Angina Pectoris and Myocardial Infarction (26 Questions)

1.1 Madame Gisèle Moreau, 62 years old, is hospitalized for a cystostomy, scheduled for the following morning. She has a history of angina pectoris and gastric ulcer.

Medical Orders:
*Acetaminophen (Tylenol) 325 mg/tab, 1–2 tabs PO q4h PRN for pain
*Aluminum hydroxide / magnesium hydroxide (Diovol) 30 mL PO PRN for gastric pain
*Lorazepam (Ativan) 1 mg/tab, 1 tab PO hs PRN the night before surgery
*Dextrose 5% IV, to be started the morning of surgery to keep the vein open

If retrosternal pain:
*ECG stat
*Oxygen at 3 L/min via nasal prongs
*Nitroglycerin sublingual spray q5 min × 3 PRN

At 21:00, Madame Moreau says:
“I’ve had a squeezing pain in my stomach for the last five minutes, and it’s radiating to my left shoulder. I’m a little nervous about tomorrow.”

Question
What is the next priority assessment question you must ask? *
1.2 After your initial assessment, angina is your leading hypothesis. You follow the medical orders: you administer oxygen at 3 L/min via nasal prongs, and Madame Moreau self-administers sublingual nitroglycerin.

She remains slightly anxious, and you are preparing to give her lorazepam (Ativan) as prescribed. However, you know that reducing myocardial oxygen demand is your immediate priority.

Question:
Before administering the lorazepam, which single intervention should you carry out to best help decrease Madame Moreau’s myocardial oxygen needs? *
1.3 Later in the evening, Madame Moreau is feeling much better. Her chest discomfort has subsided following rest and nitroglycerin administration. As part of her discharge education, you begin reviewing important information about angina and myocardial infarction (MI).

She asks, “How can I know next time if it’s just angina or something more serious like a heart attack?”

Question
What is the major difference between angina and the pain associated with myocardial infarction (MI)? *
2.1 Madame Moreau, 62 years old, admitted for pre-operative care, presented earlier with angina-like chest pain radiating to her left shoulder. As per medical orders, you administered O₂ at 3 L/min via nasal cannula and Nitroglycerin sublingual (0.4 mg) at 21:15.

At 21:30, you reassess the patient:
*Blood pressure: 88/48 mmHg
*Heart rate: 84 bpm
*SpO₂: 96% on 3 L/min O₂
*Chest pain: still present
*Cardiac monitor: shows T-wave inversion

Question:
What is your next priority nursing intervention? *
2.2 She has been prescribed Nitroglycerin sublingual tablets for management of stable angina. During your medication teaching session, she tells you:

“Sometimes I take more than one tablet when the pain doesn’t go away quickly. But then I get a bad headache. Should I be worried?”

Question:
What should you explain to Madame Moreau? *
3. Mr. Pierre Lambert, 66 years old, has a history of stable angina related to coronary artery disease. He is followed in a cardiology clinic and is prescribed:

*Nitroglycerin 0.4 mg SL PRN chest pain (may repeat q5 min ×3)
*Aspirin 81 mg PO daily
*Atorvastatin 40 mg PO at bedtime
*Metoprolol succinate 50 mg PO daily

During a teaching session, Mr. Lambert states that he experiences chest tightness when climbing stairs, which resolves after resting. He asks when he should use his nitroglycerin.

Question:
What is the most appropriate nursing teaching? *
4. Mme. Nathalie Giroux, 72 years old, presents to the emergency department with new-onset chest pain at rest. She describes pressure radiating to her left arm, associated with nausea. Medical orders include:

*Oxygen 2 L/min via nasal cannula
*Cardiac monitoring
*IV access
*Nitroglycerin SL PRN

Her ECG shows no ST elevation. Troponin results are pending.

Question:
What feature most strongly suggests unstable angina? *
5. Mr. Lavoie, 58, arrives at a community clinic for an “urgent same-day” visit. He reports a 3‑month history of chest tightness that occurs when he walks uphill to the bus stop. The discomfort is retrosternal, “pressure-like,” sometimes radiates to his left shoulder, and is associated with mild shortness of breath. It resolves within 3–5 minutes of stopping and resting. Today he had the same pain while carrying groceries; it resolved after he sat down. He denies nausea, diaphoresis, or syncope. Past history: hypertension and dyslipidemia. Medications: amlodipine, atorvastatin. Vitals: BP 136/82, HR 78, RR 16, SpO₂ 98% RA, afebrile. Physical exam unremarkable. He asks if he should go to the ER “right now.”

Question:
What is the most likely diagnosis based on the history? *
6. Ms. Nguyen, 64, presents to the ED complaining of chest pressure that started 45 minutes ago while she was watching TV. The pain is 8/10, radiates to her jaw, and she feels nauseated and sweaty. She looks pale. PMH: type 2 diabetes, HTN. Medications: metformin, ramipril. Vitals: BP 154/90, HR 102, RR 22, SpO₂ 95% RA. She says, “This feels different than my reflux.”

Question:
What is the priority nursing action? *
7. Mr. Bouchard, 59, arrives with chest pressure for 30 minutes. ECG is being obtained. He reports taking “a pill for erections” last night. PMH: HTN, stable angina. Vitals: BP 118/70, HR 90. The physician orders sublingual nitroglycerin.

Question:
Which additional assessment is most critical before administering nitroglycerin? *
8. Ms. Patel, 52, presents with crushing chest pain and diaphoresis for 70 minutes. She appears anxious and clammy. Vitals: BP 148/88, HR 108, RR 24, SpO₂ 93% RA. ECG shows ST elevation in leads II, III, and aVF. She has no known drug allergies and no recent bleeding history.

Question: What is the most appropriate immediate management step? *
9. Mr. Tremblay, 67, arrives with suspected NSTEMI. He is pale but alert, chest pressure 5/10. Vitals: BP 142/84, HR 96, RR 18, SpO₂ 98% on room air. ECG shows ST depression in V4–V6. He asks, “Should I be on oxygen to protect my heart?”

Question: What is the best response/action? *
10. Ms. Roy, 61, arrives with chest discomfort that began 6 hours ago and lasted 40 minutes; she is now pain-free. ECG shows nonspecific T-wave changes. Initial troponin is normal, repeated at 3 hours is elevated. She asks what that means. Vitals are stable.

Question:
Which interpretation is most accurate? *
11. Mr. Chen, 70, presents with chest pressure occurring at rest for 20 minutes. ECG shows ST depression in lateral leads. He is treated and becomes pain-free. Serial troponins remain negative. The provider documents “ACS” and asks the nurse to clarify for teaching.

Question:
Which diagnosis best fits? *
12. Mr. Girard, 63, had a confirmed anterior STEMI treated with PCI. Six hours later, he becomes restless and dyspneic. Skin is cool and clammy. Lung auscultation reveals crackles. Vitals: BP 82/54, HR 122, RR 28, SpO₂ 90% on 2 L nasal cannula. Urine output drops to 15 mL/hr.

Question:
Which complication is most likely? *
13. Ms. Adams, 58, is on telemetry 12 hours after NSTEMI. She suddenly becomes unresponsive. The monitor shows a chaotic rhythm with no identifiable QRS complexes. You confirm she is not breathing normally and there is no pulse.

Question:
What is the best immediate action? *
14. Mr. Santos, 55, is being discharged 3 days after an NSTEMI. New prescriptions include aspirin, a statin, a beta‑blocker, and nitroglycerin spray PRN. He tells you he plans to “take it easy for a week and then go back to normal,” and he’s unsure how to respond if chest discomfort returns at home.

Question:
Which teaching point is the highest priority? *
15. Mr. Pelletier, 62, has known stable angina and has been taught to use sublingual nitroglycerin PRN. At 07:30, while shoveling snow, he develops retrosternal chest pressure (8/10) with mild dyspnea. He stops activity, sits down, and takes 1 nitroglycerin tablet SL. At 07:35, his pain is now 2/10, but he still feels persistent pressure and “not quite right.” He calls the provincial nurse telephone triage line for advice. He is alone at home. He reports feeling slightly lightheaded but is speaking in full sentences.

Question:
What is the safest instruction to give Mr. Pelletier? *
16. In the ED, Ms. Ducharme, 71, arrives with chest pressure. She is given sublingual nitroglycerin. Two minutes later she says, “My chest is easing up. I really need to pee—can I go to the bathroom?” You note she looks slightly pale. Current vitals: BP 102/66 (was 132/78 on arrival), HR 88.

Question:
What is the best nursing action? *
17. Mr. Singh, 56, has new PRN nitroglycerin tablets for exertional angina. He demonstrates how he will take them: “I’ll chew one quickly and swallow it with water while walking to the car.”

Question:
Which instruction is most correct? *
18. A patient brings his nitroglycerin tablets to a follow-up visit. He keeps them in a weekly pill organizer on the kitchen counter “so they’re easy to remember,” and the bottle is from 2 years ago.

Question:
What is the most appropriate teaching? *
19. Mr. Ouellet, 60, presents with chest pressure. You are preparing nitroglycerin. He says, “I took tadalafil for erectile dysfunction yesterday morning.”

Question:
What is the correct action? *
20. Ms. Bernard, 65, is prescribed a nitroglycerin transdermal patch for angina prevention. She says, “I’ll keep it on 24/7 so it works better.”

Question:
What teaching is most appropriate? *
21. A patient wearing a nitroglycerin patch asks if it’s okay to use a heating pad on his chest for back pain and to sit in a hot tub later.

Question:
Best response? *
22. A patient newly prescribed nitroglycerin reports, “Every time I take it, I get a pounding headache and feel lightheaded.”

Question:
What is your best teaching? *
23. Mr. Beaulieu, 66, is admitted to a telemetry unit for evaluation of chest pain. He has a history of stable angina, hypertension, and dyslipidemia. Two hours ago, he developed substernal chest pressure (6/10) while walking to the washroom on the unit. He sat down and the nurse administered 1 dose of sublingual nitroglycerin as prescribed. Within 5 minutes, his chest pain decreased to 0–1/10. His vital signs after nitroglycerin are: BP 122/76 (baseline 130/80), HR 78, RR 16, SpO₂ 97% RA. He is alert and speaking clearly.

Ten minutes later, Mr. Beaulieu rings the call bell and states: “My chest feels better, but now I have a throbbing headache and it’s really uncomfortable.” He denies visual changes, weakness, or nausea. He is not taking any PDE-5 inhibitors and has no allergy history. His neurological assessment is unchanged from baseline.

Question:
What is the most appropriate nursing intervention? *