ATI Care of the Patient with Acute Coronary Syndrome, Chapter 7: Perrin: Understanding the Essentials of Critical Care Nursing: Chamberlain College of Nursing NR 341 (A Graded) Latest Questions and Complete Solutions Perrin: Understanding the Essentials of Critical Care NursingChapter 7: Care of the Patient with Acute Coronary Syndrome MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the questions 1) A patient says to his nurse, "I've never heard of an acute coronary syndrome. Please explain whathappened to me." The nurse should respond, "Acute coronary syndrome is: A) Another name for a myocardial infarction (MI) or heart attack." B) A group of disorders that result in insufficient oxygen supply to the heart." C) The second leading cause of death in the United States." D) A type of abnormal heart rhythm." Answer: B Explanation: A) This is the definition and/or criteria that guide a diagnosis of ACS. #1 is incorrect. An MI/heart attack is only one of the disorders that falls under this group of disorders. An MI includes tissue necrosis from arterial obstruction. #3 is incorrect. ACS is the number leading cause of death in United States. #4 is incorrect. A cardiac arrest does not alwaysoccur when ACS is present. Cardiac arrest is a possibility but it does not occur in every patient. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity B) This is the definition and/or criteria that guide a diagnosis of ACS. #1 is incorrect. An MI/heart attack is only one of the disorders that falls under this group of disorders. An MI includes tissue necrosis from arterial obstruction. #3 is incorrect. ACS is the number leading cause of death in United States. #4 is incorrect. A cardiac arrest does not alwaysoccur when ACS is present. Cardiac arrest is a possibility but it does not occur in every patient. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity C) This is the definition and/or criteria that guide a diagnosis of ACS. #1 is incorrect. An MI/heart attack is only one of the disorders that falls under this group of disorders. An MI includes tissue necrosis from arterial obstruction. #3 is incorrect. ACS is the number leading cause of death in United States. #4 is incorrect. A cardiac arrest does not alwaysoccur when ACS is present. Cardiac arrest is a possibility but it does not occur in every patient. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity D) This is the definition and/or criteria that guide a diagnosis of ACS. #1 is incorrect. An MI/heart attack is only one of the disorders that falls under this group of disorders. An MI includes tissue necrosis from arterial obstruction. #3 is incorrect. ACS is the number leading cause of death in United States. #4 is incorrect. A cardiac arrest does not alwaysoccur when 2 ACS is present. Cardiac arrest is a possibility but it does not occur in every patient. Nursing Process: Evaluation Cognitive Level: Comprehension Category of Need: Psychosocial Integrity 3 2)Which of the following is an accurate description of the progression of events in an acute coronarysyndrome (ACS)? A) A thin fibrin layer stabilizes the ruptured plaque and prevents the occlusion of coronary vesselswhen stable angina is present in ACS. B) When complete platelet occlusion occurs in a vessel, the ECG changes include nonspecific STelevation without necrosis occurring in ACS. C) The growth of platele-rtich thrombi in the smaller vessels creates a blockage and is the cause for unstable angina symptoms in ACS. D) Sudden plaque buildup in a narrow vessel immediately leads to an acute myocardial infarctionwhen stable angina is present in ACS. Answer: C Explanation: A) Unstable angina occurs when a blockage from pla-terilceht thrombi in smaller vessels occurs, causing myocardial ischemia. Because ischemic pattern of pain varies, it is unpredictable and can occur with exertion and rest. Eventually, the patient will limit activity to minimize the symptoms. #1 is incorrect. The formation of fibrin along the areaof ruptured plaque will stabilize the thrombi and fully occlude the coronary vessel. Therefore, with full occlusion an STEMI occurs. #2 is incorrect. When occlusion occurs,ST elevation occurs; necrosis and ischemia are a result of the decreased blood flow. Ischemic and necrotic tissue has decreased contractility, causing decreased cardiac output. #4 is incorrect. The buildup of plaque takes a longer period and will not give immediate symptoms of an MI. Stable angina occurs in a predictable manner, because there is gradual reduction of the vessel lumen size and other vessels may compensate forthis minor hypoxia until the vessel is completely occluded. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrity B) Unstable angina occurs when a blockage from pla-terilceht thrombi in smaller vessels occurs, causing myocardial ischemia. Because ischemic pattern of pain varies, it is unpredictable and can occur with exertion and rest. Eventually, the patient will limit activity to minimize the symptoms. #1 is incorrect. The formation of fibrin along the areaof ruptured plaque will stabilize the thrombi and fully occlude the coronary vessel. Therefore, with full occlusion an STEMI occurs. #2 is incorrect. When occlusion occurs,ST elevation occurs; necrosis and ischemia are a result of the decreased blood flow. Ischemic and necrotic tissue has decreased contractility, causing decreased cardiac output. #4 is incorrect. The buildup of plaque takes a longer period and will not give immediate symptoms of an MI. Stable angina occurs in a predictable manner, because there is gradual reduction of the vessel lumen size and other vessels may compensate forthis minor hypoxia until the vessel is completely occluded. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrity 4 C) Unstable angina occurs when a blockage from pla-terilceht thrombi in smaller vessels occurs, causing myocardial ischemia. Because ischemic pattern of pain varies, it is unpredictable and can occur with exertion and rest. Eventually, the patient will limit activity to minimize the symptoms. #1 is incorrect. The formation of fibrin along the areaof ruptured plaque will stabilize the thrombi and fully occlude the coronary vessel. Therefore, with full occlusion an STEMI occurs. #2 is incorrect. When occlusion occurs,ST elevation occurs; necrosis and ischemia are a result of the decreased blood flow. Ischemic and necrotic tissue has decreased contractility, causing decreased cardiac output. #4 is incorrect. The buildup of plaque takes a longer period and will not give immediate symptoms of an MI. Stable angina occurs in a predictable manner, because there is gradual reduction of the vessel lumen size and other vessels may compensate forthis minor hypoxia until the vessel is completely occluded. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrity D) Unstable angina occurs when a blockage from pla-terilceht thrombi in smaller vessels occurs, causing myocardial ischemia. Because ischemic pattern of pain varies, it is unpredictable and can occur with exertion and rest. Eventually, the patient will limit activity to minimize the symptoms. #1 is incorrect. The formation of fibrin along the areaof ruptured plaque will stabilize the thrombi and fully occlude the coronary vessel. Therefore, with full occlusion an STEMI occurs. #2 is incorrect. When occlusion occurs,ST elevation occurs; necrosis and ischemia are a result of the decreased blood flow. Ischemic and necrotic tissue has decreased contractility, causing decreased cardiac output. #4 is incorrect. The buildup of plaque takes a longer period and will not give immediate symptoms of an MI. Stable angina occurs in a predictable manner, because there is gradual reduction of the vessel lumen size and other vessels may compensate forthis minor hypoxia until the vessel is completely occluded. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrity 3)A nurse is discussing management of hypertension with a patient. Which of the following statements bythe patient would indicate that the patient needs additional teaching about the relationship between hypertension and acute coronary syndrome (ACS)? A) "My high blood pressure has no relationship to the severity of heart disease or its outcomes." B) "Because I'm over 80, even a 20 mm Hg drop in my blood pressure can reduce my risk." C) "High blood pressure will increase my body's need for oxygen and increase my heart's workload." D) "Controlling my blood pressure will decrease my risk of having a heart attack to some degree." Answer: A Explanation: A) (Note: The question is asking what statement needs more teaching because it isincorrect) The higher the hypertension rates, the greater the severity of ACS. Therefore, there is a direct correlation between the two. #2, #3, and #4 are incorrect answers to this questioThese statements are correct information. Minimal reduction and management of bloodpressure will decrease the severity and risk for ACS. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrity 5 B)(Note: The question is asking what statement needs more teaching because it isincorrect) The higher the hypertension rates, the greater the severity of ACS. Therefore, there is a direct correlation between the two. #2, #3, and #4 are incorrect answers to this questioThese statements are correct information. Minimal reduction and management of bloodpressure will decrease the severity and risk for ACS. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrity C) (Note: The question is asking what statement needs more teaching because it isincorrect) The higher the hypertension rates, the greater the severity of ACS. Therefore, there is a direct correlation between the two. #2, #3, and #4 are incorrect answers to this questioThese statements are correct information. Minimal reduction and management of bloodpressure will decrease the severity and risk for ACS. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrity D) (Note: The question is asking what statement needs more teaching because it isincorrect) The higher the hypertension rates, the greater the severity of ACS. Therefore, there is a direct correlation between the two. #2, #3, and #4 are incorrect answers to this questioThese statements are correct information. Minimal reduction and management of bloodpressure will decrease the severity and risk for ACS. Nursing Process: EvaluationCognitive Level: Analysis Category of Need: Psychosocial Integrit