ACS with MI

Acute Coronary Syndrome with MI An unfolding, interactive case

adapted from ATI

​The who's who of this scenario

Multiple Choice

Mr. Davis has taken the first dose of nitroglycerin. Which of the following actions should be taken first?

• Mr. Davis should chew the next two doses of nitroglycerin tablets if his chest pain continues after the first dose.

• Mrs. Davis should call 911 if her husband's chest pain is unrelieved within 5 minutes.

• Mrs. Davis should walk Mr. Davis to the bedroom to lie down, after administering two more doses of nitro

• Mr. Davis should chew three 325mg aspirin tablets.

Hotspot

The nurse reviews the EKG. Which area of the EKG would concern the nurse?

Multiple Select

Nurse Christine is preparing to initiate the orders for Mr. Davis. What prescriptions should she expect to initiate?

• Chest X-ray

• Troponin level

• Morphine

• Chest CT

Audio Response

Mr. Davis is reporting itching over his arms and chest. What is the most appropriate action Nurse Carl should take?

Open Audio Recorder

​The priority should be additional assessment for potential allergic reaction. Ask about potential allergies to shellfish, check skin for uticaria. Potential allergen = contrast dye

Multiple Choice

The nurse is assessing Mr. Davis's breath sounds and suspects Mr. Davis is starting to experience a moderate reaction to contrast dye. Which of the following breath sounds should the nurse expect to hear?

• Rhonchi

• Pleural Friction Rub

• Wheezing

• Vesicular

Multiple Choice

Nurse Carl is continuing the assessment of Mr. Davis. Which of the following manifestations should nurse Carl expect if Mr. Davis is having a sever systemic reaction or anaphylaxis?

• Bronchospasm

• Tearing of the eyes

• Pruritis

• Peripheral Tingling

Multiple Choice

Nurse Carl should expect a prescription for which of the following medications?

• Furosemide

• Epinephrine

• Prednisone

• Hydroxyzine

Multiple Choice

Nurse Carl is completing a post-hear catheterization assessment of Mr. Davis. Which of the following observations should he address first?

• Developing hematoma at the puncture site

• A one-inch area of bright red blood on the dressing over the puncture site

• Diminished right dorsalis pedis pulse

• Pain at the puncture site

Multiple Choice

Mr. Davis's puncture site is covered with gauze and a transparent dressing. Nurse Carl is assessing Mr. Davis's puncture site for bleeding. There is a 3-inch groin hematoma. The gauze is saturated with bright red blood. Which of the following actions should Nurse Carl take?

• Reinforce the dressing

• Apply a warm compress to groin

• Elevate the foot of the bed

• Apply pressure to the right groin site

Multiple Choice

Nurse Carl is review Mr. Davis's lab results in the EMR. Which value should be reported immediately to the provider?

• Creatinine level 0.7 mg/dL

• Hemoglobin 14.8 g/dL

• aPTT of 38 seconds

• Potassium of 3.2 mEq/L

Multiple Choice

Which of the following modifiable risk factors for CAD should be included in teaching

• Sex

• Ethnicity

• Obsesity

• Family hx of the disease

Multiple Select

Which of the following findings should Carl identify as manifestations of cardiogenic shock?

• Mean arterial pressure of 54 mmHg

• Agitation and restlessness

• Bradycardia

• BP 88/54

• Pitting edema

Fill in the Blank

Nurse Carl is preparing to administer Dobutamine (DOBUtrex) 2.5 mcg/kg/min by continuous IV infusion. Mr. Davis weighs 110kg/242 lbs. You have dobutamine 250 mg in 250 mL of Dexrose 5% in water. What should the iv pump in mls/hr, be set at. Round to the nearest 10th.

.

Multiple Choice

Mr. Davis remains unstable with SBP <90 mmHg even with the dobutamine infusing. Which of the following medications should nurse Carl plan to administer?

• Morphine IV

• Nicardepine IV drip

• 0.9% sodium chloride 1000 mL bolus over 1 hour

• Norepinephrine IV drip

Multiple Select

Nurse Carl is preparing to administer norepinephrine to Mr. Davis. Which of the following actions should nurse Carl plan to take?

• Administer through a central line

• set the initial rate at 0.5 mcg/min

• Have neostigmine available as an antidote for this medication

• Monitor BP every 15 mins

Multiple Choice

Nurse Carl is reviewing a medication reference for adverse effects of norepinephrine. Which of the following findings should Carl monitor as an adverse effect of the medication?

• Broncho spasm

• Decreased urine output

• Increased Deep tendon reflexes

• Metabolic alkalosis

Multiple Choice

Nurse Carl is listening to Mr. Davis who is sharing about his plans for lifestyle changes. Which of the following statements indicates that Mr. Davis is planning to make appropriate lifestyle changes?

• I will use chewing tobacco when I have the urge to smoke

• I will do muscle training once a week

• I will reduce my salt intake to 1500 mgs per day

• I will plan to resume sexual activity when I can tolerate walking a half block

Multiple Choice

Nurse Carl should determine that which of the following foods selected by Mr. Davis is the best choice for adhering to a 1500 mg low-sodium diet?

• 1 cup low fat yogurt

• 4 oz scrambled eggs

• 3/4 cup shredded wheat

• 2 turkey sausage patties

Multiple Choice

Nurse Carl is teaching Mr. Davis about taking lisinopril for hypertension. Which of the following information should Carl include in the teaching?

• Report a persistent dry cough

• Avoid drinking grapefruit juice with this medication

• Increase your potassium intake when taking this medication

• Do not take lisinopril within 4 hours if you take an erectile dysfunction medication

Open Ended

Reflection: What things did Nurse Carl do correctly? What is one thing this case study demonstrated that you can add or enhance your practice?