Nursing Assessment and Nursing Diagnosis Quiz

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Questions and Answers

Which of the following is the most important nursing priority for a patient who has experienced a myocardial infarction?

Reducing myocardial workload
Preventing and detecting life-threatening dysrhythmias or complications (correct)
Relieving pain and anxiety
Promoting cardiac health and self-care

A patient who has experienced a myocardial infarction is exhibiting decreased urinary output. Which of the following nursing diagnoses is most appropriate for this patient?

Deficient knowledge related to post-MI self-care
Impaired renal function related to decreased blood flow (correct)
Ineffective cardiac tissue perfusion related to reduced coronary blood flow
Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction

Which of the following nursing interventions is most appropriate for a patient who has experienced a myocardial infarction and is experiencing shortness of breath and dyspnea?

Encouraging bed rest with the back rest elevated to help decrease chest discomfort and dyspnea
Assessing IV sites frequently
Promoting cardiac health and self-care
Administering oxygen and medication therapy to assist with relief of symptoms (correct)

A patient who has experienced a myocardial infarction is exhibiting decreased knowledge about post-MI self-care. Which of the following nursing interventions is most appropriate for this patient?

Providing education and resources to the patient about post-MI self-care (A) Signup and view all the answers

A patient who has experienced a myocardial infarction is exhibiting decreased cardiac output and left ventricular dysfunction. Which of the following nursing diagnoses is most appropriate for this patient?

Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction (B) Signup and view all the answers

A patient who has experienced a myocardial infarction is exhibiting decreased urinary output and signs of ineffective peripheral tissue perfusion. Which of the following nursing interventions is most appropriate for this patient?

Assessing IV sites frequently to ensure adequate fluid resuscitation and perfusion (C) Signup and view all the answers

What should a nurse frequently check to monitor tissue perfusion?

Peripheral pulses and skin temperature (D) Signup and view all the answers

Which intervention is essential post-myocardial infarction?

Morphine, Oxygen, Nitroglycerin, Aspirin (MONA) (D) Signup and view all the answers

How do ACE Inhibitors work in the context of myocardial infarction?

Decrease oxygen demand of the heart (A) Signup and view all the answers

What lifestyle change is recommended to lower blood pressure in patients with hypertension?

Smoking cessation (D) Signup and view all the answers

Which action is crucial to prevent fluid pooling in the bases of the lungs?

Frequent changes in position (B) Signup and view all the answers

What is a key self-care instruction for individuals post-myocardial infarction?

Losing weight if overweight (D) Signup and view all the answers

What is the initial dose for nitroglycerin administration in the treatment of myocardial infarction?

0.4 mg sublingual tab (A) Signup and view all the answers

Why is aspirin given in the management of myocardial infarction?

To decrease mortality risk (A) Signup and view all the answers

What is a key nursing consideration when administering nitroglycerin to a patient experiencing chest pain?

Holding for a systolic BP below 90 mmHg (B) Signup and view all the answers

What is the purpose of Emergent Percutaneous Coronary Intervention in the management of myocardial infarction?

To open occluded coronary arteries and promote reperfusion (C) Signup and view all the answers

How many times can a patient receive nitroglycerin sublingual tabs if chest pain is not relieved?

Three times (C) Signup and view all the answers

In post-myocardial infarction self-care, what is the significance of monitoring peripheral tissue perfusion?

To ensure adequate blood flow to extremities (B) Signup and view all the answers

Study Notes

Monitor vital signs, including blood pressure and pulse rate, for patients with cardiac issues.
Assess for symptoms like shortness of breath, dyspnea, tachypnea, and crackles, as well as nausea, vomiting, and decreased urinary output.
Conduct a thorough physical assessment to detect complications and changes in the patient's condition.
Nursing priorities include relieving pain and anxiety, reducing myocardial workload, and promoting cardiac health and self-care.
Nursing interventions involve administering oxygen and medications, encouraging bed rest with elevation, monitoring tissue perfusion, providing information and support, and closely monitoring patient vital signs and symptoms.
Health instructions for patients include maintaining a healthy weight, being physically active, and avoiding alcohol and smoking.
Treatment options for cardiac issues include ACE Inhibitors, Thrombolytics, and MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) therapy.
Surgical therapies like Balloon angioplasty and Coronary bypass surgery may be recommended.
Emergent Percutaneous Coronary Intervention is used to open occluded coronary arteries and promote reperfusion.

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Description

Test your knowledge on assessing vital signs, symptoms, history, and complications in patients to form accurate nursing diagnoses. Questions may cover monitoring techniques, assessment methods, and potential complications.