Question 1 of 10
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Which laboratory finding is most significant for diagnosis of a myocardial infarction (MI)?
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- Elevated lactic dehydrogenase (LDH)LDH and LDH isoenzyme levels are observed over a 72-hour period. Elevation of this isoenzyme in the presence of elevation of other cardiac markers aids in confirming the diagnosis of MI. This test alone is not significant for the diagnosis of MI.
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- Elevated creatine kinase (CK)CK isoenzyme levels are observed over a 72-hour period. Elevation of this isoenzyme in the presence of elevation of other cardiac markers aids in confirming the diagnosis of MI. This test alone is not significant for the diagnosis of MI. Elevated CK indicates muscle injury but not specifically cardiac muscle.
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- Elevated troponin levelTroponin is found only in cardiac tissue. The most significant laboratory finding for diagnosis of MI is an elevated troponin level. Troponin levels are the preferred biomarker for diagnosis of myocardial infarction.
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- Elevated CK-MMCK-MM is found in skeletal muscle. This isoenzyme is not specific to cardiac muscle injury.
Question 2 of 10
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In which way is low-density lipoprotein (LDL) a contributing factor to atherosclerosis?
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- Increased LDL hardens the arteries immediatelyLDL is a major contributing factor to the formation of fatty material (plaques) within the arteries. This plaque blocks the arteries. Over time, the plaque begins to calcify, causing rigidity of the vessel wall, thus causing hardening of the arteries if left untreated over time. This is not an immediate process.
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- Increased LDL contributes to the formation of fatty material in the arteriesThe process of atherosclerosis begins during late childhood, when streaks or islands of fatty material are laid down on the inner walls of the arteries. Increased low-density lipoprotein (LDL) is the major contributing factor to the formation of this fatty material. Increased LDL contributes to the formation of fatty material in the arteries (plaque). This plaque deposited in the arteries is known as atherosclerosis.
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- Increased LDL causes increases blood flow through the arteriesLDL is a major contributing factor to the formation of fatty material (plaques) within the arteries. This plaque blocks the arteries, which decreases blood flow through the arteries.
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- Decreased LDL contributes to the formation of fatty material in the arteriesThe process of atherosclerosis begins during late childhood, when streaks or islands of fatty material are laid down on the inner walls of the arteries. LDL is the major contributing factor to the formation of this fatty material. Increased, not decreased LDL contributes to the formation of fatty material in the arteries (plaque). This plaque deposited in the arteries is known as atherosclerosis.
Question 3 of 10
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What risk factor for coronary artery disease (CAD) is being identified when blood glucose and hemoglobin A1c (HbA1c) tests are ordered?
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- AtherosclerosisDiabetes is a risk factor for CAD because of the damage it causes to the arteries. Blood glucose and HbA1c are both tests used to diagnose and manage diabetes. Atherosclerosis is a risk factor for CAD, but blood glucose and HbA1c are not tests for atherosclerosis.
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- Diabetes mellitusDiabetes is a risk factor for CAD because of the damage it causes to the arteries. Blood glucose and HbA1c are tests used to diagnose and manage diabetes. The blood glucose shows the amount of glucose in the blood at the present time, and the HbA1c shows how the blood glucose has been ranging over the last 3 to 6 months.
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- HypertensionDiabetes is a risk factor for CAD because of the damage it causes to the arteries. Blood glucose and HbA1c are both tests used to diagnose and manage diabetes. Hypertension is a risk factor for CAD, but blood glucose and HbA1c are not tests for hypertension.
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- HypercholesterolemiaDiabetes is a risk factor for CAD because of the damage it causes to the arteries. Blood glucose and HbA1c are both tests used to diagnose and manage diabetes. Hypercholesterolemia is a risk factor for CAD, but blood glucose and HbA1c are not tests for hypercholesterolemia.
Question 4 of 10
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Which nonmedication treatment lowers cholesterol and total lipids? Select all that apply. One, some, or all responses may be correct.
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- Low-fat dietA low-fat diet is prescribed to lower cholesterol and total lipids. A low-fat diet is part of a healthy lifestyle. A low-fat diet removes bad cholesterol from the bloodstream, thus reducing heart disease risk. Both kinds of cholesterol go down if you eat a low-fat diet.
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- ExerciseExercise is prescribed to lower cholesterol and total lipids. Exercise stimulates enzymes that help move low-density lipoprotein from the blood (and blood vessel walls) to the liver. The cholesterol is converted into bile (for digestion) or excreted.
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- Weight controlWeight control is prescribed to lower cholesterol and total lipids. Losing weight can help with cholesterol levels by reducing the amount of fat in the body and decreasing inflammation.
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- Relaxation techniquesRelaxation techniques are good for lowering stress, which is a risk factor for coronary artery disease. Relaxation techniques do not lower cholesterol and total lipids.
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- Smoking cessationSmoking cessation lowers risk factors for hypertension and coronary artery disease. Smoking cessation does not lower cholesterol and total lipids.
Question 5 of 10
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Which lab test would the nurse expect the provider to order periodically for a patient taking statins to lower cholesterol? Select all that apply. One, some, or all responses may be correct.
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- Creatinine kinase (CK)Because statins can injure muscle tissue, blood levels of CK (an enzyme released from damaged muscle) should be drawn periodically.
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- TroponinTroponin is a lab test that is a cardiac marker for myocardial infarction (MI). Hypercholesterolemia is a risk factor for MI, but a patient taking statins does not have to have a troponin level drawn.
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- Low-density lipoprotein (LDL)LDL is the bad cholesterol that accumulates in patients with hypercholesterolemia. A patient with hypercholesterolemia may be taking a statin. Therefore the LDL will need to be checked periodically to see if the statins are effective.
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- Liver enzymesStatins are known to be toxic to the liver. Therefore liver enzymes need to be drawn periodically to see if they are elevated, which would indicate toxic damage to the liver.
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- High-density lipoprotein (HDL)HDL is the good cholesterol that absorbs cholesterol and takes it back to the liver to be cleared from the body. A patient with a history of hypercholesterolemia will need to have HDL checked periodically to see if there is enough to clear the bad cholesterol.
Question 6 of 10
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Which statement describes the coronary arteries and blood vessels of a patient with a diagnosis of angina? Select all that apply. One, some, or all responses may be correct.
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- Vessel and artery narrowingAngina may be caused by vessel narrowing due to atherosclerosis. The blood supply to the heart is decreased and need is increased resulting in chest pain.
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- Sudden constriction (spasm) of vessel and arteryAngina may be caused or arterial spasm (sudden constriction). This sudden constriction does not allow adequate blood circulation. The constriction decreases the blood supply to the heart resulting in chest pain.
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- Vessel and artery dilationAngina may be caused by vessel narrowing due to atherosclerosis. The blood supply to the heart is decreased and need is increased resulting in chest pain. With angina, the blood vessels do not dilate.
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- Vessel and artery cloggingAngina may be caused by vessel narrowing that is due to atherosclerosis. This narrowing is the result of clogging up of the vessel with fatty deposits (plaque), which decrease blood supply to the heart.
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- Vessel and artery necrosisNecrosis is the death of the tissue. This occurs within the heart muscle itself with an MI, but it does not occur in the artery and vessels.
Question 7 of 10
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Which reason could explain why patients often delay seeking treatment when having a myocardial infarction (MI)? Select all that apply. One, some, or all responses may be correct.
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- Vague symptomsVague symptoms include fatigue, weakness, and indigestion. These symptoms make the patient think that they have another condition such as “just tired,” flu, or upset stomach.
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- Classic symptomsClassically, during an MI there is a sudden, severe pain in the chest, usually described as tightness, pressure, squeezing, or crushing, that is not relieved by nitrates or rest. The patient also shows symptoms of dyspnea; nausea with or without vomiting; wheezing; and ashen, clammy, cool skin. Signs of shock with pallor, profuse sweating, and anxiety may occur. These symptoms would take patients to the emergency department immediately.
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- DenialDenial is a significant factor in not seeking quick treatment and can lead to increased heart damage. The patient having arm pain may think they pulled a muscle. With indigestion, they may think it was something they ate or gastrointestinal upset. Others may think, “It couldn’t be happening to me.”
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- Silent MISome people experience a “silent” MI, in which no symptoms are perceived. This person would not seek medical attention because they have no symptoms.
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- History of anginaAngina and myocardial infarction present with similar symptoms. The patient may likely think that it is “just another angina attack” and therefore delay seeking treatment.
Question 8 of 10
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Which diagnostic test for myocardial infarction (MI) will be performed immediately for a patient who arrives at an emergency department with chest pain, shortness of breath, and nausea and vomiting?
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- CK-MBCK isoenzymes are observed over a 72-hour period. The CK is fractionalized into CK-MB, an enzyme that is found only in heart muscle. The level of CK-MB rises in 4 to 8 hours after onset of symptoms and begins to decline in 12 to 24 hours. Thus there is no need to do this test immediately.
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- White blood cell count (WBC)When there is necrotic tissue anywhere in the body, the WBC increases. The necrosis does not have to be cardiac specific. A WBC is a routine part of the complete blood cell count that is done per best practice for a patient with chest pain. This does not need to be done immediately.
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- Chest X-rayAn ECG is done immediately. If an MI is ruled out, a chest x-ray will be done to rule out other possible causes of the symptoms, such as a thoracic aortic aneurysm.
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- Electrocardiogram (ECG)An ECG will be performed promptly when a patient is having symptoms that could indicate acute coronary syndrome. ST-elevation myocardial infarction or non–ST-elevation myocardial infarction will be ruled in or ruled out based on the ECG. Changes occur in the QRS complex, ST segment, and T wave when ischemia or damaged tissue occurs.
Question 9 of 10
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Which cardiac event would be treated with cardiac catheterization and balloon angioplasty with placement of stents? Select all that apply. One, some, or all responses may be correct.
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- Congestive heart failure (CHF)CHF is not treated with cardiac catheterization. It is treated with medications such as diuretics and angiotensin-converting enzyme inhibitors.
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- Stable anginaWith stable angina, chest pain is usually relieved at rest. The angina attacks are usually predictable and may be brought on by stress or cold weather. A cardiac catheterization and balloon angioplasty with stents is not indicated for this patient.
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- Non–ST-elevation myocardial infarction (NSTEMI)NSTEMI is less severe than STEMI. It indicates a block in a minor artery or partial obstruction of major artery. This myocardial infarction can usually be treated with medication. In high-risk NSTEMI patients, cardiac catheterization may be performed within 12 to 24 hours after the patient arrives at the hospital (not immediately).
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- ST-elevation myocardial infarction (STEMI)If STEMI is indicated on the electrocardiogram, measures are implemented to address the complete occlusion of a coronary artery. The patient may immediately undergo cardiac catheterization and balloon angioplasty with placement of stents to restore blood flow.
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- Stable coronary artery disease (SCAD)SCAD (formerly called stable angina) can be induced by stressors such as exercise or emotion. Chest pain is usually relieved at rest. A cardiac catheterization and balloon angioplasty with stents is not indicated for this patient.
Question 10 of 10
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Which factor places a patient at increased risk for coronary artery disease (CAD)? Select all that apply. One, some, or all responses may be correct.
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- Age older than 40 yearsFactors such as age (older than 40 years) contribute to coronary artery disease.
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- African American raceFactors such as race (disproportionately higher in African Americans) contribute to coronary artery disease.
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- Postmenopausal womanPostmenopausal women are at greater risk for CAD than are women outside this category.
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- Use of oral contraceptivesWomen who use oral contraceptives or hormone replacement therapy are at greater risk for CAD than are women outside these categories.
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- Decreased cholesterol levelsIncreased (not decreased) cholesterol levels make the patient more susceptible to coronary artery disease.
