Questions and Answers
Which of the following nursing diagnoses would be appropriate for a patient with heart failure? (Select all that apply)
Which of the following would be a priority nursing diagnosis for the patient with heart failure and pulmonary edema?
Captopril may be administered to a patient with heart failure because it acts as a:
Furosemide is administered intravenously to a patient with heart failure. How soon after administration should the nurse begin to see evidence of the drug's desired effect?
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Which of the following foods should the nurse teach a patient with heart failure to avoid or limit when following a 2-gram sodium diet?
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The nurse finds the apical pulse below the 5th intercostal space. The nurse suspects:
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Which of the following actions is the first priority of care for a patient exhibiting signs & symptoms of coronary artery disease?
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Medical treatment of coronary artery disease includes which of the following procedures?
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Which of the following is the most common symptom of myocardial infarction (MI)?
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Which of the following symptoms is the most likely origin of pain the patient described as knifelike chest pain that increases in intensity with inspiration?
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Which of the following blood tests is most indicative of cardiac damage?
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What is the primary reason for administering morphine to a patient with an MI?
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Which of the following conditions is most commonly responsible for myocardial infarction?
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Which of the following complications is indicated by a third heart sound (S3)?
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After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?
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What is the first intervention for a patient experiencing MI?
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Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines & sympathetic nerve stimulation?
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What is the most common complication of an MI?
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With which of the following disorders is jugular vein distention most prominent?
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Toxicity from which of the following medications may cause a patient to see a green-yellow halo around lights?
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Which of the following symptoms is most commonly associated with left-sided heart failure?
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In which of the following disorders would the nurse expect to assess sacral edema in a bedridden patient?
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Which of the following symptoms might a patient with right-sided heart failure exhibit?
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Which of the following classes of medications maximizes cardiac performance in patients with heart failure by increasing ventricular contractility?
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Stimulation of the sympathetic nervous system produces which of the following responses?
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Which of the following conditions is most closely associated with weight gain, nausea, & a decrease in urine output?
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Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
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Which of the following types of cardiomyopathy can be associated with childbirth?
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Septal involvement occurs in which type of cardiomyopathy?
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Which of the following recurring conditions most commonly occurs in patients with cardiomyopathy?
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Dyspnea, cough, expectoration, weakness, & edema are classic signs & symptoms of which of the following conditions?
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In which of the following types of cardiomyopathy does cardiac output remain normal?
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Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
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Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?
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If medical treatments fail, which of the following invasive procedures is necessary for treating cardiomyopathy?
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Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress?
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Which of the following types of angina is most closely related with an impending myocardial infarction?
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Which of the following conditions is the predominant cause of angina?
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Which of the following tests is used most often to diagnose angina?
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Which of the following results is the primary treatment goal for angina?
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Which of the following interventions should be the first priority when treating a patient experiencing chest pain while walking?
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Study Notes
Coronary Artery Disease (CAD) and Myocardial Infarction (MI)
- First priority of care for signs of CAD is enhancing myocardial oxygenation to prevent damage.
- Medical treatments for CAD include oral medication administration, cardiac catheterization (diagnostic), and invasive options like bypass surgery and percutaneous coronary angioplasty.
Common Symptoms and Diagnosis
- Chest pain is the most prevalent symptom of MI, linked to oxygen deprivation; dyspnea follows in frequency.
- Crackles in the lungs after anterior wall MI indicate left-sided heart failure; pulmonary complications arise from impaired left ventricular function.
Cardiac Enzymes and Diagnoses
- Troponin I is the most specific blood test for cardiac damage, with detectable levels shortly after myocardial injury.
- ECG is the preferred diagnostic tool for assessing MI, showing changes indicative of ischemia.
Medication and Treatments
- Morphine decreases myocardial oxygen demand and provides pain relief during MI.
- Beta-adrenergic blockers are crucial in protecting the ischemic myocardium by blocking catecholamine effects and reducing oxygen demand.
Complications and Monitoring
- Arrhythmias are the most common complication of MI, resulting from oxygen deprivation.
- Jugular vein distention (JVD) is associated with heart failure; indicates elevated venous pressure.
Heart Failure Characteristics
- Symptoms of left-sided heart failure include pulmonary crackles, while right-sided heart failure may exhibit sacral edema.
- Inotropic agents are used to enhance cardiac contractility in heart failure patients.
Cardiomyopathy and Angina
- Cardiomyopathy can result in heart failure with symptoms often overlapping, such as edema and exertional dyspnea.
- Stable angina is predictable and occurs with exertion or stress; unstable angina indicates a higher risk for MI and has unpredictable characteristics.
Angina and Cardiac Conditions
- The goal of angina therapy is to reverse ischemia by improving oxygen supply and reducing consumption.
- Fourth heart sounds (S4) indicate ventricular filling resistance, while third heart sounds (S3) may suggest ventricular dilation.
Positioning and Emergency Response
- High Fowler's position is optimal for patients with acute pulmonary edema to facilitate breathing.
- In cases of chest pain, the first action should be to have the patient sit down, reducing oxygen demand immediately.
Compensatory Mechanisms
- Decreased cardiac output triggers compensatory mechanisms, notably increases in blood pressure and fluid retention due to sympathetic stimulation and kidney function.
Key Conditions to Recognize
- Knowledge of common and critical cardiopulmonary symptoms is vital for timely intervention.
- Accurate interpretation of heart sounds and symptoms can guide effective treatment strategies for various cardiac disorders.### Alterations in Level of Consciousness (LOC)
- LOC changes occur only with persistent decreased cardiac output.
Acute Pulmonary Edema
- Pink, frothy sputum is a hallmark sign of acute pulmonary edema.
- Initial response to a patient presenting with pink sputum is to call for help while staying with the patient.
Cardiac Afterload
- Afterload is the force the ventricles must overcome to eject blood.
- Factors influencing afterload include the aortic and pulmonic valves and systemic and pulmonary vascular resistance.
Causes of Pulmonary Edema
- Damage to the left ventricle is the primary cause of acute pulmonary edema due to inadequate cardiac output.
Rheumatic Fever Assessment
- Key findings for diagnosing rheumatic fever include erythema marginatum, subcutaneous nodules, and fever.
- Diagnosis requires specific criteria from the Jones criteria framework.
Responding to Unresponsiveness
- Upon confirming unresponsiveness in a patient, the first action is to activate the resuscitation team.
Priority Nursing Diagnoses
- For a myocardial infarction patient, the priority diagnosis is ineffective tissue perfusion due to reduced cardiac output.
- Patients with unstable conditions (e.g., new-onset atrial fibrillation) should be assessed first.
Signs and Symptoms of Pulmonary Edema
- Symptoms include shortness of breath, crackles and wheezes, and pink frothy sputum, indicating late-stage pulmonary edema.
Teaching for Endocarditis
- Essential teaching for a patient with endocarditis includes reporting signs of relapse, such as fever and night sweats.
Heart Failure Exacerbation
- Less likely contributing factors to exacerbating heart failure include peptic ulcer disease compared to conditions like atrial fibrillation and infections.
Medication for Heart Failure
- Digoxin is crucial for treating heart failure; it positively influences heart muscle contraction and rate.
- Calcium channel blockers (e.g., diltiazem) and beta-blockers reduce heart function and are not ideal for heart failure treatment.
Signs of Pulmonary Edema Agitation
- Patients with severe pulmonary edema exhibit extreme anxiety and feelings of drowning or suffocation.
Monitoring for Digoxin Toxicity
- For patients on digoxin and furosemide, monitoring serum potassium levels is vital due to the risk of toxicity associated with hypokalemia.
Risk for Acute Renal Failure
- Post-cardiac surgery patients with low urine output and elevated BUN and creatinine levels are at risk for acute renal failure.
Ambulation After Cardiac Surgery
- Premedicating with analgesics enhances tolerance for ambulation post-surgery by alleviating pain.
Electrocardiogram Interpretation
- A normal sinus rhythm presents with specific rates and intervals; deviations can indicate various dysrhythmias.
Concern for Ventricular Tachycardia
- Ventricular tachycardia is notably dangerous because it can progress to ventricular fibrillation, risking immediate patient safety.
Assessing for Digoxin Toxicity
- Early signs of digoxin toxicity include nausea, vomiting, and visual disturbances, necessitating prompt assessment.
Angina Classification
- Variant angina occurs suddenly and often in patterns, typically in the morning, distinguishing it from stable and unstable angina.
Continuous IV Nitroglycerin Administration
- An infusion pump is essential for the precise administration of continuous nitroglycerin.
Aspirin Use During Myocardial Infarction
- Aspirin's primary role in MI is its antithrombotic action, helping prevent blood clot formation.
Expected Outcomes Post-MI
- By the second day post-MI, patients should be able to perform self-care activities painlessly.
Dietary Restrictions Post-MI
- Small, easily digestible meals are recommended post-MI, avoiding large meals as they are harder to manage.
Aging and Cardiac Response
- Older adults may exhibit compromised cardiac responses to stressors due to left ventricular atrophy from lack of use.
Nursing Diagnoses for Heart Failure
- Appropriate nursing diagnoses for heart failure include ineffective tissue perfusion and decreased cardiac output related to heart function deterioration.
Heart Failure and Activity Intolerance
- Activity intolerance is a significant problem due to decreased cardiac output, leading to fatigue and dyspnea.
Role of Captopril
- Captopril acts as a vasodilator, beneficial for patients with heart failure by decreasing vascular resistance.
Furosemide Effects
- For intravenous furosemide, effects typically begin within 5 minutes, reaching peak effectiveness around 30 minutes.
Sodium Restrictions in Heart Failure
- Patients on a sodium-restricted diet should avoid high-sodium foods like tomato juice to manage fluid retention.
Apical Pulse Location
- A displaced apical pulse below the fifth intercostal space may indicate left ventricular enlargement.
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Description
This quiz covers essential concepts related to Coronary Artery Disease and Myocardial Infarction, including symptoms, diagnostic tools, and treatment options. Gain insights into cardiac care priorities and the role of cardiac enzymes in diagnosis.
