Chapter 102: Chest Pain and Coronary Artery Disease Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient reports recurrent chest pain that occurs regardless of activity and is not relieved by rest. The provider administers a nitroglycerin tablet which does not relieve the discomfort. What is the next action?

a. Administer a second nitroglycerin tablet.

b. Give the patient a beta blocker medication.

c. Prescribe a calcium channel blocker mediation.

d. Start aspirin therapy and refer the patient to a cardiologist.

ANS: B a. Administer heparin. b. Give the patient an oral beta blocker. c. Initiate fibrinolytic treatment. d. Transfer to the PCI-capable institution.

Patient with these symptoms who do not respond to nitroglycerin is likely to have microvascular angina. Treatment is effective with beta blockers. These symptoms are not characteristic of acute MI, so aspirin is not given. A second nitroglycerin tablet is used for classic angina. Calcium channel blockers are not indicated.

2. A patient is brought to an emergency department with symptoms of acute ST-segment elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary intervention (PCI) is 3 hours away. What is the initial treatment for this patient?

ANS: C

NURSINGTB.COM

Fibrinolytic therapy should be administered to any patient with evolving STEMI within 30 minutes of the time of first medical contact. Patients more than 120 minutes away from a PCI-capable hospital should be given fibrinolytic therapy since PCI should be performed within 90 minutes if possible. Giving heparin or beta blockers is not helpful.

Multiple Response

1. Which patient meets the criteria for statin therapy to help prevent atherosclerotic cardiovascular disease? (Select all that apply.)

a. A 55-year old with a history of congestive health failure (CHF) b. A 70-year old nondiabetic with a 10-year risk score of 7.5% with an LDL-C of 80 mg/dL c. An otherwise healthy 25-year old with a low-density lipoprotein (LDL-C) level of 196 mg/dL d. A 45-year old diabetic with an LDL-C of 150 mg/dL e. A 60-year old with a history of myocardial infarction

ANS: B, C, D, E

Adults with a history of known cardiovascular disease, including stroke, caused by atherosclerosis; those with LDL-C level of greater than 190 mg/dL; adults 40 to 75 years, with diabetes; adults 40 to 75 years, with LDL-C level of 70 to 189 mg/dL and a 5% to 19.9% 10-year risk of developing cardiovascular disease from atherosclerosis, with risk enhancing factors; adults 40 to 75 years, with LDL-C level of 70 to 189 mg/dL and a 20% or greater 10-year risk of developing cardiovascular disease from atherosclerosis.