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Acute Coronary Syndrome: Test Questions and Answers for NRSG 327 Week 3, Exams of Nursing

Montana State UniversityNursing

A series of questions and answers related to acute coronary syndrome (acs), focusing on assessment, predisposing factors, treatment, and ecg interpretation. It covers topics such as atherosclerosis, virchow's triad, pulmonary embolism (pe), and the role of cardiac markers in diagnosing acs. Designed to help students in nrsg 327 understand the key concepts and clinical aspects of acs.

Typology: Exams

2024/2025

Available from 03/14/2025

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NRSG 327 WEEK 3 - ACUTE CORONARY SYNDROME: TEST
QUESTIONS WITH VERIFIED ANSWERS
What assessment do you want to make sure you do when assessing chest pain post-op?
-- Answer โœ”โœ” Pain assessment
What systems can contribute to chest pain? -- Answer โœ”โœ” - Anxiety/mental health
- GI/Resp
- Cardiac (CAD)
GI chest pain -- Answer โœ”โœ” heart burn sensation
- Changes with movement
Resp chest pain -- Answer โœ”โœ” sharp pain
- changes with movement
Cardiac chest pain -- Answer โœ”โœ” Describe it as a pressure (someone sitting on their
chest), cannot get a full breath in, tightening, pressure, weight,
- does not change with movement
What predisposing factors do you usually need to develop Atherosclerosis? -- Answer
โœ”โœ” - HTN
- Fatty diet
- Uncontrolled DM
Atherosclerosis -- Answer โœ”โœ” Damage to epithelium-> accumulation of lipids (bad
cholesterol)-> starts to become fibrous-> lining starts to rip->clots form and occludes
blood vessel
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Download Acute Coronary Syndrome: Test Questions and Answers for NRSG 327 Week 3 and more Exams Nursing in PDF only on Docsity!

NRSG 327 WEEK 3 - ACUTE CORONARY SYNDROME: TEST

QUESTIONS WITH VERIFIED ANSWERS

What assessment do you want to make sure you do when assessing chest pain post-op? -- Answer โœ”โœ” Pain assessment What systems can contribute to chest pain? -- Answer โœ”โœ” - Anxiety/mental health

  • GI/Resp
  • Cardiac (CAD) GI chest pain -- Answer โœ”โœ” heart burn sensation
  • Changes with movement Resp chest pain -- Answer โœ”โœ” sharp pain
  • changes with movement Cardiac chest pain -- Answer โœ”โœ” Describe it as a pressure (someone sitting on their chest), cannot get a full breath in, tightening, pressure, weight,
  • does not change with movement What predisposing factors do you usually need to develop Atherosclerosis? -- Answer โœ”โœ” - HTN
  • Fatty diet
  • Uncontrolled DM Atherosclerosis -- Answer โœ”โœ” Damage to epithelium-> accumulation of lipids (bad cholesterol)-> starts to become fibrous-> lining starts to rip->clots form and occludes blood vessel

Virchowโ€™s Triad -- Answer โœ”โœ” o Venous Stasis o Vessel wall o Coagulation Changes in Venous statis -- Answer โœ”โœ” Immobility, obesity, increase age (various veins) Changes in vessel wall -- Answer โœ”โœ” Trauma, surgery (which is a trauma) Changes in coagulation -- Answer โœ”โœ” Surgery (giving heparin, holding onto their anticoagulants), pregnancies, massive change in diet, infections PE caused by: -- Answer โœ”โœ” Obstruction of the pulmonary artery or one of its branches by a thrombi

  • Typically caused by Afib or DVT What does a PE originate in -- Answer โœ”โœ” The venous system or RA or RV What are the 2 examples of PE -- Answer โœ”โœ” o Thrombotic: DVT, AFib o Embolic: Fat, amniotic, air S/S of PE? -- Answer โœ”โœ” o Depend on the size of thrombus and the area where the occlusion occurs o Dyspnea o Tachypnea o CP sudden onset - pleuritic PE treatment- NRSG interventions -- Answer โœ”โœ” o Raise the head of the bed o Assessment VS (usually see decrease O2- Put oxygen on is below 92%) o Listen to heart - Look for A-fib (is find an irregular rhythm ECG)

Factors which may determine peri-op myocardial ischemia and infarction: -- Answer โœ”โœ” Decreased Myocardial O2 Supply & Increased Myocardial Demand Decreased myocardial O2 supply s/s -- Answer โœ”โœ” o Hypoxia

  • Surgery- Stress, Vasospasm, Drugs o โ†“BP
  • Coronary vasospasm Increased myocardial demand s/s -- Answer โœ”โœ” o โ†‘ myocardial wall stress
  • Heart is in FLIGHT/FIGHT mode o Dysrhythmia o Changes in body temperature Why does an MI happen post-op? -- Answer โœ”โœ” Decreased Myocardial supply and an increase in the demand non modifiable risk factors -- Answer โœ”โœ” age, gender, family history modifiable risk factors -- Answer โœ”โœ” o Diet o HTN o Cholesterol levels o Smoking o Increased Blood sugar o Lifestyle- Sedentary, ETOH, Stress, Lifestyles, Occupation o Environment Angina -- Answer โœ”โœ” Chest pain that is the result of myocardial ischemia Types of Angina -- Answer โœ”โœ” o Stable

o Variant (Prinzmetal) o Acute Coronary Syndrome Stable Angina -- Answer โœ”โœ” o Very predictable (old grannies and grandpas) o Chest pain goes away at rest, usually happens from stress or exertion Prinzmetal Angina (variant) -- Answer โœ”โœ” o Not clot-related o Usually related to a spasm (coronary artery is spasming) o Coronary artery is getting stressed out and getting a decrease of O2 and chest pain o IN most people the coronary artery lays on top of the heart, but in some people it goes through the muscle of the heart (so if the heart doesn't enlarge and it stressed all the time it cuts off the blood flow) Acute Coronary Syndrome -- Answer โœ”โœ” Unstable angina, Non-STEMI and STEMI Unstable Angina -- Answer โœ”โœ” o Lumen is still quit open o Good amount of blood flow o Thrombus is small N-Stemi -- Answer โœ”โœ” o Very minimal space of the lumen o Some but minimal blood flow Stemi -- Answer โœ”โœ” - Lumen completely clotted off

  • No blood flow through the artery
  • WORST!!! Collateral Circulation -- Answer โœ”โœ” o Arterial branching o Develops over time in response to chronic ischemia o Rapid onset CAD no time to develop collateral circulation Carrot Diagram -- Answer โœ”โœ” o Big black lines are clots

o 12 lead ECG

  • Labs-> STAT
  • D dimer (good for coagulation, PE, DVT)
  • BNP (Good to look for HF)
  • Troponin ***, CK, MB (Myoglobin) ECG changes when cell does not get enough O2 -- Answer โœ”โœ” in the heart we can see electrical activity - ST segment that your txt mentions shows ventricular repolarization. Ischemia T wave inversion, injury ST depression ST elevation, Q wave means what? -- Answer โœ”โœ” Dead tissue The loss of ATP leads to decreased activity of ATP-dependent transport systems, including what? -- Answer โœ”โœ” The Na+/K+pump that normally transports K+ into the cell and Na+ out of the cell. ECG -- Answer โœ”โœ” o Usually resting o 12 lead most common o Left Ventricle (LV) o Rate, rhythm, ST elevation or depression o Telemetry is usually only 1 lead better for looking for dysrhythmias o Holter monitor: records activity over the period of 24 hours o Patient is given a journal to record episodes of chest pain, SOB or palpitations o When monitor is examined can correlate events to monitor activity Myocardial Ischemia -- Answer โœ”โœ” o Ischemia T wave inversion, o injury ST depression >1mm o ST elevation, Q wave means dead tissue o Remember that Q waves can be normal or abnormal. When abnormal, they indicate the presence of an ongoing or an old myocardial infarction.
  • The ECG findings of a pathologic Q wave include a Q wave duration of > 40 milliseconds (one small box) or size > 25% of the QRS complex amplitude 12 lead ECG -- Answer โœ”โœ” Specifically looking at the left ventricle (where most of the coronary arteries are) 15 lead ECG -- Answer โœ”โœ” Looks at the right side of the heart P wave -- Answer โœ”โœ” Depolarization of the atria (contraction) QRS wave -- Answer โœ”โœ” Depolarization of the ventricles (contraction) T wave -- Answer โœ”โœ” Repolarization of the ventricles (relaxation) ST Segment -- Answer โœ”โœ” Our isoelectric line (baseline) Should be nice and flat - in a healthy person the St segment should be at the isoelectric line - if not it is a sign of Myocardial infarction Atrial Relaxation -- Answer โœ”โœ” ยท makes up the QRS complex Changes in the T wave/ decreased ST segment -- Answer โœ”โœ” NSTEMI Increased ST -- Answer โœ”โœ” STEMI Acute Coronary Syndrome (ACS): -- Answer โœ”โœ” o We first want to rule out a STEMI (ST elevation on our 12 lead and changes in our markers - usually an elevated troponin) Cardiac Markers--> Troponin Cardiac Enzymes -- Answer โœ”โœ” - CK
  • CKMB
  • Troponin I
  • P2Y12 - Antiplatelet medications
  • Nitroglycerin - vasodilates vessels (careful who you give it to SE= Hypotension) - do not give to right-sided MI (drops their pressure to much) Thrombolytics -- Answer โœ”โœ” risk of bleeding - they just had surgery
  • does the pros outway the risks? Thrombolytics- ยท ABSOLUTE Contraindications -- Answer โœ”โœ” o Brain Problems:
  • Intracranial Hemorrhage (ICH)
  • Recent ischemic stroke <3months
  • Brain CA o Bleeding Problems:
  • Aortic Dissection
  • Recent Trauma/Active Bleeding- John just had a fem pop bypass surgery o Uncontrolled Hypertension Thrombolytics - RELATIVE Contraindications -- Answer โœ”โœ” o Brain Problems:
  • Ischemic stroke > 3months
  • Other neuro issues o Bleeding Problems:
  • High INR, anticoagulant use
  • Recent bleeding
  • Traumatic CPR o Controlled Hypertension o Pt has an hx and is a risk BUT LOOK AT RISK vs BENEFITS
  • John just had a FEM POP BYPASS SURGERY Coronary Artery Bypass Graft (CABG): -- Answer โœ”โœ” Usually, if we see a left main involved or multiple blockages - > coronary artery bypass surgery (open heart surgery)

Key points -- Answer โœ”โœ” o Really good assessment including thorough PAIN ASSESSMENT o 12 lead ECG o Cardiac enzymes - mainly troponin o P2Y12 & ASA are key!!! o Get intervention: TNKase, PCI, and/or CABG