MS 1 Final Exam Review - Todd Cardiology Flashcards
In addition to troponin levels, which laboratory result in a patient’s health record is most indicative of myocardial infarction?
1 Increased myoglobin
2 Increased C-reactive protein
3 Increased creatine kinase-MB (CK-MB)
4 Increased white blood cell count
3 Increased creatine kinase-MB (CK-MB)
Biochemical markers, such as creatine kinase (CK) and troponin are released specifically by myocardial cells when injured and are detectable in the blood. The CK enzymes are fractionated into bands. The CK-MB is specific to heart muscles and helps to quantify myocardial damage. Myoglobin, although one of the first markers to increase after a myocardial infarction (MI), does not have as high of a cardiac specificity as others. C-reactive protein is increased after an MI as a result of the inflammation caused by tissue damage; however, it is also not as highly specific to cardiac tissue. An increased white blood cell count may be present after an MI but is due to a generalized inflammatory response.
A patient with group A streptococcal pharyngitis states, “I do not want to take the antibiotics that have been prescribed.” Which response would the nurse provide?
1 “You may not want to take the antibiotics, but you will be sorry if you do not.”
2 “You will not feel well if you do not take the medicine and get over this infection.”
3 “Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease.”
4 “If you don’t take the medication, you may have complications of the infection, such as loss of balance.”
3 “Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease.”
RF is not common because of the effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say. The complications of RF do not include loss of balance.
A patient with a newly inserted permanent pacemaker receives discharge instructions from the nurse. Which patient statement indicates that further teaching is required?
1 “I should avoid using microwave ovens.”
2 “I should avoid standing near antitheft devices.”
3 “I should avoid direct blows to the pacemaker site.”
4 “I should avoid close proximity to high-output electric generators.”
1 “I should avoid using microwave ovens.”
Microwaves do not interfere with a pacemaker’s function and can be used safely. Electric signals from antitheft devices can affect pacemaker functioning. The patient should avoid direct blows to the pacemaker site to reduce pressure at the site. Electric signals from high-output electric generators can move the pacemaker from its position and affect its functioning.
A patient with a suspected acute aortic dissection tells the nurse, “I think I’m having a heart attack!” Which manifestation of an acute aortic dissection would the nurse assess for in this patient?
1 Intermittent, stabbing pain in the abdomen
2 Abrupt onset of excruciating chest or back pain
3 Gradual onset of chest pain that increases in intensity
4 Sharp chest pain that happens only with a deep breath
2 Abrupt onset of excruciating chest or back pain
The majority of patients with an acute ascending aortic dissection report abrupt onset of excruciating chest or back pain radiating to the neck or shoulders. Patients with acute descending aortic dissection are more likely to report pain located in their back, abdomen, or legs. The pain is frequently described as “sharp” and “worst ever,” followed less frequently by “tearing,” “ripping,” or “stabbing.” Dissection pain can be differentiated from myocardial infarction (MI) pain, which is more gradual in onset and has increasing intensity. As the dissection progresses, pain may migrate. Older patients are less likely to have abrupt onset of chest or back pain and are more likely to have hypotension and vague symptoms. Some patients have a painless aortic dissection, emphasizing the importance of the physical examination.
A patient with infective endocarditis is scheduled for a transesophageal echocardiogram (TEE). What would the test be expected to detect?\
1 Cardiomegaly
2 Cardiac dysrhythmias
3 Atrioventricular block
4 Vegetations on the valves
4 Vegetations on the valves
A TEE is used to detect vegetations on the heart valves. A chest x-ray is used to detect cardiomegaly. An electrocardiograph is used to detect cardiac dysrhythmias in patients with pericarditis. An electrocardiogram (ECG) detects first- or second-degree atrioventricular (AV) block.
A patient reports a recent onset of pain in the calf when climbing stairs. The pain is relieved when the patient sits and rests for about two minutes. Which condition would the nurse suspect?
1 Muscle cramping
2 Venous insufficiency
3 Intermittent claudication
4 Sore muscles from overexertion
3 Intermittent claudication
Intermittent claudication feels like a cramp and is caused by decreased arterial blood flow to an extremity during activity. It may be caused by arterial spasm, atherosclerosis, or occlusion of an artery to the limb. Symptoms are usually relieved by a few minutes of rest, and definitive treatment depends on the cause. Muscle cramping, venous insufficiency, and sore muscles from overexertion are all incorrect in light of the patient’s presenting complaints.
For which patient conditions is coronary revascularization with coronary artery bypass graft (CABG) surgery recommended? Select all that apply.
1 Severe aortic stenosis
2 Failed medical management
3 Left main coronary artery or three-vessel disease
4 Not candidates for percutaneous coronary intervention (PCI)
5 Failed PCI with continued chest pain
2 Failed medical management
3 Left main coronary artery or three-vessel disease
4 Not candidates for percutaneous coronary intervention (PCI)
5 Failed PCI with continued chest pain
Coronary revascularization with CABG is recommended for patients who have diabetes mellitus, have left main coronary artery or three-vessel disease, patients who are not candidates for percutaneous intervention and who have failed percutaneous intervention and continue to have chest pain, and those who are expected to have longer-term benefits with this surgery than with catheterization. Severe aortic stenosis is not an indicator for cardiac revascularization surgery.
The nurse is caring for a patient with manifestations of acute decompensated heart failure (ADHF). Which assessment is the nursing priority?
1 Lung sounds
2 Facial s welling
3 Level of anxiety
4 Intake and output
1 Lung sounds
The priority nursing assessment is auscultation of lung sounds. Excess fluid volume often leads to pulmonary congestion. ADHF can manifest as pulmonary edema. Facial swelling is a possible side effect with prescribed renin-angiotensin-aldosterone inhibitors for heart failure. It is important to assess the patient’s anxiety, but it is not the priority. Assessing intake and output is important for right-sided heart failure
A patient diagnosed with heart failure is treated with an angiotensin-converting enzyme (ACE) inhibitor. For which side effect would the nurse monitor the patient?
1 Cough
2 Anemia
3 Hyperpigmentation
4 Increased body temperature
1 Cough
Patients treated with ACE inhibitors have an increased risk for medication-related cough. Methyldopa causes anemia. β-Adrenergic receptor blockers (β -blockers) alter body temperature. Aspirin can increase melanin production and can cause hyperpigmentation.
A patient at risk for cardiovascular disease has splinter hemorrhages. Which condition is consistent with this finding?
1 Varicose veins
2 Arteriosclerosis
3 Vasoconstriction
4 Infective endocarditis
4 Infective endocarditis
Splinter hemorrhages are small, red-to-black streaks under the fingernails that indicate the presence of infective endocarditis. Ulcers in a patient with a risk for cardiovascular disease indicate varicose veins or arteriosclerosis. Peripheral cyanosis indicates vasoconstriction.
Which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)?
1 Diuretics
2 Narcotics
3 Vasodilators
4 Positive inotropes
1 Diuretics
Diuretics are used in patients with fluid overload, which helps them to decrease the sodium reabsorption at various sites within the nephrons. This helps with flushing out the sodium from the body and promotes water loss. Vasodilators improve coronary artery circulation by dilating the coronary artery. Narcotics, such as morphine sulfate, dilate both pulmonary and systematic blood vessels but may not help in fluid overload. Positive inotropes increase myocardial contractility and help in dilating renal blood vessels, enhancing renal output.
