Myocardial Infarction By Rnpedia.Com
Choose the letter of the correct answer.
- 1.
Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?
- A.
Worsening chest pain that began earlier in the evening.
- B.
History of cerebral hemorrhage.
- C.
History of prior myocardial infarction.
- D.
Hypertension.
Correct Answer
B. History of cerebral hemorrhage.Explanation
A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension.Rate this question:
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- 2.
Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient?
- A.
Increases fitness and prevents future heart attacks.
- B.
Prevents bedsores.
- C.
Prevents DVT (deep vein thrombosis).
- D.
Prevent constipations.
Correct Answer
C. Prevents DVT (deep vein thrombosis).Explanation
Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness, nor is it intended to prevent bedsores or constipation.Rate this question:
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- 3.
A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?
- A.
Hypertension.
- B.
Bradycardia.
- C.
Bounding pulse.
- D.
Confusion.
Correct Answer
D. Confusion.Explanation
Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.Rate this question:
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- 4.
Which of the following is the most common symptom of myocardial infarction?
- A.
Chest pain
- B.
Dyspnea
- C.
Edema
- D.
Palpitations
Correct Answer
A. Chest painExplanation
The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.Rate this question:
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- 5.
What is the primary reason for administering morphine to a client with myocardial infarction?
- A.
To sedate the client
- B.
To decrease the client's pain
- C.
To decrease the client's anxiety
- D.
To decrease oxygen demand on the client's heart
Correct Answer
D. To decrease oxygen demand on the client's heartExplanation
Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but isn't primarily given for those reasons.Rate this question:
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- 6.
A male client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:
- A.
Pleural effusion.
- B.
Pulmonary edema.
- C.
Atelectasis.
- D.
Oxygen toxicity.
Correct Answer
C. Atelectasis.Explanation
In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn’t cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn’t one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.Rate this question:
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- 7.
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac stepdown unit (CSU). While giving report to the CSU nurse, the CCU nurse says, “His pulmonary artery wedge pressures have been in the high normal range.” The CSU nurse should be especially observant for:
- A.
Hypertension
- B.
High urine output
- C.
Dry mucous membranes
- D.
Pulmonary crackles
Correct Answer
D. Pulmonary cracklesExplanation
High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With leftsided heart failure, pulmonary edema can develop causing pulmonary crackles. In leftsided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren’t directly associated with elevated pulmonary artery wedge pressures.Rate this question:
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- 8.
Alzheimer’s disease is the secondary diagnosis of a client admitted with myocardial infarction. Which nursing intervention should appear on this client’s plan of care?
- A.
Perform activities of daily living for the client to decease frustration.
- B.
Provide a stimulating environment.
- C.
Establish and maintain a routine.
- D.
Try to reason with the client as much as possible.
Correct Answer
C. Establish and maintain a routine.Explanation
Establishing and maintaining a routine is essential to decreasing extraneous stimuli. The client should participate in daily care as much as possible. Attempting to reason with such clients isn’t successful, because they can’t participate in abstract thinking.Rate this question:
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- 9.
An early finding in the EKG of a client with an infarcted mycardium would be:
- A.
Disappearance of Q waves
- B.
Elevated ST segments
- C.
Absence of P wave
- D.
Flattened T waves
Correct Answer
B. Elevated ST segmentsExplanation
This is a typical early finding after a myocardial infarct because of the altered contractility of the heart. The other choices are not typical of MI.Rate this question:
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- 10.
Jose, who had a myocardial infarction 2 days earlier, has been complaining to the nurse about issues related to his hospital stay. The best initial nursing response would be to:
- A.
Allow him to release his feelings and then leave him alone to allow him to regain his composure
- B.
Refocus the conversation on his fears, frustrations and anger about his condition
- C.
Explain how his being upset dangerously disturbs his need for rest
- D.
Attempt to explain the purpose of different hospital routines
Correct Answer
B. Refocus the conversation on his fears, frustrations and anger about his conditionExplanation
This provides the opportunity for the client to verbalize feelings underlying behavior and helpful in relieving anxiety. Anxiety can be a stressor which can activate the sympathoadrenal response causing the release of catecholamines that can increase cardiac contractility and workload that can further increase myocardial oxygen demand.Rate this question:
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- 11.
Twenty four hours after admission for an Acute MI, Jose’s temperature is noted at 39.3 C. The nurse monitors him for other adaptations related to the pyrexia, including:
- A.
Shortness of breath
- B.
Chest pain
- C.
Elevated blood pressure
- D.
Increased pulse rate
Correct Answer
D. Increased pulse rateExplanation
Fever causes an increase in the body’s metabolism, which results in an increase in oxygen consumption and demand. This need for oxygen increases the heart rate, which is reflected in the increased pulse rate. Increased BP, chest pain and shortness of breath are not typically noted in fever.Rate this question:
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- 12.
Patrick who is hospitalized following a myocardial infarction asks the nurse why he is taking morphine. The nurse explains that morphine:
- A.
Decrease anxiety and restlessness
- B.
Prevents shock and relieves pain
- C.
Dilates coronary blood vessels
- D.
Helps prevent fibrillation of the heart
Correct Answer
B. Prevents shock and relieves painExplanation
Morphine is a central nervous system depressant used to relieve the pain associated with myocardial infarction, it also decreases apprehension and prevents cardiogenic shock.Rate this question:
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- 13.
Dr. Marquez orders a continuous intravenous nitroglycerin infusion for the client suffering from myocardial infarction. Which of the following is the most essential nursing action?
- A.
Monitoring urine output frequently
- B.
Monitoring blood pressure every 4 hours
- C.
Obtaining serum potassium levels daily
- D.
Obtaining infusion pump for the medication
Correct Answer
D. Obtaining infusion pump for the medicationExplanation
Administration of Intravenous Nitroglycerin infusion requires pump for accurate control of medication.Rate this question:
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- 14.
During the second day of hospitalization of the client after a Myocardial Infarction. Which of the following is an expected outcome?
- A.
Able to perform self-care activities without pain
- B.
Severe chest pain
- C.
Can recognize the risk factors of Myocardial Infarction
- D.
Can participate in cardiac rehabilitation walking program
Correct Answer
A. Able to perform self-care activities without painExplanation
By the 2nd day of hospitalization after suffering a Myocardial Infarction, Clients are able to perform care without chest painRate this question:
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- 15.
A 42-year-old client admitted with an acute myocardial infarction asks to see his chart. What should the nurse do first?
- A.
Allow the client to view his chart
- B.
Contact the supervisor and physician for approval
- C.
Ask the client if he has concerns about his care
- D.
Tell the client that he isn't permitted to view his chart.
Correct Answer
C. Ask the client if he has concerns about his careExplanation
The nurse should first ask the client if he has concerns about his care. This is important because the client's request to see his chart may be driven by concerns or questions about his condition or treatment. By addressing the client's concerns, the nurse can provide reassurance, clarification, and support, which can contribute to the client's overall well-being and satisfaction with his care.Rate this question:
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- 16.
Nurse Betty is assigned to the following clients. The client that the nurse would see first after endorsement?
- A.
A 34 year-old post operative appendectomy client of five hours who is complaining of pain.
- B.
A 44 year-old myocardial infarction (MI) client who is complaining of nausea.
- C.
A 26 year-old client admitted for dehydration whose intravenous (IV) has infiltrated.
- D.
A 63 year-old post operative’s abdominal hysterectomy client of three days whose incisional dressing is saturated with serosanguinous fluid.
Correct Answer
B. A 44 year-old myocardial infarction (MI) client who is complaining of nausea.Explanation
Nausea is a symptom of impending myocardial infarction (MI) and should be assessed immediately so that treatment can be instituted and further damage to the heart is avoided.Rate this question:
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- 17.
In order to be effective, Percutaneous Transluminal Coronary Angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction?
- A.
60 minutes
- B.
30 minutes
- C.
9 days
- D.
6-12 months
Correct Answer
A. 60 minutesExplanation
The sixty minute interval is known as “door to balloon time” for performance of PTCA on a diagnosed MI patient.Rate this question:
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- 18.
Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a typical description of pain associated with an MI, and is now cold and clammy, pale and dyspneic. He has an IV of D5W running, and is complaining of chest pain. Oxygen therapy has not been started, and he is not on the monitor. He is frightened.During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the following patterns of cardiac enzyme elevation are most common following an MI?
- A.
SGOT, CK, and LDH are all elevated immediately.
- B.
SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
- C.
CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
- D.
CK peaks first and remains elevated for 1 to 2 weeks.
Correct Answer
C. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).Explanation
Although the timing of initial elevation, peak elevation, and duration of elevation vary with sources, current literature favors option letter c.Rate this question:
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- 19.
Which statement best describes the difference between the pain of angina and the pain of myocardial infarction?
- A.
Pain associated with angina is relieved by rest.
- B.
Pain associated with myocardial infarction is always more severe.
- C.
Pain associated with angina is confined to the chest area.
- D.
Pain associated with myocardial infarction is referred to the left arm.
Correct Answer
A. Pain associated with angina is relieved by rest.Explanation
Pain associated with angina is relieved by rest. Answer B is incorrect because it is not a true statement. Answer Pain associated with angina is confined to the chest area is incorrect because pain associated with angina can be referred to the jaw, the left arm, and the back. Pain associated with myocardial infarction is referred to the left arm is incorrect because pain from a myocardial infarction can be referred to areas other than the left arm.Rate this question:
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- 20.
A 55-year-old client is admitted with chest pain that radiates to the neck, jaw and shoulders that occurs at rest, with high body temperature, weak with generalized sweating and with decreased blood pressure. A myocardial infarction is diagnosed. The nurse knows that the most accurate explanation for one of these presenting adaptations is:
- A.
Catecholamines released at the site of the infarction causes intermittent localized pain.
- B.
Parasympathetic reflexes from the infarcted myocardium causes diaphoresis.
- C.
Constriction of central and peripheral blood vessels causes a decrease in blood pressure.
- D.
Inflammation in the myocardium causes a rise in the systemic body temperature.
Correct Answer
D. Inflammation in the myocardium causes a rise in the systemic body temperature.Explanation
Temperature may increase within the first 24 hours and persist as long as a week.Rate this question:
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- 21.
The client with an acute myocardial infarction is hospitalized for almost one week. The client experiences nausea and loss of appetite. The nurse caring for the client recognizes that these symptoms may indicate the:
- A.
Adverse effects of spironolactone (Aldactone)
- B.
Adverse effects of digoxin (Lanoxin)
- C.
Therapeutic effects of propranolol (Indiral)
- D.
Therapeutic effects of furosemide (Lasix)
Correct Answer
B. Adverse effects of digoxin (Lanoxin)Explanation
Toxic levels of Lanoxin stimulate the medullary chemoreceptor trigger zone, resulting in nausea and subsequent anorexia.Rate this question:
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- 22.
The nurse should visit which of the following clients first?
- A.
The client with diabetes with a blood glucose of 95mg/dL
- B.
The client with hypertension being maintained on Lisinopril
- C.
The client with hypertension being maintained on Lisinopril
- D.
The client with Raynaud’s disease
Correct Answer
C. The client with hypertension being maintained on LisinoprilExplanation
The client with chest pain should be seen first because this could indicate a myocardial infarction. The client in answer A has a blood glucose within normal limits. The client in answer B is maintained on blood pressure medication. The client in answer D is in no distress.Rate this question:
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- 23.
Nurse Patricia finds a female client who is post-myocardial infarction (MI) slumped on the side rails of the bed and unresponsive to shaking or shouting. Which is the nurse next action?
- A.
Call for help and note the time.
- B.
Clear the airway
- C.
Give two sharp thumps to the precordium, and check the pulse.
- D.
Administer two quick blows.
Correct Answer
A. Call for help and note the time.Explanation
Having established, by stimulating the client, that the client is unconscious rather than sleep, the nurse should immediately call for help. This may be done by dialing the operator from the client’s phone and giving the hospital code for cardiac arrest and the client’s room number to the operator, of if the phone is not available, by pulling the emergency call button. Noting the time is important baseline information for cardiac arrest procedure.Rate this question:
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- 24.
On the evening shift, the triage nurse evaluates several clients who were brought to the emergency department. Which in the following clients should receive highest priority?
- A.
An elderly woman complaining of a loss of appetite and fatigue for the past week
- B.
A football player limping and complaining of pain and swelling in the right ankle
- C.
A 50-year-old man, diaphoretic and complaining of severe chest pain radiating to his jaw
- D.
A mother with a 5-year-old boy who says her son has been complaining of nausea and vomited once since noon
Correct Answer
C. A 50-year-old man, diapHoretic and complaining of severe chest pain radiating to his jawExplanation
These are likely signs of an acute myocardial infarction (MI). An acute MI is a cardiovascular emergency requiring immediate attention. Acute MI is potentially fatal if not treated immediately.Rate this question:
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- 25.
After a myocardial infarction, a client is placed on a sodium restricted diet. When the nurse is teaching the client about the diet, which meal plan would be the most appropriate to suggest?
- A.
3 oz. broiled fish, 1 baked potato, ½ cup canned beets, 1 orange, and milk
- B.
3 oz. canned salmon, fresh broccoli, 1 biscuit, tea, and 1 apple
- C.
A bologna sandwich, fresh eggplant, 2 oz fresh fruit, tea, and apple juice
- D.
3 oz. turkey, 1 fresh sweet potato, 1/2 cup fresh green beans, milk, and 1 orange
Correct Answer
D. 3 oz. turkey, 1 fresh sweet potato, 1/2 cup fresh green beans, milk, and 1 orangeExplanation
Canned fish and vegetables and cured meats are high in sodium. This meal does not contain any canned fish and/or vegetables or cured meatsRate this question:
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- 26.
A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?
- A.
Slow, deep respirations.
- B.
Stridor.
- C.
Bradycardia.
- D.
Air hunger.
Correct Answer
D. Air hunger.Explanation
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.Rate this question:
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- 27.
A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?
- A.
A patient admitted for myocardial infarction without cardiac muscle damage.
- B.
A post-operative coronary bypass patient, recovering on schedule.
- C.
A patient with a history of ventricular tachycardia and syncopal episodes.
- D.
A patient with a history of atrial tachycardia and fatigue.
Correct Answer
A. A patient admitted for myocardial infarction without cardiac muscle damage.Explanation
An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. This is necessary in a patient with significant ventricular symptoms, such as tachycardia resulting in syncope. A patient with myocardial infarction that resolved with no permanent cardiac damage would not be a candidate. A patient recovering well from coronary bypass would not need the device. Atrial tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.Rate this question:
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- 28.
Which patient’s nursing care would be most appropriate for the charge nurse to assign to the LPN, under the supervision of the RN team leader?
- A.
A 51-year-old patient with bilateral adrenalectomy just returned from the post-anesthesia care unit
- B.
An 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary disease
- C.
A 38-year-old patient with myocardial infarction who is preparing for discharge
- D.
A 72-year-old patient admitted from long-term care with mental status changes
Correct Answer
B. An 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary diseaseExplanation
The 83-year-old patient has no complicating factors at the moment. Providing care for stable and uncomplicated patients is within the LPN’s educational preparation and scope of practice, with the care always being provided under the supervision and direction of the RN. The RN should assess the newly post-operative patient and the new admission. The patient who is preparing for discharge after MI may need some complex teaching. Focus: Delegation/supervision, assignmentRate this question:
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- 29.
The nurse is giving discharge teaching to a client 7 days post myocardial infarction. He asks the nurse why he must wait 6 weeks before having sexual intercourse. What is the best response by the nurse to this question?
- A.
"You need to regain your strength before attempting such exertion."
- B.
"When you can climb 2 flights of stairs without problems, it is generally safe.”
- C.
"Have a glass of wine to relax you, then you can try to have sex."
- D.
"If you can maintain an active walking program, you will have less risk."
Correct Answer
B. "When you can climb 2 flights of stairs without problems, it is generally safe.”Explanation
"When you can climb 2 flights of stairs without problems, it is generally safe." There is a risk of cardiac rupture at the point of the myocardial infarction for about 6 weeks. Scar tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual advice given by health care providers.Rate this question:
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- 30.
A 23 year old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6 days. She experiences sudden shortness of breath, accompanied by chest pain. Which of the following conditions is the most likely cause of her symptoms?
- A.
Myocardial infarction due to a history of atherosclerosis.
- B.
Pulmonary embolism due to deep vein thrombosis (DVT).
- C.
Anxiety attack due to worries about her baby's health.
- D.
Congestive heart failure due to fluid overload.
Correct Answer
B. Pulmonary embolism due to deep vein thrombosis (DVT).Explanation
In a hospitalized patient on prolonged bed rest, he most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload. There is no reason to suspect an anxiety disorder in this patient. Though anxiety is a possible cause of her symptoms, the seriousness of pulmonary embolism demands that it be considered first.Rate this question:
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- 31.
Helen, a nurse from the maternity unit is floated to the critical care unit because of staff shortage on the evening shift. Which client would be appropriate to assign to this nurse? A client with:
- A.
Dopamine drip IV with vital signs monitored every 5 minutes
- B.
A myocardial infarction that is free from pain and dysrhythmias
- C.
A tracheotomy of 24 hours in some respiratory distress
- D.
A pacemaker inserted this morning with intermittent capture
Correct Answer
B. A myocardial infarction that is free from pain and dysrhythmiasExplanation
This client is the most stable with minimal risk of complications or instability. The nurse can utilize basic nursing skills to care for this client.Rate this question:
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- 32.
To prevent a valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would
- A.
Assist the client to use the bedside commode
- B.
Administer stool softeners every day as ordered
- C.
Administer antidysrhythmics prn as ordered
- D.
Maintain the client on strict bed rest
Correct Answer
B. Administer stool softeners every day as orderedExplanation
Administering stool softeners every day will prevent straining on defecation which causes the Valsalva maneuver. If constipation occurs then laxatives would be necessary to prevent straining. If straining on defecation produced the valsalva maneuver and rhythm disturbances resulted then antidysrhythmics would be appropriate.Rate this question:
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- 33.
A female client is brought by ambulance to the hospital emergency room after taking an overdose of barbiturates is comatose. Nurse Trish would be especially alert for which of the following?
- A.
Epilepsy
- B.
Myocardial Infarction
- C.
Renal failure
- D.
Respiratory failure
Correct Answer
D. Respiratory failureExplanation
Barbiturates are CNS depressants; the nurse would be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate over dose.Rate this question:
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- 34.
Nursing measures for the client who has had an MI include helping the client to avoid activity that results in Valsalva’s maneuver. Valsalva’s maneuver may cause cardiac dysrhythmias, increased venous pressure, increased intrathoracic pressure and thrombi dislodgement. Which of the following actions would help prevent Valsalva’s maneuver? Have the client:
- A.
Assume a side-lying position
- B.
Clench her teeth while moving in bed
- C.
Drink fluids through a straw
- D.
Avoid holding her breath during activity
Correct Answer
D. Avoid holding her breath during activityExplanation
Holding one's breath during activity can result in the Valsalva maneuver, which can cause various complications such as cardiac dysrhythmias, increased venous pressure, increased intrathoracic pressure, and thrombi dislodgement. Therefore, the client should avoid holding her breath during activity to prevent the occurrence of Valsalva's maneuver.Rate this question:
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- 35.
The greatest danger of an uncorrected atrial fibrillation for a male patient will be which of the following:
- A.
Pulmonary embolism
- B.
Cardiac arrest
- C.
Thrombus formation
- D.
Myocardial infarction
Correct Answer
C. Thrombus formationExplanation
Uncorrected atrial fibrillation in a male patient can lead to thrombus formation. Atrial fibrillation causes the atria to quiver instead of contracting normally, which can result in blood pooling in the atria. When blood pools, it has a higher chance of forming clots or thrombi. These clots can then travel through the bloodstream and cause blockages in other parts of the body, leading to serious complications such as stroke or heart attack. Therefore, thrombus formation is the greatest danger in this scenario.Rate this question:
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Mar 22, 2023Quiz Edited by
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