Chapter 35: Critical Care of Patients with
Acute Coronary Syndromes
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with coronary artery disease (CAD) asks the nurse about taking fish oil
supplements. What response by the nurse is best?
a. “Fish oil is contraindicated with most drugs for CAD.”
b. “The best source is fish, but pills have benefits too.”
c. “There is no evidence to support fish oil use with CAD.”
d. “You can reverse CAD totally with diet and supplements.”
ANS: B
Omega-3 fatty acids have shown benefit in reducing lipid levels, in reducing the
incidence of sudden cardiac death, and for stabilizing atherosclerotic plaque. The
preferred source of omega-3 acids is from fish rich in long-chain n-3 polyunsaturated
fatty acids two times a week or a daily fish oil nutritional supplement (1 to 2 g/day).
The other options are not accurate.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Coronary artery disease, Health teaching MSC: Client
Needs Category: Health Promotion and Maintenance
2. A client has presented to the emergency department with an acute myocardial
infarction (MI). What action by the nurse is best for optimal client outcomes?
a. Obtain an electrocardiogram (ECG) within 20 minutes.
b. Give the client a nonenteric coated aspirin.
, c. Notify the Rapid Response Team immediately.
d. Prepare to administer thrombolytics within 30 minutes.
ANS: B
Best practice recommendations for acute MI require that aspirin is administered when
a client with MI presents to the emergency department or when an MI occurs in the
hospital. A rapid ECG (within 10 minutes) is vital for best outcomes. The Rapid
Response Team is not needed if an emergency department provider is available.
Thrombolytics may or may not be needed depending on the type of myocardial
infarction the client has.
DIF: Remembering TOP: Integrated Process: Nursing Process:
Implementation KEY: Coronary artery disease, Best practice
MSC: Client Needs Category: Safe and Effective Care Environment:
Management of Care
3. A nurse is caring for four client s. Which client would the nurse assess first?
a. Client with an acute myocardial infarction, pulse 102 beats/min
b. Client who is 1 hour post-angioplasty, and has tongue swelling and anxiety
c. Client who is post coronary artery bypass, with chest tube drained 100 mL/hr
d. Client who is post coronary artery bypass, with potassium 4.2 mEq/L (4.2
mmol/L)
ANS: B
The post-angioplasty client with tongue swelling and anxiety is exhibiting signs and
symptoms of an allergic reaction (perhaps to the contrast medium) that could progress
to anaphylaxis. The nurse would assess this client first. The client with a heart rate of
102 beats/min may have increased oxygen demands but is just over the normal limit
for heart rate. The two post coronary artery bypass clients are stable.
, DIF: Analyzing TOP: Integrated Process: Nursing Process: Analysis
KEY: Coronary artery disease, Critical rescue MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
4. A nurse is caring for a client who is intubated and has an intra-aortic balloon pump.
The client is restless and agitated. What action would the nurse perform first for
comfort?
a. Allow family members to remain at the bedside.
b. Ask the family if the client would like a fan in the room.
c. Keep the television tuned to the client’s favorite channel.
d. Speak loudly to the client in case of hearing problems.
ANS: A
Allowing the family to remain at the bedside can help calm the client with familiar
voices (and faces if the client wakes up). A fan might be helpful but may also spread
germs through air movement or may agitate the client further. The TV would not be
kept on all the time to allow for rest. Speaking loudly may agitate the client more.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Intra-aortic balloon pump, Nonpharmacologic
comfort measures MSC: Client Needs Category: Physiological Integrity:
Basic Care and Comfort
5. The nurse is caring for a client with a chest tube after a coronary artery bypass graft.
The drainage stops suddenly. What action by the nurse is most important?
a. Increase the setting on the suction.
b. Notify the primary health care provider immediately.
c. Reposition the chest tube.
d. Take the tubing apart to assess for clots.
ANS: B
Acute Coronary Syndromes
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client with coronary artery disease (CAD) asks the nurse about taking fish oil
supplements. What response by the nurse is best?
a. “Fish oil is contraindicated with most drugs for CAD.”
b. “The best source is fish, but pills have benefits too.”
c. “There is no evidence to support fish oil use with CAD.”
d. “You can reverse CAD totally with diet and supplements.”
ANS: B
Omega-3 fatty acids have shown benefit in reducing lipid levels, in reducing the
incidence of sudden cardiac death, and for stabilizing atherosclerotic plaque. The
preferred source of omega-3 acids is from fish rich in long-chain n-3 polyunsaturated
fatty acids two times a week or a daily fish oil nutritional supplement (1 to 2 g/day).
The other options are not accurate.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Coronary artery disease, Health teaching MSC: Client
Needs Category: Health Promotion and Maintenance
2. A client has presented to the emergency department with an acute myocardial
infarction (MI). What action by the nurse is best for optimal client outcomes?
a. Obtain an electrocardiogram (ECG) within 20 minutes.
b. Give the client a nonenteric coated aspirin.
, c. Notify the Rapid Response Team immediately.
d. Prepare to administer thrombolytics within 30 minutes.
ANS: B
Best practice recommendations for acute MI require that aspirin is administered when
a client with MI presents to the emergency department or when an MI occurs in the
hospital. A rapid ECG (within 10 minutes) is vital for best outcomes. The Rapid
Response Team is not needed if an emergency department provider is available.
Thrombolytics may or may not be needed depending on the type of myocardial
infarction the client has.
DIF: Remembering TOP: Integrated Process: Nursing Process:
Implementation KEY: Coronary artery disease, Best practice
MSC: Client Needs Category: Safe and Effective Care Environment:
Management of Care
3. A nurse is caring for four client s. Which client would the nurse assess first?
a. Client with an acute myocardial infarction, pulse 102 beats/min
b. Client who is 1 hour post-angioplasty, and has tongue swelling and anxiety
c. Client who is post coronary artery bypass, with chest tube drained 100 mL/hr
d. Client who is post coronary artery bypass, with potassium 4.2 mEq/L (4.2
mmol/L)
ANS: B
The post-angioplasty client with tongue swelling and anxiety is exhibiting signs and
symptoms of an allergic reaction (perhaps to the contrast medium) that could progress
to anaphylaxis. The nurse would assess this client first. The client with a heart rate of
102 beats/min may have increased oxygen demands but is just over the normal limit
for heart rate. The two post coronary artery bypass clients are stable.
, DIF: Analyzing TOP: Integrated Process: Nursing Process: Analysis
KEY: Coronary artery disease, Critical rescue MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
4. A nurse is caring for a client who is intubated and has an intra-aortic balloon pump.
The client is restless and agitated. What action would the nurse perform first for
comfort?
a. Allow family members to remain at the bedside.
b. Ask the family if the client would like a fan in the room.
c. Keep the television tuned to the client’s favorite channel.
d. Speak loudly to the client in case of hearing problems.
ANS: A
Allowing the family to remain at the bedside can help calm the client with familiar
voices (and faces if the client wakes up). A fan might be helpful but may also spread
germs through air movement or may agitate the client further. The TV would not be
kept on all the time to allow for rest. Speaking loudly may agitate the client more.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Intra-aortic balloon pump, Nonpharmacologic
comfort measures MSC: Client Needs Category: Physiological Integrity:
Basic Care and Comfort
5. The nurse is caring for a client with a chest tube after a coronary artery bypass graft.
The drainage stops suddenly. What action by the nurse is most important?
a. Increase the setting on the suction.
b. Notify the primary health care provider immediately.
c. Reposition the chest tube.
d. Take the tubing apart to assess for clots.
ANS: B
