Assessment of AMI
When assessing the Pain associated with AMI what questions would the nurse ask?
O- onset of pain
P- Provoking factors Q- quality of pain
R- region or radiation
S- severity of pain (0-10)
T- timing of pain (how long)
Which of the following are cardiac related labs / values? SELECT ALL THAT APPLY
A. Troponins
B. Creatine Kinase
C. LFT
D. Serum Electrolytes
E. Ammonia
A,B
Source: ATI
The emergency department nurse is caring for a client who was just admitted with left anterior chest pain, possible acute myocardial infarction. Which action will the nurse take first?
A. Insert the IV catheter.
B. Auscultate heart sounds
C. Administer sublingual nitroglycerin
D. Draw blood for troponin 1 measurement.
C
Rationale: Nitro should relieve the chest pain if having an MI, if the pain persists it is probably not an MI
Source: Board Vitals
Which are modifiable risk factors for Coronary Artery Disease? SELECT ALL THAT APPLY?
A. Smoking
B. Hypertension
C. Hypercholesterolemia
D. Race
E. Sedentary Lifestyle
F. Age
G. Diet
A,B,C,E,G
Rationale: All of these can be changed or managed except Race and Age.
Source: Board Vitals
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client’s breath sounds?
A.Stridor
B.Crackles
C.Scattered rhonchi
D.Diminished breath sounds
B. Crackles
Rationale: Crackles are a manifestation of pulmonary edema
Source: Saunders Q669 pg 790
When the nurse is monitoring a 53yo client who is undergoing a treadmill stress test, which finding will require the most immediate response?
1. BP of 152/88 mmHg
2. HR of 134 bpm
3. SpO2 sat of 91%
4. Chest pain level of 3 (on a scale of 10)
4
Rationale: Chest pain indicates ischemia and is an indication to stop the test to avoid injury or MI.
Source: Saunders pg.65 question 6
. Ms. S tells the nurse that she has worsening chest discomfort. The cardiac monitor shows ST-segment elevation, and the nurse notifies the HCP. Which prescribed action takes priority at this time?
A.Administer morphine sulfate 2 mg IV push
B.Schedule an ECG
C.Draw blood for coagulation studies
D.Administer ranitidine 75 mg PO every 12 hours
A. Administer Morphine 2mg IV Push
Rational: Used to relieve pain R/T AMI
Source: LaCharity pg 207 Question 6
What does AMI stand for? And what does it mean?
AMI Meaning= Acute Myocardial Infarction and it means that there has been a lack of oxygen to part of the hearts tissue resulting in death of the tissue as a result of Ischemia
A client who had just arrived in the emergency department reports substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol?
A.Creatine kinase MB level
B.Troponin I level
C.Myoglobin level
D.C-reactive protein level
Rationale: Troponin levels elevate in the blood 3 hours after an MI before others markers appear in the blood.
Source: Lacharity pg.65 question 5What are some signs/symptoms of an MI? SELECT ALL THAT APPLY
A. Left arm PainB. SOB (shortness of breath)
C. Tightness/Pressure in chest
D. H/A (headache)
E. Feeling of Impending Doom
A,B,C,D,E
Source: Board Vitals
2. Which information is most important to prevent recurrence of re-occlusion of the coronary artery, chest discomfort, or myocardial infarction (MI)?
A.Remain on bed rest for the next 24 hours
B.Client will be prescribed dual anti-platelet therapy (DAT)
C.Client should do no heavy lifting for 48 hours
D.HCP will prescribe a beta-blocker
B. Client will be prescribed dual anti-platelet therapy (DAT)
Rational: DAT help to prevent re-occlusion due to the artery's normal elasticity and memory.
Source: LaCharity pg 207 Question 10
What does Ischemia Mean? And what happens if someone becomes Ischemic?
Ischemia = inadequate blood supply to apart of the body, and as a result the effected part of the body is not perfused and therefore is at higher risk for injury and death.
A nurse is caring for a client who is experiencing chest pain. The nurse should identify that which of the following characteristics distinguishes angina from myocardial infarction?
A.Stable angina is relieved with rest and nitroglycerin.
B.The pain of an MI resolves in less than 15 minutes.
C.The type of activity that causes an MI is identifiable.
D.Stable angina can occur for longer than 30 minutes.
A
Rationale: Stable angina subsides with pain and Rx therapy and unstable does not.
Source: Board Vitals
What are the three components of a lipid panel? and what are the acceptable levels of eachfor cardiovascular patients?
LDL - < 70mg/dL
HDL - > 40mg/dL
Triglycerides - < 150mg/dL
**Total Cholesterol - < 200 mg/dL
. Ms. S has returned from a cardiac catherization and a percutaneous coronary intervention procedure. Which follow-up care orders should the nurse assign to an experienced LPN/LVN? Select all the apply.
1 .Reminding the client to remain on bed rest with the insertion site extremity straight
2 .Preparing a teaching plan that includes activity restrictions and risk factor modification
3 .Measuring the clients vital signs every 15 minutes for the first hour
4 . Assessing the catheter insertion site for bleeding or hematoma formation
5 .Monitor peripheral pulses, skin temperature, and skin color with each measurement of vital signs
6 .Administering two tables of acetaminophen for back pain
6 .
1,3,4,5,6
Rational: All are within the scope of an LPN/LVN except preparing an initial teaching, careplan
Sourse: LaCharity pg 207 question 9
What are the three layers of the Heart wall from Inner to outer?
Epicardium -outermost
Myocardium - middle/actual contracting muscleEndocardium - innermost layer lines the chambers and valves.
A nurse is teaching a student nurse about a client’s atypical presentation of myocardial infarction. Which of the following factors does the nurse understand are factors that increase the risk of an atypical presentation of acute myocardial infarction? SELECT ALL THAT APPLY
A.Smoking
B.Diabetes Mellitus
C.Elevated triglycerides
D.Hypertension
E.Female gender
B, E
Rationale: females manifest with non traditional symptoms and DM decreases the pain felt R/T an MI due to neuropathy.
Source: Board Vitals
**DAILY DOUBLE**
How long does it take for Troponin I to manifest in the blood post MI and how long does it persist for?Troponin I rises in the blood within 3 hours post MI and persists for 7-10 days. Making it the earliest and most reliable marker of am MI.
A client is being monitored after a cardiac catheterization 3 hours earlier through a left femoral artery catheterization site. Which of the following observations suggest a potential complication and should be reported immediately to the healthcare provider. SELECT ALL THAT APPLY
A.Sleepiness
B.Urine output of 150 mL since the procedure
C.Increase swelling at the site of catheterization
D.Numbness of left foot
C, D
Rationale: May indicate a bleed and loss of circulation/perfusion
Source: Board Vitals
What does CAD stand for? and what is it?
Coronary Artery Disease. condition that decreases blood flow to the heart by occlusion of the central and peripheral blood vessels as a result of plaque build up.