What is the first intervention for a client experiencing MI?
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Solution
Administer oxygen
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.
Options A and C: Morphine and nitro are also used to treat MI, but they’re more commonly administered after the oxygen.
Option D: An ECG is the most common diagnostic tool used to evaluate MI.
After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?
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Solution
Left-sided heart failure
The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn’t function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles.
Options B, C, and D: Pulmonic and tricuspid valve malfunction cause right-sided heart failure.
Which of the following complications is indicated by a third heart sound (S3)?
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Solution
Ventricular dilation
Rapid filling of the ventricle causes vasodilation that is auscultated as S3.
Option B and D: Increased atrial contraction or systemic hypertension can result in a fourth heart sound.
Option C: Aortic valve malfunction is heard as a murmur.
Which of the following conditions is most commonly responsible for myocardial infarction?
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Solution
Coronary artery thrombosis
Coronary artery thrombosis causes an inclusion of the artery, leading to myocardial death.
Option A: An aneurysm is an outpouching of a vessel and doesn’t cause an MI.
Option B: Heart failure is usually a result from an MI.
Option D: Renal failure can be associated with MI but isn’t a direct cause.
What is the primary reason for administering morphine to a client with an MI?
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Solution
To decrease oxygen demand on the client’s heart
Morphine is administered because it decreases myocardial oxygen demand.
Options A, B, and C: Morphine will also decrease pain and anxiety while causing sedation, but it isn’t primarily given for those reasons.
Which of the following blood tests is most indicative of cardiac damage?
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Solution
Troponin I
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.
Option A: Lactate dehydrogenase (LDH) is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing a cardiac injury.
Option B: CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes.
Option D: Because CK levels may rise with a skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.
Which of the following symptoms is the most likely origin of pain the client described as knifelike chest pain that increases in intensity with inspiration?
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Solution
Pulmonary
Pulmonary pain is generally described by these symptoms.
Options A and B: Cardiac and GI pains don’t change with respiration.
Option C: Musculoskeletal pain only increases with movement.
Which of the following is the most common symptom of myocardial infarction (MI)?
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Solution
Chest pain
The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart.
Option B: Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI.
Option C: Edema is a later sign of heart failure, often seen after an MI.
Option D: Palpitations may result from reduced cardiac output, producing arrhythmias.
Medical treatment of coronary artery disease includes which of the following procedures?
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Solution
Oral medication therapy
Oral medication administration is a noninvasive, medical treatment for coronary artery disease.
Option A: Cardiac catheterization isn’t a treatment, but a diagnostic tool.
Options B and D: Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.
Which of the following actions is the first priority of care for a client exhibiting signs and symptoms of coronary artery disease?
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Solution
Enhance myocardial oxygenation
Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygenation, the myocardium suffers damage.
Options A and D: Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.
Option C: Sublingual nitroglycerin is administered to treat acute angina, but the administration isn’t the first priority.