Evolve Chap 40 Flashcards
The client with unstable angina has received education about the acute coronary syndrome. Which of the following indicates that he understood the teaching?
a. “This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year.”
b. “Angina is just a temporary interruption of blood flow to my heart.”
c. “I need to tell my wife I’ve had a heart attack.”
d. “Because this was temporary, I will not need to take any medications for my heart.”
- a. “This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year.”
- Among people who have unstable angina, 10% to 30% have a myocardial infarction (MI) within 1 year.
The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure?
a. Inferior wall
b. Anterior wall
c. Lateral wall
d. Posterior wall
- b. Anterior wall
- Owing to the large size of the anterior wall, the amount of tissue infarction may be large enough to decrease the force of contraction, leading to heart failure.
The nurse is providing a cardiac class for a women’s group. The nurse emphasizes that which characteristics place women at high risk for myocardial infarction (MI)? Select all that apply.
a. Premenopausal
b. Increasing age
c. Family history
d. Abdominal obesity
e. Breast cancer
- b. Increasing age
- c. Family history
- d. Abdominal obesity
- Increasing age is a risk factor, especially after 70 years.
- Family history is a significant risk factor in both men and women.
- A large waist size/abdominal obesity is a risk factor for both metabolic syndrome and MI.
The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize?
a. Reduce abdominal fat.
b. Avoid stress.
c. Do not smoke or chew tobacco.
d. Avoid alcoholic beverages.
- c. Do not smoke or chew tobacco.
- Tobacco exposure, including secondhand smoke, reduces coronary blood flow, causes vasoconstriction and endothelial dysfunction and thickening of the vessel wall, increases carbon monoxide, and decreases oxygen. Because this is highly addicting, beginning smoking in the teen years may lead to decades of exposure.
The nurse is teaching the client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion? Select all that apply.
a. Truncal obesity
b. Hypercholesterolemia
c. Elevated homocysteine levels
d. Glucose intolerance
e. Client taking losartan (Cozaar)
- b. Hypercholesterolemia
- d. Glucose intolerance
- e. Client taking losartan (Cozaar)
- Decreased high-density lipoprotein cholesterol (HDL-C) (usually with high low-density lipoprotein cholesterol [LDL-C]), HDL-C less than 40 mg/dL for men or less than 50 mg/dL for women, or taking an anticholesterol drug is a sign of metabolic syndrome.
- Increased fasting blood glucose (caused by diabetes, glucose intolerance, or insulin resistance) is included in the constellation of metabolic syndrome.
- Blood pressure greater than 130/85 or taking antihypertensive medication indicates metabolic syndrome.
Which of the following atypical symptoms may be present in the female client experiencing myocardial infarction (MI)? Select all that apply.
a. Sharp, inspiratory chest pain
b. Dyspnea
c. Dizziness
d. Extreme fatigue
e. Anorexia
- b. Dyspnea
- c. Dizziness
- d. Extreme fatigue
*Many women present with fatigue, dyspnea, and light-headedness.
To validate that the client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests?
a. Creatine kinase-MB fraction (CK-MB) and alkaline phosphatase
b. Homocysteine and C-reactive protein
c. Total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterols
d. Myoglobin and troponin
- d. Myoglobin and troponin
* Myoglobin, troponin, and CK-MB are the cardiac markers used to determine whether MI has occurred.
When caring for a client with acute myocardial infarction, the nurse recognizes that prompt pain management is essential for which reason?
a. The discomfort will increase client anxiety and reduce coping.
b. Pain relief improves the oxygen supply and decreases oxygen demand.
c. Relief of pain indicates that the myocardial infarction is resolving.
d. Pain medication should not be used until a definitive diagnosis has been established.
- b. Pain relief improves the oxygen supply and decreases oxygen demand.
- The focus of pain relief is on reducing myocardial oxygen demand.
When planning care for a client in the emergency department, the nurse recognizes that which interventions are needed in the acute phase? Select all that apply.
a. Morphine sulfate
b. Oxygen
c. Nitroglycerin
d. Naloxone
e. Acetaminophen
f. Verapamil (Calan, Isoptin)
- a. Morphine sulfate
- b. Oxygen
- c. Nitroglycerin
- Morphine is needed to reduce oxygen demand, preload, pain, and anxiety.
- Administering oxygen will increase available oxygen for the ischemic myocardium.
- Nitroglycerin is used to reduce preload and chest pain.
After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign?
a. 1 inch backup of blood in the IV tubing
b. Facial drooping
c. Partial thromboplastin time (PTT) 68 seconds
d. Report of chest pressure during dye injection
- b. Facial drooping
- During and after thrombolytic administration, the nurse observes for any indications of bleeding, including changes in neurologic status, which may indicate intracranial bleeding.
The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity should the nurse suggest?
a. The need to increase activities slowly at home
b. Planning and participating in a walking program
c. Placing a chair in the shower for independent hygiene
d. Consultation with social worker for disability planning
- c. Placing a chair in the shower for independent hygiene
- Phase 1 begins with the acute illness and ends with discharge from the hospital. It focuses on promoting rest and allowing clients to improve their ADLs based on their abilities.
The nurse is caring for a client 36 hours post coronary artery bypass grafting (CABG), with a diagnosis of activity intolerance related to imbalance of myocardial oxygen supply and demand. Which of these findings causes the nurse to terminate an activity and return the client to bed?
a. Pulse 60 and regular
b. Urinary frequency
c. Incisional discomfort
d. Respiratory rate 28
- d. Respiratory rate 28
* Tachypnea and tachycardia reflect activity intolerance; activity should be terminated.
The nurse in the coronary care unit is caring for a group of clients who have had myocardial infarction. Which client should the nurse see first?
a. Client with dyspnea on exertion when ambulating to the bathroom
b. Client with third-degree heart block on the monitor
c. Client with normal sinus rhythm and PR interval of 0.28 second
d. Client who refuses to take heparin or nitroglycerin
- b. Client with third-degree heart block on the monitor
- Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system is involved. Third-degree heart block usually requires pacemaker insertion.
The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure?
a. Urine output of 1500 mL on the preceding day
b. Crackles in the lung fields
c. Pedal edema
d. Expectoration of yellow sputum
- b. Crackles in the lung fields
- Manifestations of left ventricular failure and pulmonary edema are noted by listening for crackles and identifying their locations in the lung fields.
The nurse is concerned that the client who had myocardial infarction (MI) has developed cardiogenic shock. Which of these findings indicates shock? Select all that apply.
a. Bradycardia
b. Cool, diaphoretic skin
c. Crackles in the lung fields
d. Respiratory rate of 12
e. Anxiety and restlessness
f. Temperature of 100.4
- b. Cool, diaphoretic skin
- c. Crackles in the lung fields
- e. Anxiety and restlessness
- The client with shock has cool, moist skin.
- ventricle cannot forward blood adequately, resulting in pulmonary congestion and crackles.
- status, anxiety, and restlessness are expected.
