Lewis ATI med-surg chapter. 33 coronary artery disease &
acute coronary syndrome Problem Solving Exam Questions
and certified for accuracy solutions; updated 2025/2026
Which treatment is used first for the patient with a confirmed mi to open the blocked
artery within 90 minutes of arrival to a health care facility?
A. Tmr
b. Stent placement
c. Coronary artery bypass graft (cabg)
d. Percutaneous coronary intervention (pci)
D. Percutaneous coronary intervention (pci)
Emergent percutaneous coronary intervention (pci) is the first treatment for patients with
a confirmed mi within 90 minutes of arriving at the facility with an interventional cardiac
catheterization laboratory. Tmr, stent placement, and cabg are usually done to facilitate
circulation in nonemergency situations.
Collaboration: in planning care for a patient who has just returned to the unit following
a pci, the nurse may delegate which activity to unlicensed assistive personnel (uap)?
A. Monitor the iv fluids and measure urine output.
B. Check vital signs and report changes in hr, bp, or pulse oximetry.
C. Explain to the patient the need for frequent vital signs and pulse checks.
D. Assess circulation to the extremity used by checking pulses, skin temperature, and
color.
B. Check vital signs and report changes in hr, bp, or pulse oximetry.
The uap can check vital signs and report results to the rn. The other actions include
assessment, teaching, and monitoring of iv fluids, which are all responsibilities of the rn.
A patient is scheduled to have cabg surgery. What should the nurse explain is involved
with the procedure?
A. A synthetic graft will be used as a tube for blood flow from the aorta to a coronary
artery distal to an obstruction.
B. A stenosed coronary artery will be resected, and a synthetic arterial tube graft will be
inserted to replace the diseased artery.
C. The internal mammary artery will be detached from the chest wall and attached to a
coronary artery distal to the stenosis.
,D. Reversed segments of a saphenous artery from the aorta will be anastomosed to the
coronary artery distal to an obstruction.
C. The internal mammary artery will be detached from the chest wall and attached to a
coronary artery distal to the stenosis.
The most common method of coronary artery bypass involves leaving the internal
mammary artery attached to its origin from the subclavian artery but dissecting it from
the chest wall and anastomosing it distal to an obstruction in a coronary artery. Other
grafts options include using the saphenous vein, and/or radial artery.
Interprofessional care of the patient with nstemi differs from that of a patient with stemi
in that nstemi is more often initially treated with what?
A. Pci
b. Cabg
c. Acute intensive drug therapy
d. Reperfusion therapy with thrombolytics
C. Acute intensive drug therapy
An nstemi is an acs that indicates a transient thrombosis or incomplete coronary artery
occlusion. Treatment involves intensive drug therapy with antiplatelets, glycoprotein
iib/iiia inhibitors, antithrombotics, and heparin to prevent clot extension. In addition, iv
ntg is used. Reperfusion therapy using thrombolytics, cabg, or pci is used for treatment
of stemi.
During treatment with reteplase (retavase) for a patient with a stemi, which finding
should most concern the nurse?
A. Oozing of blood from the iv site
b. Bp of 102/60 mm hg with an hr of 78 bpm
c. Decrease in the responsiveness of the patient
d. Intermittent accelerated idioventricular rhythms
C. Decrease in the responsiveness of the patient
Decreasing level of consciousness (loc) may reflect hypoxemia resulting from internal
bleeding, which is always a risk with thrombolytic therapy. Oozing of blood is expected,
as are reperfusion dysrhythmias. Bp is low but not considered abnormal because the
pulse is within normal range. Idioventricular dysrhythmias are common with reperfusion.
The nurse recognizes that thrombolytic therapy for the treatment of an mi has not been
successful when the patient displays which manifestation?
A. Continues to have chest pain
b. Develops gastrointestinal (gi) bleeding
, c. Has a marked increase in ck-mb levels within 3 hours of therapy
d. Develops premature ventricular contractions and ventricular tachycardia during
treatment
A. Continues to have chest pain
If chest pain is unchanged, it is a sign that reperfusion was not successful. Indications
that the occluded coronary artery is patent and blood flow to the myocardium is
reestablished following thrombolytic therapy include return of st-segment to baseline on
the ecg; relief of chest pain; marked, rapid rise of the ck-mb within 3 hours of therapy;
and the presence of reperfusion dysrhythmias. Bleeding is a complication of
thrombolytic therapy but does not indicate lack of success or successful reperfusion.
When the patient who is diagnosed with an mi is not relieved of chest pain with iv ntg,
which medication will the nurse expect to be used?
A. Iv morphine sulfate
b. Calcium channel blockers
c. Iv administration of amiodarone
d. Angiotensin-converting enzyme (ace) inhibitors
A. Iv morphine sulfate
morphine sulfate decreases anxiety and cardiac workload as a vasodilator and reduces
preload and myocardial o2 consumption, which relieves chest pain. Calcium channel
blockers, amiodarone, and angiotensin-converting enzyme (ace) inhibitors will not
relieve chest pain related to an mi.
What is the rationale for using docusate sodium (colace) for a patient after an mi?
A. Relieves cardiac workload
b. Minimizes vagal stimulation
c. Controls ventricular dysrhythmias
d. Prevents the binding of fibrinogen to platelets
B. Minimizes vagal stimulation
docusate sodium (colace) is a stool softener, which prevents straining and provoking
dysrhythmias. It does not do any of the other options. Antidysrhythmics are used to
control ventricular dysrhythmias; morphine sulfate is used to decrease anxiety and
cardiac workload; and glycoprotein iib/iiia inhibitors and antiplatelets prevent the binding
of fibrinogen to platelets.
A patient who has hypertension just had an mi. Which type of medication should the
nurse expect to be added to decrease the cardiac workload?
A. Ace inhibitor
acute coronary syndrome Problem Solving Exam Questions
and certified for accuracy solutions; updated 2025/2026
Which treatment is used first for the patient with a confirmed mi to open the blocked
artery within 90 minutes of arrival to a health care facility?
A. Tmr
b. Stent placement
c. Coronary artery bypass graft (cabg)
d. Percutaneous coronary intervention (pci)
D. Percutaneous coronary intervention (pci)
Emergent percutaneous coronary intervention (pci) is the first treatment for patients with
a confirmed mi within 90 minutes of arriving at the facility with an interventional cardiac
catheterization laboratory. Tmr, stent placement, and cabg are usually done to facilitate
circulation in nonemergency situations.
Collaboration: in planning care for a patient who has just returned to the unit following
a pci, the nurse may delegate which activity to unlicensed assistive personnel (uap)?
A. Monitor the iv fluids and measure urine output.
B. Check vital signs and report changes in hr, bp, or pulse oximetry.
C. Explain to the patient the need for frequent vital signs and pulse checks.
D. Assess circulation to the extremity used by checking pulses, skin temperature, and
color.
B. Check vital signs and report changes in hr, bp, or pulse oximetry.
The uap can check vital signs and report results to the rn. The other actions include
assessment, teaching, and monitoring of iv fluids, which are all responsibilities of the rn.
A patient is scheduled to have cabg surgery. What should the nurse explain is involved
with the procedure?
A. A synthetic graft will be used as a tube for blood flow from the aorta to a coronary
artery distal to an obstruction.
B. A stenosed coronary artery will be resected, and a synthetic arterial tube graft will be
inserted to replace the diseased artery.
C. The internal mammary artery will be detached from the chest wall and attached to a
coronary artery distal to the stenosis.
,D. Reversed segments of a saphenous artery from the aorta will be anastomosed to the
coronary artery distal to an obstruction.
C. The internal mammary artery will be detached from the chest wall and attached to a
coronary artery distal to the stenosis.
The most common method of coronary artery bypass involves leaving the internal
mammary artery attached to its origin from the subclavian artery but dissecting it from
the chest wall and anastomosing it distal to an obstruction in a coronary artery. Other
grafts options include using the saphenous vein, and/or radial artery.
Interprofessional care of the patient with nstemi differs from that of a patient with stemi
in that nstemi is more often initially treated with what?
A. Pci
b. Cabg
c. Acute intensive drug therapy
d. Reperfusion therapy with thrombolytics
C. Acute intensive drug therapy
An nstemi is an acs that indicates a transient thrombosis or incomplete coronary artery
occlusion. Treatment involves intensive drug therapy with antiplatelets, glycoprotein
iib/iiia inhibitors, antithrombotics, and heparin to prevent clot extension. In addition, iv
ntg is used. Reperfusion therapy using thrombolytics, cabg, or pci is used for treatment
of stemi.
During treatment with reteplase (retavase) for a patient with a stemi, which finding
should most concern the nurse?
A. Oozing of blood from the iv site
b. Bp of 102/60 mm hg with an hr of 78 bpm
c. Decrease in the responsiveness of the patient
d. Intermittent accelerated idioventricular rhythms
C. Decrease in the responsiveness of the patient
Decreasing level of consciousness (loc) may reflect hypoxemia resulting from internal
bleeding, which is always a risk with thrombolytic therapy. Oozing of blood is expected,
as are reperfusion dysrhythmias. Bp is low but not considered abnormal because the
pulse is within normal range. Idioventricular dysrhythmias are common with reperfusion.
The nurse recognizes that thrombolytic therapy for the treatment of an mi has not been
successful when the patient displays which manifestation?
A. Continues to have chest pain
b. Develops gastrointestinal (gi) bleeding
, c. Has a marked increase in ck-mb levels within 3 hours of therapy
d. Develops premature ventricular contractions and ventricular tachycardia during
treatment
A. Continues to have chest pain
If chest pain is unchanged, it is a sign that reperfusion was not successful. Indications
that the occluded coronary artery is patent and blood flow to the myocardium is
reestablished following thrombolytic therapy include return of st-segment to baseline on
the ecg; relief of chest pain; marked, rapid rise of the ck-mb within 3 hours of therapy;
and the presence of reperfusion dysrhythmias. Bleeding is a complication of
thrombolytic therapy but does not indicate lack of success or successful reperfusion.
When the patient who is diagnosed with an mi is not relieved of chest pain with iv ntg,
which medication will the nurse expect to be used?
A. Iv morphine sulfate
b. Calcium channel blockers
c. Iv administration of amiodarone
d. Angiotensin-converting enzyme (ace) inhibitors
A. Iv morphine sulfate
morphine sulfate decreases anxiety and cardiac workload as a vasodilator and reduces
preload and myocardial o2 consumption, which relieves chest pain. Calcium channel
blockers, amiodarone, and angiotensin-converting enzyme (ace) inhibitors will not
relieve chest pain related to an mi.
What is the rationale for using docusate sodium (colace) for a patient after an mi?
A. Relieves cardiac workload
b. Minimizes vagal stimulation
c. Controls ventricular dysrhythmias
d. Prevents the binding of fibrinogen to platelets
B. Minimizes vagal stimulation
docusate sodium (colace) is a stool softener, which prevents straining and provoking
dysrhythmias. It does not do any of the other options. Antidysrhythmics are used to
control ventricular dysrhythmias; morphine sulfate is used to decrease anxiety and
cardiac workload; and glycoprotein iib/iiia inhibitors and antiplatelets prevent the binding
of fibrinogen to platelets.
A patient who has hypertension just had an mi. Which type of medication should the
nurse expect to be added to decrease the cardiac workload?
A. Ace inhibitor
