WKU MED SURG 2 EXAM 1 TEST BANK
PRACTICE QUESTIONS SOLUTIONS
DETAILED EXPLANATIONS VERIFIED
●● A patient who has had chest pain for several hours is admitted with a
diagnosis of rule out acute myocardial infarction test is most specific for
the nurse to
monitor in determining whether the patient has had an AMI?
Myoglobin
Homocysteine
C-reactive protein
Cardiac-specific troponin
Answer: D
Troponin levels increase about 4 to 6 hours after the onset of myocardial
infarction (MI) and are highly specific indicators for MI. Myoglobin is
released within 2 hours of MI, but it lacks specificity and its use is
limited. The other laboratory data are useful in determining the patient's
risk for developing coronary artery disease but are not helpful in
determining whether an acute MI is in progress.
●● A patient who has recently had an acute myocardial infarction (AMI)
ambulates in the hospital hallway. Which data would indicate to the
nurse that the patient should stop and rest?
O2 saturation drops from 99% to 95%.
,Heart rate increases from 66 to 98 beats/min.
Respiratory rate goes from 14 to 20 breaths/min.
Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.
Answer: b
A change in heart rate of more than 20 beats over the resting heart rate
indicates that the patient should stop and rest. The increases in BP and
respiratory rate, and the slight decrease in O2 saturation, are normal
responses to exercise.
●● A patient recovering from a myocardial infarction (MI) develops
chest pain on day 3 that increases when taking a deep breath and is
relieved by leaning forward. Which action should the nurse take as
focused follow-up on this symptom?
Assess both feet for pedal edema.
Palpate the radial pulses bilaterally.
Auscultate for a pericardial friction rub.
Check the heart monitor for dysrhythmias.
Answer: C
The patient's symptoms are consistent with the development of
pericarditis, a possible complication of MI. The other assessments listed
are not consistent with the description of the patient's symptoms.
●● The nurse is caring for a patient who was admitted to the coronary
care unit following an acute myocardial infarction (AMI) and
,percutaneous coronary intervention the previous day. What should
teaching for this patient include today?
Typical emotional responses to AMI
When cardiac rehabilitation will begin
Pathophysiology of coronary artery disease
Information regarding discharge medications
Answer: B
Early after an AMI, the patient will want to know when resumption of
usual activities can be expected. At this time, the patient's anxiety level
or denial will interfere with good understanding of complex information
such as the pathophysiology of coronary artery disease. Teaching about
discharge medications should be done closer to discharge. The nurse
should support the patient by decreasing anxiety rather than discussing
the typical emotional responses to myocardial infarction.
●● When admitting a patient with a non-ST-segment-elevation
myocardial infarction (NSTEMI) to the intensive care unit, which action
should the nurse perform first?
Attach the heart monitor.
Obtain the blood pressure.
Assess the peripheral pulses.
d. Auscultate the breath sounds.
Answer: A
Because dysrhythmias are the most common complication of myocardial
infarction (MI), the first action should be to place the patient on a heart
, monitor. The other actions are also important and should be
accomplished as quickly as possible.
●● Which information about a patient receiving thrombolytic therapy
for an acute myocardial infarction is most important for the nurse to
communicate to the health care provider?
An increase in troponin levels from baseline
A large bruise at the patient's IV insertion site
No change in the patient's reported level of chest pain
A decrease in ST-segment elevation on the electrocardiogram
Answer: C
Continued chest pain suggests that the thrombolytic therapy is not
effective and that other interventions such as percutaneous coronary
intervention may be needed. Bruising is a possible side effect of
thrombolytic therapy, but it is not an indication that therapy should be
discontinued. The decrease of the ST-segment elevation indicates that
thrombolysis is occurring, and perfusion is returning to the injured
myocardium. An increase in troponin levels is expected with reperfusion
and is related to the washout of cardiac biomarkers into the circulation
as the blocked vessel is opened.
●● The nurse obtains the following data when assessing a patient who
experienced an ST-segment-elevation myocardial infarction (STEMI) 2
days previously. Which information is most important to report to the
health care provider?
The troponin level is elevated.
PRACTICE QUESTIONS SOLUTIONS
DETAILED EXPLANATIONS VERIFIED
●● A patient who has had chest pain for several hours is admitted with a
diagnosis of rule out acute myocardial infarction test is most specific for
the nurse to
monitor in determining whether the patient has had an AMI?
Myoglobin
Homocysteine
C-reactive protein
Cardiac-specific troponin
Answer: D
Troponin levels increase about 4 to 6 hours after the onset of myocardial
infarction (MI) and are highly specific indicators for MI. Myoglobin is
released within 2 hours of MI, but it lacks specificity and its use is
limited. The other laboratory data are useful in determining the patient's
risk for developing coronary artery disease but are not helpful in
determining whether an acute MI is in progress.
●● A patient who has recently had an acute myocardial infarction (AMI)
ambulates in the hospital hallway. Which data would indicate to the
nurse that the patient should stop and rest?
O2 saturation drops from 99% to 95%.
,Heart rate increases from 66 to 98 beats/min.
Respiratory rate goes from 14 to 20 breaths/min.
Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.
Answer: b
A change in heart rate of more than 20 beats over the resting heart rate
indicates that the patient should stop and rest. The increases in BP and
respiratory rate, and the slight decrease in O2 saturation, are normal
responses to exercise.
●● A patient recovering from a myocardial infarction (MI) develops
chest pain on day 3 that increases when taking a deep breath and is
relieved by leaning forward. Which action should the nurse take as
focused follow-up on this symptom?
Assess both feet for pedal edema.
Palpate the radial pulses bilaterally.
Auscultate for a pericardial friction rub.
Check the heart monitor for dysrhythmias.
Answer: C
The patient's symptoms are consistent with the development of
pericarditis, a possible complication of MI. The other assessments listed
are not consistent with the description of the patient's symptoms.
●● The nurse is caring for a patient who was admitted to the coronary
care unit following an acute myocardial infarction (AMI) and
,percutaneous coronary intervention the previous day. What should
teaching for this patient include today?
Typical emotional responses to AMI
When cardiac rehabilitation will begin
Pathophysiology of coronary artery disease
Information regarding discharge medications
Answer: B
Early after an AMI, the patient will want to know when resumption of
usual activities can be expected. At this time, the patient's anxiety level
or denial will interfere with good understanding of complex information
such as the pathophysiology of coronary artery disease. Teaching about
discharge medications should be done closer to discharge. The nurse
should support the patient by decreasing anxiety rather than discussing
the typical emotional responses to myocardial infarction.
●● When admitting a patient with a non-ST-segment-elevation
myocardial infarction (NSTEMI) to the intensive care unit, which action
should the nurse perform first?
Attach the heart monitor.
Obtain the blood pressure.
Assess the peripheral pulses.
d. Auscultate the breath sounds.
Answer: A
Because dysrhythmias are the most common complication of myocardial
infarction (MI), the first action should be to place the patient on a heart
, monitor. The other actions are also important and should be
accomplished as quickly as possible.
●● Which information about a patient receiving thrombolytic therapy
for an acute myocardial infarction is most important for the nurse to
communicate to the health care provider?
An increase in troponin levels from baseline
A large bruise at the patient's IV insertion site
No change in the patient's reported level of chest pain
A decrease in ST-segment elevation on the electrocardiogram
Answer: C
Continued chest pain suggests that the thrombolytic therapy is not
effective and that other interventions such as percutaneous coronary
intervention may be needed. Bruising is a possible side effect of
thrombolytic therapy, but it is not an indication that therapy should be
discontinued. The decrease of the ST-segment elevation indicates that
thrombolysis is occurring, and perfusion is returning to the injured
myocardium. An increase in troponin levels is expected with reperfusion
and is related to the washout of cardiac biomarkers into the circulation
as the blocked vessel is opened.
●● The nurse obtains the following data when assessing a patient who
experienced an ST-segment-elevation myocardial infarction (STEMI) 2
days previously. Which information is most important to report to the
health care provider?
The troponin level is elevated.
