1. Answer:
C.
Furosemide, a loop diuretic, does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may move from the periphery, decreasing edema. Fluid load is reduced, lowering blood pressure.
Furosemide, a loop diuretic, does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may move from the periphery, decreasing edema. Fluid load is reduced, lowering blood pressure.
2. Answer:
A
Obesity
is an important risk factor for coronary artery disease that can be modified by
improved diet and weight loss. Family history of coronary artery disease, male
gender, and advancing age increase risk but cannot be modified.
3. Answer:
B.
A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension.
A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension.
4. Answer:
C.
Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness, nor is it intended to prevent bedsores or constipation.
Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase physical fitness, nor is it intended to prevent bedsores or constipation.
5. Answer:
D
Cardiogenic
shock severely impairs the pumping function of the heart muscle, causing diminished
blood flow to the organs of the body. This results in diminished brain function
and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic
shock is a serious complication of myocardial infarction with a high mortality
rate.
6. Answer:
D
A
patient with congestive heart failure and dyspnea may have pulmonary edema,
which can cause severe hypertension. Therefore, taking the patient's blood
pressure should be the first action. Lying flat on the exam table would likely
worsen the dyspnea, and the patient may not tolerate it. Blood draws for
chemistry and ABG will be required, but not prior to the blood pressure
assessment.
7. Answer
D.
Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development.
Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development.
8. Answer
A.
Streptokinase is a clot busting drug and the best choice in this situation.
Streptokinase is a clot busting drug and the best choice in this situation.
9. Answer
B.
Check the intake and output prior to making any decisions about patient care.
Check the intake and output prior to making any decisions about patient care.
10. Answer
B.
Dizziness can be a sign of hypotension, which may be a contraindication with morphine.
Dizziness can be a sign of hypotension, which may be a contraindication with morphine.
11. Answer
C.
The early signs of congestive heart failure (CHF) include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress. A cough may occur in CHF as a result of mucosal swelling and irritation but is not an early sign. Pallor may be noted in the infant with CHF but is also not an early sign.
The early signs of congestive heart failure (CHF) include tachycardia, tachypnea, profuse scalp sweating, fatigue and irritability, sudden weight gain, and respiratory distress. A cough may occur in CHF as a result of mucosal swelling and irritation but is not an early sign. Pallor may be noted in the infant with CHF but is also not an early sign.
12. Answer
A.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.
13. Answer
B.
14. Answer
D. 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.
15. Answer
C.
Coronary thrombosis causes an occlusion of the artery, leading to myocardial death. An aneurysm is an out pouching of a vessel and doesn’t cause an MI. Renal failure can be associated with MI but isn’t a direct cause. Heart failure is usually the result of an MI.
Coronary thrombosis causes an occlusion of the artery, leading to myocardial death. An aneurysm is an out pouching of a vessel and doesn’t cause an MI. Renal failure can be associated with MI but isn’t a direct cause. Heart failure is usually the result of an MI.
16. Answer
A.
Validation of a client’s feeling is the most appropriate response. It gives the client a feeling of comfort and safety. The other three responses give the client false hope. No one can determine if a client experiencing a myocardial infarction will feel or get better and therefore, these responses are inappropriate.
Validation of a client’s feeling is the most appropriate response. It gives the client a feeling of comfort and safety. The other three responses give the client false hope. No one can determine if a client experiencing a myocardial infarction will feel or get better and therefore, these responses are inappropriate.
17. Answer
A.
Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end – diastolic pressure (preload) and systemic vascular resistance.
Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end – diastolic pressure (preload) and systemic vascular resistance.
18. Answer
C.
Arrythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. Heart failure is the second most common complication because the pumping function of the heart is compromised by a myocardial infarction. Pericarditis most commonly results from a bacterial or viral infection but may occur after MI.
Arrythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. Heart failure is the second most common complication because the pumping function of the heart is compromised by a myocardial infarction. Pericarditis most commonly results from a bacterial or viral infection but may occur after MI.
19. Answer
B
20. Answer
C
21. Answer
D
22. Answer
B
Administering supplemental oxygen to the patient is the first priority. Administer oxygen to increase SpO2 to greater than 90% to help prevent further cardiac damage. Sublingual nitroglycerin and morphine are commonly administered after oxygen.
Administering supplemental oxygen to the patient is the first priority. Administer oxygen to increase SpO2 to greater than 90% to help prevent further cardiac damage. Sublingual nitroglycerin and morphine are commonly administered after oxygen.
23. Answer
C.
High Fowler’s position facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen breathing and increase the heart’s workload.
High Fowler’s position facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen breathing and increase the heart’s workload.
24. Answer A.
Kidney disease interferes with metabolism and excretion of Quinidine, resulting in higher drug concentrations in the body. Quinidine can depress myocardial excitability enough to cause cardiac arrest.
25. Answer
C.
Administer oxygen at 2 liters per minute and no more, for if the client is emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function.
Administer oxygen at 2 liters per minute and no more, for if the client is emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function.
26. Answer
is D.
When
dealing with a medical emergency, the rule is airway first, then breathing, and
then circulation. Starting oxygen is the priority.
27. Answer
is C.
Establish an airway Establishing an airway is always the primary objective in a cardiopulmonary arrest.
Establish an airway Establishing an airway is always the primary objective in a cardiopulmonary arrest.
28. Answer is A.
Blood pressure 94/60 Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within normal range (HR 60-100; systolic B/P over 100) in order to safely administer both medications.
29. Answer
A.
When a client has CHF, the goal is to reduce fluid accumulation. One way that this is accomplished is by sodium restriction. Ham, cheese (and most cold cuts, and potao chips are high in sodium. Daily weighing is an appropriate intervention to help the client monitor fluid overload. Most fresh fruits and vegetables are low in sodium.
When a client has CHF, the goal is to reduce fluid accumulation. One way that this is accomplished is by sodium restriction. Ham, cheese (and most cold cuts, and potao chips are high in sodium. Daily weighing is an appropriate intervention to help the client monitor fluid overload. Most fresh fruits and vegetables are low in sodium.
30. Answer
A.
To ensure the best outcome, clients should be able to comply with instructions related to activity, diet, medications, and follow-up health care on discharge from the hospital following an MI. The remaining options indicate that the client will be successful in these areas.
To ensure the best outcome, clients should be able to comply with instructions related to activity, diet, medications, and follow-up health care on discharge from the hospital following an MI. The remaining options indicate that the client will be successful in these areas.
31. Answer
A
32. Answer
C
33. Answer
C
34. Answer
C
35. Answer
B
36. Answer
A
37. Answer
B. vital signs that remain near baseline indicate good cardiac reserve with
exercise.
38. Answer
B.
This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as lactic acid accumulates from poor blood flow, preventing waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.
This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as lactic acid accumulates from poor blood flow, preventing waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.
39. Answer
C
40. Answer
D
41. Answer
C
42. Answer
A
43. Answer
D
44. Answer
B
45. Answer
D
46. Answer
B
47. Answer
C
48. Answer
A
49. Answer
C
50. Answer
C
51. Answer
A
52. Answer D
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.
53. Answer:
D.
A patient with congestive heart failure and dyspnea may have pulmonary edema, which can cause severe hypertension. Therefore, taking the patient's blood pressure should be the first action. Lying flat on the exam table would likely worsen the dyspnea, and the patient may not tolerate it. Blood draws for chemistry and ABG will be required, but not prior to the blood pressure assessment.
A patient with congestive heart failure and dyspnea may have pulmonary edema, which can cause severe hypertension. Therefore, taking the patient's blood pressure should be the first action. Lying flat on the exam table would likely worsen the dyspnea, and the patient may not tolerate it. Blood draws for chemistry and ABG will be required, but not prior to the blood pressure assessment.
54. Answer
D
55. Answer
C
56. Answer
A
58. Answer
B
59. Answer
D
60. Answer
C
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