MS 1 Final Exam Review - Hand Cardiology

Question 1

The electrocardiogram (ECG) monitor of a patient in the cardiac care unit after myocardial infarction (MI) indicates ventricular fibrillation. Which action would the nurse take immediately?

1 Perform synchronized cardioversion.
2 Administer IV amiodarone.
3 Perform cardiopulmonary resuscitation (CPR).
4 Prepare for insertion of a temporary transvenous pacemaker.

Answer 1

3 Perform cardiopulmonary resuscitation (CPR).

Treatment consists of immediate initiation of CPR and advanced cardiac life support (ACLS) with the use of defibrillation and definitive drug therapy (e.g., epinephrine, vasopressin). There should be no delay in using a defibrillator once available. Amiodarone, cardioversion, and temporary pacemakers are not used to treat ventricular fibrillation.

Question 2

A patient who has angina is being seen in a health care provider’s office. While in the office, the patient experiences chest pain and takes a total of three nitroglycerin tablets, five minutes apart. The patient’s chest pain is not relieved. Which is the nurse’s priority action?

1 Assess a complete set of vital signs.
2 Contact the emergency medical services (EMS).
3 Repeat the medication in another five minutes.
4 Instruct the patient to lie quietly and take deep breaths.

Answer 2

2 Contact the emergency medical services (EMS).

A patient with angina who takes sublingual nitroglycerin and whose condition worsens or does not resolve after administration of the medication should be referred to an EMS immediately for help. The drug should be administered to the patient every five minutes for a maximum of three doses. The nurse should take measures to reduce the severity of the condition first and then monitor vital signs and provide patient instructions.

Question 3

A patient presents to the emergency department reporting chest pain. Which component of the patient’s blood work would most specifically indicate an acute myocardial infarction (MI)?

1 Troponin
2 Myoglobin
3 Creatine kinase (CK)
4 C-reactive protein (CRP)

Answer 3

1 Troponin

Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of other markers. CK enzymes are found in a variety of organs and tissues. Myoglobin elevation is a sensitive indicator of very early myocardial injury but lacks specificity for MI. CRP levels are not used to diagnose acute MI; rather, an increased level has been linked with the presence of atherosclerosis.

Question 4

The nurse is caring for a patient who develops atrial fibrillation. Which treatments may be included the patient’s treatment plan? Select all that apply.

1 Atropine injection
2 Electrical cardioversion
3 Anticoagulation therapy
4 Implantable cardioverter-defibrillator (ICD)
5 Radiofrequency catheter ablation

Answer 4

2 Electrical cardioversion
3 Anticoagulation therapy
5 Radiofrequency catheter ablation

Electrical cardioversion converts the atrial fibrillation into normal sinus rhythm. If a patient is in atrial fibrillation for more than 48 hours, anticoagulation therapy with warfarin will be required for three to four weeks. This should commence before the cardioversion and has to be continued for several weeks after successful cardioversion. For patients with drug-refractory atrial fibrillation or those who do not respond to electrical conversion, radiofrequency catheter ablation may be done. Atropine increases the heart rate and would not be prescribed for a patient with atrial fibrillation. The ICD is not appropriate for patients with atrial fibrillation.

Question 5

A patient has received alteplase to treat an acute myocardial infarction. Which assessment finding is the highest priority to report to the health care provider immediately?

1 Anorexia
2 Hematuria
3 Oral temperature of 100.4° F (38° C)
4 Occasional premature ventricular contractions

Answer 5

2 Hematuria

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.