Chapter 58: Management of Clients with Myocardial Infarction Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 58: Management of Clients with Myocardial Infarction

MULTIPLE CHOICE

1. After instructing a client with stable angina, the nurse would evaluate that the client has a proper understanding of the condition when the client says

a.

Angina pain usually feels like being stabbed with a knife.

b.

Each time I have angina, my heart is damaged.

c.

If I have chest pain, then Im probably having another heart attack.

d.

My chest pain can occur if I overexert myself.

ANS: D

When fixed blockages are present in the coronary arteries, conditions that increase myocardial oxygen demand (e.g., physical exertion, emotion, exposure to cold) may precipitate episodes of angina. The heart is damaged during an MI (myocardial infarction), not angina. The pain of angina is described as squeezing, burning, pressing, aching, or bursting pressure. Clients do not describe angina as knife-like. Angina signifies that the balance of myocardial oxygen supply and demand is abnormal but does not mean that the client is having an MI, although having an MI is possible.

DIF: Evaluation/Evaluating REF: p. 1483 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. A client admitted for angina reports experiencing pain of long duration while at rest and also early in the morning. The nurse would recognize this pattern as

a.

angina decubitus.

b.

nocturnal angina.

c.

unstable angina.

d.

variant angina.

ANS: D

Variant angina (Prinzmetals angina) is chest discomfort that is similar to classic angina but is of longer duration and may occur while at rest. These attacks tend to happen in the early hours of the day. Angina decubitus occurs while the client is recumbent. Nocturnal angina is associated with REM sleep. Unstable angina is unpredictable and paroxysmal.

DIF: Comprehension/Understanding REF: p. 1485 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. A nurse is instructing a client in the proper administration of sublingual nitroglycerin (NTG). The nurse would include in the teaching plan information that the client should

a.

assess blood pressure for reactive hypertension after each dose.

b.

repeat the dosage every 5 minutes for three times if pain is not relieved.

c.

store NTG tablets in the refrigerator for up to 6 months.

d.

take an aspirin before taking the first dose of NTG.

ANS: B

NTG tablets should be stored at room temperature. If the pain is not relieved after three NTG tablets, each taken 5 minutes apart, the client should take an aspirin and notify the physician. A common side effect is hypotension.

DIF: Application/Applying REF: p. 1488 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

4. A home health care nurse is visiting a client who was dismissed after having an STEMI (ST-elevation myocardial infarction). The nurse is reinforcing teaching done while the client was hospitalized. When the nurse asks the client if he/she has any more questions, the client says no but appears anxious. The best action by the nurse would be to

a.

ask the client if he/she has questions about resuming sexual activity.

b.

find out if the client is worried about being at home instead of in the hospital.

c.

inquire about the feasibility of the client returning to his/her old job after recovery.

d.

speak with the spouse privately to see if she/he knows why the client is anxious.

ANS: A

Resuming normal sexual activities is one of the most difficult aspects of recovering from an MI. Clients are often too timid to bring the subject up with the health care provider, so if the client does not ask, the nurse should specifically ask the client if he/she has questions about resuming sexual activity. All other options are feasible questions, but the priority would be on sexuality.

DIF: Application/Applying REF: p. 1501 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Human Sexuality

5. A nurse is reinforcing diet teaching done by the dietitian. The nurse would evaluate that some goals have been met when the client admitted for angina requests which foods for breakfast?

a.

Bran flakes with skim milk, apple slices, and orange juice

b.

French toast with syrup, grapefruit half, and skim milk

c.

Oatmeal with skim milk, one bacon slice, and hot tea

d.

Scrambled eggs, whole-wheat toast, and prune juice

ANS: A

A high-fiber diet not only may prevent constipation and other intestinal tract ailments, but also may decrease the number and severity of anginal attacks. Diets high in fiber may also lower serum cholesterol and triglyceride levels. Option a has the most fiber and least fat, which should also be restricted.

DIF: Evaluation REF: p. 1488 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

6. A client presents to the emergency department complaining of chest pain that began 2 hours earlier; the clients electrocardiogram (ECG) is consistent with acute myocardial infarction. The nurse would know that the standard treatment at this time is

a.

diazepam.

b.

lidocaine.

c.

streptokinase.

d.

verapamil.

ANS: C

Clinicians treat acute MI with medications that lyse (dissolve) the clot that forms part of the blockage of the coronary artery. Thrombolytic therapy includes streptokinase, urokinase, tissue plasminogen activator (t-PA, alteplase), anisoylated plasminogen-streptokinase activator complex (APSAC, anistreplase), urokinase plasminogen activator, and the newest agent, reteplase. To qualify for thrombolytic agents, the client must present within 12 hours after the onset of chest pain, meet specific diagnostic criteria, and have no absolute contraindications for the therapy.

DIF: Application REF: p. 1495 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

7. The nurse would explain to a client that the most common site for MI is the

a.

anterior wall of the left ventricle.

b.

anterior wall of the right ventricle.

c.

inferior (diaphragmatic) surface.

d.

posterior wall of the left ventricle.

ANS: A

The most common site for myocardial infarction is the anterior wall of the left ventricle near the apex. Infarction of the anterior left ventricle results from thrombosis of the descending branch of the left coronary artery.

DIF: Comprehension/Understanding REF: p. 1490 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

8. Four hours after the onset of pain from an MI, the nurse would expect an increase in which laboratory result?

a.

Alkaline phosphatase (ALP)

b.

CK-MB

c.

Lactate dehydrogenase (LDH)

d.

Leukocyte count

ANS: B

Serum levels of CK-MB, an isoenzyme of creatine kinase (CK) found primarily in cardiac muscle, increase 3 to 6 hours after the onset of chest pain, peak in 12 to 18 hours, and return to normal levels in 2 to 3 days. CK-MB is one of the preferred cardiac enzymes for diagnosing myocardial infarction. The leukocyte count is measured as it does increase after MI, but is not diagnostic and does not have a predictable pattern of rise, peak, and return to normal. The other two options are not measured as part of the normal diagnostic workup for MI.

DIF: Comprehension/Understanding REF: p. 1493 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

9. A client has received thrombolytic therapy after an ST segment myocardial infarction (STEMI). A half-hour later, the nurse notices frequent PVCs. The most appropriate action by the nurse is to

a.

administer lidocaine per the dysrhythmia protocol.

b.

document the finding and conclude the therapy worked.

c.

prepare to send the client for emergent PTCA.

d.

request an order for an anxiolytic medication.

ANS: B

Successful reperfusion of the coronary arteries is evidenced by return of the ECG changes to normal; relief of chest pain; presence of reperfusion dysrhythmias, usually sudden onset of frequent premature ventricular contractions (PVCs) or short runs of PVCs; and a rapid, early peak of CK-MB isoenzyme (washout). The physician should be notified of any changes in the client status.

DIF: Analysis/Analyzing REF: p. 1496 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

10. When caring for a client immediately after an MI, the nurses first priority would be

a.

monitoring for dysrhythmias.

b.

preventing an embolism.

c.

relieving pain.

d.

relieving the clients apprehension.

ANS: C

The first 6 hours after the onset of pain is the crucial time frame for the salvage of the myocardium. Pain control is a priority, usually with IV morphine. Continued pain is a manifestation of myocardial ischemia. Pain also stimulates the autonomic nervous system and preload, increasing myocardial demands.

DIF: Analysis/Analyzing REF: p. 1495 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

11. When the nurse notes a run of four premature ventricular contractions (PVCs) on the monitor of a client with a recent MI, the nurse would

a.

administer sublingual nitroglycerin.

b.

change the clients ECG leads.

c.

continue observing for six PVCs or more.

d.

notify the physician immediately.

ANS: C

The nurse should notify the physician if more than six PVCs occur per minute and the client is symptomatic.

DIF: Analysis/Analyzing REF: p. 1497 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

12. When the immediate post-MI client complains about the high-fiber diet and being encouraged to drink water, the nurse would inform the client that the purpose of such a diet is to

a.

create a high-bulk, soft stool.

b.

lower cholesterol levels.

c.

maintain bowel health to decrease gas.

d.

promote easy digestion.

ANS: A

The stool, being soft, does not require that the client perform the Valsalva maneuver during evacuation, which can cause bradycardia and decrease cardiac output.

DIF: Comprehension/Understanding REF: pp. 1502-1509

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

13. For a 40-year-old client who wants to be more active the first 24 hours after an MI, the nurse could safely suggest that the client

a.

ambulate in the hall with supervision.

b.

perform gentle isometric exercises.

c.

take a bath in the shower.

d.

use the bedside commode for bowel movements.

ANS: D

The client should be on complete bed rest for the first day or so after MI, with use of the bedside commode for bowel movements. Using a bedpan involves more straining and increases the chances of a vagal response. Walking in the hallway is usually started after the client transfers out of the coronary care unit. Showering must be done carefully in warm, not hot, water with a shower chair. Isometric exercises should be avoided.

DIF: Application/Applying REF: pp. 1500, 1502-1509

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

14. In the discharge teaching plan for a client after MI, the nurse would include that the client should

a.

begin walking for short periods every day.

b.

continue previous lifestyle when ready.

c.

resume sexual intercourse in 3 months.

d.

take 1 aspirin every 8 hours as ordered.

ANS: A

The physician may allow sexual intercourse 4 to 8 weeks after an MI. The nurse should encourage frequent walks; the walking program aims for a goal of 2 miles in less than 60 minutes. After an acute MI, many clients are instructed to take 1 aspirin daily.

DIF: Application/Applying REF: p. 1500 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

15. The nurse would remind a client that the cause of sudden death after myocardial infarction is usually

a.

congestive heart failure.

b.

dysrhythmias.

c.

myocardial ischemia.

d.

stroke.

ANS: B

Dysrhythmias are the major cause of death after an MI (40% to 50% of deaths). Ectopic rhythms arise in or near the borders of intensely ischemic and damaged myocardial tissues.

DIF: Comprehension/Understanding REF: p. 1497 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

16. The nurse would explain to a client that increased levels of troponin I are evident within

a.

1 to 2 hours after MI pain has started.

b.

3 to 12 hours after MI pain has started.

c.

7 to 9 hours after MI pain has started.

d.

12 to 15 hours after MI pain has started.

ANS: B

Troponin I is similar to CK-MB, and levels increase within 3 to 12 hours after pain has started. This test is very specific to myocardial muscle damage and is not affected by any other disease or injury. Elevations persist for 5-10 days.

DIF: Comprehension/Understanding REF: p. 1493 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

17. For a client whose resting pulse rate is 71 beats/min, the nurse would check the clients pulse rate to ensure that during post-MI activities, the clients heart rate does not exceed

a.

89 beats/min.

b.

96 beats/min.

c.

101 beats/min.

d.

112 beats/min.

ANS: A

The post-MI activity of a client should not cause the pulse rate to rise above 25% of the resting heart rate: ; , or 89 beats/min.

DIF: Analysis/Analyzing REF: p. 1500 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

18. In order to be most effective, the nurse planning a new cardiac rehabilitation program for the community hospital realizes to be most successful, the program

a.

cannot begin until the clients go home.

b.

needs to be cost-effective.

c.

only should address physical problems.

d.

should use a case management approach.

ANS: D

Comprehensive cardiac rehabilitation needs to employ a case management approach. It certainly should be cost-effective, but a coordinated approach is best for the client. Rehabilitation begins on admission and addresses psychosocial issues, too.

DIF: Comprehension/Understanding REF: p. 1499 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Case Management

19. A client is scheduled for the early release discharge after suffering an STEMI. Which action by the nurse would most facilitate a successful outcome after discharge?

a.

Arranging to have all medications delivered to the home

b.

Referring the client for home health care visits

c.

Reviewing the clients medications before discharge

d.

Teaching the client to monitor his/her own blood pressure

ANS: B

A growing trend is for early discharge from the hospital following uncomplicated MI. The clients are discharged to a home environment that is restful and are closely supervised by nurses. The other options are viable discharge plans, but the home visits allow the nurse to monitor the clients physiological status, exercise routine, and diet.

DIF: Application/Applying REF: p. 1500 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Continuity of Care

20. A nurse is visiting a client in the home 3 weeks after having an STEMI. The client appears distressed and the spouse is nervously hovering nearby. Which assessment by the nurse would provide the most useful data? The nurse should inquire if

a.

neighbors have been dropping by and fatiguing the client.

b.

the client is able to adhere to the prescribed exercise routine.

c.

the spouse is able to shop for and prepare appropriate foods.

d.

there are fears that allowing the client activity may provoke another MI.

ANS: D

Family members should be included in any teaching provided to the client. Sometimes the family fears that if the client increases activity, he/she will suffer another MI, and their attempts to help the client actually discourage autonomy. The other three options are valid assessments; however, they will not provide data that is as helpful as option d.

DIF: Analysis/Analyzing REF: p. 1500 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Family Dynamics

21. A client newly diagnosed with STEMI has the nursing diagnosis Anxiety related to hospital admission. The nurse assesses that goals have been met when the client

a.

continues to ask questions.

b.

cries openly while the nurse is there.

c.

is able to rest quietly.

d.

needs repetition of information.

ANS: C

When the client has decreased anxiety he/she will demonstrate appropriate range of feelings, will be able to participate in treatment decisions, will ask fewer questions, and will be able to rest.

DIF: Evaluation REF: pp. 1502-1509 OBJ: Evaluation

MSC: Psychosocial Integrity Coping and Adaptation-Stress Management

22. A client in intensive care has had an STEMI. The client is alternately yelling out and crying. The client states Ill never be able to go back to work again! The most appropriate nursing diagnosis for this client is

a.

Altered Body Image.

b.

Anxiety.

c.

Fear.

d.

Powerlessness.

ANS: D

A client with powerlessness verbalizes feelings of doom and often cries or is angry. Nursing interventions revolve around helping the client maintain some control over the situation.

DIF: Analysis/Analyzing REF: pp. 1502-1509

OBJ: Diagnosis

MSC: Psychosocial Integrity Coping and Adaptation-Stress Management

23. A client is being evaluated in the emergency department for possible thrombolytic therapy to treat an STEMI. The nurse assesses a relative contraindication for this treatment, which is

a.

aortic aneurysm.

b.

known intracranial tumor.

c.

pregnancy.

d.

previous hemorrhagic stroke.

ANS: C

Suspected or known aortic aneuyrsm, intracranial tumors, and previous hemorrhagic stroke are all absolute contraindications for thrombolytic therapy. Pregnancy is a relative contraindication.

DIF: Analysis/Analyzing REF: p. 1496 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

24. A client with recurrent angina is being treated with aspirin, 81 mg/day. When the client asks why the aspirin is needed, the best response by the nurse is to say Aspirin

a.

keeps platelets from sticking together and forming a clot.

b.

prevents the fever that goes along with angina.

c.

treats the pain of angina without dropping your blood pressure.

d.

will reduce the inflammation in your heart.

ANS: A

Aspirin is used both in acute events and for long-term therapy for its antiplatelet aggregate effects. One aspirin a day would not be effective for pain, inflammation, or fever relief.

DIF: Comprehension/Understanding REF: p. 1487 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

MULTIPLE RESPONSE

1. The nursing actions that would most help to prevent cardiogenic shock in a client after a myocardial infarction are (Select all that apply)

a.

administering vasopressor agents.

b.

enhancing the hearts pumping function.

c.

giving the client IV lidocaine.

d.

providing adequate IV fluids.

e.

treating pain rapidly.

ANS: A, B, D, E

Shock can be prevented with rapid relief of pain and with sufficient IV fluids to prevent circulatory collapse. Other measures to prevent shock include giving vasopressor agents to raise blood pressure and improving the hearts pumping function with inotropic agents or an intra-aortic balloon pump.

DIF: Application/Applying REF: p. 1498 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

Leave a Reply