Angina, MI, Aneurysms Questions

Angina, MI, Aneurysms Questions

(NCLEX)

The nurse teaches the client that the major difference between angina and pain

associated with myocardial infarction (MI) is that:

• Angina is relieved with nitroglycerin and rest.
• Angina can be fatal.
• MI pain always radiates to the left arm or jaw.
• MI pain cannot be treated. - Answer- A) Angina is relieved with nitroglycerin and rest.

The teaching plan for a client being started on long-acting nitroglycerin includes the action of this drug. The nurse teaches that this drug relieves chest pain by which action?

• Dilating just the coronary arteries
• Decreasing the blood pressure
• Increasing contractility of the heart
• Dilating arteries and veins - Answer- D) Dilating arteries and veins

The nurse cautions the client receiving isosorbide dinitrate for treatment of angina that

long-term use can lead to the development of:

• Tolerance.
• Tachycardia.
• Hypotension.
• Urinary retention. - Answer- A) Tolerance.

The nurse prepares discharge teaching for a client receiving isosorbide dinitrate for treatment of angina. What information must the nurse include?

• Limit exercise to 30 minutes twice per week.
• Avoid alcohol consumption.
• Monitor intake and output.
• Report skin flushing to the physician. - Answer- B) Avoid alcohol consumption.

The nurse recognizes that the mechanism for action of beta-adrenergic blockers in the

treatment of angina is:

• Positive chronotropic effect.
• Negative inotropic effect.

• Positive inotropic effect.
• Antidysrhythmia. - Answer- B) Negative inotropic effect.

Rationale: Beta blockers decrease the workload of the heart by slowing heart rate (negative chronotropic effect) and reducing contractility (negative inotropic effect).What does the nurse include in the teaching plan for a client receiving a beta blocker for treatment of angina?

• Discontinue drug if heart rate <60.
• Do not discontinue drug abruptly.
• Exercise heart rate should be 110-120.
• Monitor for hyperglycemia. - Answer- B) Do not discontinue drug abruptly.

Rationale: Beta blocker treatment should never be abruptly discontinued. With abrupt cessation, a rebound excitation occurs, and adrenergic receptors are stimulated. This can exacerbate angina, increase heart rate, and cause myocardial infarction. Clients often tolerate heart rates as low as 50. The beta blocker might blunt the compensatory increase in heart rate with exercise. Hypoglycemia can occur.The nurse recognizes that calcium channel blockers prescribed for treatment of angina

exert their effect by:

• Increasing preload.
• Decreasing afterload.
• Positive chronotropic effect.
• Positive inotropic effect. - Answer- B) Decreasing afterload.

Rationale: Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased afterload).This decreases myocardial oxygen demand, and reduces frequency of anginal pain.The nurse determines that treatment of a client with a beta-adrenergic blocker for

myocardial infarction has been effective when:

• Tachycardia occurs.
• Blood pressure is 90/50.
• Decreased dysrhythmias occur.
• Decreased urinary output occurs. - Answer- C) Decreased dysrhythmias occur.

Rationale: Beta blockers have the ability to decrease heart rate, decrease contractility, and decrease blood pressure, leading to decreased oxygen demand. They also slow conduction, which suppresses dysrhythmias. Tachycardia would not be desired with an MI. A low BP alone would not indicate effective treatment of the MI.

Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease?

• Decrease anxiety
• Enhance myocardial oxygenation
• Administer sublingual nitroglycerin
• Educate the client about his symptoms - Answer- B) Enhance myocardial

oxygenation Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.Medical treatment of coronary artery disease includes which of the following procedures?

• Cardiac catherization
• Coronary artery bypass surgery
• Oral medication therapy
• Percutaneous transluminal coronary angioplasty - Answer- C) Oral medication

therapy Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage. Sublingual nitroglycerin is administered to treat acute angina, but administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.

• Oral medication administration is a noninvasive, medical treatment for coronary artery

disease. Cardiac catherization isn't a treatment, but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.Which of the following is the most common symptom of myocardial infarction (MI)?

• Chest pain
• Dyspnea
• Edema
• Palpitations - Answer- A) Chest pain

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.Which of the following symptoms is the most likely origin of pain the client described as knifelike chest pain that increases in intensity with inspiration?

• Cardiac
• Gastrointestinal
• Musculoskeletal
• Pulmonary - Answer- D) Pulmonary

Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases with movement. Cardiac and GI pains don't change with respiration.Which of the following blood tests is most indicative of cardiac damage?

• Lactate dehydrogenase
• Complete blood count (CBC)
• Troponin I
• Creatine kinase (CK) - Answer- C) Troponin I

Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury.Troponin I levels aren't detectable in people without cardiac injury. Lactate dehydrogenase (LDH) is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes.Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.What is the primary reason for administering morphine to a client with an MI?

• To sedate the client
• To decrease the client's pain
• To decrease the client's anxiety
• To decrease oxygen demand on the client's heart - Answer- D) To decrease oxygen

demand on the client's heart Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons Which of the following conditions is most commonly responsible for myocardial infarction?

• Aneurysm
• Heart failure