Lewis Med-Surg Ch. 33 CAD and Acute
Coronary Syndrome
A few days after experiencing a myocardial infarction (MI) and successful percutaneous
coronary intervention, the patient states, "It became just a little chest ache. As soon as I get out
of here, I'm going for my excursion as deliberate." Which respond could be maximum
appropriate for the nurse to make?
A. "What do you think precipitated your chest pain?"
b. "Where are you making plans to move for your vacation?"
c. "Sometimes plans want to change after a heart attack."
d. "Recovery from a heart attack takes at the least a few weeks." - ANS-ANS: A
When the affected person is experiencing denial, the nurse must assist the affected person in
testing truth till the patient has stepped forward past this step of the emotional adjustment to MI.
Asking the patient about holiday plans reinforces the patient's plan, which isn't always suitable in
the instant post-MI period. Reminding the affected person in denial approximately the MI is likely
to make the affected person angry and result in distrust of the nursing group of workers.
DIF: Cognitive Level: Apply (application)
A patient admitted to the coronary care unit (CCU) with an ST-phase-elevation myocardial
infarction (STEMI) is stressed and irritating. The blood strain is 86/40 mm Hg, and heart fee is
132 beats/min. Based in this information, which nursing analysis is a concern for the affected
person?
A. Acute pain associated with myocardial infarction
b. Anxiety associated with perceived threat of death
c. Stress overload associated with acute trade in fitness
d. Decreased cardiac output related to cardiogenic shock - ANS-ANS: D
All the nursing diagnoses may be appropriate for this affected person, but the hypotension and
tachycardia indicate reduced cardiac output and shock from the broken myocardium. This will
result in reduced perfusion to all critical organs (e.G., brain, kidney, heart) and is a priority.
DIF: Cognitive Level: Analyze (analysis)
A patient had a non-ST-section-elevation myocardial infarction (NSTEMI) 3 days ago. Which
nursing intervention protected inside the plan of care is suitable for the registered nurse (RN) to
delegate to an skilled certified practical/vocational nurse (LPN/LVN)?
A. Evaluation of the affected person's response to walking in the hallway
b. Completion of the referral form for a home fitness nurse observe-up
c. Education of the affected person about the pathophysiology of heart sickness
d. Reinforcement of teaching about the purpose of prescribed medicinal drugs - ANS-ANS: D
, LPN/LVN schooling and scope of exercise include reinforcing schooling that has previously
been carried out through the RN. Evaluating the affected person's response to exercising after a
NSTEMI calls for more schooling and ought to be completed by the RN. Teaching and discharge
planning and referral are abilities that require RN schooling and scope of exercise.
DIF: Cognitive Level: Apply (utility)
A patient recuperating from a myocardial infarction (MI) develops chest pain on day 3 that
increases whilst taking a deep breath and is relieved through leaning ahead. Which motion need
to the nurse take as targeted comply with-up in this symptom?
A. Assess the ft for pedal edema.
B. Palpate the radial pulses bilaterally.
C. Auscultate for a pericardial friction rub.
D. Check the coronary heart screen for dysrhythmias. - ANS-ANS: C
The patient's signs are constant with the improvement of pericarditis, a possible worry of MI.
The other checks listed aren't steady with the outline of the affected person's signs and
symptoms.
DIF: Cognitive Level: Apply (application)
A affected person who has chest ache is admitted to the emergency branch (ED), and all the
following are ordered. Which one ought to the nurse set up to be completed first?
A. Chest x-ray c. Electrocardiogram (ECG)
b. Troponin stage d. Insertion of a peripheral IV - ANS-ANS: C
The priority for the affected person is to decide whether or not an acute myocardial infarction
(AMI) is occurring so that the correct remedy can start as speedy as viable. ECG modifications
arise very swiftly after coronary artery occlusion, and an ECG must be received as quickly as
feasible. Troponin tiers will growth after about 3 hours. Data from the chest x-ray may effect the
affected person's care however are not helpful in determining whether the affected person is
experiencing a myocardial infarction. Peripheral access might be wanted however now not
before the ECG.
DIF: Cognitive Level: Analyze (evaluation)
A affected person who has had chest pain for several hours is admitted with a prognosis of rule
out acute myocardial infarction (AMI). Which laboratory test ought to the nurse monitor to
satisfactory determine whether or not the affected person has had an AMI?
A. Myoglobin c. C-reactive protein
b. Homocysteine d. Cardiac-precise troponin - ANS-ANS: D
Troponin ranges boom approximately four to six hours after the onset of myocardial infarction
(MI) and are fairly specific indicators for MI. Myoglobin is released inside 2 hours of MI, but it
lacks specificity and its use is restrained. The other laboratory facts are useful in figuring out the
patient's risk for developing coronary artery ailment however aren't beneficial in determining
whether or not an acute MI is in progress.
DIF: Cognitive Level: Understand (comprehension)
Coronary Syndrome
A few days after experiencing a myocardial infarction (MI) and successful percutaneous
coronary intervention, the patient states, "It became just a little chest ache. As soon as I get out
of here, I'm going for my excursion as deliberate." Which respond could be maximum
appropriate for the nurse to make?
A. "What do you think precipitated your chest pain?"
b. "Where are you making plans to move for your vacation?"
c. "Sometimes plans want to change after a heart attack."
d. "Recovery from a heart attack takes at the least a few weeks." - ANS-ANS: A
When the affected person is experiencing denial, the nurse must assist the affected person in
testing truth till the patient has stepped forward past this step of the emotional adjustment to MI.
Asking the patient about holiday plans reinforces the patient's plan, which isn't always suitable in
the instant post-MI period. Reminding the affected person in denial approximately the MI is likely
to make the affected person angry and result in distrust of the nursing group of workers.
DIF: Cognitive Level: Apply (application)
A patient admitted to the coronary care unit (CCU) with an ST-phase-elevation myocardial
infarction (STEMI) is stressed and irritating. The blood strain is 86/40 mm Hg, and heart fee is
132 beats/min. Based in this information, which nursing analysis is a concern for the affected
person?
A. Acute pain associated with myocardial infarction
b. Anxiety associated with perceived threat of death
c. Stress overload associated with acute trade in fitness
d. Decreased cardiac output related to cardiogenic shock - ANS-ANS: D
All the nursing diagnoses may be appropriate for this affected person, but the hypotension and
tachycardia indicate reduced cardiac output and shock from the broken myocardium. This will
result in reduced perfusion to all critical organs (e.G., brain, kidney, heart) and is a priority.
DIF: Cognitive Level: Analyze (analysis)
A patient had a non-ST-section-elevation myocardial infarction (NSTEMI) 3 days ago. Which
nursing intervention protected inside the plan of care is suitable for the registered nurse (RN) to
delegate to an skilled certified practical/vocational nurse (LPN/LVN)?
A. Evaluation of the affected person's response to walking in the hallway
b. Completion of the referral form for a home fitness nurse observe-up
c. Education of the affected person about the pathophysiology of heart sickness
d. Reinforcement of teaching about the purpose of prescribed medicinal drugs - ANS-ANS: D
, LPN/LVN schooling and scope of exercise include reinforcing schooling that has previously
been carried out through the RN. Evaluating the affected person's response to exercising after a
NSTEMI calls for more schooling and ought to be completed by the RN. Teaching and discharge
planning and referral are abilities that require RN schooling and scope of exercise.
DIF: Cognitive Level: Apply (utility)
A patient recuperating from a myocardial infarction (MI) develops chest pain on day 3 that
increases whilst taking a deep breath and is relieved through leaning ahead. Which motion need
to the nurse take as targeted comply with-up in this symptom?
A. Assess the ft for pedal edema.
B. Palpate the radial pulses bilaterally.
C. Auscultate for a pericardial friction rub.
D. Check the coronary heart screen for dysrhythmias. - ANS-ANS: C
The patient's signs are constant with the improvement of pericarditis, a possible worry of MI.
The other checks listed aren't steady with the outline of the affected person's signs and
symptoms.
DIF: Cognitive Level: Apply (application)
A affected person who has chest ache is admitted to the emergency branch (ED), and all the
following are ordered. Which one ought to the nurse set up to be completed first?
A. Chest x-ray c. Electrocardiogram (ECG)
b. Troponin stage d. Insertion of a peripheral IV - ANS-ANS: C
The priority for the affected person is to decide whether or not an acute myocardial infarction
(AMI) is occurring so that the correct remedy can start as speedy as viable. ECG modifications
arise very swiftly after coronary artery occlusion, and an ECG must be received as quickly as
feasible. Troponin tiers will growth after about 3 hours. Data from the chest x-ray may effect the
affected person's care however are not helpful in determining whether the affected person is
experiencing a myocardial infarction. Peripheral access might be wanted however now not
before the ECG.
DIF: Cognitive Level: Analyze (evaluation)
A affected person who has had chest pain for several hours is admitted with a prognosis of rule
out acute myocardial infarction (AMI). Which laboratory test ought to the nurse monitor to
satisfactory determine whether or not the affected person has had an AMI?
A. Myoglobin c. C-reactive protein
b. Homocysteine d. Cardiac-precise troponin - ANS-ANS: D
Troponin ranges boom approximately four to six hours after the onset of myocardial infarction
(MI) and are fairly specific indicators for MI. Myoglobin is released inside 2 hours of MI, but it
lacks specificity and its use is restrained. The other laboratory facts are useful in figuring out the
patient's risk for developing coronary artery ailment however aren't beneficial in determining
whether or not an acute MI is in progress.
DIF: Cognitive Level: Understand (comprehension)
