01 The Client with Myocardial Infarction

[John]

The Client with Myocardial Infarction

1. A 50-year-old male client comes into the emergency department with complaints of crushing substernal chest pain that radiates to his shoulder and left arm.

The admitting diagnosis is acute myocardial infarction (MI).

Immediate admission orders include oxygen by nasal cannula at 4 L/minute, blood work, a chest radiograph, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfate given intravenously.

The nurse should first

1. administer the morphine.

the nurse's priority action should be to relieve the crushing chest pain.

Therefore, administering morphine sulfate is the priority action. 

2. obtain a 12-lead ECG.

3. obtain the blood work.

4. order the chest radiograph.

2. When administering a thrombolytic drug to the client experiencing an MI,

the nurse explains to him that the purpose of the drug is to

1. help keep him well hydrated.

2. dissolve clots that he may have.

administered within the first 6 hours after onset of a myocardial infarction

to lyse clots and reduce the extent of myocardial damage.

3. prevent kidney failure.

4. treat potential cardiac dysrhythmias.



3. The nurse is assessing a client who has had an MI.

The nurse notes the cardiac rhythm shown on the ECG strip below.

The nurse identifies this rhythm as which of the following?

1. Atrial fibrillation.

2. Ventricular tachycardia.

3. Premature ventricular contractions (PVCs).

QRS of longer than 0.10 seconds by a wide, notched or slurred QRS complex.

no P wave related to the QRS complex,

T wave is usually inverted. 

4. Third-degree heart block.

4. The nurse is assessing a client who has had an MI.

The nurse notes the cardiac rhythm shown on the ECG strip below.

The nurse identifies this rhythm as which of the following?

1. Atrial fibrillation.

2. Ventricular tachycardia.

3. PVCs.

4. Sinus tachycardia.

normal conduction

a regular rhythm, but with a rate exceeding 100 bpm.

A P wave precedes each QRS,

the QRS is usually normal.

5. The nurse is assessing a client who has had an MJ.

The nurse notes the cardiac rhythm shown on the EEG strip below.

The nurse identifies this rhythm as which of the following?

1. Atrial fibrillation.

an atrial rate of 350 bpm or greater and a ventricular rate of 120 bpm or greater.

no P waves, but there are F (fibrillatory) waves that can be identified.

The QRS is usually normal.

2. Ventricular tachycardia.

3. PVCs.

4. Third-degree heart block.

6. When interpreting the ECG,

the nurse would keep in mind which of the following about the P wave?

Select all that apply.

1. Reflects electrical impulse beginning at the SA node.

the activation of the electrical impulse in the SA node,

which is then transmitted to the AV node.

2. Indicates electrical impulse beginning at the AV node.

3. Reflects atrial muscle depolarization.

represents atrial muscle depolarization, not ventricular depolarization.

4. Identifies ventricular muscle depolarization.

5. Has a duration normally of 0.11 second or less.

The normal duration of the P wave

is 0.11 seconds or less in duration and 2.5 mm or more in height.

1. Sinoatrial node (SA node)
2. Atrioventricular node (AV node)
3. Common AV Bundle
4. Right & Left Bundle Branches

 

7. If the client who was admitted for MI develops cardiaogenic shock,

which characteristic sign should the nurse expect to observe?

1. Oliguria.                                 

decreased urine output

Cardiogenic shock is a serious complication of MI,

with a mortality rate approaching 90%.

Typical signs of cardiogenic shock include low blood pressure, rapid and weak pulse, decreased urine output, and signs of diminished blood flow to the brain, such as confusion and restlessness.

Oliguria occurs during cardiogenic shock

because there is reduced blood flow to the kidneys.

2. Bradycardia.                                        

rapid and weak pulse

3. Elevated blood pressure.        

4. Fever.                                     

not a typical sign of cardiogenic shock.

8. The physician orders continuous intravenous nitroglycerin infusion for the client with MI. Essential nursing actions include which of the following?

1. Obtaining an infusion pump for the medication.

Intravenous nitroglycerin infusion

requires an infusion pump for precise control of the medication.

2. Monitoring blood pressure every 4 hours.

would be done with a continuous system,

and more frequently than every 4 hours.

3. Monitoring urine output hourly.

Hourly urine outputs are not always required.

4. Obtaining serum potassium levels daily.

is not associated with nitroglycerin infusion.

9. When teaching the client with MI,

the nurse explains that the pain associated with MI is caused by

1. left ventricular overload.

2. impending circulatory collapse.

3. extracellular electrolyte imbalances.

4. insufficient oxygen reaching the heart muscle.

An MI interferes with or blocks blood circulation to the heart muscle.

Decreased blood supply to the heart muscle

causes ischemia, or poor myocardial oxygenation.

Diminished oxygenation or lack of oxygen to the cardiac muscle

results in ischemic pain or angina.

10. Aspirin is administered to the client experiencing an MI because of its

1. antipyretic action.

2. antithrombotic action.

the primary reason aspirin is administered to the client experiencing an MI

is its antithrombotic action.

In clinical trials, the antithrombotic action of aspirin

has been thought to account for improved outcomes in clients with MI.

3. antiplatelet action.

4. analgesic action.

11. While caring for a client who has sustained an MI,

the nurse notes eight PVCs in 1 minute on the cardiac monitor.

The client is receiving

an intravenous infusion of 5% dextrose in water (Ds W) and oxygen at 2 L/ minute.

The nurse's first course of action should be to

1. increase the intravenous infusion rate.

would not decrease the number of PVCs

2. notify the physician promptly.

An occasional PVC is not considered dangerous, but

if PVCs occur at a rate greater than five or six per minute in the post-Ml client,

the physician should be notified immediately.

More than six PVCs per minute is considered serious and usually calls for decreasing ventricular irritability by administering medications such as lidocaine hydrochloride.

3. increase the oxygen concentration.

should not be the nurse's first course of action;

rather, the nurse should notify the physician promptly.

4. administer a prescribed analgesic.

would not decrease ventricular irritability.

PVCs are often a precursor of life-threatening

dysrhythmias, including ventricular tachycardia and ventricular fibrillation.

12. Which of the following is an expected outcome for a client on the second day of hospitalization after an ME The client

1. has severe chest pain.

2. can identify risk factors for Ml.

3. agrees to participate in a cardiac rehabilitation walking program.

4. can perform personal self-care activities without pain.

clients are expected to be able to perform personal care without chest pain.

Day 2 of hospitalization may be too soon for clients to be able to identify risk factors for MI or to begin a walking program; however, the client may be sitting up in a chair as part of the cardiac rehabilitation program.

Severe chest pain should not be present.

13. When teaching a client about the expected outcomes after intravenous administration of furosemide, the nurse would include which outcome?

1. Increased blood pressure.

2. Increased urine output.

a loop diuretic that acts to increase urine output.

does not increase blood pressure, decrease pain, or decrease dysrhythmias.

3. Decreased pain.

4. Decreased PVCs.

14. After an MI, the hospitalized client is taught to move the legs while resting in bed. This type of exercise is recommended primarily to help

1. prepare the client for ambulation.

2. promote urinary and intestinal elimination.

3. prevent thrombophlebitis and blood clot formation.

to promote venous return.

to aid in venous return and

to prevent venous stasis in the lower extremities.

4. decrease the likelihood of pressure ulcer formation.

15. Which of the following reflects the principle on which a client's diet will most likely be based during the acute phase of MI

1. Liquids as desired.

2. Small, easily digested meals.

avoiding large meals because small, easily digested foods are better tolerated.

3. Three regular meals per day.

4. Nothing by mouth.

16. Which of the following controllable risk factors for coronary artery disease (CAD) appears most closely linked to the development of the disease?

1. Age.

4. Gender.

Age and gender are uncontrollable risk factors for CAD.

2. Medication usage.

Medication usage is not considered a risk factor for CAD.

3. High cholesterol levels.

            are considered a controllable risk factor for CAD

appear most closely linked to the development of the disease.

can be modified through diet, exercise, and medication.

17. Which of the following is an uncontrollable risk factor that has been linked to the development of CAD?

1. Exercise.

2. Obesity.

3. Stress.

Exercise, obesity, and stress are controllable risk factors for CAD. 

4. Heredity.

Heredity has been linked to CAD and is an uncontrollable risk factor.

18. If a client displays risk factors for CAD such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior.

The nurse can best reinforce new adaptive behaviors by

1. explaining how the old behavior leads to poor health.

2. withholding praise until the new behavior is well established.

3. rewarding the client whenever the acceptable behavior is performed.

behavior that is learned and continued is behavior that has been rewarded.

Other reinforcement techniques have not been found to be as effective as reward.

4. instilling mild fear into the client to extinguish the behavior.

19. Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of MI to

1. control chest pain.

2. reduce coronary artery vasospasm.

3. control the dysrhythmias associated with MI.

4. revascularize the blocked coronary artery.

The thrombolytic agent t-PA, administered intravenously,

lyses the clot blocking the coronary artery.

The drug is most effective when administered within the first 6 hours.

20. After the administration oft-PA,

the nurse understands that a nursing assessment priority is to

1. observe the client for chest pain.

because closure of the previously obstructed coronary artery may recur.

Clients who receive t - PA frequently receive heparin

to prevent closure of the artery after tPA.

Careful assessment for signs of bleeding and monitoring of partial thromboplastin time are essential to detect complications.

2. monitor for fever.

3. monitor the 12-lead ECG every 4 hours.

4. monitor breath sounds.



21. When monitoring a client who is receiving t-PA, the nurse understands

it is important to monitor vital signs and have resuscitation equipment available because reperfusion of the cardiac tissue can result in which of the following?

1. Cardiac dysrhythmias.

commonly observed with administration oft-PA.

are associated with reperfusion of the cardiac tissue.

2. Hypertension.           

Hypotension

3. Seizure.

4. Hypothermia.



22. Contraindications to the administration oft-PA include which of the following?

1. Age greater than 50 years.

2. History of cerebral hemorrhage.

because the risk of hemorrhage may be further increased.

3. History of heart failure.

4. Cigarette smoking.



23. A client has driven himself to the emergency room.

He is 50 years old, has a history of hypertension,

and informs the nurse that his father died from a heart attack at 60 years of age.

The client is presently complaining of indigestion.

The nurse connects him to an ECG monitor

and begins administering oxygen at 2 L/minute per nasal cannula.

The nurse's next action would be to

1. call for the doctor.

2. start an intravenous line.

at least one or two intravenous lines be inserted in one or both

of the antecubital spaces.

3. obtain a portable chest radiograph.

4. draw blood for laboratory studies.

24. Crackles heard on lung auscultation indicate which of the following?

1. Cyanosis.

2. Bronchospasm.          wheezing sounds.

3. Airway narrowing.     wheezing sounds

4. Fluid-filled alveoli.    Crackles

25. A 58-year-old female client on day 2 after hip surgery has no cardiac history but starts to complain of chest heaviness. The first nursing action should be to

1. inquire about the onset, duration, severity, and precipitating factors of the heaviness.

Further assessment is needed in this situation.

will provide pertinent information to convey to the physician.

2. administer oxygen via nasal cannula.

3. offer pain medication for the chest heaviness.

4. inform the physician of the chest heaviness.



26. The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician.

An increased myoglobin level suggests which of the following?

1. Cancer.

2. Hypertension.

3. Liver disease.

4. Myocardial damage.

one diagnostic tool to determine whether myocardial damage has occurred.

Myoglobin is generally

detected about 1 hour after a heart attack is experienced

peaks within 4 to 6 hours after infarction.

27. An older, sedentary adult may not respond to emotional or physical stress as well as a younger individual because of

1. left ventricular atrophy.

In older adults who are less active and do not exercise the heart muscle,

atrophy can result.

Disuse or deconditioning can lead to abnormal changes

in the myocardium of the older adult.

As a result, under sudden emotional or physical stress,

the left ventricle is less able to respond to the increased demands on the myocardial muscle.

Decreased cardiac output, cardiac hypertrophy, and heart failure

are examples of the chronic conditions

            develop in response to inactivity, rather than in response to the aging process.

2. irregular heartbeats.

not associated with an older sedentary adult's lifestyle

3. peripheral vascular occlusion.

4. pacemaker placement.

should not affect response to stress