Review Myocardial Infarction (MI) and Angina Pectoris

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Exam Review

Myocardial Infarction (MI) and Angina Pectoris

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Question 1:

A client comes to the emergency department with chest pain, and the nurse suspects a myocardial infarction (MI). What is the priority action for the nurse?

A. Obtain a detailed health history from the client. B. Administer aspirin as prescribed. C. Perform a complete physical examination. D. Place the client in a supine position.

Answer and Explanation

Choice A:

This choice is incorrect because obtaining a detailed health history is important, but administering aspirin is the priority action in a suspected MI. Aspirin helps to prevent further clot formation and reduces the risk of complications during a myocardial infarction.

Choice B:

This choice is correct. Administering aspirin as prescribed is the priority action in a suspected MI. Aspirin acts as an antiplatelet agent and can help to prevent the formation of blood clots that could exacerbate the blockage in the coronary artery.

Choice C:

This choice is incorrect because while performing a complete physical examination is important, administering aspirin takes precedence in a suspected MI to address the potential clot formation.

Choice D:

This choice is incorrect because placing the client in a supine position is not the priority action in a suspected MI. The client's position should be adjusted based on their comfort and ability to breathe effectively.

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Question 2:

A client is experiencing chest pain that subsides with rest and nitroglycerin administration. The nurse suspects angina pectoris. What type of angina does this presentation most likely indicate?

A. Stable angina. B. Unstable angina. C. Variant (Prinzmetal) angina. D. Microvascular angina.

Answer and Explanation

Choice A:

This choice is correct. Stable angina is typically predictable and occurs with exertion or emotional stress. It subsides with rest and nitroglycerin use. The pain is usually relieved within a few minutes after rest or medication administration.

Choice B:

This choice is incorrect because unstable angina is characterized by chest pain that occurs at rest or with minimal exertion and is more severe and prolonged than stable angina. It may indicate an impending myocardial infarction and requires immediate medical attention.

Choice C:

This choice is incorrect because variant (Prinzmetal) angina is caused by coronary artery vasospasm, which leads to chest pain even at rest. It is not typically relieved by rest and nitroglycerin, but rather by calcium channel blockers or nitrate medications.

Choice D:

This choice is incorrect because microvascular angina is characterized by chest pain caused by abnormalities in the small blood vessels in the heart. It may not always be relieved by nitroglycerin, and it is not the most likely diagnosis in this presentation.

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Question 3:

A nurse is providing education to a client with angina pectoris. What is the nurse's priority teaching point about managing angina episodes?

A. "Take aspirin at the onset of chest pain." B. "Keep a log of activities that trigger your angina." C. "Limit physical activity to avoid exertion." D. "Use nitroglycerin as needed for chest pain relief."

Answer and Explanation

Choice A:

This choice is incorrect because while aspirin is important for clients with angina, the priority teaching point is the use of nitroglycerin for chest pain relief during angina episodes.

Choice B:

This choice is incorrect because keeping a log of triggers can be helpful for managing angina, but it is not the priority teaching point regarding the immediate relief of chest pain.

Choice C:

This choice is incorrect because limiting physical activity to avoid exertion is not the primary management strategy for angina. Moderate exercise, as tolerated, is beneficial for clients with stable angina.

Choice D:

This choice is correct. Nitroglycerin is a vasodilator that helps to relax and widen blood vessels, improving blood flow and relieving chest pain during an angina episode. Teaching the client to use nitroglycerin as needed for chest pain relief is a priority in angina management.

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Question 4:

A nurse is assessing a client with suspected myocardial infarction (MI). Which assessment finding is most indicative of an acute MI?

A. Sharp, stabbing chest pain. B. Chest pain relieved by rest and nitroglycerin. C. Sudden, severe chest pain radiating to the back. D. Mild, intermittent chest discomfort during activity.

Answer and Explanation

Choice A:

This choice is incorrect because sharp, stabbing chest pain is not the typical presentation of an acute MI. It is more common in conditions like pleuritis or pneumothorax.

Choice B:

This choice is incorrect because chest pain relieved by rest and nitroglycerin is more characteristic of stable angina, not an acute MI. Acute MI pain is typically not relieved by these measures.

Choice C:

This choice is correct. Sudden, severe chest pain that radiates to the back is a classic presentation of an acute myocardial infarction. The pain is often described as crushing or pressure-like and may be accompanied by other symptoms such as shortness of breath, diaphoresis, and nausea.

Choice D:

This choice is incorrect because mild, intermittent chest discomfort during activity is more typical of stable angina, not an acute MI. Acute MI pain is usually more severe, prolonged, and occurs at rest or with minimal exertion.

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Question 5:

A client with angina pectoris is prescribed sublingual nitroglycerin tablets. What instructions should the nurse provide about taking nitroglycerin?

A. "Place the tablet under your tongue at the onset of chest pain and swallow it immediately." B. "Take the tablet with a full glass of water at the first sign of chest discomfort." C. "Crush the tablet and mix it with food to enhance its effect." D. "Keep the tablets in their original bottle, away from moisture and heat."

Answer and Explanation

Choice A:

This choice is correct. Sublingual nitroglycerin tablets are designed to be placed under the tongue at the onset of chest pain (angina) for rapid absorption into the bloodstream. The client should not swallow the tablet but rather allow it to dissolve and be absorbed through the mucous membranes under the tongue.

Choice B:

This choice is incorrect because sublingual nitroglycerin should not be taken with a glass of water. It is intended for sublingual use and should not be swallowed whole.

Choice C:

This choice is incorrect because crushing the nitroglycerin tablet or mixing it with food can alter its effectiveness. Sublingual nitroglycerin is formulated for rapid absorption when placed under the tongue.

Choice D:

This choice is incorrect because while keeping the tablets in their original bottle and away from moisture and heat is important for medication storage, it is not directly related to the administration of nitroglycerin. The client should be instructed on proper sublingual administration for immediate chest pain relief.Questions

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Question 6:

A nurse is teaching a client about the pathophysiology of myocardial infarction (MI). What is the primary cause of MI?

A. Vasospasm of the coronary arteries. B. Formation of atherosclerotic plaques. C. Inflammation of the heart muscle. D. Increased heart rate and contractility.

Answer and Explanation

Choice A:

This choice is incorrect because vasospasm of the coronary arteries, known as variant (Prinzmetal) angina, is a type of angina pectoris but not the primary cause of MI. Vasospasms may contribute to the development of unstable angina but are not the primary mechanism leading to MI.

Choice B:

This choice is correct. The formation of atherosclerotic plaques within the coronary arteries is the primary cause of MI. Atherosclerosis is a gradual process of plaque buildup, narrowing the coronary arteries, and reducing blood flow to the heart muscle. If a plaque ruptures, it can lead to the formation of a blood clot that completely obstructs the artery, causing MI.

Choice C:

This choice is incorrect because inflammation of the heart muscle, known as myocarditis, is a separate condition and not the primary cause of MI.

Choice D:

This choice is incorrect because increased heart rate and contractility can be associated with certain conditions but are not the primary cause of MI. MI is primarily caused by atherosclerotic plaque formation and subsequent thrombus formation in the coronary arteries.

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Question 7:

A client asks the nurse about the risk factors for developing angina pectoris. What should the nurse include as a modifiable risk factor for angina?

A. Family history of coronary artery disease. B. Age over 65 years old. C. Hypertension. D. Gender (male).

Answer and Explanation

Choice A:

This choice is incorrect because a family history of coronary artery disease is a non-modifiable risk factor for angina pectoris. It increases the client's risk but cannot be altered through lifestyle changes.

Choice B:

This choice is incorrect because age over 65 years old is a non-modifiable risk factor for angina pectoris. While the risk of angina increases with age, it cannot be changed through lifestyle modifications.

Choice C:

This choice is correct. Hypertension (high blood pressure) is a modifiable risk factor for angina. Managing blood pressure through lifestyle changes, medications, and other interventions can help reduce the risk of developing angina and other cardiovascular diseases.

Choice D:

This choice is incorrect because gender (male) is a non-modifiable risk factor for angina pectoris. While men are generally at higher risk for angina than premenopausal women, gender cannot be changed to alter the risk.

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Question 8:

A nurse is educating a group of clients about the risk factors for myocardial infarction (MI). Which risk factor is considered a non-modifiable risk factor for MI?

A. Smoking. B. Sedentary lifestyle. C. Diabetes mellitus. D. Family history of MI.

Answer and Explanation

Choice A:

This choice is incorrect because smoking is a modifiable risk factor for MI. Cessation of smoking can significantly reduce the risk of developing MI and other cardiovascular diseases.

Choice B:

This choice is incorrect because a sedentary lifestyle is a modifiable risk factor for MI. Engaging in regular physical activity can help reduce the risk of MI.

Choice C:

This choice is incorrect because diabetes mellitus is a modifiable risk factor for MI. Managing diabetes through lifestyle changes, medications, and blood sugar control can help reduce the risk of cardiovascular complications, including MI.

Choice D:

This choice is correct. A family history of MI is a non-modifiable risk factor because it is based on genetic factors that cannot be changed through lifestyle modifications. Having a close relative with a history of MI increases an individual's risk of developing MI, but it cannot be altered or eliminated through lifestyle changes.

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Question 9:

A client with a history of angina pectoris asks the nurse about the underlying cause of the chest pain. What should the nurse explain to the client?

A. "The chest pain is caused by an irregular heart rhythm." B. "The coronary arteries are narrowed, reducing blood flow to the heart muscle." C. "There is inflammation in the lining of the heart, leading to chest discomfort." D. "The heart muscle is overworking, causing temporary oxygen deprivation."

Answer and Explanation

Choice A:

This choice is incorrect because chest pain caused by an irregular heart rhythm is more characteristic of arrhythmias, not angina pectoris.

Choice B:

This choice is correct. Angina pectoris is caused by the narrowing of the coronary arteries due to atherosclerotic plaques, leading to reduced blood flow to the heart muscle during periods of increased demand (e.g., physical exertion, stress).

Choice C:

This choice is incorrect because inflammation in the lining of the heart is associated with conditions like pericarditis or myocarditis, not angina pectoris.

Choice D:

This choice is incorrect because chest pain caused by the heart muscle overworking is more typical of conditions like heart failure, not angina pectoris.

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Question 10:

A client with multiple risk factors for myocardial infarction (MI) asks the nurse how to lower the risk. What should the nurse recommend as the most effective approach?

A. "Engage in regular physical activity and maintain a healthy weight." B. "Limit saturated fat intake and avoid high-cholesterol foods." C. "Quit smoking and reduce alcohol consumption." D. "Control stress through relaxation techniques and counseling."

Answer and Explanation

Choice A:

This choice is correct. Engaging in regular physical activity and maintaining a healthy weight are effective strategies for reducing the risk of MI. Physical activity helps improve cardiovascular health, manage weight, and reduce other risk factors like hypertension and diabetes.

Choice B:

This choice is incorrect because while limiting saturated fat intake is important for heart health, it is not the most effective approach to lower the risk of MI when compared to engaging in physical activity and maintaining a healthy weight.

Choice C:

This choice is incorrect because quitting smoking and reducing alcohol consumption are essential for reducing the risk of MI, but they may not be as effective as regular physical activity and weight management.

Choice D:

This choice is incorrect because controlling stress through relaxation techniques and counseling is beneficial for overall well-being, but it may not be the most effective approach to reduce the risk of MI when compared to regular physical activity and weight management. Stress management is still an important aspect of cardiovascular health, but it should be combined with other lifestyle changes for optimal risk reduction.Questions

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Question 11:

A client is experiencing chest pain and seeks medical attention. The nurse asks the client about the nature of the pain. Which characteristic is most consistent with angina pectoris?

A. Sharp, stabbing pain. B. Constant, burning pain. C. Crushing or pressure-like pain. D. Radiating pain to the left arm.

Answer and Explanation

Choice A:

This choice is incorrect because sharp, stabbing pain is not typically associated with angina pectoris. It may be more characteristic of conditions like pleuritis or musculoskeletal pain.

Choice B:

This choice is incorrect because constant, burning pain is not typical of angina pectoris. It may be associated with conditions like heartburn or gastroesophageal reflux disease (GERD).

Choice C:

This choice is correct. Angina pectoris is often described as a crushing or pressure-like pain in the chest, which can be triggered by exertion or emotional stress. The pain may also radiate to the neck, jaw, or left arm.

Choice D:

This choice is incorrect because radiating pain to the left arm is associated with both angina pectoris and myocardial infarction (MI), but it is not specific enough to differentiate between the two conditions.

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Question 12:

A nurse is assessing a client with suspected myocardial infarction (MI). Which clinical manifestation should the nurse prioritize as an early sign of MI?

A. Diaphoresis (profuse sweating). B. Elevated blood pressure. C. Elevated body temperature. D. Bradycardia (slow heart rate).

Answer and Explanation

Choice A:

This choice is correct. Diaphoresis (profuse sweating) is an early sign of myocardial infarction (MI) and is caused by the activation of the sympathetic nervous system in response to the heart muscle's decreased oxygen supply. Diaphoresis is often accompanied by other symptoms such as chest pain, shortness of breath, and nausea.

Choice B:

This choice is incorrect because elevated blood pressure can occur during an acute MI, but it is not an early sign of the condition.

Choice C:

This choice is incorrect because elevated body temperature is not typically associated with an MI. It may be indicative of an infection or other inflammatory conditions.

Choice D:

This choice is incorrect because bradycardia (slow heart rate) is not an early sign of an MI. Tachycardia (rapid heart rate) is more commonly associated with an acute MI as the body attempts to compensate for the decreased cardiac output.

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Question 13:

A client with angina pectoris complains of chest pain after walking up a flight of stairs. What nursing action is the priority during this angina episode?

A. Administer sublingual nitroglycerin. B. Assist the client to lie flat in bed. C. Obtain an electrocardiogram (ECG). D. Provide oxygen therapy via nasal cannula.

Answer and Explanation

Choice A:

This choice is correct. Administering sublingual nitroglycerin is the priority action during an angina episode. Nitroglycerin acts as a vasodilator and helps relax and widen blood vessels, improving blood flow to the heart and reducing chest pain during an angina attack.

Choice B:

This choice is incorrect because assisting the client to lie flat in bed is not the priority during an angina episode. The client should be positioned in a comfortable position that allows them to breathe easily.

Choice C:

This choice is incorrect because obtaining an electrocardiogram (ECG) is important for assessing the client's cardiac status, but it is not the priority during an ongoing angina episode.

Choice D:

This choice is incorrect because providing oxygen therapy may be beneficial if the client is hypoxic, but it is not the priority during an angina episode. The priority is to administer nitroglycerin to relieve chest pain.

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Question 14:

A client is admitted with chest pain, and the nurse is assessing for clinical manifestations of myocardial infarction (MI). Which sign is characteristic of an MI but not usually seen in stable angina?

A. Pain relieved by rest and nitroglycerin. B. Diaphoresis and nausea. C. Chest pain triggered by emotional stress. D. Shortness of breath and wheezing.

Answer and Explanation

Choice A:

This choice is incorrect because chest pain relieved by rest and nitroglycerin is characteristic of stable angina, not an MI. Stable angina is triggered by physical exertion or emotional stress and is usually relieved by rest and nitroglycerin use.

Choice B:

This choice is correct. Diaphoresis (profuse sweating) and nausea are clinical manifestations commonly associated with an MI but not usually seen in stable angina. These symptoms are a result of the sympathetic nervous system's response to the heart muscle's decreased oxygen supply during an MI.

Choice C:

This choice is incorrect because chest pain triggered by emotional stress is characteristic of stable angina, not an MI. Emotional stress can cause vasospasms in the coronary arteries, leading to angina episodes.

Choice D:

This choice is incorrect because shortness of breath and wheezing may occur in both stable angina and MI, especially if the heart's pumping ability is compromised. These symptoms are not specific to MI and can also be seen in other cardiac and respiratory conditions.

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Question 15:

A client is admitted with chest pain, and the nurse is assessing for clinical manifestations of myocardial infarction (MI). Which assessment finding is concerning and requires immediate action?

A. Blood pressure of 130/80 mmHg. B. Heart rate of 90 beats per minute. C. Oxygen saturation of 95% on room air. D. Elevated ST segment on the electrocardiogram (ECG).

Answer and Explanation

Choice A:

This choice is not the most concerning finding among the options presented. A blood pressure of 130/80 mmHg is within a normal range and does not indicate an immediate risk to the client.

Choice B:

This choice is not the most concerning finding among the options presented. A heart rate of 90 beats per minute is within a normal range and does not indicate an immediate risk to the client.

Choice C:

This choice is not the most concerning finding among the options presented. An oxygen saturation of 95% on room air is within a normal range and does not indicate an immediate risk to the client.

Choice D:

This choice is correct. An elevated ST segment on the electrocardiogram (ECG) is an important sign of an acute myocardial infarction (MI). It indicates myocardial ischemia and injury. The nurse should take immediate action, such as notifying the healthcare provider and implementing appropriate interventions for the client's acute coronary syndrome. Prompt medical intervention is crucial to minimize cardiac damage and improve the client's prognosis.Questions

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Question 16:

A client presents to the emergency department with chest pain and is suspected of having a myocardial infarction (MI). The client asks the nurse about the diagnostic test used to confirm the diagnosis. Which test should the nurse mention?

A. Electrocardiogram (ECG). B. Echocardiogram. C. Magnetic Resonance Imaging (MRI). D. Chest X-ray.

Answer and Explanation

Choice A:

This choice is correct. An electrocardiogram (ECG) is one of the primary diagnostic tests used to confirm the diagnosis of a myocardial infarction (MI). An ECG can show characteristic changes, such as ST-segment elevation or Q waves, indicative of myocardial ischemia and injury.

Choice B:

This choice is incorrect because an echocardiogram is a useful imaging test to assess the heart's structure and function, but it is not the primary diagnostic test for confirming an MI.

Choice C:

This choice is incorrect because a magnetic resonance imaging (MRI) is a valuable tool for assessing heart function and detecting certain cardiac abnormalities, but it is not typically the initial diagnostic test for MI.

Choice D:

This choice is incorrect because a chest X-ray can help identify other conditions like pulmonary edema or lung disorders, but it is not the primary diagnostic test for MI.

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Question 17:

A client is admitted with chest pain, and the nurse suspects angina pectoris. Which diagnostic test would the nurse expect to be ordered as an initial assessment?

A. Troponin levels. B. Stress test. C. Coronary angiography. D. Cardiac catheterization.

Answer and Explanation

Choice A:

This choice is correct. Measuring troponin levels in the blood is a common initial diagnostic test for evaluating suspected angina pectoris or myocardial infarction (MI). Troponins are specific markers released into the bloodstream when there is cardiac muscle damage, and elevated troponin levels indicate myocardial injury.

Choice B:

This choice is incorrect because a stress test is used to assess the heart's response to increased demand and is typically performed after the initial evaluation, such as measuring troponin levels, to confirm the presence of angina or MI.

Choice C:

This choice is incorrect because coronary angiography is an invasive procedure used to visualize the coronary arteries and assess for blockages. It is not typically the initial diagnostic test for angina pectoris or MI.

Choice D:

This choice is incorrect because cardiac catheterization is an invasive procedure used to measure pressures within the heart and evaluate coronary artery blockages. It is not typically the initial diagnostic test for angina pectoris or MI.

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Question 18:

A client is undergoing a stress test to evaluate possible myocardial ischemia. What is the primary purpose of this test?

A. To assess for the presence of atherosclerotic plaques. B. To measure cardiac biomarker levels in the blood. C. To evaluate the heart's response to increased demand. D. To visualize the coronary arteries for blockages.

Answer and Explanation

Choice A:

This choice is incorrect because a stress test is not primarily used to assess for the presence of atherosclerotic plaques. It is used to evaluate the heart's response to increased demand and identify exercise-induced changes in the ECG, which may indicate myocardial ischemia.

Choice B:

This choice is incorrect because a stress test does not measure cardiac biomarker levels in the blood. Cardiac biomarkers like troponin are typically measured through blood tests to diagnose myocardial infarction (MI).

Choice C:

This choice is correct. The primary purpose of a stress test is to evaluate the heart's response to increased demand, such as physical exercise or the administration of medication that simulates exercise. During the test, the client's heart rate, blood pressure, and ECG are monitored for signs of ischemia.

Choice D:

This choice is incorrect because a stress test is not used to visualize the coronary arteries for blockages. It is a non-invasive test primarily used to assess the heart's functional capacity.

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Question 19:

A client with suspected angina pectoris is scheduled for a coronary angiography. The client asks the nurse about the purpose of the test. How should the nurse respond?

A. "Coronary angiography will measure the levels of cardiac biomarkers in your blood." B. "It is a stress test that evaluates your heart's response to increased demand." C. "The test involves injecting dye into your coronary arteries to visualize any blockages." D. "Coronary angiography will assess your heart's function using sound waves."

Answer and Explanation

Choice A:

This choice is incorrect because measuring the levels of cardiac biomarkers in the blood is not the purpose of coronary angiography. Cardiac biomarkers are measured through blood tests to diagnose conditions like myocardial infarction (MI).

Choice B:

This choice is incorrect because a stress test evaluates the heart's response to increased demand and is different from coronary angiography.

Choice C:

This choice is correct. Coronary angiography is an invasive procedure that involves injecting a contrast dye into the coronary arteries. The dye allows visualization of the coronary arteries and identifies any blockages or narrowing that may be causing angina or other cardiac symptoms.

Choice D:

This choice is incorrect because assessing the heart's function using sound waves is characteristic of an echocardiogram, not coronary angiography.Questions

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Question 20:

A nurse is caring for a client experiencing chest pain and suspecting myocardial infarction (MI). What is the priority nursing intervention during the initial assessment?

A. Administering sublingual nitroglycerin. B. Obtaining a 12-lead electrocardiogram (ECG). C. Initiating intravenous (IV) access. D. Administering aspirin.

Answer and Explanation

Choice A:

This choice is incorrect because administering sublingual nitroglycerin is an important intervention to relieve chest pain in clients with angina pectoris, but obtaining a 12-lead ECG is the priority in a client suspected of experiencing an MI. The ECG helps in diagnosing MI and determining the appropriate treatment plan.

Choice B:

This choice is correct. The priority nursing intervention during the initial assessment of a client with suspected MI is to obtain a 12-lead ECG. The ECG provides crucial information about cardiac electrical activity and helps identify ST-segment elevation, indicating myocardial ischemia or injury.

Choice C:

This choice is incorrect because initiating intravenous (IV) access is an essential step in the management of an MI, but it is not the priority over obtaining a 12-lead ECG.

Choice D:

This choice is incorrect because administering aspirin is an essential intervention during an MI to help reduce platelet aggregation and prevent further clot formation. However, obtaining a 12-lead ECG takes precedence in the initial assessment to confirm the diagnosis and guide further interventions.

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Question 21:

A client with angina pectoris reports chest pain and is receiving oxygen therapy. The client asks the nurse about the purpose of oxygen administration. How should the nurse respond?

A. "Oxygen reduces chest pain by dilating your coronary arteries." B. "Oxygen helps your heart pump blood more effectively." C. "Oxygen increases your oxygen levels and relieves shortness of breath." D. "Oxygen prevents further clot formation in your coronary arteries."

Answer and Explanation

Choice A:

This choice is correct. Oxygen administration helps dilate coronary arteries, increasing the oxygen supply to the heart muscle. This action can reduce chest pain and alleviate myocardial ischemia associated with angina pectoris.

Choice B:

This choice is incorrect because oxygen administration does not directly impact the heart's pumping ability. It primarily improves oxygenation to the heart muscle.

Choice C:

This choice is incorrect because although oxygen therapy does increase oxygen levels in the blood, its primary purpose in angina pectoris is to alleviate chest pain by dilating the coronary arteries.

Choice D:

This choice is incorrect because oxygen administration does not prevent further clot formation in coronary arteries. Aspirin and other anticoagulant medications are used to prevent clot formation in acute coronary syndrome.

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Question 22:

A client with angina pectoris is receiving sublingual nitroglycerin for chest pain relief. After administering the medication, what should the nurse instruct the client to do?

A. Lie down in bed and rest for at least 30 minutes. B. Monitor blood pressure and heart rate every 15 minutes. C. Avoid drinking water or any fluids for an hour. D. Sit or lie down and avoid sudden position changes.

Answer and Explanation

Choice A:

This choice is incorrect because while rest is essential during an angina episode, lying down in bed for an extended period is not necessary after administering nitroglycerin.

Choice B:

This choice is incorrect because monitoring blood pressure and heart rate every 15 minutes is not a standard nursing intervention after nitroglycerin administration. Monitoring vital signs as needed for the client's condition is appropriate.

Choice C:

This choice is incorrect because there is no need for the client to avoid drinking water or fluids after taking sublingual nitroglycerin.

Choice D:

This choice is correct. After taking sublingual nitroglycerin for chest pain relief, the client should sit or lie down and avoid sudden position changes. Nitroglycerin can cause systemic vasodilation and may lead to orthostatic hypotension, increasing the risk of dizziness or falls if the client stands up abruptly. Taking a seated or lying position reduces this risk and allows the medication to work effectively to relieve chest pain.

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Question 23:

A nurse is caring for a client with a confirmed myocardial infarction (MI) and a history of congestive heart failure (CHF). The client is prescribed a medication to reduce myocardial oxygen demand. Which medication should the nurse expect to administer?

A. Furosemide. B. Metoprolol. C. Aspirin. D. Nitroglycerin.

Answer and Explanation

Choice A:

This choice is incorrect because furosemide is a loop diuretic used to treat fluid retention and edema in clients with congestive heart failure (CHF), but it does not directly reduce myocardial oxygen demand.

Choice B:

This choice is correct. Metoprolol is a beta-blocker that reduces heart rate and blood pressure, resulting in decreased myocardial oxygen demand. It is often prescribed to clients with an MI and a history of CHF to improve cardiac function and reduce the workload on the heart.

Choice C:

This choice is incorrect because aspirin is an antiplatelet medication that prevents further clot formation and is commonly prescribed in clients with acute coronary syndrome, including MI. While it is beneficial in the context of MI management, it does not directly reduce myocardial oxygen demand.

Choice D:

This choice is incorrect because nitroglycerin is a vasodilator used to relieve chest pain (angina) by dilating blood vessels and increasing blood flow to the heart muscle. While it helps reduce anginal symptoms, it does not directly reduce myocardial oxygen demand as metoprolol does.

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Question 24:

A client with angina pectoris is prescribed sublingual nitroglycerin for chest pain episodes. The nurse educates the client about its administration. Which statement by the client indicates understanding of the instructions?

A. "I will swallow the tablet with water to relieve the pain quickly." B. "I should take the medication 30 minutes before a meal." C. "I will place the tablet under my tongue when chest pain starts." D. "I can take the nitroglycerin every day to prevent chest pain."

Answer and Explanation

Choice A:

This choice is incorrect because sublingual nitroglycerin should not be swallowed with water. It is intended to dissolve under the tongue for rapid absorption into the bloodstream to provide quick relief from chest pain.

Choice B:

This choice is incorrect because the timing of nitroglycerin administration is not dependent on meals. Sublingual nitroglycerin should be taken as needed when chest pain occurs.

Choice C:

This choice is correct. Sublingual nitroglycerin is administered by placing the tablet under the tongue, where it dissolves and is absorbed directly into the bloodstream. This method allows for rapid onset of action and is used to relieve acute chest pain.

Choice D:

This choice is incorrect because sublingual nitroglycerin is not meant for daily or preventive use. It is specifically used to treat acute episodes of chest pain (angina) and should be taken only when needed. Clients with angina may be prescribed long-acting nitroglycerin preparations for prophylactic use, but sublingual nitroglycerin is intended for immediate relief of anginal symptoms.Questions

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Question 25:

A client with acute myocardial infarction (MI) is prescribed aspirin. The client asks the nurse about the purpose of this medication. How should the nurse respond?

A. "Aspirin helps dilate your coronary arteries and increase blood flow to your heart." B. "It prevents blood clot formation and reduces the risk of further blockages in your coronary arteries." C. "Aspirin lowers your blood pressure and helps your heart pump more efficiently." D. "It is used to relieve chest pain and reduce inflammation in your heart muscle."

Answer and Explanation

Choice A:

This choice is incorrect because aspirin does not directly dilate coronary arteries. Aspirin's primary action in MI management is its antiplatelet effect, which prevents platelets from clumping together and forming blood clots in coronary arteries, reducing the risk of further blockages.

Choice B:

This choice is correct. Aspirin is commonly prescribed during an acute MI to prevent blood clot formation and reduce the risk of further blockages in the coronary arteries. It is a crucial medication in the management of acute coronary syndrome.

Choice C:

This choice is incorrect because aspirin's primary action is not to lower blood pressure or improve cardiac pumping efficiency. These actions are typically achieved through other medications, such as beta-blockers or ACE inhibitors, in the management of MI.

Choice D:

This choice is incorrect because while aspirin is used to relieve pain and reduce inflammation, its primary role in MI management is its antiplatelet effect, as mentioned earlier.

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Question 26:

A nurse is caring for a client with unstable angina and receives an order for antiplatelet therapy. Which medication should the nurse expect to administer?

A. Clopidogrel (Plavix). B. Nitroglycerin. C. Atorvastatin (Lipitor). D. Metoprolol.

Answer and Explanation

Choice A:

This choice is correct. Clopidogrel (Plavix) is an antiplatelet medication commonly prescribed for clients with unstable angina to prevent platelet aggregation and reduce the risk of blood clot formation in coronary arteries.

Choice B:

This choice is incorrect because nitroglycerin is a vasodilator used to relieve angina symptoms, but it does not have the antiplatelet effect necessary for managing unstable angina.

Choice C:

This choice is incorrect because atorvastatin is a statin medication used to lower cholesterol levels and prevent cardiovascular events, but it does not have the antiplatelet effect required for managing unstable angina.

Choice D:

This choice is incorrect because metoprolol is a beta-blocker used to reduce heart rate and blood pressure, but it is not an antiplatelet agent like clopidogrel.

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Question 27:

A client who had an acute myocardial infarction (MI) is scheduled for percutaneous coronary intervention (PCI). The client asks the nurse about the purpose of this procedure. How should the nurse respond?

A. "PCI is used to relieve chest pain and reduce inflammation in your heart muscle." B. "It involves the placement of a stent in your coronary artery to keep it open and improve blood flow to your heart." C. "PCI will help lower your blood pressure and improve your heart's pumping function." D. "It is a surgical procedure to bypass blocked coronary arteries and restore blood flow to your heart."

Answer and Explanation

Choice A:

This choice is incorrect because while PCI can indirectly relieve chest pain by restoring blood flow to the heart, its primary purpose is not to reduce inflammation in the heart muscle.

Choice B:

This choice is correct. Percutaneous coronary intervention (PCI) involves the insertion of a catheter with a balloon at the tip into the blocked coronary artery. The balloon is inflated to compress the plaque and open the artery, and then a stent is placed to keep the artery open and improve blood flow to the heart.

Choice C:

This choice is incorrect because PCI's primary purpose is not to lower blood pressure but to restore blood flow to the heart by treating coronary artery blockages.

Choice D:

This choice is incorrect because the description provided is more characteristic of coronary artery bypass grafting (CABG) surgery, not PCI.

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Question 28:

A client with unstable angina is prescribed heparin therapy. The client asks the nurse about the purpose of this medication. How should the nurse respond?

A. "Heparin is used to dissolve blood clots in your coronary arteries and restore blood flow to your heart." B. "It helps relax your blood vessels and improve blood flow to your heart muscle." C. "Heparin is an anticoagulant that prevents further clot formation in your coronary arteries." D. "It is a pain reliever used to reduce chest discomfort during episodes of angina."

Answer and Explanation

Choice A:

This choice is incorrect because heparin does not directly dissolve existing blood clots in coronary arteries. It is used to prevent further clot formation and growth.

Choice B:

This choice is incorrect because heparin's primary action is not to relax blood vessels. It is an anticoagulant that inhibits clot formation.

Choice C:

This choice is correct. Heparin is an anticoagulant medication used to prevent further clot formation in coronary arteries and reduce the risk of complications in clients with unstable angina.

Choice D:

This choice is incorrect because heparin is not a pain reliever. It does not directly address chest discomfort during angina episodes; its role is in preventing and managing thrombosis.

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Question 29:

A client with ST-elevation myocardial infarction (STEMI) is admitted to the emergency department. The healthcare provider orders fibrinolytic therapy. What is the primary purpose of fibrinolytic therapy in this situation?

A. To reduce heart rate and blood pressure. B. To dissolve existing blood clots in coronary arteries. C. To stabilize the heart's electrical activity. D. To improve oxygen supply to the heart muscle.

Answer and Explanation

Choice A:

This choice is incorrect because fibrinolytic therapy is not used to reduce heart rate and blood pressure. Its primary purpose is to dissolve blood clots that are causing the myocardial infarction.

Choice B:

This choice is correct. Fibrinolytic therapy, also known as thrombolytic therapy, is used to break down existing blood clots in coronary arteries during an ST-elevation myocardial infarction (STEMI). By dissolving the clot, blood flow to the heart muscle can be restored and prevent further damage.

Choice C:

This choice is incorrect because stabilizing the heart's electrical activity is not the primary purpose of fibrinolytic therapy. It is used to address the mechanical obstruction caused by the clot in coronary arteries.

Choice D:

This choice is incorrect because although fibrinolytic therapy does improve blood flow to the heart muscle by dissolving clots, its primary purpose is not to improve oxygen supply directly. Rather, it aims to restore blood flow by eliminating the clot causing the infarction.

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Question 30:

A client with unstable angina is scheduled for coronary artery bypass grafting (CABG). The client asks the nurse about the purpose of this surgery. How should the nurse respond?

A. "CABG surgery involves inserting a stent to keep your coronary artery open and improve blood flow to your heart." B. "It is a procedure to remove plaque from your coronary arteries and improve blood circulation." C. "CABG surgery is a minimally invasive procedure to repair damaged heart valves and improve cardiac function." D. "It is a surgical procedure to bypass blocked coronary arteries and restore blood flow to your heart."

Answer and Explanation

Choice A:

This choice is incorrect because inserting a stent is a part of percutaneous coronary intervention (PCI) and not coronary artery bypass grafting (CABG). CABG involves using blood vessels (grafts) to bypass blocked coronary arteries and restore blood flow to the heart.

Choice B:

This choice is incorrect because removing plaque from coronary arteries is not the primary purpose of CABG. CABG involves bypassing blocked arteries rather than removing the plaque.

Choice C:

This choice is incorrect because repairing damaged heart valves and improving cardiac function is a different surgical procedure, such as valve repair or replacement surgery. CABG does not address heart valve issues.

Choice D:

This choice is correct. Coronary artery bypass grafting (CABG) is a surgical procedure that involves taking a healthy blood vessel from another part of the body and grafting it to the blocked coronary artery. The graft bypasses the blockage, restoring blood flow to the heart and improving myocardial oxygen supply. CABG is used to treat significant coronary artery disease and improve cardiac function in clients with unstable angina or myocardial infarction.

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Question 31:

A client with angina pectoris is prescribed ranolazine (Ranexa) as an anti-anginal medication. What is the primary action of ranolazine in managing angina?

A. Increasing heart rate and cardiac output. B. Dilating coronary arteries and improving blood flow to the heart. C. Reducing myocardial oxygen demand and improving oxygen utilization. D. Preventing platelet aggregation and reducing the risk of clot formation.

Answer and Explanation

Choice A:

This choice is incorrect because ranolazine does not increase heart rate and cardiac output. Instead, it has a neutral effect on heart rate.

Choice B:

This choice is incorrect because ranolazine does not directly dilate coronary arteries. Its primary action is to reduce myocardial oxygen demand and improve oxygen utilization in the heart.

Choice C:

This choice is correct. Ranolazine is an anti-anginal medication that primarily works by reducing myocardial oxygen demand. It achieves this by inhibiting the late sodium current in cardiac cells, which helps decrease intracellular calcium levels, thereby reducing the energy required for the heart's contraction and relaxation. This results in improved oxygen utilization in the heart muscle and decreased anginal symptoms.

Choice D:

This choice is incorrect because ranolazine is not an antiplatelet medication. Its mechanism of action is related to its effects on myocardial oxygen demand and utilization, not its impact on platelet aggregation and clot formation.Questions

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Question 32:

A client who recently had a myocardial infarction (MI) is scheduled to start a cardiac rehabilitation program. The client asks the nurse about the purpose of this program. How should the nurse respond?

A. "Cardiac rehabilitation helps strengthen your heart muscle and improves blood flow to your coronary arteries." B. "It involves lifestyle changes to prevent future heart attacks and promote heart health." C. "Cardiac rehabilitation focuses on psychological counseling to help you cope with the emotional impact of an MI." D. "It is a program that includes physical exercise to improve your lung function and oxygenation."

Answer and Explanation

Choice A:

This choice is incorrect because while cardiac rehabilitation may have cardiovascular benefits, its primary focus is on promoting overall heart health and reducing the risk of future heart attacks through lifestyle changes and education.

Choice B:

This choice is correct. Cardiac rehabilitation is a comprehensive program that aims to improve the overall cardiovascular health of individuals who have experienced a myocardial infarction or other heart conditions. It involves a combination of exercise, education, and counseling to support lifestyle changes that promote heart health and prevent future cardiovascular events.

Choice C:

This choice is incorrect because while psychological counseling may be a part of the cardiac rehabilitation program, it is not the primary purpose. The main focus is on physical and lifestyle aspects to improve cardiovascular health.

Choice D:

This choice is incorrect because cardiac rehabilitation does involve physical exercise, but the primary goal is not to improve lung function and oxygenation. Instead, it aims to improve cardiovascular endurance, strength, and overall heart health.

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Question 33:

A client who recently had an MI is instructed to participate in cardiac rehabilitation. The client asks the nurse about the benefits of exercise in the program. How should the nurse respond?

A. "Exercise will help you lose weight and reduce your risk of developing diabetes." B. "It improves blood flow to your heart and can help lower your blood pressure." C. "Exercise is primarily for building muscle strength and improving bone health." D. "It helps you cope with stress and anxiety related to your heart condition."

Answer and Explanation

Choice A:

This choice is incorrect because while exercise can contribute to weight loss and reduce the risk of diabetes, its primary benefit in cardiac rehabilitation is related to cardiovascular health, specifically improving blood flow to the heart and lowering blood pressure.

Choice B:

This choice is correct. Regular exercise in cardiac rehabilitation has significant benefits for the cardiovascular system. It improves blood flow to the heart muscle, enhances collateral circulation, and can help lower blood pressure, all of which are crucial in managing and preventing further complications after an MI.

Choice C:

This choice is incorrect because although exercise can help build muscle strength and improve bone health, these are not the primary benefits sought in cardiac rehabilitation. The focus is on cardiovascular health and recovery.

Choice D:

This choice is incorrect because while exercise can have positive effects on mental health, such as reducing stress and anxiety, its primary benefit in cardiac rehabilitation is related to cardiovascular health.

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Question 34:

A nurse is providing education to a client who recently had an MI about dietary changes to improve heart health. The nurse advises the client to limit intake of saturated fats. Which food choices should the client avoid to comply with this recommendation?

A. Nuts and seeds. B. Avocado and olive oil. C. Fatty cuts of red meat and butter. D. Whole grains and legumes.

Answer and Explanation

Choice A:

This choice is incorrect because nuts and seeds are sources of healthy fats and can be beneficial for heart health when consumed in moderation.

Choice B:

This choice is incorrect because avocado and olive oil are sources of monounsaturated fats, which are considered heart-healthy fats. They can be included in a heart-healthy diet.

Choice C:

This choice is correct. Saturated fats, commonly found in fatty cuts of red meat and butter, are known to increase LDL cholesterol levels and should be limited in a heart-healthy diet to reduce the risk of future cardiovascular events.

Choice D:

This choice is incorrect because whole grains and legumes are sources of complex carbohydrates and plant-based proteins that can be part of a heart-healthy diet. They provide essential nutrients and fiber that are beneficial for heart health.

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Question 35:

A client who had an MI is advised to quit smoking to reduce the risk of future cardiac events. The client expresses difficulty in quitting and asks the nurse for suggestions. What should the nurse recommend?

A. "Switch to e-cigarettes or vaping as a less harmful alternative to smoking." B. "Gradually decrease the number of cigarettes you smoke each day." C. "Consider nicotine replacement therapy, such as patches or gum, to manage cravings." D. "Set a quit date and avoid situations or triggers that make you want to smoke."

Answer and Explanation

Choice A:

This choice is incorrect because e-cigarettes and vaping are not considered safe alternatives to smoking and are not recommended as a way to quit smoking. They can also pose health risks to the cardiovascular system.

Choice B:

This choice is incorrect because gradually decreasing cigarette intake may not be as effective as setting a quit date and quitting smoking altogether.

Choice C:

This choice is incorrect because while nicotine replacement therapy (NRT) can be helpful for some individuals in managing cravings during the quitting process, it is not the primary recommendation. Avoiding triggers and setting a quit date are essential strategies for successful smoking cessation.

Choice D:

This choice is correct. Setting a quit date is an effective approach to quitting smoking. It allows individuals to mentally prepare for the change and commit to the process. Avoiding situations or triggers that may lead to smoking is also crucial for breaking the habit and preventing relapse.

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Question 36:

A nurse is providing education to a client with angina about stress management techniques. The client asks the nurse how stress affects the heart. How should the nurse respond?

A. "Stress causes the heart to pump faster, increasing blood flow to the body." B. "It leads to vasodilation of the coronary arteries, improving blood flow to the heart." C. "Stress triggers the release of adrenaline, which can constrict coronary arteries and increase heart rate." D. "It suppresses the sympathetic nervous system, leading to decreased heart rate and blood pressure."

Answer and Explanation

Choice A:

This choice is incorrect because stress does not cause the heart to pump faster. While stress can activate the sympathetic nervous system and increase heart rate, the primary impact on the heart is related to hormonal responses.

Choice B:

This choice is incorrect because stress-induced vasodilation of coronary arteries is not a typical response. Instead, stress can lead to vasoconstriction, potentially reducing blood flow to the heart.

Choice C:

This choice is correct. During stress, the body releases adrenaline (epinephrine) and other stress hormones, which can lead to vasoconstriction of coronary arteries, reducing blood flow to the heart muscle. Additionally, the release of adrenaline can increase heart rate, resulting in increased myocardial oxygen demand.

Choice D:

This choice is incorrect because stress activates the sympathetic nervous system, leading to increased heart rate and blood pressure rather than suppressing these responses.

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Question 37:

A client who experienced an MI is prescribed beta-blocker medication. The client asks the nurse about the purpose of this medication. How should the nurse respond?

A. "Beta-blockers help dilate your blood vessels, improving blood flow to your heart." B. "It reduces your cholesterol levels and prevents the formation of plaques in your arteries." C. "Beta-blockers lower your blood pressure and decrease the workload of your heart." D. "It prevents blood clots from forming in your coronary arteries and causing another MI."

Answer and Explanation

Choice A:

This choice is incorrect because beta-blockers do not directly dilate blood vessels. They primarily work by blocking the effects of adrenaline on the heart and blood vessels, leading to decreased heart rate and reduced blood pressure.

Choice B:

This choice is incorrect because beta-blockers do not directly affect cholesterol levels or prevent the formation of plaques in arteries. Their primary action is on the cardiovascular system, particularly the heart and blood pressure.

Choice C:

This choice is correct. Beta-blockers are commonly prescribed after an MI to reduce the workload of the heart and lower blood pressure. By blocking the effects of adrenaline, they help slow down the heart rate and reduce the force of contraction, thereby decreasing myocardial oxygen demand and improving the heart's efficiency.

Choice D:

This choice is incorrect because beta-blockers do not directly prevent blood clot formation in coronary arteries. Anticoagulant or antiplatelet medications are used to reduce the risk of clot formation in individuals at high risk for recurrent heart attacks.

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Question 38:

A nurse is providing education to a client who recently had an MI about the importance of medication adherence. The client expresses concerns about potential side effects of the prescribed medications. What should the nurse do to address the client's concerns effectively?

A. Encourage the client to stop taking the medications if side effects occur. B. Explain that side effects are rare and unlikely to happen. C. Provide information about possible side effects and when to report them to the healthcare provider. D. Suggest the client take over-the-counter medications to manage any side effects.

Answer and Explanation

Choice A:

This choice is incorrect because encouraging the client to stop taking medications without consulting the healthcare provider can be dangerous, especially after an MI. Medications prescribed after an MI are essential for managing cardiovascular risks and should not be discontinued without medical advice.

Choice B:

This choice is incorrect because it is not appropriate to downplay the potential side effects of medications. While side effects may be uncommon, it is essential to provide accurate information and address the client's concerns.

Choice C:

This choice is correct. Providing information about possible side effects and instructing the client to report any adverse reactions to the healthcare provider is essential. It empowers the client to recognize and manage potential side effects appropriately, ensuring that any concerns are addressed promptly by the healthcare team.

Choice D:

This choice is incorrect because suggesting over-the-counter medications without consulting the healthcare provider can be unsafe and may interact with prescribed medications. It is essential to address side effects with the healthcare team for appropriate management and adjustments to the medication regimen if needed.Questions

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Question 39:

A nurse is caring for a client admitted with chest pain, and the healthcare provider orders a cardiac biomarker test. Which biomarker is most specific for diagnosing a myocardial infarction (MI)?

A. Myoglobin. B. C-reactive protein (CRP). C. Brain natriuretic peptide (BNP). D. Troponin.

Answer and Explanation

Choice A:

This choice is incorrect because myoglobin is a cardiac biomarker that may be elevated in MI, but it lacks specificity and can also be elevated in other conditions like skeletal muscle injury.

Choice B:

This choice is incorrect because C-reactive protein (CRP) is an inflammatory marker and is not specific to MI. It may be elevated in various inflammatory conditions.

Choice C:

This choice is incorrect because brain natriuretic peptide (BNP) is a biomarker associated with heart failure and is not specific to diagnosing MI.

Choice D:

This choice is correct. Troponin is the most specific biomarker for diagnosing MI. Elevated troponin levels in the blood indicate cardiac muscle damage, making it a reliable marker for myocardial infarction. Troponin levels rise shortly after the onset of MI and remain elevated for several days, making it valuable in both early and delayed MI detection.

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Question 40:

A client with suspected myocardial infarction (MI) is admitted to the emergency department. The nurse asks the client about the onset and duration of chest pain. Which response should the nurse consider as indicative of an MI?

A. "The pain started suddenly and has lasted for 30 minutes." B. "I have been experiencing chest discomfort for the past few days." C. "The pain comes and goes, lasting only a few seconds at a time." D. "I had a similar episode of chest pain a few months ago."

Answer and Explanation

Choice A:

This choice is correct. The sudden onset of chest pain lasting for 30 minutes is a typical clinical manifestation of myocardial infarction (MI). The duration and intensity of chest pain are important indicators that suggest an acute cardiac event.

Choice B:

This choice is incorrect because chest discomfort lasting for a few days may be more characteristic of unstable angina, not an MI. Unstable angina is also a serious condition that requires prompt medical attention, but it is not synonymous with MI.

Choice C:

This choice is incorrect because chest pain that comes and goes, lasting only a few seconds at a time, is not typical of an MI. Such symptoms may indicate other non-cardiac conditions or stable angina.

Choice D:

This choice is incorrect because a similar episode of chest pain a few months ago is not indicative of the current acute event. The nurse should focus on the client's current symptoms and their acute presentation to determine the appropriate interventions.

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Question 41:

A nurse is caring for a client admitted with myocardial infarction (MI). The client's blood pressure drops, and the client becomes restless and anxious. What intervention should the nurse initiate first?

A. Administer oxygen therapy. B. Elevate the client's legs. C. Obtain a 12-lead electrocardiogram (ECG). D. Initiate cardiopulmonary resuscitation (CPR).

Answer and Explanation

Choice A:

This choice is correct. Administering oxygen therapy is the priority intervention when a client with MI experiences a drop in blood pressure and becomes restless and anxious. Oxygen can improve tissue oxygenation and help stabilize the client's condition.

Choice B:

This choice is incorrect because elevating the client's legs may be beneficial in certain situations, but it is not the priority when the client is experiencing a drop in blood pressure and restlessness due to MI.

Choice C:

This choice is incorrect because obtaining a 12-lead ECG is important for assessing and diagnosing MI, but it is not the priority when the client's condition is deteriorating rapidly.

Choice D:

This choice is incorrect because initiating cardiopulmonary resuscitation (CPR) is not indicated in this scenario. The client is still conscious and experiencing symptoms, indicating a need for prompt oxygen administration and further assessment.

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Myocardial Infarction (MI) and Angina Pectoris

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