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A 60-year-old male client comes into the emergency department with complaints of crushingsubsternal chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acutemyocardial infraction (MI). Immediate admission orders include oxygen by nasal cannula at 4 L/minute,blood work, a chest radiograph, a 12-lead electrocardiogram (ECG), and 2 mg of morphine sulfategiven intravenously. The nurse should first: a. Administer the morphine b. Obtain a 12-lead ECG c. Obtain the blood work d. Order the chest radiograph Ans: A although obtaining the ECG, chest radiograph, and blood work are all important, the nurse spriority action should be to relieve the crushing chest pain. Therefore, administering morphine sulfateis priority action. 2. When administering a thrombolytic drug to the client experiencing an MI, the nurse explains to himthat the purpose of the drug is to: a. Help keep him well hydrated b. Dissolve clots that he may have c. Prevent kidney failure d. Treat potential cardiac dysrhythmias Ans: B thrombolytic drugs are administered within the first 6 hours after of myocardial infarction tolyse clots and reduce the extent of myocardial damage. 3. If the client who has admitted for MI develops cardiogenic shock, which characteristic signs shouldthe nurse expect to observe? a. Oliguria b. Bradycardia c. Elevated blood pressure d. Fever Ans: A oliguria occurs during cardiogenic shock because there is reduced blood flow to the kidneys.Typically signs of cardiogenic shock include low blood pressure, rapid and weak pulse, decrease urineoutput, and signs of diminished blood flow to the brain, such as confusion and restlessness.Cardiogenic shock is a serious complication of MI, with a mortality rate approaching 90%. Fever is nota typical sign of cardiogenic shock. 4. The physician orders continuous intravenous nitroglycerin infusion for the client with MI. essentialnursing action include which of the following? a. Obtaining an infusion pump for the medication b. Monitoring blood pressure every 4 hours c. Monitoring urine output hourly d. Obtaining serum potassium levels daily

Ans: A intravenous nitroglycerin infusion requires an infusion pump for precise control of themedication. Blood pressure monitoring would be done with a continuous system, and more frequentlythan every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels isnot associated with nitroglycerin infusion. 5. When teaching the client with MI, the nurse explains that the pain associated with MI is caused by: a. Left ventricular overload b. Impending circulatory collapse c. Extracellular electrolyte imbalances d. Insufficient oxygen reaching the heart muscle Ans: D an MI interferes with or blocks circulation to the heart muscle. Decreased blood supply to theheart muscle causes ischemia, or poor myocardial oxygenation. Diminished oxygenation or lack of oxygen to the cardiac muscle results in ischemic pain or angina. 6. Aspirin is administered to the client experiencing an MI because of its: a. Antipyretic action b. Antithrombotic action c. Antiplatelet action d. Analgesic action Ans: B aspirin does have antipyretic, antiplatelet, and analgesic actions, but the primary reasonaspirin is administered to the client experiencing an MI is its antithrombotic action. In clinical trials, theantithrombotic action of aspirin has been thought to account for improved outcomes in clients with MI.

7. While caring for a client who has sustained an MI, the nurse notes eight PVCs in 1 minute on thecardiac monitor. The client is receiving an intravenous infusion of 5% dextrose in water and oxygen at2 L/minute. The nurses first course of action should be to: a. Increase the intravenous infusion rate b. Notify the physician promptly c. Increase the oxygen concentration d. Administer a prescribed analgesic Ans: B PVCs are often a precursor of life-threatening dysrhythmias, including ventricular tachycardiaand ventricular fibrillation. An occasional PVC is not considered dangerous, but if PVCs occur at a rategreater than five or six per minute in the post-MI client, the physician should be notified immediately.More than six PVCs per minute is considered serious and usually calls for decreasing ventricular irritability by administering medications such as lidocaine hydrochloride. Increasing the intravenousinfusion rate would not decrease the number of PVCs. Increasing the oxygen concentration should not.

be the nurses first course of action; rather, the nurse should notify the physician promptly.Administering a prescribed analgesic would not decrease ventricular irritability. 8. Which of the following is an expected outcome for a client on the second day of hospitalization after an MI? The client: a. Has minimal chest pain b. Can identify risk factors for MI c. Agrees to participate in a cardiac rehabilitation program d. Can perform personal self-care activities without pain Ans: D by day 2 of hospitalization after an MI, clients are expected to be able to perform personalcare without chest pain. Day 2 of hospitalization may be too soon for clients to be able to identify risk factors for MI or to be able to agree to participate in a cardiac rehabilitation program. 9. When teaching a client about the expected outcomes after intravenous administration of furosemide,the nurse would include which outcome? a. Increased blood pressure b. Increased urine output c. Decreased pain d. Decreased PVCs Ans: B furosemide is a loop diuretic acts to increase urine output. Furosemide does not increaseblood pressure, decrease pain, or decrease dysrhythmias. 10. After an MI, the hospitalized client is taught to move the legs about while resting in bed. This typeof exercise is recommended primarily to help: a. Prepare the client for ambulation b. Promote urinary and intestinal elimination c. Prevent thrombophlebitis and blood clot formation d. Decrease the likelihood of decubitus ulcer formation Ans: C although this type of exercise may decrease the likelihood of heel decubitus ulcer formformation, it is taught to the MI client to prevent thrombophlebitis and blood clot formation. Movementof the lower extremities provides muscular action and aids venous return. As a result, the activity helpsprevent stasis of blood, which predisposes the client to thrombophlebitis and blood clot formation. Thistype of exercise is not associated with promoting urinary and intestinal elimination. 11. Which of the following reflects the principle on which a clients diet will most likely be basedduring the acute phase of MI? a. Liquids as desired b. Small, easily digested meals c. Three regular meals per day d. Nothing by mouth

Ans: B recommended dietary principles in the acute phase of MI include avoiding large mealsbecause small, easily digested foods are better tolerated. Fluids are given according to the clients needs, and sodium restrictions may be prescribed, especially for clients with manifestations of heartfailure. Cholesterol restrictions may be ordered as well. Clients are not prescribed diets of liquids onlyor restricted to nothing by mouth unless their condition is very unstable. 12. Of the following controllable risk factors for coronary artery disease (CAD) appears most closelylinked to the development of the disease? a. Age b. Medication usage c. High cholesterol levels d. Gender Ans: C high cholesterol levels are considered a controllable risk factor for CAD and appear mostclearly linked to the development of the disease. High cholesterol levels can be modified through diet,exercise, and medication. Age and gender are uncontrollable risk factors for CAD. Medication usage isnot considered a risk factor for CAD. 13. Which of the following is an uncontrollable risk factor that has been linked to the development of CAD? a. Exercise b. Obesity c. Stress d. Heredity Ans: D heredity has been linked to CAD and is an uncontrollable risk factor. Exercise, obesity, andstress are controllable risk factor for CAD. 14. If a client displays risk factors for CAD such as smoking cigarettes, eating a diet high in saturatedfat, or leading a sedentary lifestyle, technique of behavior modification may be used to help the clientchange behavior. The nurse can best reinforce new adaptive behaviors by: a. Explaining how the old behavior leads to poor health b. Withholding praise until the new behavior is well established c. Rewarding the client whenever the acceptable behavior is performed d. Instilling mild fear into the client to extinguish the behavior Ans: C a basic principle of behavior modification is that behavior that is learned and continued isbehavior that has been rewarded. Other reinforcement techniques have not been found to be as effectiveas reward. 15. Alteplase recombinant. Or tissue plasminogen activator (t-PA), a thrombolytic enzyme, isadministered during the first 6 hours after onset of MI to: a. Control chest pain b. Reduce coronary artery vasospasm c. Control the dysrhythmias associated with MI d. Revascularize the blocked coronary artery

Ans: D the thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary