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

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

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