)

Answer 22

B

Question 23

A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. Which of the following will you include in your discharge teaching about this medication?*
A. Check your heart rate regularly because Metoprolol can cause an irregular heart rate.
B. Check your glucose regularly because this medication can cause hyperglycemia.
C. Check your blood pressure regularly because this medication can cause hypertension.
D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.

Answer 23

D

Question 24

True or False: ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin II to Angiotensin I which causes vasodilation.

Answer 24

False
ACE Inhibitors block conversion of angiotensin I to II. Slows progression of HF, decreases morbidity and mortality
Promote vasodilation and diuresis by decreasing afterload and preload
Decrease secretion of aldosterone which reduces retention of Na and water

Question 25

The client is also taking a diuretic that decreases her potassium level. The nurse expects that a low potassium level (hypokalemia) could have what effect on the digoxin?

a. Increase the serum digoxin sensitivity level
b. Decrease the serum digoxin sensitivity level
c. Not have any effect on the serum digoxin sensitivity level
d. Cause a low average serum digoxin sensitivity level

Answer 25

A
if K is low, greater potential for digitalis toxicity

Question 26

Why is an EKG ordered for patients experiencing ACS?

Answer 26

To rule out previous MI, to determine the presence of ischemic changes to the heart and check for irregular heart rhythms

Question 27

Why is oxygen saturation taken for patients experiencing ACS?

Answer 27

To determine whether symptoms are related to a respiratory disorder or whether the heart can adequately pump blood through the lungs

Question 28

Why is chest x-ray taken for patients experiencing ACS?

Answer 28

To rule out heart enlargement, to detect any structural defects and rule out pulmonary edema

Question 29

What other sources, in addition to cardiac ischemia, might be responsible for her chest and abdominal discomfort?

Answer 29

Gastrointestinal: indigestion, gastritis, hiatal hernia, reflux esophagitis, gastroesophageal reflux disease (GERD), gallbladder disease, esophageal spasm, peptic ulcer disease (PUD)
Respiratory: pleurisy, pulmonary embolism, pneumonia, pneumothorax
Cardiac: vasospastic angina, mitral valve prolapse (MVP), severe aortic stenosis, cardiac dysrhythmia, pericarditis
Musculoskeletal: rib fracture, costochondritis, respiratory muscle strain, vertebral fractures or compression resulting in nerve impingement
Metabolic: anemia, carbon monoxide toxicity
Psychosocial: anxiety or stress, panic attack

Question 30

After how many nitroglycerin admins with unrelieved chest pain would you notify the physician?

Answer 30

3

Question 31

Using the teach-back method, you ask RK what to do if she experiences chest pain, Which statement by R.K. indicates that further teaching is needed?



A. “At the first sign of chest discomfort, I will stop what I’m doing and sit down.”

B. If I have chest pain I will place one nitroglycerin tablet under my tongue.”

C. “If the chest pain does not stop, I can take another tablet in 5 minutes.”

D. “My husband will need to call 911 if the chest pain does not stop after three nitroglycerin tablets



Answer 31

Answer: D
Current guidelines state that if chest discomfort or pain is unimproved or worsening 5 minutes after one nitroglycerin dose has been taken, then the patient or family member needs to access the emergency medical system (EMS) immediately

Question 32

A client tells you that she hates the headache after she takes a nitro. What can you suggest to her for this problem?

Answer 32

Headaches associated with sublingual nitroglycerin are typically short-lived (about 20 minutes), but she can take acetaminophen for the pain.

Question 33

What essential safety point will the nurse emphasize when discussing sublingual nitro?

Answer 33

It is essential to sit or lie down when taking sublingual nitroglycerin because it will cause a drop in BP, she will be at a higher risk for falling
Should be dissolved under tongue not swallowed; do not take any oral meds when sublingual nitro in place

Question 34

What S&S are associated with anginal pain?

Answer 34

May be described as tightness, choking, or a heavy sensation
It is frequently retrosternal and may radiate to the neck, jaw, shoulders, back, or arms
Anxiety frequently accompanies the pain
Other symptoms may occur, which include dyspnea or shortness of breath, dizziness, nausea, and vomiting

Question 35

Define Prinzmental’s Angina

Answer 35

often occurs at rest, usually in response to a spasm of a major coronary artery.
-Not precipitated by increased physical demand
-Usually occurs at the same time every day