Pak, Chaeryeong 10 Licensure Exam Questions- Myocardial Infarction

1. A male client with angina pectoris has been having an increased number of episodes of pain recently. He is
admitted for observation. During the admission interview, he tells the nurse that he has been having chest
pain during the last week. Which statement by the client would be of greatest concern to the nurse?

a. “I had chest pain while I was walking in the snow on Thursday.”

b. “We went out for a big dinner to celebrate my wife’s birthday, but I couldn’t enjoy it because I got the
pain before we got home from the restaurant.”
c. “I had chest pain yesterday while I was sitting in the living room watching television.”
d. “I felt pain all the way down my left arm after I was playing with my grandson on Monday.”

Answer: c. This answer indicates pain at rest, which suggests a progression of the angina. The other
answers all indicate pain with known causes of angina, such as exercise, cold environment, or eating.

Reference: Miller& McMahon (2011), Delmar's practice questions for NCLEX-PN. Q.13

2. Which of the following controllable risk factors for coronary artery disease (CAD) appears most closely
linked to the development of the disease?

a. Age.
b. Medication usage.
c. High cholesterol levels.
d. Gender.

Answer: c. High cholesterol levels are considered a controllable risk factor for CAD and appear most
closely linked to the development of the disease. High cholesterol levels can be modified through diet,
exercise, and medication. Age and gender are uncontrollable risk factors for CAD. Medication usage is not
considered a risk factor for CAD.

Reference: Lippincott’s Review for NCLEX-RN Q. 16 page 240

3. The nurse is caring for an adult who is being treated for a myocardial infarction. Oxygen is ordered.
Administering oxygen to this client is related to which of the following client problems?

a. Anxiety.
b. Chest pains.
c. Ineffective myocardial perfusion.
d. Alteration in heart rate, rhythm, or conduction.

Answer: c. With acute myocardial infarction there is ineffective myocardial perfusion, resulting in a
decrease in the amount of oxygen available for tissue perfusion. Oxygen is administered to improve tissue
perfusion in these clients.

Reference: Oglesby (2010), NCLEX-RN Review. Q. 167

4. A coronary care unit (CCU) nurse is caring for a client admitted with acute myocardial infarction (MI). The
nurse should monitor the client for which most common complication of MI?
 a. Heart failure
b. Cardiogenic shock
c. Cardiac dysrhythmias
d. Recurrent myocardial infarction

Answer: 3. Dysrhythmias are the most common complication and cause of death after an MI. Heart failure,
cardiogenic shock, and recurrent MI are also complications but occur less frequently.

Reference: Ignatavicius, Workman (2016). Pp 649, 759 Q. 355

5. A male client is admitted to the hospital with a diagnosis of myocardial infarction. During the interviewing
process, the client tells the nurse that the pain is probably related to the greasy cheeseburger he had for
lunch. The nurse knows that this response from the client is common for people experiencing an MI and
will be better able to help the client because:

a. a diet high in fat causes MI.

b. the client wants to blame something else for his problem.
c. denial is a major factor in not seeking immediate treatment
d. the client does not understand the factors that cause the disease process.

Answer: c. An individual’s first response to the pain that he or she is experiencing is denial because the
individual cannot believe that he or she is really having an MI; this in turn keeps the individual from
seeking immediate medical treatment. Knowing that this is a common response, the nurse will be better
able to help the client face the reality of the situation. Opinion 1 is not necessarily accurate, and there is
not adequate data in the question to determine that options 2 and 4 are correct.

Reference: Saunders Q & A Review for the NCLEX-PN Examination. P.239. Q. 502

6. An adult is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The adult asks the
nurse, “Can you tell me again what the doctor is going to do?” What is the nurse’s best response?

a. “A clot dissolving drug is administered through a catheter into the blocked section of your artery.
b. “A piece of vein from your leg is used to bypass the blocked section of your artery.”
c. “A tiny rotating blade is used to scrape off the plaque that is blocking your artery.”
d. “A balloon is placed next to the plaque blocking your artery, then the balloon is inflated to crush the
plaque.”

Answer: d. PTCA is also called balloon angioplasty because a balloon-tipped catheter is used. When the
balloon Is inflated, the plaque is compressed, leaving the artery unobstructed.

Reference: Oglesby (2010), NCLEX-RN Review. Q. 190

7. The nurse admitting a client diagnosed with MI to the coronary care unit (CCU) should plan care by
implementing which intervention?

a. Beginning thrombolytic therapy

b. Placing the client on continuous cardiac monitoring
c. Infusing intravenous (IV) fluid at a rate of 150 mL per hour
d. Administering oxygen at a rate of 6 L per minute by nasal cannula
 Answer: b. Standard interventions upon admittance to the CCU as they relate to this question include
continuous cardiac monitoring. Thrombolytic therapy may or may not be prescribed by the primary health
care provider. Thrombolytic agents are most effective if administered within the first 6 hours of the
coronary event. The nurse should ensure that there is an adequate IV line insertion of an intermittent lock.
If an IV infusion is administered, it is maintained at a keep-vein-open rate to prevent fluid overload and
heart failure. Oxygen should be administered at a rate of 2 to 4 L per minute unless otherwise prescribed.

Reference: Ignatavicius, Workman (2016), p. 764 Q. 279

8. When administering a thrombolytic drug to the client experiencing an MI, the nurse explains to him that
the purpose of the drug is to:

a. help keep him well hydrated.

b. dissolve clots that he may have.
c. prevent kidney failure.
d. treat potential cardiac dysrhythmias

Answer: b. Thrombolytic drugs are administered within the first 6 hours after onset of a myocardial
infarction to lyse clots and reduce the extent of myocardial damage.

Reference: Lippincott’s Review for NCLEX-RN Q. 2 page 238

9. A client is diagnosed with an ST-segment elevation myocardial infarction (STEMI) and is receiving tissue
plasminogen activator, alteplase. Which action is a priority nursing intervention?

a. Monitor for kidney failure.

b. Monitor psychosocial status.
c. Monitor for signs of bleeding.
d. Have heparin sodium available.

Answer: c. Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of

thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring
the client’s psychosocial status are important but are not the most critical interventions. Heparin may be
administered after thrombolytic therapy, but the question is not asking about follow-up medications.

Reference: Silvestri (2015), Saunders comprehensive review for the NCLEX-RN examination. Q. 726

10. Contraindications to the administration of t-PA include which of the following?

a. Age greater than 60 years.

b. History of cerebral hemorrhage.
c. History of heart failure.
d. Cigarette smoking.

Answer: b. A history of cerebral hemorrhage is a contraindication to administration of t-PA because the

risk of hemorrhage may be further increased. Age greater than 60 years, history of heart failure, and
cigarette smoking are not contraindications.

Reference: Lippincott’s Review for NCLEX-RN Q. 22 pg 240