What is the goal from patient symptom onset to restoring blood flow to the coronary artery?

lease answer each question to the best of your ability. You must receive a score of 100% to pass.

1)

You are in the Emergency Department when a 54 year old male arrives rubbing the center of his chest. He states “it feel like someone is sitting on my chest.” He appears pale and his skin is diaphoretic. His radial pulse is strong, but fast. Blood pressure is 130/80 with a pulse ox of 90% on room air. He has no past medical history and takes no medications except for Tylenol for an occasional headache. He has no allergies. You take him back to a room, place on the monitor and gain IV access.

His monitor strip is as follows. src=/Uploads/FCK_Files/userfiles/1/Image/SSM_SLUH/Question_1.jpg This rhythm is?

Atrial Flutter

Third Degree Heart Block

Normal Sinus Rhythm

Atrial Fibrilation

2) Although the patient is not short of breath, he should receive oxygen because

He is hypoxic

Third Degree Heart Block

Normal Sinus Rhythm

Atrial Fibrillation

3) Early signs and symptoms of Acute Coronary Syndrome (ACS) – MI or Heart Attack include:

Pressure – fullness, squeezing, or pain in the center of the chest lasting several minutes (usually more than 15 minutes)

Pain – spreading to the shoulders, neck, arms, or jaw, or pain in the back or between the shoulder blades

Other symptoms: weakness, dizziness, sweating, N/V, uneasiness, dyspnea; distress, anxiety, or sense of impending doom

ALL of these are signs and symptoms of Acute Coronary Syndrome/MI or Heart Attack

4) Women may NOT exhibit typical signs and symptoms of ACS. Which of the following heart attack symptoms is LESS common in women?

Shortness of breath

Profound sense of fatigue/flu-like discomfort

Indigestion or heartburn

Sudden onset of crushing chest pressure

5) The next priority in his assessment (within 10 minutes of arrival) is

Obtain a 12 lead ECG and have it interpreted by a physician.

Exercise stress test

Portable chest X-ray

CT scan

6) You complete a 12 Lead ECG which reveals: src=/Uploads/FCK_Files/userfiles/1/Image/SSM_SLUH/Q_6.jpg

Unstable angina

Normal ECG

Bundle branch block

STEMI

7) This patient most likely has experienced an

Occlusion of a carotid artery

Occlusion of a coronary vein

Occlusion of a coronary artery

Occlusion of a peripheral artery

8) What should you do next?

Wait and see if the patient improves.

Place the ECG in the chart.

Activate a Code STEMI by dialing X22222 and saying “911 STAT Cardiology Consult.”

Look for a Resident or Attending

9) Which medication(s) should be given immediately upon diagnosis of myocardial infarction?

Dual antiplatelet therapy such as Aspirin and Ticagrelor

Epinephrine

Lidocaine

Amiodarone

10) Nitroglycerin is administered to this patient without pain relief. He continues to complain of chest pain that he rates as an 8/10. He is obviously uncomfortable. Which type of medication should be given to relieve the pain of myocardial infarction?

Narcotics such as Morphine, Fentanyl

Calcium Channel Blockers such as Diltiazem

Beta blockers such as Lopressor

Statins such as Lipitor

11) Which of the following Lab tests are important to the diagnosis of Acute MI?

Complete blood count

Lactic Acid level

Troponin Level

Chem-14

12) This patient should be prepared to be emergently transported to?

Radiology for a CT scan

The cardiac catheterization lab

The cardiac telemetry unit

The ICU/coronary care unit

13) What is the goal from patient symptom onset to restoring blood flow to the coronary artery?

There are no goals

The amount of time the vessel remains blocked does not affect patient outcomes

10 minutes

90 minutes

14) The size of this patient’s infarction (amount of myocardium that dies) is what will determine how well he does into the future (mortality). The size of his infarction is dependent upon

LDL levels at discharge.

Amount of time it takes to get a beta blocker.

Genetics.

Length of time until the vessel is opened and flow is restored.

15) As you are preparing the patient for transport, he suddenly becomes dizzy and feels as if he is going to pass out. You follow protocol and the patient is currently on a transport cardiac monitor which reveals Sinus Bradycardia at a rate of 32. His blood pressure is now 70/50 and his pulse oximetry is 96%. IV access was obtained earlier. You should

Administer Epinephrine 1mg IVP.

Administer Amiodarone 150mg IVP.

Administer an additional 181mg of aspirin.

Administer Atropine 0.5mg IV.

16) There is no response to the administration of Atropine. Another option in the acute management of this patient is

Transcutaneous pacing

Defibrillation

Amiodarone 150mg

Cardioversion

17) After a successful percutaneous coronary intervention in which the patient received a coronary stent, he returns to the floor. Two hours later, your patient complains of chest pressure and shortness of breath. Assessment of his telemetry rhythm reveals Sinus Rhythm with frequent PVCs and ST segment elevation. Identify which the strip below exhibits ST segment elevation: src=/Uploads/FCK_Files/userfiles/1/Image/SSM_SLUH/Question_17.JPG

A

B

C

D

18) What do you do next?

Document the strip and place it in the chart.

Activate a Code Stroke

Call Pastoral Care

Immediately obtain a 12 lead ECG and activate Code STEMI process by dialing X22222 and saying “911 STAT Cardiology Consult.”

19) If you suspect your patient is having a MI, but are not sure, which course of action could be harmful?

Activating the Code STEMI process.

Notifying the physician.

Notifying your team leader or charge nurse.

Waiting one hour and see if things improve.

20) You would expect this patient to be discharged on

Cardizem, Digoxin, Beta Blocker and Verapamil

Beta Blocker, Ace Inhibitor, Aspirin and High intensity Statin

There are no guidelines or recommendations for patients with an acute MI.

Amiodarone, Lidocaine and Epinephrine

21) Modifiable risk factors for Heart Disease include ALL of the following, EXCEPT:

Physical inactivity

Obesity

Old age

High cholesterol

22) All Acute MI patient receive Cardiac Rehabilitation inpatient education because:

Cardiac rehab is most effective when introduced while in a hospital setting.

Cardiac rehab cuts the risk of repeat heart attacks by 15-20% by educating patients on modifiable risk factors.

Cardiac rehab participants have a 35% lower death rate than non-participants.

All of the above.

23) SSM SLUH STEMI Program information and resources can be found:

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