Chest Pain
A 58-year-old patient presents to the emergency department with chest pressure radiating to the jaw and left arm. The nurse notes diaphoresis and shortness of breath.
Which assessment finding most strongly suggests myocardial ischemia?
A. Sharp pain that worsens with inspiration
B. Crushing substernal chest pressure
C. Pain relieved by position changes
D. Localized chest wall tenderness
B. Crushing substernal chest pressure
A patient with chest pain arrives in the emergency department.
Which diagnostic test should the nurse anticipate first?
A. Troponin level
B. Echocardiogram
C. 12-lead ECG
D. Stress test
C. 12-lead ECG
A patient arrives to the emergency department with chest pain. The ECG shows ST depression and troponin levels are elevated.
Which condition is most consistent with these findings?
A. Stable angina
B. NSTEMI
C. STEMI
D. Variant angina
B. NSTEMI
A patient with a STEMI arrives at a hospital that does not have a cardiac catheterization lab available at the moment.
Which treatment should the nurse anticipate?
A. Thrombolytic therapy
B. Stress testing
C. Echocardiogram
D. CABG surgery
A. Thrombolytic therapy
Which complication occurs most frequently following myocardial infarction?
A. Stroke
B. Pulmonary embolism
C. Dysrhythmias
D. Renal failure
C. Dysrhythmias
The nurse is assessing the patient's chest pain using the PQRST method.
Which question best evaluates the “Q” component?
A. “When did the pain start?”
B. “What does the pain feel like?”
C. “Where does the pain travel?”
D. “What makes the pain worse?”
B. “What does the pain feel like?”
A patient undergoing a cardiac stress test develops chest pain and ST changes on ECG.
What is the nurse’s priority action?
A. Administer aspirin
B. Stop the test immediately
C. Increase oxygen
D. Document findings
B. Stop the test immediately
Which finding differentiates STEMI from NSTEMI?
A. ST elevation on ECG
B. Presence of chest pain
C. Elevated troponin levels
D. Dyspnea
A. ST elevation on ECG
A patient with STEMI is being transported to a cardiac catheterization lab.
What is the primary purpose of PCI?
A. Dissolve blood clots
B. Reduce myocardial oxygen demand
C. Restore blood flow to the blocked artery
D. Prevent arrhythmias
C. Restore blood flow to the blocked artery
A patient develops shortness of breath, crackles in the lungs, and decreased oxygen saturation after MI.
Which complication should the nurse suspect?
A. Pulmonary edema
B. Cardiogenic shock
C. Cardiac tamponade
D. Pericarditis
A. Pulmonary edema
A patient with suspected ACS is being assessed. Which findings should increase the nurse’s suspicion for myocardial ischemia?
Select all that apply.
A. Diaphoresis
B. Nausea
C. Hypertension
D. Palpitations
E. Pain recreated with deep palpation
A. Diaphoresis
B. Nausea
C. Hypertension
D. Palpitations
A patient has an elevated troponin level.
What does this finding indicate?
A. Decreased cardiac output
B. Valve dysfunction
C. Monitor until gag reflex returns
D. Pericardial inflammation
C. Injury or stress to heart muscle
A patient diagnosed with NSTEMI is being treated with medications.
Which medication should NOT be administered?
A. Nitrates
B. Aspirin
C. Thrombolytic therapy
D. Beta blockers
C. Thrombolytic therapy
After a coronary artery stent is placed, the patient is prescribed aspirin and Plavix.
What complication are these medications intended to prevent?
A. Heart failure
B. Pulmonary edema
C. Stent thrombosis
D. Cardiogenic shock
C. Stent thrombosis
Which procedure removes fluid from the pericardial sac to treat cardiac tamponade?
A. Thoracentesis
B. Angioplasty
C. Pericardial window
D. Pericardiocentesis
D. Pericardiocentesis
A patient receives three doses of sublingual nitroglycerin five minutes apart, but the chest pain persists.
What is the priority action by the nurse?
A. Administer morphine
B. Initiate evaluation for myocardial infarction
C. Reassess pain in 30 minutes
D. Encourage rest and relaxation
B. Initiate evaluation for myocardial infarction
A patient is scheduled for a TEE.
Which nursing intervention is most important after the procedure?
A. Encourage oral fluids immediately
B. Monitor until gag reflex returns
C. Ambulate the patient
D. Monitor blood glucose
B. Monitor until gag reflex returns
A patient with STEMI arrives to the hospital. The nurse understands that the primary goal of treatment is:
A. Lowering blood pressure
B. Preventing arrhythmias
C. Restoring coronary blood flow rapidly
D. Decreasing cholesterol levels
C. Restoring coronary blood flow rapidly
A patient with STEMI is being evaluated for thrombolytic therapy.
Which conditions must be considered before administering this treatment?
Select all that apply.
A. Presence of contraindications
B. Availability of PCI
C. Time since onset of chest pain
D. Troponin levels
E. Blood pressure stability
A. Presence of contraindications
B. Availability of PCI
C. Time since onset of chest pain
An IABP assists the heart primarily by:
A. Improving coronary perfusion and reducing workload
B. Increasing heart rate
C. Removing excess fluid
D. Regulating cardiac rhythm
A. Improving coronary perfusion and reducing workload
A patient arrives with chest pain and the ECG shows ST elevation in leads II, III, and aVF.
Which intervention should the nurse anticipate as the priority treatment goal?
A. Lower cholesterol levels
B. Restore coronary blood flow within 90 minutes
C. Reduce myocardial oxygen demand
D. Administer diuretics
B. Restore coronary blood flow within 90 minutes
A patient with suspected MI has laboratory tests ordered. Which findings support the diagnosis?
Select all that apply.
A. Elevated troponin
B. Elevated CK-MB
C. Elevated WBC
D. ST elevation on ECG
E. Decreased troponin
A. Elevated troponin
B. Elevated CK-MB
C. Elevated WBC
D. ST elevation on ECG
Which findings are most consistent with NSTEMI?
Select all that apply.
A. ST depression
B. Elevated troponin
C. Complete coronary artery occlusion
D. Myocardial ischemia
E. ST elevation
A. ST depression
B. Elevated troponin
D. Myocardial ischemia
A patient with STEMI undergoes cardiac catheterization, and a balloon catheter successfully opens a narrowed coronary artery. The provider wants to prevent the artery from narrowing again and maintain blood flow.
Which intervention should the nurse anticipate?
A. Coronary artery stent placement
B. Initiation of thrombolytic therapy
C. Emergency coronary artery bypass graft surgery
D. Placement of an intra-aortic balloon pump
A. Coronary artery stent placement
Which assessments are essential for a patient receiving IABP therapy?
Select all that apply.
A. Distal pulses
B. Bowel sounds
C. Leg temperature and color
D. Urine output
E. Heart rhythm
A. Distal pulses
C. Leg temperature and color
D. Urine output
E. Heart rhythm