acute coronary syndrome NCLEX

acute coronary syndrome NCLEX 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." 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." 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 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. The nurse is providing a cardiac class for a women's group. The nurse emphasizes that which characteristics place women at high risk for myocardial infarction (MI)? Select all that apply. Premenopausal Increasing age Family history Abdominal obesity Breast cancer Increasing age, especially after 70 yo Family history is a risk factor in both men and women Abdominal obesity: A large waist size/abdominal obesity is a risk factor for both metabolic syndrome and MI. The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize? 1.Reduce abdominal fat. 2. Avoid stress. 3. Do not smoke or chew tobacco. 4. Avoid alcoholic beverages. 3. Tobacco exposure, including secondhand smoke, reduces coronary blood flow, causes vasoconstriction and endothelial dysfunction and thickening of the vessel wall, increases carbon monoxide, and decreases oxygen. Because this is highly addicting, beginning smoking in the teen years may lead to decades of exposure. The nurse is teaching the client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion? Select all that apply. Truncal obesity Hypercholesterolemia Elevated homocysteine levels Glucose intolerance Client taking losartan (Cozaar) Hypercholesterolemia: Decreased high-density lipoprotein cholesterol (HDL-C) (usually with high low-density lipoprotein cholesterol [LDL-C]), HDL-C less than 40 mg/dL for men or less than 50 mg/dL for women, or taking an anticholesterol drug is a sign of metabolic syndrome. Glucose intolerance: Increased fasting blood glucose (caused by diabetes, glucose intolerance, or insulin resistance) is included in the constellation of metabolic syndrome. Client taking losartan (Cozaar): Blood pressure greater than 130/85 or taking antihypertensive medication indicates metabolic syndrome. Which of the following atypical symptoms may be present in the female client experiencing myocardial infarction (MI)? Select all that apply. Sharp, inspiratory chest pain Dyspnea Dizziness Extreme fatigue Anorexia Dyspnea, Dizziness, Extreme fatigue 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 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. 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. 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) 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 2. During and after thrombolytic administration, the nurse observes for any indications of bleeding, including changes in neurologic status, which may indicate intracranial bleeding. 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 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 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 4. Client who refuses to take heparin or nitroglycerin 2. Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system is involved. Third-degree heart block usually requires pacemaker insertion. The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure? 1. Urine output of 1500 mL on the preceding day 2. Crackles in the lung fields 3. Pedal edema 4. Expectoration of yellow sputum 2. Manifestations of left ventricular failure and pulmonary edema are noted by listening for crackles and identifying their locations in the lung fields. Edema is a sign of right ventricular heart failure. The nurse is concerned that the client who had myocardial infarction (MI) has developed cardiogenic shock. Which of these findings indicates shock? Select all that apply. Bradycardia Cool, diaphoretic skin Crackles in the lung fields Respiratory rate of 12 Anxiety and restlessness Temperature of 100.4 Cool, diaphoretic skin: The client with shock has cool, moist skin. Crackles in the lung fields: Owing to extensive tissue necrosis (MI), the left ventricle cannot forward blood adequately, resulting in pulmonary congestion and crackles. Anxiety and restlessness: Owing to poor tissue perfusion, a change in mental status, anxiety, and restlessness are expected. All types of shock (except neurogenic) present with tachycardia. Owing to pulmonary congestion, the client with cardiogenic shock typically has tachypnea.Cardiogenic shock does not present with low-grade fever; this would be more likely to occur in pericarditis. The client undergoing coronary artery bypass grafting (CABG) asks why the doctor has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct? 1. "This way you will not need to have a leg incision." 2. "The surgeon prefers this approach because it is easier." 3. "These arteries remain open longer." 4. "The surgeon has chosen this approach because of your age." 3. Mammary arteries have remained patent much longer than other grafts. The client has just returned from coronary artery bypass graft (CABG) surgery. For which finding should the nurse contact the surgeon? 1. Temperature 98.2° F 2. Chest tube drainage 175 mL last hour 3. Serum potassium 3.9 mEq/L 4. Incisional pain 6 on a scale of 1 to 10 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. 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?" 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. 3. Assess pulmonary artery wedge pressure (PAWP). 4. Give ordered loop diuretics. 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 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