exertional dyspnea
Weight gain, due to fluid retention and worsening heart failure, causes exertional dyspnea in clients with mitral regurgitation. The rise in left atrial pressure that accompanies mitral valve disease is transmitted backward into pulmonary veins, capillaries, and arterioles and eventually to the right ventricle. Signs and symptoms of pulmonary and systemic venous congestion follow.
Additional Rationales:When the mitral valve regurgitates, some blood
flows forward into the left ventricle and some blood flows back into the left atrium.
Hint #2
There are no valves to protect the pulmonary veins from backward flow of blood as pressure in the left atrium increases.
Hint #3
Dyspnea may develop as blood will backs up into the lungs, causing pulmonary edema.
Which of the following chronic complications is associated with diabetes?
1. Dizziness, dyspnea on exertion, and coronary artery disease.
2. Retinopathy, neuropathy, and coronary artery disease
3. Leg ulcers, cerebral ischemic events, and pulmonary infarcts
4. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia's
Answer: 2. Retinopathy, neuropathy, and coronary artery disease
These are all chronic complications of diabetes. Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism. Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia.
When taking a health history, the nurse screens for manifestations suggestive of diabetes type I. Which of the following manifestations are considered the primary manifestations of diabetes type I and would be most suggestive of diabetes type I and require follow-up investigation?
a. Excessive intake of calories, rapid weight gain, and difficulty losing weight
b. Poor circulation, wound healing, and leg ulcers,
c. Lack of energy, weight gain, and depression
d. An increase in three areas: thirst, intake of fluids, and hunger
Medications used after MI
Morphine= peripheral vasodilator & decreases venous return
Nitrates
Aspirin
Ace inhibitors
Oxygen
Beta blockers
Calcium channel blockers (When beta blockers are contraindicated)
Antiplatelet aggregates
Management for MI:
1. Administer medications as ordered
2. Obtain VS &
EKG
3. Give O2 at 2-6 L via N.C.
4. Obtain cardiac enzymes (CK-MB, myoglobin, troponins)
5. Provide quiet, restful environment
6. Asses breath sound for rales (indicates pulmonary edema)
7. Maintain patent IV
8. Monitor fluid balance
9. Keep in Semi-Fowlers
10. Maintain bed rest for 24 hrs
11. Encourage pt to resume activity gradually
12. Encourage verbalization of fears
13. Provide info. about disease process & cardiac rehab
MONA
morphine, O2, nitroglycerin, aspirin
Medical Interventions
1. Thrombolytics (Streptokinase, Tenecteplase, Reteplase, Urokinase) within 1-4 hrs of MI, but no more than 12 hrs
2. Intraaortic balloon pump (IABP) to improve myocardial perfusion
3. Surgical reperfusion w/CABG
MI Priorities
a. Relieve chest pain.
b. Reduce the extent of myocardial damage.
c. Maintain cardiovascular stability.
d. Decrease cardiac workload.
e. Prevent complications.
3. Which of the following is the most common symptom of myocardial infarction (MI)?
1. Chest pain
2. Dyspnea
3. Edema
4. Palpitations
1. Chest pain
The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart.
Option B: Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI.
Option C: Edema is a later sign of heart failure, often seen after an MI.
Option D: Palpitations may result from reduced cardiac output, producing arrhythmias.
6. What is the primary reason for administering morphine to a client with an MI?
1. To sedate the
client
2. To decrease the client's pain
3. To decrease the client's anxiety
4. To decrease oxygen demand on the client's heart
Answer: 4. To decrease oxygen demand on the client's heart
Morphine is administered because it decreases myocardial oxygen demand.
Options A, B, and C: Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons.
7. Which of the following conditions is most commonly responsible for myocardial infarction?
1. Aneurysm
2. Heart failure
3. Coronary artery thrombosis
4. Renal failure
3. Coronary artery thrombosis
Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death.
Option A: An aneurysm is an outpouching of a vessel and doesn't cause an MI.
Option B: Heart failure is usually a result from an MI.
Option D:
Renal failure can be associated with MI but isn't a direct cause.
9. After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?
1. Left-sided heart failure
2. Pulmonic valve malfunction
3. Right-sided heart failure
4. Tricupsid valve malfunction
1. Left-sided heart failure
The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles.
Options B, C, and D: Pulmonic and tricuspid valve malfunction cause right-sided heart failure.
10. What is the first intervention for a client experiencing MI?
1.
Administer morphine
2. Administer oxygen
3. Administer sublingual nitroglycerin
4. Obtain an ECG
Answer: 2. Administer oxygen
Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage.
Options A and C: Morphine and nitro are also used to treat MI, but they're more commonly
administered after the oxygen.
Option D: An ECG is the most common diagnostic tool used to evaluate MI.
12. What is the most common complication of an MI?
1. Cardiogenic shock
2. Heart failure
3. arrhythmias
4. Pericarditis
Answer: 3. Arrhythmias
Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI.
Option A: Cardiogenic shock,
another complication of an MI, is defined as the end stage of left ventricular dysfunction. This condition occurs in approximately 15% of clients with MI.
Option B: Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication.
Option D: Pericarditis most commonly results from a bacterial or viral infection but may occur after the MI.
31. Which of the following types of angina is most closely related with an impending MI?
1. Angina decubitus
2. Chronic stable angina
3. Nocturnal angina
4. Unstable angina
Answer: 4. Unstable angina
Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months.
45. A 55-year-old client is admitted with an acute inferior-wall myocardial infarction. During the admission interview, he says he stopped taking his metoprolol (Lopressor) 5 days ago because he was feeling better. Which of the following nursing diagnoses takes priority for this client?
1. Anxiety
2. Ineffective tissue perfusion; cardiopulmonary
3. Acute pain
4. Ineffective therapeutic regimen management
Answer: 2. Ineffective tissue perfusion; cardiopulmonary
MI results from prolonged myocardial ischemia caused by reduced blood flow through the coronary arteries. Therefore, the priority nursing diagnosis for this client is Ineffective tissue perfusion (cardiopulmonary).
Options A, C, and D: Anxiety, acute pain, and ineffective therapeutic regimen management are appropriate but don't take priority.
59. 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
2. Monitoring BP q4h
3. Monitoring urine output hourly
4. Obtaining serum potassium levels daily
Answer: 1. Obtaining an infusion pump for the medication
IV nitro infusion requires an infusion pump for precise control of the medication.
Option B: BP monitoring would be done with a continuous system, and more frequently than every 4 hours.
Option C: Hourly urine outputs are not always required.
Option
D: Obtaining serum potassium levels is not associated with nitroglycerin infusion.
60. Aspirin is administered to the client experiencing an MI because of its:
1. Antipyretic action
2. Antithrombotic action
3. Antiplatelet action
4. Analgesic action
Answer: 2. Antithrombotic action
Aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reason ASA is administered to the client experiencing an MI is its antithrombotic action.
61. Which of the following is an expected outcome for a client on the second day of hospitalization after an MI?
1. Has severe chest pain
2. Can identify risks factors for MI
3. Agrees to participate in a cardiac rehabilitation walking program
4. Can perform personal self-care activities without pain
Answer: 4. Can perform personal self-care activities without pain
By day 2 of hospitalization after an MI, clients are expected to be able to perform personal care without chest pain. Day 2 hospitalization may be too soon for clients to be able to identify risk factors for MI or 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.
62. 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 ordered
2. Small, easily digested meals
3. Three regular meals per day
4. NPO
Answer: 2. Small, easily digested meals
Recommended dietary principles in the acute phase of MI include avoiding large meals because small, easily digested foods are better digested foods are better tolerated. Fluids are given according to the client's needs, and sodium restrictions may be prescribed, especially for clients with manifestations of heart failure. Cholesterol restrictions may be ordered as well.
Options A and D: Clients are not prescribed a diet of liquids only or NPO unless their condition is very unstable.
1. You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to
re-educate them?*
A. Coronary artery dissection can happen spontaneously and occurs more in women.
B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension.
C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction.
D. Both A and B are incorrect.
B.
2. You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage?
A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle.
B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle.
C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle.
D. The left anterior descending artery is least likely to be affected by coronary artery disease.
B
3. A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from?
A. Cardiac dissection
B. Ventricular septum rupture
C. Mitral valve prolapse
D. Pericarditis
D
4. After a myocardial infraction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue?
A. 24 hours
B. 2 days
C. 10 days
D. 6 hours
C
5. 24-36 hours after a myocardial infarction _________ congregate at the site during the inflammation phase.
A. Neutrophils
B. Eosinophils
C. Platelets
D. Macrophages
A
8. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time?
A. Troponin result and when the next troponin level is due to be collected
B. Diet status
C. Oxygen saturation
D. CK result and when the next CK level is due to be collected
A
9. A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers.
A. Myoglobin
B. CK-MB
C. CK
D. Troponin
D
10. A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status:
A. Obtain a 12-lead EKG
B. Place the patient in supine position
C. Assess urinary output
D. Administer Nitroglycerin sublingual as ordered per protocol
E. Collect cardiac enzymes as ordered per protocol
F. Encourage patient to cough and deep breath
G. Administer Morphine IV as ordered per protocol
H. Place patient on oxygen via nasal cannula
I. No interventions are needed at this time
ADEGH
11. In regards to the patient in the previous question, after administering the first dose of Nitroglycerin sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave inversion on the cardiac monitor. What is your next nursing intervention?
A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders.
B. Administer Morphine IV and place the patient in reverse Trendelenburg position.
C. Administer Nitroglycerin and monitor the patient's blood pressure.
D. All the options are incorrect.
A
13. A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of heparin therapy and requires intervention?
A. K+ 3.7
B. PTT 65 seconds
C. Hgb 14.5
D. Platelets 135,000
D
16. A patient is being discharged home after receiving treatment for a myocardial infarction. The patient will be taking Coreg. What statement by the patient demonstrates they understood your education material about this drug?
A. "I will take this medication at night."
B. "I will take this medication as needed."
C. "I will monitor my heart rate and blood pressure while taking this medication."
D. "I will take this medication in the morning with grapefruit juice."
C
18. A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction. What medication below can cause an increased potassium level?
A. Losartan
B. Norvasc
C. Aspirin
D. Cardizem
A
The primary purpose of a soft, high-fiber diet immediately following a myocardial infarction (MI) is to A. promote easy digestion. B. lower cholesterol levels. C. maintain bowel health to decrease gas. D. create a high-bulk, soft stool to minimize Valsalva maneuver.
D. create a high-bulk, soft stool to minimize Valsalva maneuver.
2. Etiology of heart failure after MI is related to the A. increased myocardial workload. B. increased oxygen demands of the myocardium. C. inability of the heart chambers to fill adequately. D. impairment of the contractile function of the ventricle.
D. impairment of the contractile function of the ventricle.
13. Four hours after the onset of pain from an MI, a nurse should expect an increase in the A. creatine kinase-MB (CK-MB). B. leukocyte count. C. alkaline phosphatase (ALP). D. lactate dehydrogenase (LHD).
A. creatine kinase-MB (CK-MB).