Acute Coronary Syndrome (Carl Shapiro)test questions and answers

When a patient is experiencing angina, the nurse administers nitroglycerin sublingually at what frequency? A. every 15 minutes, 3 doses max B. Every 3 min, no restriction on # of doses C. Every 5 min, 3 dose max D. Once only, then administer morphine C. every 5 min, 3 dose max when a patient is experiencing acute angina, it is recommended that the patient allow one sublingual tablet to dissolve under the tongue (or spray nitroglycerin under the tongue) and repeat every 5 minutes for a max of 3 doses. When administering medication to the patient with suspected myocardial infarction, the nurse understands that morphine has which of the following beneficial effects? (SATA) A. decreases preload B. decreases respiratory rate C. decreases pain D. decreases after-load E. decreases anxiety A, C, D, E morphine is the drug of choice to reduce pain, thereby reducing anxiety. It also reduces preload and afterload, decreasing the work of the heart. ****The patient must be monitored closely for the side effects of hypotension and respiratory depression. Which of the following are cardiac markers assessed in the patient experiencing angina to determine potential myocardial injury? (SATA) A. CK-MB B. Hemoglobin C. CK-MM D. Creatinine E. Troponin A, E Cardiac enzymes and biomarkers, which include troponn, creatine kinase (CK) and myoglobin are used to diagnose an acute MI. Of the 3 CK isoenzymes, CK myocardial bound (MB) is specific to the heart muscle. The nurse recognizes that ST elevation on the 12 lead ECG typically indicates which of the following? A. myocardial injury B. myocardial ischemia C. this is a normal finding D. hyperkalemia A. myocardial injury myocardial injury causes ST-segment and T-wave changes on an ECG The nurse knows that which factors may increase the patient's risk of developing coronary artery disease? (SATA) A. cigarette smoking B. metabolic syndrome C. activity limited to walking D. female less than age 55 E. family history A, B, E Non-modifiable risk factors for CAD include family history and increasing age (more than 55 yrs. for women). Cigarette smoking and metabolic syndrome are modifiable risk factors for CAD. A diagnosis of metabolic syndrome includes 3 of the following conditions: *Insulin resistance *Central obesity *Dyslipidemia *BP consistently >130/85 *High levels of C-reactive protein *High fibrinogen levels Which of the following does the nurse recognize as typical signs and symptoms exhibited by a patient experiencing angina? (SATA) A. diaphoresis B. tenderness over apical area C. Shortness of breath D. Pain on inspiration E. Substernal chest pain A, C, E: diaphoresis, SOB, chest pain Typical s&s of angina can include chest pain or heaviness that may radiate, SOB, dusky or pallor skin, diaphoresis, weakness, N&V, and denial by the patient. The nurse understands that aspirin is administered to a patient with a suspected myocardial infarction (MI) for which of the following reasons A. to promote thrombolysis B. to improve oxygenation to the myocardium C. to prevent ventricular dysrhythmias D. to prevent platelet aggregation D. to prevent platelet aggregation the patient with a suspected MI should receive aspirin immediately, unless allergic to it, to help platelet aggregation Based on this ECG waveform, the nurse recognizes that the patient is experiencing which dysrhythmia? A. Atrial fibrillation B. ventricular fibrillation C. ventricular tachycardia D. ventricular flutter B. ventricular fibrillation ventricular fibrillation is characterized by a ventricular rate greater than 300 bpm, an extremely irregular rhythm without a specific pattern, and irregular, undulating waves without recognizable QRS complexes The nurse recalls that, according the AHA guidelines for adult CPR, the correct compression: ventilation ratio and rate per minute is which of the following? A. 15:2, 60 to 100/min B. 30:1, 60 to 80/min C. 30:2, at least 100/min D. 15:1, at least 100/min 30:2, at least 100/min the correct compression : ventilation ratio and rate per minute is 30 compressions to 2 breaths with at least 1-00/min Is the following statement true or false? According to the AHA guidelines, epinephrine 1 mg is administered for ventricular fibrillation after the second defibrillation TRUE Per the guidelines, epinephrine can be administered every 3-5 minutes. The first dose of epinephrine is administered after the second defibrillation. When the patient is to receive defibrillation, the nurse ensures that which of the following safety measures are implemented? (SATA) A. Chest compressions are not interrupted B. Ventilations are not interrupted C. Removing the oxygen from the bed during defibrillation D. Not touching the bed or allowing any objects to touch the bed E. Clearing the bed at least twice prior to defibrillating *Not touching the bed or allowing any objects to touch the bed *Removing the oxygen from the bed during defibrillation *Clearing the bed at least twice prior to defibrillating It is important during defibrillation that the bed be cleared at least twice prior to discharging the paddles to prevent injury to any staff: that O2 be removed from the bed to prevent the danger of starting a fire: and that no person or object s touching the bed, in order to prevent any conduction of electrical current that might injure the patient or staff member. **Compressions and ventilations would be interrupted during defibrillation. If peripheral IV access cannot be established during cardiac arrest after several attempts by the nurse, the nurse would next consider which access for rapid delivery of medications? A. keep trying to place IV B. Central Line C. Endotracheal tube D. Intraosseous (IO) access Intraosseous Access (IO) ideally 2 large-bore peripheral IV lines are established during a code for fluid and medication administration. Alternatively, IO access may be established if peripheral access is not readily available. These can be inserted without interrupting CPR. If IV or IO access cannot be established, medications such as epinephrine and vasopressin can be administered through an ET tube during cardiac arrest. A central line takes more time to place. When viewing the past medical history, the nurse identifies which cardiac risk factors specific to Carl Shapiro? A. diabetes B. obesity C. hypertension D. cigarette smoking E. metabolic syndrome Hypertension, cigarette smoking, obesity non-modifiable risk factors can include family history, gender, race and age. Modifiable cardiac risk factors can include hyperlipidemia, tobacco use, HTN, DM, Metabolic syndrome, obesity & physical inactivity Carl Shapiro, white male, presented with HTN, obesity and had a history of Cigarette smoking and physical inactivity During CPR, hw often should the nurse assess the carotid pulse for return of spontaneous circulation (ROSC)? A. 3 minutes B. 2 minutes C. 1 minute D. 4 minutes 2 minutes the carotid pulse should be assessed every 2 minutes for return of spontaneous circulation Is the following statement true or false? If Carl Shapiro had proceeded into asystole after the ventricular fibrillation, continuing to defibrillate would have been the appropriate intervention. FALSE AHA guidelines do not support defibrillation for asystole What is the next drug after epinephrine that the nurse should expect to administer to the patient in ventricular fibrillation? A. atropine B. Epinephrine C. Amiodarone D. Nitroglycerin Amiodarone per the AHA guidelines, the medication to give to the patient after continuing CPR and administering the epinephrine is amiodarone 300 mg with a second dose of amiodarone 150 mg, if needed During ventricular fibrillation, pitressin (Vasopressin) may be used in place of epinephrine for the first or second dose. If administering Vasopressin what dosage would the nurse expect to administer? A. 1 mg IV only B. 80 units IV/IO C. 40 units IV/IO D. 150 mg IV/IO 40 units IV/IO Pitessin (Vasopressin)40 units IV/IO can be used to replace either the first or second dose of epinephrine When the nurse discovers a patient is not visibly breathing, the nurse knows that which of the following is the immediate priority? A. defibrillation B. inserting an airway C. starting compressions D. assessing the carotid pulse Assessing the carotid pulse assessing the carotid pulse is the immediate priority. If there is no pulse, then the nurse needs to start compressions immediately while initiating a code. A nurse is caring for a client who has heart failure and reports increased shortness of breath. Which of the following actions should the nurse take first? A. obtain the client's weight B. assist the client into a high-Fowlers position C. auscultate lung sounds D. check oxygen saturation with pulse oximeter B. assist the client into a High Fowlers position using the ABC priority approach, the first action to take id o assist the client into a high fowlers position. *******This will decrease venous return to the heart (preload) and help relieve lung congestion****** A nurse is teaching a client with heart failure and new prescriptions for furosemide and digoxin. Which of the following information should the nurse include? (SATA) A. weight daily, first thing each morning B. decrease intake of potassium C. expect muscle weakness while taking digoxin D. hold digoxin if heart rate is less than 70/min E. decrease sodium intake A, E ** weighing daily when first getting out of bed will assist the client in tracking fluid loss and gain **decrease sodium intake to prevent fluid retention, which could worsen heart failure congestion