ACS Recognition
Name the three classic categories of acute coronary syndrome (ACS).
ANSWER: Unstable angina, NSTEMI, STEMI.
Which rapid, noninvasive test records the electrical activity of the heart and is a priority early test for suspected ACS?
ANSWER: 12-lead ECG
Aspirin belongs to which medication class used in ACS?
ANSWER: Antiplatelet.
What does the abbreviation PCI stand for?
ANSWER: Percutaneous coronary intervention.
A patient being treated for ACS develops recurrent chest pressure. What is the nurse’s priority response?
ANSWER: Immediate reassessment and escalation/reporting.
A patient has ischemic chest discomfort and an acute rise/fall in troponin, but there is no persistent ST-segment elevation. Which type of ACS is most likely?
ANSWER: NSTEMI.
Which blood biomarker is preferred for detecting myocardial injury in suspected ACS?
ANSWER: High-sensitivity cardiac troponin
Which two vital signs should the nurse especially assess before administering an ordered beta blocker?
ANSWER: Heart rate and blood pressure.
What is the primary goal of reperfusion therapy for a patient with STEMI?
ANSWER: Restore coronary blood flow as rapidly as possible to limit myocardial injury.
After femoral cardiac catheterization, which assessment finding in the affected leg suggests impaired arterial perfusion?
ANSWER: Cool/pale extremity or diminished/absent distal pulse.
A patient has ongoing symptoms concerning for ACS, but the first 12-lead ECG is normal. Why should the ACS evaluation continue?
ANSWER: Ischemic changes may be transient or not present on the first tracing; ongoing symptoms may require serial ECGs/biomarkers.
Which noninvasive test uses ultrasound to evaluate ventricular function, ejection fraction, and wall-motion abnormalities?
ANSWER: Echocardiogram.
What important medication history must be checked before administering nitroglycerin because of the risk for severe hypotension?
ANSWER: Recent PDE-5 inhibitor use
What is the major life-threatening adverse effect that must be considered with fibrinolytic therapy?
ANSWER: Major bleeding, especially intracranial hemorrhage.
After femoral catheterization, which combination of findings should raise concern for occult or retroperitoneal bleeding?
ANSWER: Hypotension/tachycardia with back or flank pain, especially after femoral access.
Name four possible anginal equivalents or associated ischemic symptoms that may occur instead of classic chest pain.
ANSWER: Examples: dyspnea, diaphoresis, nausea, fatigue, jaw/arm/back/upper abdominal discomfort.
Which invasive diagnostic test visualizes the coronary arteries and may proceed directly to treatment with PCI?
ANSWER: Coronary angiography/cardiac catheterization with PCI.
What does DAPT stand for, and which two types of antiplatelet therapy are commonly combined?
Dual antiplatelet therapy: aspirin plus a P2Y12 inhibitor in typical ACS contexts
Which surgical procedure uses graft vessels to route blood around obstructed coronary arteries?
ANSWER: CABG.
Why is continuous cardiac rhythm monitoring important during an acute myocardial infarction?
ANSWER: Ischemia can trigger life-threatening dysrhythmias
What finding most directly helps distinguish NSTEMI from unstable angina?
ANSWER: Evidence of acute myocardial necrosis/injury consistent with MI, reflected by an acute troponin rise/fall in the ischemic clinical context.
Why is kidney function, including serum creatinine, important before or around contrast-based coronary testing?
ANSWER: To assess kidney function and contrast/medication safety risk.
Why are high-intensity statins commonly used after ACS even after the patient’s chest pain has resolved?
ANSWER: It reduces atherogenic cholesterol and recurrent cardiovascular risk as secondary prevention.
A patient has a diagnostic STEMI pattern and compatible symptoms. Why should reperfusion planning not be delayed while waiting for a later troponin result?
ANSWER: Reperfusion is time-sensitive; delaying restoration of blood flow increases myocardial injury
Name three major categories of complications the nurse should monitor for after PCI.
ANSWER: Examples: bleeding/vascular injury, recurrent ischemia/stent thrombosis, dysrhythmia, contrast-related kidney injury, allergic reaction