STUVIA 2024/2025
SPC Level 2 Exam 3- Acute Coronary Syndrome
Adaptive Quiz
-"In what location did you feel the pain?"
Using PQRST, the assessment data not volunteered by the patient is the radiation (R) of pain, the
area in which the patient felt the pain and if it radiated. The precipitating event (P) was going to the
bathroom and having a bowel movement. The quality (Q) of the pain was "like before I was admitted,"
although a more specific description may be helpful. Severity (S) of the pain was the "worst chest
pain ever," although an actual number may be needed. Timing (T) is supplied by the patient
describing when the pain occurred and that the patient had had this pain previously. - ✔✔A patient
with angina states, "I walked to the bathroom. While I was having a bowel movement, I started having
the worst chest pain ever. It was similar to the pain I had at home. The pain went away rather quickly."
Which further subjective assessment data would the nurse obtain?
-"What precipitated the pain?"
-"Has the pain changed this time?"
-"In what location did you feel the pain?"
-"Please rate the pain on a scale from 0 to 10."
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-"Physical activity should be regular, rhythmic, and repetitive."
Physical activity should be regular, rhythmic, and repetitive, using large muscles to build up
endurance (e.g., walking, cycling, swimming, rowing). Physical activity sessions should be at least 30
minutes long. Instruct the patient to begin slowly at personal tolerance (perhaps only 5 to 10 minutes)
and build up to 30 minutes. Encourage the patient to perform physical activity on most days of the
week. Activity intensity is determined by the patient's heart rate. If an exercise stress test has not
been performed, the heart rate of the patient recovering from an MI should not exceed 20 beats/min
over the resting heart rate. - ✔✔A patient is recovering from an uncomplicated myocardial infarction
(MI). Which instructions will the nurse include about physical activity?
-"Start out with 30-minute sessions."
-"Be sure to perform physical activity at least twice a week."
-"Physical activity should be regular, rhythmic, and repetitive."
-"Your heart rate during exercise should only be 30 beats over your resting rate."
-"Significant head trauma within the past three months is a relative contraindication."
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Significant closed-head or facial trauma within the past three months is an absolute contraindication
due to increased risk of bleeding; the benefit does not outweigh the risk. Signs and symptoms of
bleeding during thrombolytic therapy include a drop in BP, increase in HR, sudden change in the
patient's mental status, and blood in the urine or stool. Treatment of ST-segment-elevation myocardial
infarction (STEMI) with thrombolytic therapy aims to limit the infarction size by dissolving the
thrombus in the coronary artery and reperfusing the heart muscle rapidly. The most reliable sign of
blood flow restoration is the return of the ST segment to baseline on the ECG. - ✔✔The nurse
provides information about thrombolytic therapy to a group of student nurses. Which statement made
by a student nurse indicates the need for further teaching?
-"Significant head trauma within the past three months is a relative contraindication."
-"A symptom of major bleeding with thrombolytic therapy is an increase in heart rate (HR)."
-"The goal is to give the thrombolytic within 30 minutes of the patient's arrival to the emergency
department."
-"The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the
electrocardiogram (ECG)."
-"Take chewable aspirin. The total dose should be 325 mg."
The symptoms described by the patient may be due to acute coronary syndrome (ACS). Advise the
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patient to take chewable aspirin; the dose is 162 to 325 mg (typically 4 baby aspirin or 2 adult
aspirin). The patient's BP may be elevated, and lying with the feet elevated will most likely increase
the BP. The patient should not increase oxygen demand by walking to a neighbor's house or by taking
the BP. - ✔✔A patient phones a health care provider's office and states, "I am having severe chest
tightness that won't go away even when I lie down." In addition to contacting emergency responders,
which instruction would the nurse provide to the patient?
-"Lie down with your feet elevated."
-"Go to a neighbor's house to get assistance."
-"Take chewable aspirin. The total dose should be 325 mg."
-"Take your blood pressure. It will be useful to know for your care."
-"Take the drug on an empty stomach."
The drug should be taken with food. Side effects include flushing and pruritus in the upper torso and
face, as well as gastrointestinal (GI) disturbances. Most side effects subside with time. Decreased
liver function may occur with high doses. - ✔✔A patient with acute coronary syndrome (ACS)
receives a prescription for niacin to treat hyperlipidemia. The nurse observes another care provider
giving information about the medication to the patient. Which item included in the education would the
nurse question?
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, STUVIA 2024/2025
-"Most side effects subside with time."
-"Take the drug on an empty stomach."
-"A side effect is flushing in the upper torso and face."
-"Decreased liver function may occur with high doses."
-"The patient's pain can be relieved by sitting in the forward position."
Acute pericarditis is an inflammation of the pericardium that may occur within two to three days of
acute myocardial infarction. The patient's chest pain is relieved after sitting in the forward position.
The pain may return after a change in position or inspiration. Massaging the chest region may
aggravate the symptoms. IV heparin is given to a patient with an unstable thrombus or coronary
artery spasm. Papillary muscle dysfunction treatment involves mitral valve repair or replacement.
Acute pericarditis treatment involves nonsteroidal antiinflammatory agents, aspirin, and
corticosteroids. - ✔✔The nurse teaches a student nurse about acute pericarditis. Which statement
made by the student nurse indicates effective learning?
-"I should massage the patient's chest region to relieve symptoms."
-"The patient's pain can be relieved by sitting in the forward position."
-"Acute pericarditis should be treated immediately by IV heparin."
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-"Treatment of acute pericarditis involves mitral valve repair or replacement."
-24-hour Holter monitoring
-Implantable cardiac monitor
-Signal-averaged electrocardiogram (ECG)
-Electrophysiologic study (EPS) under fluoroscopy
Because most SCD patients have lethal ventricular dysrhythmias associated with a high recurrence
rate, they are closely monitored to assess when they are most likely to have a recurrence and to
determine which drug therapies are most effective for them. This monitoring may include 24-hour
Holter monitoring, implantable cardiac monitor, signal-averaged ECG, and an EPS done under
fluoroscopy. MRI is not used to monitor for lethal dysrhythmias. - ✔✔The nurse is caring for a patient
who survived sudden cardiac death (SCD) caused by a lethal ventricular dysrhythmia. Which tests
will likely be prescribed to monitor the effectiveness of drug treatment? Select all that apply.
-24-hour Holter monitoring
-Implantable cardiac monitor
-MRI
-Signal-averaged electrocardiogram (ECG)
-Electrophysiologic study (EPS) under fluoroscopy
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