Exam 1: Angina MI NCLEX

Exam 1: Angina & MI (NCLEX)

A client admitted for uncontrolled hypertension and chest pain was started on a daily diuretic two days ago upon admission, with prescriptions for a daily basic metabolic panel. The clients potassium level this morning is 2.7 mEq/L. Which action should the nurse take next?

• Notify the healthcare provider that the potassium level is above normal
• Notify the healthcare provider that the potassium level is below normal
• No action is required because the potassium level is within normal limits
• Hold the clients morning diuretic dose - Answer- B

A client arrives at the emergency room complaining of chest pain and dizziness. The client has a history of angina. The healthcare provider prescribes an ECG and lab tests.A change in which component of the ECG tracing should the nurse recognize as the client actively having a myocardial infarction?

• QRS complex
• ST segment
• P wave
• R wave - Answer- B

A client who had a MI receives 15 mg of morphine sulfate for chest pain. 15 minutes after receiving the drug, The client complains of feeling dizzy. What action should the nurse take?

• Determine if this is an allergic reaction
• Place the client in the supine position and take the vital signs
• Elevate the clients head and keep the extremities warm
• Tell the client that this is not a typical sensation after receiving morphine sulfate -

Answer- B A client admitted to the hospital for chest pain is diagnosed with angina. The nurse should teach the client that the most common characteristic of anginal pain is that it is:

• Relieved by rest
• Precipitated by light activity
• Described by sharp or knifelike
• Unaffected by the administration of vasodilators - Answer- A

Anginal pain is commonly relieved by immediate rest because rest decreases the cardiac workload. Angina is usually precipitated by exertion, emotion, or a heavy meal.

anginal pain is usually described as tightness, or heaviness. Nitroglycerin dilates coronary arteries which increases oxygen to the myocardium, decreasing the pain.The healthcare provider prescribes Nitroglycerin ointment to be applied topically every 8 hours for a client who was admitted for chest pain and a MI. Which statement, if made by the client, would indicate understanding of the side effects of nitroglycerin ointment?

"I may experience:

• A headache
• Increased BP readings
• A slow Pulse rate
• Confusion - Answer- A

The most common SE of Nitro is a headache. Additional cardio SE are tachycardia, hypotension and dizziness not confusion.A client is admitted to the ER with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication?

• Gabapentin
• Midazolam
• Alprazolam
• Aspirin - Answer- D

Early administration of aspirin in the setting of acute MI has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, can be lifesaving.A client admitted for uncontrolled hypertension and chest pain was prescribed a low sodium diet and started on furosemide (Lasix). The nurse should instruct the client to include which foods in the diet?

• cabbage
• Liver
• Apples
• Bananas - Answer- D

A client who had several episodes of chest pain is scheduled for an exercise ECG.Which explanation should the nurse include when teaching the client about this procedure?

• "This is a noninvasive test to check your heart's response to physical activity".
• "This test is the definitive method to identify the actual cause of your chest pain".
• "The findings of this test will be of minimal assistance in the treatment of angina".

• "The findings from this minimally invasive test will show how your body reacts to

exercise". - Answer- A This test evaluates the hearts ability to meet the need for additional oxygen in response to the stress of exercising. Changes in the ECG identify dysrhythmias and ST changes indicative of myocardial ischemia. This test assists in the differential diagnosis of chest pain; the diagnosis of heart disease is made via the results of a variety of diagnostic procedures and laboratory tests. This is a valuable test that will influence the diagnosis and treatment of heart disease. This is a noninvasive test.An ECG is prescribed for a client who reports chest pain. What early finding does the nurse expect on the lead over the infarcted area?

• Flattened T waves
• Absence of P waves
• Elevated ST segments
• Disappearance of Q waves - Answer- C

Elevated ST segments are an early typical finding after a MI, because of altered contractility of the heart. Flattened or depressed T waves indicate hypokalemia.Absence of P waves occurs in atrial and ventricular fibrillation Q waves may become distorted with conduction or rhythm problems but they do not disappear unless cardiac standstill occurs.A pregnant woman develops chest pain and is found to be in atrial fibrillation. Which medication would be appropriate to prescribe for this client?

• Warfarin
• Heparin
• Aspirin
• Atenolol - Answer- B

Heparin is the only one of the medications that would be used for this problem and does not cross the placental barrier. Warfarin, atenolol and aspirin cross the placenta and are distributed in breast milk, leading to potential fetal death, neonatal hemorrhage, or intrauterine death.A client with a coronary occlusion is experiencing chest pain and distress. What is the primary reason that the nurse should administer oxygen to this client?

• Prevent dyspnea
• Prevent cyanosis
• Increase oxygen concentration to heart cells
• Increase oxygen tension in the circulating blood - Answer- C

Administration of oxygen increases the transalveolar oxygenngradient, which improves the efficiency of the cardiopulmonary system; this increases the oxygen supply to the heart. Increased oxygen to the heart cells will improve cardiac output, which may or may not prevent dyspnea. Pallor, not cyanosis, is usually associated with MI. Although

administrating oxygen will increase oxygen tension in the circulating blood, it is not specific to heart cells, which are hypoxic when there is a MI.The nurse caring for a client admitted for chest pain and a MI is preparing to apply

nitroglycerin ointment. Before applying, the nurse should:

• Assess the client's pulse rate
• Prepare the site with an alcohol swab
• Remove ointment previously applied
• Expect the client to be relieved of pain within 20 minutes - Answer- C

Before applying the nitro ointment, the nurse should remove the previous ointment. If the previously applied ointment is not removed, the client could receive too much medication. The nurse should assess blood pressure reading, not pulse rate. There is no need to clean the site with alcohol before administration. nitro ointment is not used to treat acute pain.A client presenting to the ER with chest pain and dizziness was found to be having a MI and subsequently suffered cardiac arrest. The ER health care team was able to successfully resuscitate the client. Lab work shows that the client is now acidotic. The

nurse understands that the acidic serum pH most likely is caused from:

• fat forming ketoacids that are broken down.
• The client receiving too much sodium bicarbonate during resuscitation efforts.
• The decreased tissue perfusion that subsequently caused lactic acid production.
• An irregular heartbeat the client experienced during cardiac arrest. - Answer- C

Cardiac arrest causes decreased tissue perfusion, which results in ischemic and cardiac insufficiency. Cardiac insufficiency causes anaerobic metabolism, which leads to lactic acid production. Fat-forming ketoacids occur in diabetes. Too much sodium bicarbonate causes alkalosis, not acidosis. An irregular heartbeat does not cause acidosis necessarily.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

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