Myocardial Infarction (MI) NCLEX Questions and Answers; Graded A_2021/2022
Myocardial Infarction (MI) NCLEX Questions Your Grade: A Percentage of What you Got Right: 100 1. You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them? A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect. The answer is B. The most common cause of a myocardial infarction is CORONARY ARTERY DISEASE...not coronary spasm which is uncommon. 2. You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage? A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle. B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle. C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle. D. The left anterior descending artery is least likely to be affected by coronary artery disease. The answer is B. The LCA (if blocked) can cause the MOST amount of damage to the heart muscle. It affects the ANTERIOR part of the heart which affects the LEFT ventricle. The left descending artery is MOST likely to be affected by coronary artery disease. 3. A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from? A. Cardiac dissection B. Ventricular septum rupture C. Mitral valve prolapse D. Pericarditis The answer is D. A complication of a myocardial infarction is PERICARDITIS, especially 24-36 hours post MI. This is because of neutrophils being present at the site which causes inflammation. The patient's signs and symptoms are classic pericarditis. To learn more about pericarditis for the NCLEX exam: 4. After a myocardial infraction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue? A. 24 hours B. 2 days C. 10 days D. 6 hours The answer is C. 5. 24-36 hours after a myocardial infarction _____________ congregate at the site during the inflammation phase.A. Neutrophils B. Eosinophils C. Platelets D. Macrophages The answer is A. 6. A patient is complaining of chest pain. You obtain a 12-lead EKG and see ST elevation in leads II, III, AVF. What area of the heart does this represent? A. Lateral B. Septal C. Anterior D. Inferior The answer is D. 7. On an EKG, the lateral view of the heart is represented with leads? A. V1, V2, V3 B. II, II, AVF C. I, AVL, V5, V6 D. V1, V2, V6 The answer is C. 8. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time? A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Last consumption of caffeine D. CK result and when the next CK level is due to be collected The answer is A. The key words in this question are "chest pain" and "been in the ER for 5 hours". The patient should have already had one troponin level drawn since it starts to elevate 2-4 hours after injury and has been in the ER for 5 hours. Therefore, it is essential you know what the level is and when the next level is due. If the patient's chest pain is caused by a myocardial event the troponin levels will trend upward. Troponin levels are usually ordered every 6 hours x 3. CK results are not as specific as a troponin levels. This question wanted to know the MOST important, and the troponin level for this patient/when it is drawn next is MOST important. Diet status and last consumption of caffeine are things the nurse needs to know but not the MOST important. 9. A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers. A. Myoglobin B. CK-MB C. CK D. Troponin The answer is D. 10. A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce Twave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient’s current status: A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula I. No interventions are needed at this time The answers are A, D, E, G, and H. 11. In regard to the patient in the previous question, after administering the first dose of Nitroglycerin sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave inversion on the cardiac monitor. What is your next nursing intervention? A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders. B. Administer Morphine IV and place the patient in reverse Trendelenburg position. C. Administer Nitroglycerin and monitor the patient’s blood pressure. D. All the options are incorrect. The answer is A. Nitroglycerin can cause hypotension, however, if there is a significant drop in blood pressure with SBP 90, further doses of Nitroglycerin should be held. The doctor should be notified for further orders, especially since the patient is still having chest pain and t-wave inversion. Morphine should NOT be given because it can cause hypotension. 12. A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth. On assessment, you note there is bleeding on the anterior gums. Which medication can cause this? A. Coreg B. Cardizem C. Lovenox D. Lipitor The answer is C. Lovenox is antithrombotic. An adverse side effect of this medication is bleeding. Coreg (beta-blocker), Cardizem (calcium channel blocker), and Lipitor (statin) do NOT cause excessive bleeding. 13. A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of Heparin therapy and requires intervention? A. K+ 3.7 B. PTT 65 seconds C. Hgb 14.5 D. Platelets 135,000 The answer is D. Platelet value of 150,000 indicates thrombocytopenia and is found in patients with Heparin-Induced Thrombocytopenia. The potassium and hemoglobin level are normal. The PTT level is therapeutic (60-80 seconds) for Heparin and isn't a cause for concern. 14. A patient is experiencing Heparin-Induced Thrombocytopenia from Heparin therapy. The doctor orders Heparin to be discontinued. The patient will most likely be placed on what other medication? A. ArgatrobanB. Lovenox C. Levophed D. Tridil The answer is A. Argatroban or Angiomax may be prescribed in place of Heparin for a patient experiencing HIT (heparin-induced thrombocytopenia). 15. A patient taking Lovenox is having a severe reaction. What is the antidote for this medication? A. Activated Charcoal B. Acetylcysteine C. Narcan D. Protamine sulfate The answer is D. 16. A patient is being discharged home after receiving treatment for a myocardial infarction. The patient will be taking Coreg. What statement by the patient demonstrates they understood your education material about this drug? A. "I will take this medication at night." B. "I will take this medication as needed." C. "I will monitor my heart rate and blood pressure while taking this medication." D. "I will take this medication in the morning with grapefruit juice." The answer is C. It is the only correct option that reflects Coreg. This medication doesn't have to be taken at night, preferably in the morning. It is taken daily (not as needed), and must be avoided with grapefruit juice because it slow down the absorption of Coreg. 17. A patient is complaining of a nagging cough that is continuous. Which medication below can cause this side effect? A. Losartan B. Lisinopril C. Cardizem D. Lipitor The answer is B. ACE inhibitors, such as Lisinopril, can cause a nagging cough that is continuous. The patient may be switched to an ARB (angiotensin receptor blocker) if the cough is troublesome. 18. A patient's morning lab work shows a potassium level of 6.3. The patient’s potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction. What medication below can cause an increased potassium level? A. Losartan B. Norvasc C. Aspirin D. Cardizem The answer is A. Losartan is an ARB. ARBs (angiotensin receptor blockers) and ACE inhibitors (angiotension converting enzyme inhibitors) can cause an INCREASE potassium level because of it affects of decreasing aldosterone. A normal potassium level is 3.5-5.1. 19. Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY: A. Lengthening p-waves B. ST-segment elevationC. T-wave inversion D. Tall t-waves E. QT interval narrowing F. ST-segment depression The answers are B, C, D, and F. Heart Failure NCLEX Questions Your Grade: A Percentage of What you Got Right: 100 1. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza. The answers to this question are options: A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza) 2. A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition? A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema." Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema. 3. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-thatapply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea The answers are B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure. 4. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%.B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure. The answer is D. Both Options A and C are correct. Option B is a finding expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is 60% in a healthy heart. 5. True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction. True False The answer is TRUE. Patient with left-sided DIASTOLIC dysfunction heart failure normally have a normal ejection fraction. However, patients with left-sided SYSTOLIC dysfunction heart failure usually do not because the heart is unable to CONTRACT efficiently rather than fill properly as with diastolic dysfunction. 6. A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? A. “I’ve noticed that I’ve gain 6 lbs in one week.” B. “While I sleep I have to prop myself up with a pillow so I can breathe.” C. “I haven’t noticed any swelling in my feet or hands lately.” D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct. The answer is E. Options A and B are classic signs and symptoms a patient may experience with heart failure exacerbation. 7. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation? A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis. Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers. 8. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin 0.02The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. 100 no failure, 100-300 present, 300 pg/mL mild, 600 pg/mL moderate, 900 pg/mL severe 9. Which of the following tests/procedures are NOT used to diagnose heart failure? A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring The answer is D. Options A, B, and C are all used to diagnose heart failure...however a holter monitor is not. A holter monitor is used to monitor a patient's heart rate and rhythm. 10. What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath. A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction The answer is D. This statement describes left ventricular DIASTOLIC dysfunction. 11. A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention? A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy. The answer is C. Due to the patient being in fluid overload (especially with left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier. 12. You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching? A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals." The answer is D. Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them. 13. Select all the correct statements about educating the patient with heart failure: A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day.D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks. The answers are B, C, and D. Option A is wrong because heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated. 14. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient? A. Narcan B. Aminophylline C. Digibind No medication because this is a normal Digoxin level. The answer is C. The patient is experiencing Digoxin toxicity...therefore the physician will order the antidote for Digoxin which is Digibind. 15. Which of the following is a late sign of heart failure? A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothyblood tinged sputum is a late sign. 16. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors The answer is D. This is a description of ACE inhibitors (option D). 17. A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings? A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5 The answer is C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).18. During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue? A. Lisinopril B. Losartan C. Lasix D. Digoxin The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity. 19. Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure: A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure. The answers are B and D. 20. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom? A. Measure and record the urine voided. B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient. The answer is B. The best answer for this particular question is option B. All the options are important for the nurse to perform. However, Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension. The patient should transfer slowly and gradually to decrease dizziness and the risk of falling. 21. A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action? A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient’s potassium level is normal. The answer is C. The patient is Digoxin toxic. A normal Digoxin level is 2 ng/mL. Therefore, the nurse should not administer the dose but hold it and notify the doctor for further orders. 22. Which of the following is a common side effect of Spironolactone? A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough The answer is B. Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).23. The physician’s order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority? A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level The answer is D. Lasix is a diuretic that wastes potassium. A normal potassium level is 3.5-5.1. The nurse should hold the dose and notify the physician who will order a potassium supplement to replace the potassium deficient.
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myocardial infarction mi nclex questions and answers
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youre educating a patient about the causes of a myocardial infarction which statement by the patient indicates they misunderstood your teach
