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.

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:
  On the SSM SLUH Intranet site under Departments/STEMI Program
  Twitter
  Snapchat
  In the bathroom
 
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