Chapter 21- Acute Myocardial Infarction My Nursing Test Banks

 

1.

A patient has been found to be at high risk for cardiovascular disease after a highly sensitive C-reactive protein (hs-CRP) blood test indicated a value of 3.0 mg/dL. The patient would like to know what this test measures. What would be the best answer for the nurse to give?

A)

Systemic inflammation related to atherosclerosis

B)

Cardiac output following myocardial infarction

C)

Blood pressure related to congestive heart failure

D)

Lipid levels in connection with stress response

2.

A patient newly diagnosed with atherosclerosis wants to know what the plaque building up in his arteries actually consists of. Which of the following should the nurse mention? Select all that apply.

A)

Fatty substances

B)

Osteocytes

C)

Epithelial tissue

D)

Cholesterol

E)

Cellular waste products

F)

Collagen and elastic fibers

3.

A patient with atherosclerosis acknowledges that he is a smoker but does not understand how this contributes to his atherosclerosis. Which response would be best for the nurse to give him?

A)

Smoking causes stress, which increases his lipid levels.

B)

Smoking triggers in him a craving for high-cholesterol foods.

C)

Smoking injures the inner layer of his arteries, facilitating plaque buildup.

D)

Smoking causes vasoconstriction.

4.

A young patient who seems perfectly healthy is displaying symptoms of angina pectoris. Which of the following are possible underlying causes of the patients condition? Select all that apply.

A)

Atherosclerotic narrowing of the coronary arteries

B)

Hemophilia

C)

Use of aspirin

D)

Spasm of a coronary artery

E)

Arterial inflammation

F)

Tachycardia

5.

A patient in the CCU complains of pain and a squeezing sensation in his chest. He says that it typically affects him in the middle of the night, waking him from sleep. The nurse recognizes that this patient is most likely experiencing which of the following?

A)

Stable angina

B)

Unstable angina

C)

Classic angina

D)

Variant angina

6.

A 78-year-old woman in the CCU complains of shortness of breath, along with prolonged chest pain unrelieved by rest or sublingual nitroglycerin. The nurse recognizes that this patient is most likely experiencing which condition?

A)

Stable angina pectoris

B)

Atherosclerosis

C)

Classic angina

D)

Myocardial infarction

7.

A patient in the CCU has severe angina pectoris and is undergoing ECG assessment. The nurse knows that this patient had a previous myocardial infarction (MI) 10 years ago and that this old MI is likely to show up on the ECG. Which of the following would show that the patient had a previous MI but is not having one now?

A)

Abnormal Q waves accompanied by ST-segment elevation

B)

Abnormal Q waves accompanied by a normal ST segment

C)

Normal Q waves accompanied by a ST-segment elevation

D)

Normal Q waves accompanied by ST-segment depression

8.

A patient is recovering in the CCU following a myocardial infarction 24 hours ago. She is now pain free and is beginning to eat solid foods. To prevent the Valsalva maneuver from occurring in this patient, what intervention should the nurse take?

A)

Administer fibrinolytic therapy.

B)

Administer a stool softener.

C)

Administer sublingual nitroglycerin.

D)

Administer aspirin.

9.

A patient in the CCU is recovering from a myocardial infarction. He complains of new chest pain and trouble breathing. The nurse observes that he has cool, moist skin and is breathing rapidly. On taking his pulse, she finds that it is rapid and thready. She takes his blood pressure and finds it to be 80/60 mm Hg. What complication is this patient most likely experiencing?

A)

Recurrent myocardial ischemia

B)

Ventricular septal wall rupture

C)

Cardiogenic shock

D)

Pericarditis

10.

A patient is being discharged from the CCU following a myocardial infarction (MI). He will be participating in cardiac rehabilitation following discharge. His wife is wondering what she can do to help her husband during rehabilitation. What instructions should the nurse include in the discharge teaching plan? Select all that apply.

A)

Take cardiopulmonary resuscitation training.

B)

Learn to interpret ECG readings.

C)

Encourage her husband to stop smoking.

D)

Exercise with her husband.

E)

Prepare heart-healthy meals.

F)

Perform a stress test on her husband monthly.

11.

The nurse is teaching several patients how to reduce their risk for coronary artery disease or atherosclerosis. What risk factors should the nurse most emphasize?

A)

Serum cholesterol, high stress, and anger management

B)

Male gender, increased age, and hypertension

C)

Serum cholesterol, hypertension, and cigarette smoking

D)

Cigarette smoking, smokeless tobacco, and ethnicity

12.

The nurse is explaining the process of atherosclerosis to a patient and family. What information should the nurse include?

A)

This disease is purely genetic in nature and cannot be prevented.

B)

The central process involves the formation of lipid-filled arterial plaques.

C)

Alterations in lifestyle have no effect on the formation of plaques.

D)

Anginal chest pain occurs when a coronary artery is 100% occluded.

13.

A patient has been diagnosed with unstable angina. Unstable angina may be described as what?

A)

Occurring with exercise

B)

Crescendo pattern

C)

Predictable pattern

D)

Relieved by rest

14.

The patient is complaining of midsternal chest pain that feels like constant severe pressure. The pain is not relieved by rest or three nitroglycerin tablets and is different than the pain the patient has had in the past. What is the priority nursing action?

A)

Administer another nitroglycerin tablet.

B)

Obtain a 12-lead electrocardiogram.

C)

Use anxiety reduction techniques.

D)

Teach risk reduction strategies.

15.

The patient is experiencing severe chest pain after a stressful incident at work. On the 12-lead ECG, the nurse notices ST segment depression in the anterior leads that resolves as the patients pain resolves. What is the most appropriate nursing action?

A)

Send the patient home, since the symptoms have resolved.

B)

Implement a risk reduction teaching plan.

C)

Schedule the patient for immediate further diagnostic tests.

D)

Refer the patient for psychological evaluation and treatment.

16.

A patient with stable angina is being treated with a beta-blocker. What assessment finding would most cause the nurse to question the use of this medication?

A)

Heart rate 60 at rest, denies dizziness when standing

B)

Systolic blood pressure 82, complains of chronic fatigue

C)

Sinus rhythm with rare premature atrial complexes (PACs)

D)

Diastolic blood pressure 80 with normal pulse pressure

17.

A patient with anginal chest pain is given a low-dose chewable aspirin tablet. In explaining the rationale for this medication to the patient and family, what information does the nurse include?

A)

Aspirin will help control the pain.

B)

Reduction of low-grade fever is important.

C)

Anticoagulation effects will reduce clot formation.

D)

Aspirin is less toxic to the liver than Tylenol.

18.

The patient has been diagnosed with an acute anterior myocardial infarction. What complication does the nurse most anticipate?

A)

Second-degree AV block, Mobitz 1

B)

Few or no complications

C)

Cardiac failure or cardiogenic shock

D)

Intractable nausea and vomiting

19.

The patient has been diagnosed with an acute inferior myocardial infarction. What 12-lead ECG changes does the nurse expect to find after several hours?

A)

ST segment elevation and large Q wave in leads II, III and aVF

B)

ST segment depression and wide QRS in leads II, III, and aVR

C)

ST segment elevation and large Q wave in leads V1V4

D)

ST segment depression and large S wave in leads V2V4

20.

The patient is being evaluated for acute myocardial infarction. Elevation in what laboratory value would confirm an acute MI?

A)

Troponin I or T

B)

CK-MB or CK-MM

C)

Myoglobin after 12 hours

D)

Leukocyte count

21.

A patient with an acute myocardial infarction has received three nitroglycerin tablets, oxygen, and aspirin and is still complaining of severe crushing chest pain. What is the best nursing action?

A)

Give 5 mg intravenous morphine.

B)

Assess for drug-seeking behavior.

C)

Give intravenous benzodiazepine.

D)

Use anxiety reduction measures.

22.

As part of treatment for acute myocardial infarction, a patient is receiving an infusion of tissue plasminogen activator (tPA). Two hours after the initiation of the infusion, the patient has a short run of accelerated idioventricular rhythm. During the arrhythmia, the patients blood pressure is 110/78 but he denies any other change in symptoms. What is the best nursing action?

A)

Discontinue the tPA.

B)

Initiate an intravenous lidocaine drip.

C)

Assess for pulmonary adventitious sounds.

D)

Continue close observation of the patient.

23.

A patient with an acute myocardial infarction has been started on daily enalapril (Vasotec), an ACE inhibitor, to preserve ejection fraction. What is the most important nursing assessment before giving this medication?

A)

Intake and output

B)

Daily weight

C)

Blood pressure

D)

Pulse oximetry

24.

After an acute myocardial infarction, the patient is receiving tissue plasminogen activator (tPA) and initially on nitroglycerin for chest pain at 10 on 0/10 scale. The patient has rare premature ventricular contractions (PVCs) and a blood pressure of 82/55 mm Hg. What is the most important nursing action?

A)

Discontinue the nitroglycerin infusion rate.

B)

Increase the tPA infusion rate.

C)

Administer a bolus of amioderone.

D)

Obtain a 12-lead electrocardiogram.

25.

The patient is 24 hours post acute myocardial infarction and may have developed a ventricular septum rupture. What nursing assessment would best indicate this complication?

A)

Loud holosystolic murmur

B)

Dyspnea and basal crackles

C)

Sinus tachycardia

D)

Pain unrelieved by nitroglycerin

26.

A patient who has had a myocardial infarction is started on a cardiac rehabilitation program. The patient asks the nurse why he must participate in this program. What is the most important information for the nurse to include in answering the patients question?

A)

This program has been ordered by the physician and is required.

B)

Participation has been shown to decrease the risk of subsequent coronary events.

C)

The program includes monitored exercise and risk reduction counseling.

D)

Participation will improve the patients quality of life and emotional stability.

Answer Key

1.

A

2.

A, D, E, F

3.

C

4.

A, D, E, F

5.

D

6.

D

7.

B

8.

B

9.

C

10.

A, C, D, E

11.

C

12.

B

13.

B

14.

B

15.

C

16.

B

17.

C

18.

C

19.

A

20.

A

21.

A

22.

D

23.

C

24.

A

25.

A

26.

B

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