Cardiovascular disorders- MI

Cardiovascular disorders- MI

By Maam Li

Multiple Choice

Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?

• Cardiac catheterization

• Cardiac enzymes

• Echocardiogram

• Electrocardiogram

​RATIONALE:

The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. Cardiac enzymes are used to diagnose MI but can’t determine the location. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately

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Multiple Choice

Which of the following is the most common symptom of myocardial infarction?

     

• Chest pain

• Dyspnea

• Edema

• Palpitations

RATIONALE:

The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias.

Multiple Choice

Which of the following blood tests is most indicative of cardiac damage?

    

• Lactate dehydrogenase

• Complete blood count

• Troponin 1

• Creatine kinase

RATIONALE:

​Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren't detectable in people without cardiac injury. Lactate dehydrogenase is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Because CK levles may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.

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Multiple Choice

.What is the primary reason for administering morphine to a client with myocardial infarction?   

• To sedate the client

• To decrease the client's pain

• To decrease the client's anxiety

• To decrease oxygen demand on the client's heart

RATIONALE:

Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but isn't primarily given for those reasons.

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Multiple Choice

Which of the followng conditions is most commonly responsible for myocardial infarction?

• Aneurysm

• Heart failure

• Coronary artery thrombosis

• Renal failure

RATIONALE:

Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and doesn't cause an MI. Renal failure can be associated with MI but isn't a direct cause. Heart failure is usually the result of an MI.

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Multiple Choice

What is the first intervention for a client experiencing myocardial infarction?    

• Administer morphine

• Administer oxygen

• Administer sublingual nitroglyceri

• Obtain an electrocardiogram

RATIONALE:

Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage.

Morphine and sublingual nitroglycerin are also used to treat MI, but they’re more commonly administered after the oxygen.

An ECG is the most common diagnostic tool used to evaluate MI.

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Multiple Choice

Which of the following conditions most commonly results in CAD?

• Atherosclerosis

• DM

• MI

• Renal failure

RATIONALE:

Atherosclerosis, or plaque formation, is the leading cause of CAD. DM is a risk factor for CAD but isn't the most common cause. Renal failure doesn't cause CAD, but the two conditions are related. Myocardial infarction is commonly a result of CAD.

Multiple Choice

Which of the following risk factors for coronary artery disease cannot be corrected?a. b. c.d.

• Cigarette smoking

• DM

• Heredity

• HPN

RATIONALE:

Because "heredity" refers to our genetic makeup, it can't be changed. Cigarette smoking cessation is a lifestyle change that involves behavior modification. Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Altering one's diet, exercise, and medication can correct hypertension.

Multiple Choice

After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic changes are these?

• Electrophysiologic

• Hematologic

• Mechanical

• Metabolic

RATIONALE: ​

Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Mechanical changes are those that affect the pumping action of the heart, and electro physiologic changes affect conduction. Hematologic changes would affect the blood​

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Multiple Choice

What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?

• "Tell me about your feeling right now.

• "When the doctor arrives, everything will be fine."

• "This is a bad situation, but you'll feel better soon."erything we can to make you feel better."

• "Please be assured we're doing everything we can to make you feel better."

RATIONALE:

Validation of the client’s feelings is the most appropriate response. It gives the client a feeling of comfort and safety.

The other three responses give the client false hope. No one can determine if a client experiencing MI will feel or get better and therefore, these responses are inappropriate.

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Multiple Choice

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

• Beta-adrenergic blockers

• Calcium channel blockers

• Narcotics

• Nitrates

RATIONALE:

• Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand.

• Calcium channel blockers reduce the workload of the heart by decreasing the heart rate.

• Narcotics reduce myocardial oxygen demand, promote vasodilation, and decreased anxiety.

• Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

Multiple Choice

What is the most common complication of a myocardial infarction?

• Cardiogenic shock

• Heart failure

• Arrhythmias

• Pericarditis

RATIONALE:

• Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI.

• cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI.

• Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication.

• Pericarditis most commonly results from a bacterial of viral infection but may occur after MI.

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