Acute Coronary Syndrome: NCLEX Review for Nurses, Exams of Nursing

Download Acute Coronary Syndrome: NCLEX Review for Nurses and more Exams Nursing in PDF only on Docsity! acute coronary syndrome NCLEX Acute Coronary Syndrome NCLEX 63 (Medical-Surgical Nursing, 7th Edition, Ch. 40) Exam Questions with Certified Solutions 2024. The client with unstable angina has received education about the acute coronary syndrome. Which of the following indicates that he understood the teaching? 1. "This is a big warning; I must modify my lifestyle or risk having a heart attack in the next year." acute coronary syndrome NCLEX 2. "Angina is just a temporary interruption of blood flow to my heart." 3. "I need to tell my wife I've had a heart attack." 4. "Because this was temporary, I will not need to take any medications for my heart." - Answer: 1. Among people who have unstable angina, 10% to 30% have a myocardial infarction (MI) within 1 year. Although angina pain is temporary, it reflects underlying coronary artery disease (CAD), which requires attention, including lifestyle modifications. Unstable angina reflects tissue ischemia, but infarction represents tissue necrosis. Clients with underlying CAD may need medications such as aspirin (ASA), lipid-lowering agents, antianginals, or antihypertensives. 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? 1. Inferior wall 2. Anterior wall 3. Lateral wall 4. Posterior wall - Answer: 2. 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. with the inferior wall, the client is more likely to develop right ventricular MI. regarding clients with obstruction of the circumflex artery may experience a lateral wall or posterior wall MI and sinus dysrhythmias. acute coronary syndrome NCLEX To validate that the client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests? 1. Creatine kinase-MB fraction (CK-MB) and alkaline phosphatase 2. Homocysteine and C-reactive protein 3. Total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterols 4. Myoglobin and troponin - Answer: 4. Myoglobin, troponin, and CK-MB are the cardiac markers used to determine whether MI has occurred. Homocysteine and C-reactive protein are markers of inflammation, which may represent risk for MI, but they are not diagnostic for MI. When caring for a client with acute myocardial infarction, the nurse recognizes that prompt pain management is essential for which reason? 1.The discomfort will increase client anxiety and reduce coping. 2. Pain relief improves the oxygen supply and decreases oxygen demand. 3. Relief of pain indicates that the myocardial infarction is resolving. 4. Pain medication should not be used until a definitive diagnosis has been established. - Answer: 2. The focus of pain relief is on reducing myocardial oxygen demand. Chest discomfort will increase anxiety, but it may not affect coping. The major purpose of pain relief is to reduce myocardial oxygen demand. Relief of pain is secondary to the use of opiates or indicates that the tissue infarction is complete. acute coronary syndrome NCLEX 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. Morphine sulfate Oxygen Nitroglycerin Naloxone Acetaminophen Verapamil (Calan, Isoptin) - Answer: Morphine: Morphine is needed to reduce oxygen demand, preload, pain, and anxiety. Oxygen: will increase available oxygen for the ischemic myocardium. Nitroglycerin is used to reduce preload and chest pain. The client is given aspirin to chew; acetaminophen may be used for headache related to nitroglycerin. Owing to negative inotropic action, calcium channel blockers are used for angina, not for myocardial infarction (MI). After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign? 1. 1 inch backup of blood in the IV tubing 2. Facial drooping 3. Partial thromboplastin time (PTT) 68 seconds 4. Report of chest pressure during dye injection - Answer: 2. During and after thrombolytic administration, the nurse observes for any indications of bleeding, including changes in neurologic status, which may indicate intracranial bleeding. acute coronary syndrome NCLEX The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity should the nurse suggest? 1. The need to increase activities slowly at home 2. Planning and participating in a walking program 3. Placing a chair in the shower for independent hygiene 4. Consultation with social worker for disability planning - Answer: 3. 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? 1. Pulse 60 and regular 2. Urinary frequency 3. Incisional discomfort 4. Respiratory rate 28 - Answer: 4. 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? 1. Client with dyspnea on exertion when ambulating to the bathroom 2. Client with third-degree heart block on the monitor 3. Client with normal sinus rhythm and PR interval of 0.28 second acute coronary syndrome NCLEX 4. Incisional pain 6 on a scale of 1 to 10 - Answer: 2. Some bleeding is expected after surgery; however, the nurse should report chest drainage over 150 mL per hour to the surgeon. The visiting nurse is seeing a client post coronary artery bypass graft. Which nursing action should be performed first? 1. Assess coping skills. 2. Assess for postoperative pain at the client's incision site. 3. Monitor for dysrhythmias. 4. Monitor mental status. - Answer: 3. Dysrhythmias are the leading cause of prehospital death. The nurse should monitor the client's heart rhythm. During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response? 1. "You are right. Work on your diet then." 2. "You must find someplace to walk." 3. "Walk around the edge of your apartment complex." 4. "Where might you be able to walk?" - Answer: 4. This response calls for cooperation and participation from the client. The older adult client, 4 hours post coronary artery bypass graft (CABG), has a blood pressure of 80/50. What action should the nurse take? 1. No action is required; low blood pressure is normal for older adults. 2. No action is required for postsurgical CABG clients. acute coronary syndrome NCLEX 3. Assess pulmonary artery wedge pressure (PAWP). 4. Give ordered loop diuretics. - Answer: 3. Decreased preload as exhibited by decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation. Hypotension could cause the graft to collapse. The nurse is assessing the client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI? 1. Chest pain brought on by exertion or stress 2. Substernal chest discomfort occurring at rest 3. Substernal chest discomfort relieved by nitroglycerin or rest 4. Substernal chest pressure relieved only by opioids - Answer: 4. Substernal chest pressure relieved only by opioids is typically indicative of MI. Chest pain brought on by exertion or stress is indicative of angina. Substernal chest discomfort that occurs at rest is not necessarily indicative of MI; it could be a sign of unstable angina. Substernal chest discomfort relieved by nitroglycerin or rest is indicative of angina. The client comes to the emergency department with chest discomfort. Which action does the nurse perform first? 1. Administers oxygen therapy 2. Obtains the client's description of the chest discomfort 3. Provides pain relief medication 4. Remains calm and stays with the client - Answer: 2. A description of the chest discomfort must be obtained before further action can be taken. acute coronary syndrome NCLEX Which statement by the client scheduled for a percutaneous transluminal coronary angioplasty indicates a need for further preoperative teaching? 1. "I will be awake during this procedure." 2. "I will have a balloon in my artery to widen it." 3. "I must lie still after the procedure." 4. "My angina will be gone for good." - Answer: 4. Reocclusion of angina is possible after the procedure. The client is typically awake, but drowsy, during this procedure. The procedure uses a balloon to widen the artery. The client will have to lie still after the procedure because of the large-bore venous access. Time is necessary to allow the ìholeî to heal and prevent hemorrhage. After receiving change-of-shift report in the coronary care unit, which client should you assess first? 1. The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea 2. The client with percutaneous coronary angioplasty who has a dose of heparin scheduled 3. The client who had bradycardia after a myocardial infarction and now has a paced heart rate of 64 4. A client who has first-degree heart block, rate 68, after having an inferior myocardial infarction - Answer: 1. Dyspnea and weight gain are symptoms of left ventricular failure and pulmonary edema; the client needs prompt intervention. acute coronary syndrome NCLEX A client had a coronary artery bypass graft 2 days ago and has a new onset of atrial fibrillation. What diagnostic test will the nurse check that could explain this dysrhythmia? A. Arterial oxygen level B. Serum potassium C. Serum sodium D. Blood urea nitrogen - Answer: B Rationale: Hypokalemia after a coronary artery bypass graft procedure is a common cause of atrial fibrillation. Other complications may also include hypotension, hypothermia, hypertension, bleeding, cardiac tamponade, decreased level of consciousness, and anginal pain. Studies remain inconclusive on the role sodium plays in the development of atrial fibrillation. Elevated blood urea nitrogen levels may occur related to dehydration or decreased cardiac perfusion but have no connection to the development of atrial fibrillation. Which of the following instructions given to a patient who is about to undergo Holter monitoring is most appropriate? A. "You may remove the monitor only to shower or bathe." B. "You should connect the monitor whenever you feel symptoms." C. "You should refrain from exercising while wearing this monitor." D. "You will need to keep a diary of all your activities and symptoms." - Answer: D. A Holter monitor is worn for at least 24 hours while a patient continues with usual acute coronary syndrome NCLEX activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor. The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. Which of the following allergies is most important for the nurse to assess before this procedure? A. Iron B.Iodine C. Aspirin D .Penicillin - Answer: B. The physician usually will use an iodine-based contrast to perform this procedure. Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish. The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. Which of the following is an age-related change that contributes to this finding? A. Stenosis of the heart valves B. Decreased adrenergic sensitivity C. Increased parasympathetic activity D. Loss of elasticity in arterial vessels - Answer: D. An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results. acute coronary syndrome NCLEX The nurse is providing care for a patient who has decreased cardiac output related to heart failure. The nurse recognizes that cardiac output is: A. Calculated by multiplying the patient's stroke volume by the heart rate. B. The average amount of blood ejected during one complete cardiac cycle. C. Determined by measuring the electrical activity of the heart and the patient's heart rate. D .The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure. - Answer: A. Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output. Which of the following cardiovascular effects of aging should the nurse anticipate when providing care for older adults (select all that apply)? Arterial stiffening Increased blood pressure Increased maximal heart rate Decreased maximal heart rate Increased recovery time from activity - Answer: arterial stiffening, increased BP, decreased maximal HR, increased recovery time from activity. Well-documented cardiovascular effects of the aging process include arterial stiffening, possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age. acute coronary syndrome NCLEX D. A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2 - Answer: A> Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD. When providing nutritional counseling for patients at risk for CAD, which of the following foods would the nurse encourage patients to include in their diet (select all that apply)? tofu walnuts tuna fish whole milk orange juice - Answer: Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly. For which of the following antilipemic medications would the nurse question an order in a patient with cirrhosis of the liver? A. Niacin (Nicobid) B. Ezetimibe (Zetia) C. Gemfibrozil (Lopid) D. Atorvastatin (Lipitor) - Answer: D. Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage and myopathy. Liver enzymes must be monitored acute coronary syndrome NCLEX frequently and the medication stopped if these enzymes increase. Thus liver disease is a contraindication for atorvastatin. After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient states: A. "I will replace my nitroglycerin supply every 6 months." B. "I can take up to five tablets every 3 minutes for relief of my chest pain." C. "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." D. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain." - Answer: B. The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system. The nurse would assess a patient with complaints of chest pain for which of the following clinical manifestations associated with a myocardial infarction (MI) (select all that apply)? flushing ashen skin diaphoresis Nausea and vomiting S3 or S4 heart sounds - Answer: During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing an increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, acute coronary syndrome NCLEX diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds. When planning emergent care for a patient with a suspected MI, the nurse will anticipate administration of: A. Oxygen, nitroglycerin, aspirin, and morphine. B. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine. C. Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen. D. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin). - Answer: A. The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which of the following food choices? A. Baked flounder B. angel food cake C. baked potato with margarine acute coronary syndrome NCLEX tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion. For which of the following is percutaneous coronary intervention (PCI) most clearly indicated? A. Chronic stable angina B. Left-sided heart failure C. Coronary artery disease D. Acute myocardial infarction - Answer: D. PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure. of the following risk factors for CAD, what is the 2nd major risk factor for CAD? A. DM B. HTN C. obesity D. high alcohol consumption - Answer: B. (according to old patho notes) which of the following risk factors is associated with a two fold increase in the risk for CAD death and up to a sixfold risk for stroke? A. DM B. HTN C. obesity D. high alcohol consumption - Answer: A> (according to old patho notes) acute coronary syndrome NCLEX how does nicotine increase atherosclerosis? A. by the release of histamine B. by decreasing nitric oxide C. by the release of angiotensin II D. by the release of epinephrine and norepinephrine - Answer: D. (according to old patho notes) which angina occurs because of vasospasms of one or more coronary arteries and often during sleep? A. unstable B. stable C. silent D. Prinzmetal - Answer: D. (according to old patho notes) cardiac cells can withstand ischemic conditions and still return to a viable state for ______ minutes. A. 10 B. 15 C. 20 D. 25 - Answer: C. (according to old patho notes) CAD can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause________, a local state in which the cells are temporarily deprived of blood supply. acute coronary syndrome NCLEX A. infarction B. ischemia C. necrosis D. inflammation - Answer: B. (according to old patho notes) Angina pectoris is chest pain caused my myocardial ischemia. T/F - Answer: T. (according to old patho notes) how does angiotensin II increase the workload of the heart? A. by increasing the PVR B. by causing dysrhythmias as a a result of hyperkalemia C. by redacting the contractility of the myocardium D. by stimulating the SNS - Answer: A. (according to old patho notes) the mechanism of action of calcium channel blockers is to: A. force calcium out of the myocardial cells B. block the entry of calcium into the myocardial and vascular smooth muscle cells C. relax the blood vessels D. act as an autonomic drug - Answer: B, causing decreased contractility and decreased conductivity of the heart, thus decreasing the demand for oxygen (and decreasing BP, HR) a pt taking nitroglycerine should be taught that a common adverse effect is: A. blurred vision B. dizziness