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The nurse is admitting a patient who has chest pain. Which
assessment data suggest that the pain is caused by an acute
myocardial infarction (AMI)?
A. The pain increases with deep breathing.
B. The pain has lasted longer than 30 minutes.
C. The pain is relieved after the patient takes nitroglycerin.
D. The pain is reproducible when the patient raises the arms. -
ANSWER -B. The pain has lasted longer than 30 minutes.
Which information about a patient who has been receiving
thrombolytic therapy for an acute myocardial infarction is most
important for the nurse to communicate to the health care provider?
A. An increase in troponin levels from baseline
B. A large bruise at the patient's IV insertion site
C. No change in the patient's reported level of chest pain
D. A decrease in ST-segment elevation on the electrocardiogram -
ANSWER -C. No change in the patient's reported level of chest pain
,Heparin is ordered for a patient with a non-ST-segment-elevation
myocardial infarction (NSTEMI). What is the purpose of the heparin?
A. Heparin enhances platelet aggregation at the plaque site.
B. Heparin decreases the size of the coronary artery plaque.
C. Heparin prevents the development of new clots in the coronary
arteries.
D. Heparin dissolves clots that are blocking blood flow in the
coronary arteries. - ANSWER -C. Heparin prevents the development
of new clots in the coronary arteries.
When evaluating the effectiveness of preoperative teaching with a
patient scheduled for coronary artery bypass graft (CABG) surgery
using the internal mammary artery, the nurse determines that
additional teaching is needed when the patient says which of the
following?
A. "They will circulate my blood with a machine during surgery."
B. "I will have incisions in my leg where they will remove the vein." C.
"They will use an artery near my heart to go around the area that is
blocked."
D. "I will need to take an aspirin every day after the surgery to keep
the graft open." - ANSWER -B. "I will have incisions in my leg where
they will remove the vein."
Which assessment finding in a patient admitted with acute
decompensated heart failure (ADHF) requires the most immediate
action by the nurse?
A. O2 saturation of 88%
, B. Heart rate of 106 beats/min
C. Weight gain of 1 kg (2.2 lb)
D. Urine output of 50 mL over 2 hours - ANSWER -A. O2 saturation of
88%
The nurse obtains a health history from an older patient with a
prosthetic mitral valve who has symptoms of infective endocarditis
(IE). Which question by the nurse is most focused on identifying a
risk factor for IE?
A. "Do you have a history of a heart attack?"
B. "Is there a family history of endocarditis?"
C. "Have you had any recent immunizations?"
D. "Have you had dental work done recently?" - ANSWER -D. "Have
you had dental work done recently?"
A patient is admitted to the hospital with possible acute pericarditis.
The nurse should plan to teach the patient about the purpose of:
A. blood cultures.
B. cardiac catheterization.
C. echocardiography.
D. 24-hour Holter monitor. - ANSWER -C. echocardiography.