QUIZ 1 (ACS) Flashcards
A patient arrives at the emergency department with chest pain that has lasted for 20 minutes. The nurse knows that which of the following ECG findings is most indicative of a STEMI?
A. ST-segment depression
B. T-wave inversion
C. ST-segment elevation in two contiguous leads
D. Prolonged PR interval
Answer: C
Rationale: ST-segment elevation in two contiguous leads is the hallmark ECG finding in a STEMI. ST-segment depression and T-wave inversion suggest ischemia or NSTEMI.
Which cardiac biomarker is the most specific for myocardial infarction?
A. CK-MB
B. Myoglobin
C. Troponin I
D. LDH
Answer: C
Rationale: Troponin I (or T) is the most specific and sensitive biomarker for myocardial infarction. It rises within 4-6 hours, peaks at 10-24 hours, and remains elevated for up to 14 days.
A nurse is assessing a patient with suspected unstable angina. Which of the following findings differentiates unstable angina from a myocardial infarction?
A. Chest pain that is relieved with rest
B. Elevated serum troponin levels
C. ST-segment elevation on ECG
D. Pain that lasts longer than 30 minutes
Answer: B
Rationale: Unstable angina does not cause myocardial necrosis, so troponin levels remain normal. It is characterized by chest pain that occurs unpredictably but is relieved with rest or nitroglycerin.
Which statement about NSTEMI is correct?
A. NSTEMI is caused by a total coronary artery occlusion.
B. NSTEMI does not usually cause ST-segment elevation.
C. Thrombolytic therapy is the treatment of choice for NSTEMI.
D. Patients with NSTEMI do not require cardiac catheterization.
Answer: B
Rationale: NSTEMI is caused by a partial occlusion and does not typically show ST-segment elevation. Thrombolytic therapy is only used for STEMI. Patients with NSTEMI undergo cardiac catheterization within 12-72 hours.
A patient with a suspected MI reports chest pain that radiates to the left arm and jaw. What other symptom is most common in an acute MI?
A. Epigastric burning
B. Sharp pleuritic pain on inspiration
C. Weakness, nausea, and diaphoresis
D. Pain that improves with deep breathing
Answer: C
Rationale: MI pain is often accompanied by nausea, diaphoresis, and weakness due to activation of the sympathetic nervous system.
Which assessment finding would be expected in a patient with a right ventricular infarction?
A. Pulmonary congestion
B. Jugular vein distention
C. Crackles in the lungs
D. Increased urine output
Answer: B
Rationale: Right ventricular infarction can cause JVD, hepatic engorgement, and peripheral edema due to systemic venous congestion.
A nurse is assessing an elderly patient with an MI. Which symptom is the patient most likely to report?
A. Severe chest pain
B. Nausea and vomiting
C. Left arm pain
D. Shortness of breath and confusion
Answer: D
Rationale: Older adults often present with atypical symptoms such as confusion, dyspnea, and generalized weakness rather than classic chest pain.
What is the priority nursing action for a patient presenting with chest pain?
A. Obtain a 12-lead ECG
B. Administer morphine
C. Obtain a troponin level
D. Give aspirin
Answer: A
Rationale: A 12-lead ECG should be obtained immediately to determine if the patient has ST-segment elevation, guiding treatment decisions.
Which medication should be administered first in a patient with suspected MI?
A. Nitroglycerin
B. Morphine
C. Atorvastatin
D. Metoprolol
Answer: A
Rationale: Nitroglycerin is given first to relieve chest pain by vasodilation. Morphine is used if pain persists.
Which of the following is a contraindication to thrombolytic therapy?
A. Onset of chest pain 1 hour ago
B. History of GI bleeding 6 months ago
C. STEMI confirmed on ECG
D. Blood pressure of 190/110 mmHg
Answer: D
Rationale: Severe hypertension (≥180/110 mmHg) is a contraindication due to increased risk of intracranial hemorrhage.
A patient with an anterior wall MI suddenly develops crackles in the lungs and S3 heart sounds. What complication should the nurse suspect?
A. Cardiogenic shock
B. Left ventricular heart failure
C. Pulmonary embolism
D. Right ventricular infarction
Answer: B
Rationale: Left ventricular failure can occur due to impaired contractility, leading to pulmonary congestion and crackles.
Which ECG change is a sign of myocardial infarction resolution after thrombolytic therapy?
A. ST-segment elevation persists
B. Return of ST-segment to baseline
C. Prolonged QT interval
D. New left bundle branch block
Answer: B
Rationale: The return of the ST-segment to baseline indicates successful reperfusion of the myocardium.
Which laboratory finding is most concerning in a patient receiving heparin for ACS?
A. Platelet count of 90,000/mm³
B. Hemoglobin of 13 g/dL
C. Troponin of 1.5 ng/mL
D. INR of 1.2
Answer: A
Rationale: A low platelet count suggests heparin-induced thrombocytopenia (HIT), a serious complication.
Which statement by a patient recovering from an MI indicates a need for further teaching?
A. “I will take my aspirin every day.”
B. “I can stop taking my beta-blocker when I feel better.”
C. “I should avoid heavy lifting for a while.”
D. “I need to follow a heart-healthy diet.”
Answer: B
Rationale: Beta-blockers should not be stopped abruptly as this increases the risk of rebound hypertension and another MI.
Which dietary recommendation is best for a patient with ACS?
A. High-fat, low-carbohydrate diet
B. Low-sodium, low-fat diet
C. High-protein, high-fat diet
D. Low-fiber diet
Answer: B
Rationale: A heart-healthy diet should be low in saturated fat and sodium to reduce cardiovascular risk.
A patient presents to the emergency department with chest pain. The provider orders an ECG and cardiac biomarkers. The ECG shows ST-segment depression and T-wave inversion, but the initial troponin level is negative. What should the nurse anticipate?
A. The patient will be discharged home.
B. A second troponin level will be drawn in 3-6 hours.
C. The patient will receive thrombolytic therapy.
D. The patient is experiencing a STEMI.
Answer: B
Rationale: Troponin levels may not rise immediately; serial cardiac biomarkers are needed to determine if an MI has occurred.
Which of the following diagnostic tests provides direct visualization of coronary artery blockages?
A. 12-lead ECG
B. Echocardiogram
C. Chest X-ray
D. Coronary angiography
Answer: D
Rationale: Coronary angiography is the gold standard for identifying the location and severity of coronary artery blockages.
Which patient is at highest risk for developing ACS?
A. A 45-year-old woman with a history of migraines
B. A 60-year-old man with hypertension and hyperlipidemia
C. A 30-year-old man with a history of anxiety
D. A 55-year-old woman who exercises regularly
Answer: B
Rationale: Hypertension and hyperlipidemia are significant risk factors for atherosclerosis, which can lead to ACS.
Which of the following medications is given to prevent platelet aggregation in ACS?
A. Furosemide
B. Metoprolol
C. Clopidogrel
D. Atorvastatin
Answer: C
Rationale: Clopidogrel (Plavix) is an antiplatelet agent that prevents clot formation, reducing the risk of worsening ACS.
A nurse is administering nitroglycerin IV to a patient with a STEMI. What is the most important nursing assessment?
A. Monitor blood pressure closely
B. Monitor respiratory rate
C. Assess for nausea and vomiting
D. Evaluate capillary refill
Answer: A
Rationale: IV nitroglycerin can cause hypotension due to vasodilation. Blood pressure should be closely monitored.
A patient with a history of ACS asks why they are prescribed aspirin daily. What is the best response?
A. “Aspirin dissolves clots that may form in your coronary arteries.”
B. “Aspirin prevents the platelets from sticking together to form a clot.”
C. “Aspirin lowers your cholesterol levels, reducing plaque buildup.”
D. “Aspirin will help to lower your blood pressure.”
Answer: B
Rationale: Aspirin inhibits platelet aggregation, reducing the risk of clot formation in the coronary arteries.
A patient receiving thrombolytic therapy for a STEMI suddenly reports severe headache and confusion. What is the nurse’s priority action?
A. Check the patient’s blood glucose level
B. Stop the thrombolytic infusion immediately
C. Administer naloxone
D. Give additional IV fluids
Answer: B
Rationale: Severe headache and confusion may indicate intracranial hemorrhage, a serious complication of thrombolytic therapy. The infusion should be stopped immediately.
Which is the most common complication after an MI?
A. Heart failure
B. Stroke
C. Pulmonary embolism
D. Ventricular dysrhythmias
Answer: D
Rationale: Ventricular dysrhythmias, such as ventricular fibrillation, are the most common cause of death following an MI.
A patient with an anterior wall STEMI is at greatest risk for developing which complication?
A. Right-sided heart failure
B. Cardiogenic shock
C. Peripheral edema
D. Pericarditis
Answer: B
Rationale: An anterior wall STEMI affects the left ventricle, impairing cardiac output and leading to cardiogenic shock.
A patient recovering from an MI asks when they can resume sexual activity. What is the best response?
A. “You should wait at least 6 months before resuming sexual activity.”
B. “If you can climb two flights of stairs without symptoms, you may resume sexual activity.”
C. “Sexual activity is not recommended after a heart attack.”
D. “You can resume sexual activity immediately if you feel ready.”
Answer: B
Rationale: The “two-flight rule” is often used to assess a patient’s cardiac fitness for resuming sexual activity.
Which of the following ECG changes is most indicative of myocardial ischemia?
A. ST-segment elevation
B. Prolonged PR interval
C. Q waves
D. ST-segment depression
Answer: D
Rationale: ST-segment depression indicates ischemia, while ST-segment elevation suggests infarction.
Which lifestyle modification should be emphasized for a patient with ACS?
A. Eliminating all dietary fat
B. Avoiding all physical activity
C. Engaging in regular moderate exercise
D. Drinking 3-4 alcoholic beverages per day
Answer: C
Rationale: Moderate exercise improves cardiovascular health and reduces the risk of future cardiac events.
Which statement by a patient recovering from an MI indicates a need for further education?
A. “I will take my prescribed medications even if I feel fine.”
B. “I will attend my cardiac rehab sessions.”
C. “I will follow a low-fat, low-sodium diet.”
D. “I should stop taking my beta-blocker once my chest pain is gone.”
Answer: D
Rationale: Beta-blockers should not be stopped abruptly, as this increases the risk of rebound hypertension and another MI.
Which finding indicates that a patient with ACS is experiencing cardiogenic shock?
A. Blood pressure of 88/54 mmHg, weak pulse, and cool extremities
B. Heart rate of 50 bpm with bounding pulses
C. BP of 130/80 mmHg with clear breath sounds
D. Complaints of mild chest discomfort
Answer: A
Rationale: Cardiogenic shock is characterized by hypotension, weak pulse, and cool extremities due to poor cardiac output.
A nurse is teaching a patient about sublingual nitroglycerin. Which statement indicates a need for further teaching?
A. “I will keep the tablets in a dark, tightly sealed bottle.”
B. “If my chest pain is not relieved after one tablet, I can take another after 5 minutes.”
C. “I should chew the tablet for faster absorption.”
D. “I should call 911 if chest pain persists after taking 3 tablets.”
Answer: C
Rationale: Sublingual nitroglycerin should not be chewed—it should dissolve under the tongue for rapid absorption.
Which action is the priority for a patient with a STEMI who arrives at a hospital without PCI capability?
A. Start thrombolytic therapy within 30 minutes of arrival.
B. Administer aspirin and discharge the patient.
C. Transport the patient for elective cardiac catheterization.
D. Give a beta-blocker immediately.
Answer: A
Rationale: If PCI is unavailable, thrombolytic therapy must be started within 30 minutes to dissolve the clot and restore blood flow.
Which finding indicates that thrombolytic therapy for STEMI has been successful?
A. New onset of chest pain
B. Persistent ST-segment elevation
C. Return of ST-segment to baseline
D. Bradycardia and hypotension
Answer: C
Rationale: Return of the ST segment to baseline indicates successful reperfusion of the myocardium.
A patient receiving thrombolytic therapy for STEMI is at greatest risk for which complication?
A. Stroke
B. Infection
C. Liver failure
D. Electrolyte imbalance
Answer: A
Rationale: Stroke (intracranial hemorrhage) is the most serious complication of thrombolytic therapy due to excessive clot breakdown.
Which medication is used in ACS to reduce myocardial oxygen demand and heart rate?
A. Morphine
B. Beta-blockers
C. Atorvastatin
D. Nitroglycerin
Answer: B
Rationale: Beta-blockers (e.g., metoprolol) lower heart rate, blood pressure, and myocardial oxygen consumption.
A patient with an MI is at highest risk for developing which dysrhythmia within the first hour?
A. Atrial fibrillation
B. Sinus bradycardia
C. Ventricular fibrillation
D. First-degree AV block
Answer: C
Rationale: Ventricular fibrillation is the most common cause of sudden cardiac death within the first hour after an MI.
Which of the following is an early sign of cardiogenic shock in a patient with an MI?
A. Bounding pulses and hypertension
B. Increased urine output
C. Slow capillary refill and bradycardia
D. Cold, clammy skin and hypotension
Answer: D
Rationale: Cold, clammy skin and hypotension occur due to decreased cardiac output and impaired tissue perfusion in cardiogenic shock.
Which symptom suggests a possible right ventricular infarction?
A. Crackles in the lungs
B. Jugular vein distention and hypotension
C. Pulmonary congestion
D. Cyanosis and bradypnea
Answer: B
Rationale: Right ventricular infarctions lead to JVD, hypotension, and systemic venous congestion rather than pulmonary congestion.
Which statement by a patient recovering from an MI indicates a need for further education?
A. “I will avoid smoking to prevent another heart attack.”
B. “I will take my aspirin daily.”
C. “I can stop taking my medications once I feel better.”
D. “I will follow a heart-healthy diet.”
Answer: C
Rationale: Medications such as beta-blockers, aspirin, and statins must be continued long-term to prevent recurrence.
Which dietary recommendation is most appropriate for a patient recovering from ACS?
A. High-fat, low-carbohydrate diet
B. Low-sodium, low-fat diet
C. High-protein, high-fat diet
D. Low-fiber diet
Answer: B
Rationale: A low-sodium, low-fat diet helps control hypertension and cholesterol, reducing future cardiovascular events.
A nurse is teaching a patient with a history of ACS about physical activity. Which statement requires further teaching?
A. “I should gradually increase my activity level as tolerated.”
B. “If I experience chest pain during exercise, I should rest and take nitroglycerin.”
C. “I should avoid all exercise to prevent another heart attack.”
D. “Cardiac rehab can help me safely regain strength.”
Answer: C
Rationale: Regular moderate exercise helps strengthen the heart and reduce the risk of another MI.
A patient recovering from an MI asks how long they should wait before driving. What is the best response?
A. “You should wait at least 1 week before driving.”
B. “You can drive as soon as you feel comfortable.”
C. “You should wait at least 2 weeks or until cleared by your provider.”
D. “You should never drive again.”
Answer: C
Rationale: Driving is usually restricted for at least 2 weeks or until the patient is cleared by a healthcare provider.
Which statement by a patient taking nitroglycerin sublingual tablets indicates correct understanding?
A. “I can take up to three tablets, five minutes apart, if my chest pain does not go away.”
B. “I should swallow the tablet whole.”
C. “I can take as many tablets as I need until my pain stops.”
D. “I should store my nitroglycerin in a warm, humid place.”
Answer: A
Rationale: Up to 3 doses of nitroglycerin can be taken 5 minutes apart for persistent chest pain before calling 911.
Which of the following is an expected side effect of nitroglycerin?
A. Hypertension
B. Bradycardia
C. Headache
D. Hypoglycemia
Answer: C
Rationale: Headaches are common due to vasodilation. Patients may take acetaminophen if needed.
Which of the following lifestyle modifications is most important for a patient recovering from ACS?
A. Drinking 3-4 alcoholic beverages per day
B. Smoking cessation
C. Avoiding all physical activity
D. Eating a high-fat diet
Answer: B
Rationale: Smoking cessation is the single most effective way to reduce the risk of another MI.
Which statement by a patient recovering from ACS indicates a need for further education?
A. “I should limit my saturated fat intake.”
B. “I will take my prescribed statin every night.”
C. “I can stop my medications once my cholesterol improves.”
D. “I will monitor my blood pressure regularly.”
Answer: C
Rationale: Statins and other medications should not be stopped without consulting a healthcare provider.
Which medication reduces ventricular remodeling after an MI?
A. Beta-blockers
B. ACE inhibitors
C. Aspirin
D. Morphine
Answer: B
Rationale: ACE inhibitors (e.g., lisinopril) reduce ventricular remodeling and prevent heart failure.
Which is an expected finding 48 hours after an MI?
A. Hypothermia
B. Fever (100.4°F or 38°C)
C. Decreased white blood cell count
D. Decreased glucose levels
Answer: B
Rationale: A low-grade fever is expected due to the inflammatory response to myocardial necrosis.
Which assessment finding would indicate that a patient is experiencing reinfarction after an initial MI?
A. ST-segment elevation in previously normal leads
B. Resolution of chest pain
C. Decrease in cardiac biomarkers
D. Hypotension and bradycardia
Answer: A
Rationale: New ST-segment elevation in different leads suggests reinfarction, indicating that another area of the heart is affected.
A patient with an MI is prescribed a statin medication. What is the primary reason for this prescription?
A. To dissolve existing plaque in the coronary arteries
B. To reduce cholesterol levels and prevent further plaque buildup
C. To reduce myocardial oxygen demand
D. To lower blood pressure
Answer: B
Rationale: Statins (e.g., atorvastatin) lower LDL cholesterol, reducing the risk of atherosclerotic plaque progression and future cardiac events.
Which patient education point is most important for preventing future cardiac events in a patient with ACS?
A. “You should take your prescribed medications even if you feel fine.”
B. “You only need to follow a heart-healthy diet for six months.”
C. “You can stop taking aspirin once your chest pain resolves.”
D. “It is safe to resume smoking in moderation.”
Answer: A
Rationale: Medications such as aspirin, beta-blockers, and statins must be taken long-term to prevent recurrent cardiac events.
Scenario:
A 58-year-old male arrives at the emergency department (ED) with severe substernal chest pain that started 30 minutes ago while watching TV. The pain radiates to his left arm and jaw. He is diaphoretic, anxious, and rates his pain as 9/10. His blood pressure is 160/95 mmHg, heart rate 102 bpm, respiratory rate 22 breaths/min, and oxygen saturation 96% on room air. An ECG shows ST-segment elevation in leads II, III, and aVF.
Question 1:
What is the priority action the nurse should take?
A. Obtain a troponin level
B. Administer IV morphine
C. Prepare for emergent PCI
D. Obtain a chest X-ray
Answer: C
Rationale: This patient is experiencing an inferior-wall STEMI, as indicated by ST-segment elevation in leads II, III, and aVF. The priority action is to restore coronary blood flow via percutaneous coronary intervention (PCI) within 90 minutes. While troponin testing, pain management, and a chest X-ray are part of the ACS workup, rapid reperfusion therapy takes precedence.
Scenario:
A 67-year-old female with hypertension and hyperlipidemia presents to the ED with chest pain that started while she was walking. The pain is relieved with rest and nitroglycerin. Her ECG shows ST-segment depression and T-wave inversion, and her initial troponin is negative.
Question 2:
Which diagnosis is most likely?
A. STEMI
B. NSTEMI
C. Unstable angina
D. Pericarditis
Answer: C
Rationale: Unstable angina (UA) presents with new-onset or worsening chest pain but negative cardiac biomarkers (troponin). ST depression and/or T-wave inversion suggest ischemia. In contrast, NSTEMI has positive troponins, and STEMI presents with ST-segment elevation. Pericarditis often presents with diffuse ST elevation and pericardial friction rub.
A 72-year-old male with NSTEMI is started on IV heparin, aspirin, and clopidogrel. The patient asks why he needs two antiplatelet medications.
Question 3:
What is the best response by the nurse?
A. “Aspirin reduces blood clotting, and clopidogrel prevents platelet aggregation.”
B. “These medications dissolve the clot and restore blood flow.”
C. “You need them to control your blood pressure and cholesterol.”
D. “You only need aspirin, but clopidogrel is given as extra protection.”
Answer: A
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel (or ticagrelor) is standard in NSTEMI and STEMI to prevent platelet aggregation and reduce clot formation. Heparin prevents new clot formation but does not dissolve existing clots.
Scenario:
A 60-year-old male is admitted with a STEMI and undergoes PCI with stent placement. Two hours later, he reports severe chest pain similar to his initial symptoms.
Question 4:
What is the most concerning possible cause of this symptom?
A. Reperfusion injury
B. Stent thrombosis
C. Gastric reflux
D. Anxiety attack
Answer: B
Rationale: Recurrent chest pain after PCI raises concern for stent thrombosis, a life-threatening complication that can cause reinfarction. Immediate ECG and cardiac biomarkers are needed to confirm reinfarction and determine further intervention.
Scenario:
A 55-year-old male presents to a rural hospital with STEMI in leads V1-V4 (suggesting anterior wall infarction). The hospital does not have PCI capability.
Question 5:
What is the most appropriate next step?
A. Start thrombolytic therapy within 30 minutes
B. Transfer to a PCI-capable hospital, delaying treatment
C. Administer IV heparin and monitor
D. Give IV fluids and recheck troponins in 3 hours
Answer: A
Rationale: If PCI is unavailable within 120 minutes, thrombolytic (fibrinolytic) therapy must be initiated within 30 minutes to dissolve the clot and restore blood flow. Delaying treatment worsens myocardial damage.
Scenario:
A patient post-STEMI suddenly develops hypotension (BP 80/50 mmHg), cool and clammy skin, and weak pulses.
Question 6:
Which complication is most likely?
A. Pulmonary embolism
B. Cardiogenic shock
C. Heart failure
D. Anxiety attack
Answer: B
Rationale: Cardiogenic shock occurs when a damaged left ventricle fails to pump blood effectively, causing hypotension, poor perfusion, and cool skin. It is a life-threatening emergency requiring vasopressors, fluids, and possible mechanical support.
Scenario:
A 68-year-old patient with inferior-wall STEMI (leads II, III, aVF) develops jugular vein distention (JVD), hypotension, and clear lungs.
Question 7:
Which treatment should be avoided?
A. IV fluids
B. Cardiac monitoring
C. Pain management
D. Nitrates
Answer: D
Rationale: Right ventricular infarction causes preload-dependent hypotension. Nitrates can dangerously drop blood pressure by reducing preload, worsening hypotension. IV fluids help maintain cardiac output.
Scenario:
A 74-year-old male with type 2 diabetes presents with fatigue and shortness of breath but no chest pain.
Question 8:
Which test is most important to rule out MI?
A. Chest X-ray
B. Troponin levels
C. D-dimer test
D. CT angiography
Answer: B
Rationale: Diabetic patients often have “silent” MIs due to cardiac neuropathy. Troponin levels help confirm myocardial injury.
Scenario:
A patient recovering from an MI asks how to prevent future heart attacks.
Question 9:
Which lifestyle change is most critical?
A. Drinking red wine daily
B. Increasing salt intake
C. Smoking cessation
D. Avoiding all exercise
Answer: C
Rationale: Smoking cessation is the single most important modifiable risk factor to prevent recurrent MI.
Scenario:
A patient with ACS is prescribed a statin, beta-blocker, aspirin, and nitroglycerin.
Question 10:
Which statement indicates a need for further teaching?
A. “I can stop taking my statin once my cholesterol is normal.
B. ““I should take my nitroglycerin if I have chest pain.”
C. “I should avoid fatty and salty foods.”
D. “I will take my aspirin every day.”
Answer: A
Rationale: Statins should not be discontinued once cholesterol levels normalize because they prevent atherosclerosis progression and reduce MI risk.
What does the T wave represent in a ECG?
The T wave on an ECG (electrocardiogram) represents ventricular repolarization, which is the relaxing phase of the ventricles after they contract.
What does the ST interval mean on an ECG?
The ST segment on an ECG (electrocardiogram) represents the period between ventricular depolarization and repolarization. It is the flat, isoelectric line between the end of the QRS complex (ventricular depolarization) and the beginning of the T wave (ventricular repolarization).
