CARDIOVASCULAR NCLEX REVIEW

ANTIANGINAL MEDICATIONS: NITRATES -3.) Sustained-Released Medications

-Instruct the pt to swallow and NOT to chew or crush the medication

HEART FAILURE MEDICATIONS: 6.) Human B-Type Natriuretic Peptides: -Pt Education:

-The pt can be asymptomatic w/a low BP -Remind the pt to sit & lie down slowly

CARDIOVASCULAR MEDICATIONS: ANTIHYPERTENSIVE MEDS-DIURETICS 4.) Thiazide Diuretics: -A.) Description:

-Thiazide diuretics increase Na+ & water excretion by inhibiting Na+ reabsorption in the distal tubule of the kidney -Used for: HPTN & peripheral edema -NOT EFFECTIVE for immediate diuresis -Use in pts w/normal renal fxn (contraindicated in pts w/renal failure) -Thiazide diuretics should be used w/caution in pts taking Lithium, b/c lithium toxicity can occur, and in the pt taking digoxin, corticosteroids, or hypoglycemic meds

The nurse is evaluating the condition of a client after pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective? a.) Muffled heart sounds b.) A rise in BP c.) Jugular venous distention d.) Pt expressions of dyspnea

ANSWER=B RATIONALE: Following pericardiocentesis, the pt usually expresses immediate relief. Heart sounds are no longer muffled or distant & BP increases. Distended neck veins are a sign of increased venous pressure, which occurs w/cardiac tamponade

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?: A.) Glipizide B.) Metformin C.) Repaglinide D.) Regular insulin

ANSWER=B RATIONALE: Metformin needs to be w/held 24 hrs before and for 48 hrs after cardiac catheterization b/c of the injection of contrast medium during the procedure. If the contrast medium affects kidney fxn, w/metformin in the system the pt would be at an increased risk for lactic acidosis. The meds in the remaining options do not need to be w/held 24 hrs before & 48 hrs after cardiac catheterization

A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL/hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL (16 mmol/L) and the serum creatinine level is 2.2 mg/dL (194 mcmol/L). On the basis of these findings, the nurse would anticipate that the client is at risk for which problem? A.) Hypovolemia B.) Acute kidney injury C.) Glomerulonephritis D.) Urinary tract infection (UTI)

ANSWER=B RATIONALE: The pt who undergoes cardiac surgery is at risk for renal injury from poor perfusion, hemolysis, low CO, or vasopressor (potent vasoconstrictor) med therapy. Renal injury is signaled by decreased UO and increased BUN & creatinine levels. Normal reference levels are BUN, 10-20 mg/dL & Creatinine, MALE, 0.6-1.2 mg/dL & FEMALE, 0.5-1.1 mg/dL. The pt may need meds to increase renal perfusion and possibly could need peritoneal dialysis or hemodialysis. No data in question indicate the presence of hypovolemia, glomerulonephritis or UTI

HEART FAILURE MEDICATIONS: 5.) Vasodilators:

Nitroglycerin & isosorbide mononitrate prevent coronary artery vasospasm & reduce preload & afterload, decreasing myocardial O2 demand

HEART FAILURE (HF): -Classification:

-Acute HF: occurs suddenly -Chronic HF: develops over time; however, a pt w/chronic HF can develop an acute episode

HEART FAILURE MEDICATIONS: 1.) Diuretics: -Nursing Considerations:

-Administer furosemide IV no faster than 20 mg/min -Loop & thiazide diuretics can cause hypokalemia and K+ supplementation can be required

ANGINA: -Patterns of Angina 1.) Stable Angina:

-Also called: Exertional angina -Occurs w/activities that involve: exertion or emotional stress -Relieved w/: rest or nitroglycerin -Usually has a stable pattern of onset, duration, severity, & relieving factors

ANGINA: -Patterns of Angina 2.) Unstable Angina:

-Also called: Preinfarction angina -Occurs w/ an: unpredicatable degree of exertion or emotion & increases in occurrence, duration & severity over time -Pain may NOT be relieved w/nitroglycerin

ANGINA: -Patterns of Angina 3) Variant Angina:

-Also called: Prinzmetal's or Vasospastic angina -Results from: Coronary Artery Spasm -May occur @ rest -Attacks may be assoc. w/: ST segment elevation noted on the ECG

ANGINA: -Description:

-Angina=chest pain resulting from myocardial ischemia caused by inadequate myocardial blood & O2 supply -Caused by an imbalance b/w O2 supply & demand -Causes includes: obstruction of coronary blood flow resulting from athersclerosis; coronary artery spasm; or conditions increasing myocardial O2 consumption **THE GOAL OF TX FOR ANGINA= TO PROVIDE RELIEF FROM THE ACUTE ATTACK, CORRECT THE IMBALANCE B/W MYOCARDIAL O2 SUPPLY & DEMAND, & TO PREVENT THE PROGRESSION OF THE DX & FURTHER ATTACKS TO REDUCE THE RISK OF MI ****

CARDIOVASCULAR MEDICATIONS: 3.) Cardiac Glycosides (Digoxin): -B.) Side & Adverse Effects:

-Anorexia, N/V/D -Bradycardia -Visual disturbances: diplopia, blurred vision, yellow vision, photophobia -HA -Fatigue, weakness -Drowsiness ***EARLY SIGNS OF DIGOXIN TOXICITY PRESENT AS GI MANIFESTATIONS (Anorexia, N/V/D) THEN HR ABNORMALITIES & VISUAL DISTURBANCES APPEAR!***

HEART FAILURE MEDICATIONS: 7.) Anticoagulants: -Nursing Considerations:

-Assess for contraindications: acive bleeding, peptic ulcer dx, hx of cerebrovascular accident (CVA), and recent trauma -Monitor bleeding times: PT, aPTT, INR & CBC

ANGINA: -Patterns of Angina 5.) Preinfarction Angina:

-Assoc. w/: Acute Coronary insufficiency -Lasts longer than >15 mins -Sx of worsening cardiac ischemia -Characterized by: chest pain that occurs day to weeks before an MI

HEART FAILURE (HF): -Types of HF: 1.) Right Ventricular Failure, Left Ventricular Failure:

-B/c the 2 ventricles of the heart represent 2 separate pumping systems, it is possible for 1 to fail alone for a short period -Most HF begins w/left ventricular failure & progresses to failure of both ventricles -Acute pulmonary edema, a medical emergency, results from left ventricular failure -If pulmonary edema is not treated-->death will occur from suffocation b/c the pt literally drowns in his/her own fluids

BETA-ADRENERGIC BLOCKERS: -1.) Side & Adverse Effects:

-Bradycardia -Bronchospasm -Hypotension -Hyperglycemia -Weakness, fatigue -Dizziness -N/V -Agranulocytosis -Behavioral or Psychotic response -Depression -Nightmares

CARDIOVASCULAR MEDICATIONS: 1.) Antiplatelet Medications: -B.) Side & Adverse Effects:

-Bruising -Hematuria -GI bleeding -Tarry stools

HEART FAILURE (HF): -New York Heart Association's Functional Classification Scale:

-CLASS I: pt exhibits no sx's w/activity -CLASS II: Pt has sx's w/oridnary exertion -CLASS III: pt displays sx's w/minimal exertion -CLASS IV: pt has sx's at rest

CARDIOVASCULAR MEDICATIONS: 1.) Antiplatelet Medications: -C.) Interventions:

-Determine sensitivity BEFORE administration -Monitor: VS & bleeding time -Instruct the pt to take med w/food if GI upset occurs -Instruct the pt to monitor for side & adverse effects & in the measures to prevent bleeding

CARDIOVASCULAR MEDICATIONS: 2.) Positive Inotropic & Cardiotonic Medications: -B.) Side & Adverse Effects:

-Dysrhythmias -Hypotension -Thrombocytopenia -Hepatotoxicity manifested by: elevated liver enzyme levels -Hypersensitivity manifested by: wheezing, SOB, pruritus, uritcaria, clammy skin & flushing

ANGINA: -Diagnostic Studies:

-Electrocardiography: Readings ar normal during rest, w/ST depression or T-wave inversion during an episode of pain -Stress Testing: Chest pain or changes in the ECG or VS during testing may indicate ischemia -Cardiac Enzyme & Troponin Levels: Findings are normal in angina -Cardiac Catheterization: Provides a definitive diagnosis by providing info about the patency of the coronary arteries

HEART FAILURE MEDICATIONS: 3.) Inotropic Agents: -Nursing Considerations:

-For a pt taking Digoxin-take the apical HR for 1 min. Hold the med if apical pulse is <60/min and notify the HCP -Observe the pt for N/V -Dopamine, Dobutamine, & milrinone are administered via IV. The ECG, BP, and UO must be closely monitored

ANTIANGINAL MEDICATIONS: NITRATES -Side & Adverse Effects:

-HA -Orthostatic hypotension -Dizziness, weakness -Faintness -Flushing or pallor -Dry mouth -Reflex tachycardia

HEART FAILURE (HF): -Description:

-HF is the inability of the heart to maintain adequate CO to meet the metabolic needs of the body b/c of impaired pumping ability -Diminished CO results in inadequate peripheral tissue perfusion -Congestion of the lungs & periphery may occur; the pt can develop acute pulmonary edema

HEART FAILURE (HF): -Types of HF: -2.) Forward Failure, Backward Failure:

-In Forward Failure-->an inadequate ouput of the affected ventricle causes decreased perfusion to vital organs -In Backward Failure-->Blood gets backed up behind the affected ventricle , causing increased pressure in the atrium behind the affected ventricle

HEART FAILURE (HF): -Types of HF: -3.) Low Output, High Output:

-In Low Output Failure-->not enough CO is available to meet the demands of the body -High Output Failure-->occurs when a condition causes the heart to work harder to meet the demands of the body

HEART FAILURE MEDICATIONS: 2.) Afterload-Reducing Agents: -Pt. Education: ACE Inhibitors

-Inform the pt that this medication can cause a dry cough -Notify the HCP if the pt observes a rash or has a decreased sense of taste -Notify HCP if swelling of the face or extremities occurs -Remind the pt that BP needs to be monitored for 2 hrs after the initial dose to detect hypotension

CARDIOVASCULAR MEDICATIONS: 1.) Antiplatelet Medications: -A.) Description:

-Inhibit aggregation of platelets in the clotting process thereby prolonging the bleeding time -May be used w/: Anticoagulants -Used in: The prophylaxis of long-term complications following MI, Coronary Revascularization, Stent & Stroke -These meds are contraindicated in those w/: Bleeding disorders & known sensitivity

CARDIOVASCULAR MEDICATIONS: 3.) Cardiac Glycosides (Digoxin): -A.) Description:

-Inhibit the sodium-potassium pump, thus increasing intracellular Ca++ which causes the heart muscle fibers to contract more efficiently -Produce a positive inotropic action, which increases the force of myocardial contractions -Produce a negative chronotropic action, which slows the HR -Produce a negative dromotropic action that slows conduction velocity thru the AV node -The increase in myocardial contractility increases cardiac, peripheral & kidneys fxn by: increasing CO, decreasing preload, improving blood flow to the periphery & kidneys, decreasing edema, and increasing fluid excretion; as a result fluid retention in the lungs and extremities is decreased -Cardiac glycosides are used 2nd-line for HF (meds affecting the renin-angiotensin-aldosterone system are used more often) and cardiogenic shock, atrial tachycardia, atrial fibrillation, and atrial flutter; they are used less frequently for rate control in atrial dysrhythmias (beta blockers and Ca++ channel blockers are used more often) -These meds are contraindicated in those w/: ventricular dysrhythmias & 2nd- or 3rd-degree heart block & should be used w//caution in pts w/: renal dx, hypothyroidism and hypokalemia

ANTIANGINAL MEDICATIONS: NITRATES -2.) Translingual Medications (spray):

-Instruct the pt to direct the spray against the oral mucosa -Instruct the pt to AVOID inhaling the spray

ANTIANGINAL MEDICATIONS: NITRATES -5.) Topical Ointments:

-Instruct the pt to remove the ointment on the skin from the previous dose -Instruct the pt to squeeze a ribbon of ointment of the prescribed length onto the applicator or dose-measuring paper -Instruct the pt to spread the ointment over a 2.5- X 3.5-inch area and cover w/plastic wrap, using the chest, back abdomen, upper arm or anterior thigh (AVOID hairy areas) -Instruct the pt to rotate sites and to AVOID touching the ointment when applying

HEART FAILURE MEDICATIONS: 4.) Beta-Adrenergic Blockers (Beta-Blockers) -Pt Education:

-Instruct the pt to weight daily -Advise the pt to regularly check BP -Tell the pt to follow the HCP's instructions for increasing medication dosage

ANGINA: -Patterns of Angina 4.) Intractable Angina:

-Is a chronic, incapacitating angina unresponsive to interventions

HEART FAILURE MEDICATIONS: 4.) Beta-Adrenergic Blockers (Beta-Blockers) -Nursing Considerations:

-Monitor BP, pulse, activity tolerance & orthopnea -Check orthostatic BP readings

ANTIANGINAL MEDICATIONS: NITRATES -1.) Sublingual Medications:

-Monitor VS -Offer sips of water before giving b/c dryness may inhibit medication absorption -Instruct the pt: -->To place under the tongue and leave until fully dissolved -->Not to swallow the medication -->To store the med in a dark, tightly closed bottle -->To take Acetaminophen for HA -INstruct the at-home pt to take: 1 tablet for pain and to IMMEDIATELY contact emergency medical services if pain is NOT relieved; In the hospitalized pt: 1 tablet is administered EVERY 5 mins for a total of 3 doses & the HCP is IMMEDIATELY notified if pain is NOT relieved following the 3 doses ** (the BP is checked BEFORE EACH administration)*** -Inform the pt that a stinging or burning sensation may indicate that the tablet is fresh

HEART FAILURE MEDICATIONS: 2.) Afterload-Reducing Agents: -Nursing Considerations:

-Monitor pts taking ACE inhibitors for hypotension following the initial dose -ACE inhibitors can cause angioedema (swelling of the tongue & throat), decreased sense of taste, or skin rash -Monitor for increased levels of K+

BETA-ADRENERGIC BLOCKERS: -2.) Interventions:

-Monitor: -->VS -->For signs of HF or worsening HF -W/hold the med if the pulse or BP is NOT w/in the prescribed parameters -Assess for respiratory distress and for signs of wheezing & dyspnea (bronchospasm) -Instruct the pt: -->To report dizziness, lightheadedness, or nasal congestion -->Not to Stop the medication b/c Rebound HPTN, Rebound Tachycardia , or an Anginal Attack can occur **** -->Taking insulin to monitor the blood glucose level -->In how to take pulse & BP -->To change positions SLOWLY to prevent orthostatic hypotension -->To AVOID OTC meds, esp .cold meds and nasal decongestants -Advise the pt taking insulin that the beta-adrenergic blocker can mask early signs of hypoglycemia, such as tachycardia and nervousness ***

INVASIVE CARDIOVASCULAR PROCEDURES: 2.) Coronary Artery Bypass Grafts (CABG): -B.) Potential Diagnoses:

-Over 50% blockage of left main coronary artery w/anginal episodes (blockage inaccessible to angioplasty & stenting) -Significant 2-vessel dx w/unstable angina -Triple-vessel dx w/or w/out angina -Persistent ischemia or likely MI following coronary angiography, PCI, or stent placement -HF or cardiogenic shock w/acute MI or ischemia (might not be reasonable for pts who have poor ejection fractions) -Coronary arteries that are unable to be accessed or treated by angioplasty and stent placement (narrow or calcified) -Coronary artery dx (CAD) nonresponsive to medical management -Heart valve dx

HEART FAILURE MEDICATIONS: 7.) Anticoagulants: -Pt Education:

-Remind the pt of the risk for bruising and bleeding while on this medication -Instruct the pt to have blood monitored routinely to check bleeding times

HEART FAILURE MEDICATIONS: 5.) Vasodilators: -Pt Education:

-Remind the pt that a HA is a common side effect of this medication -Encourage the pt to sit & lie down slowly

CARDIOVASCULAR MEDICATIONS: 2.) Positive Inotropic & Cardiotonic Medications: -A.) Description:

-Stimulate myocardial contractility & produce a positive inotropic effect -These meds are used for-short-term management of advanced HF-->the increase in myocardial contractility improves cardiac, peripheral & kidney fxn by: increasing preload, improving blood flow to the periphery & kidneys, decreasing edema, & increasing fluid excretion-->As a result: Fluid retention in the lungs & extremities is decreased

HEART FAILURE MEDICATIONS: 5.) Vasodilators: -Nursing Considerations:

-Vasodilators are give to treat angina & help control BP -Use cautiously w/other antihypertensive meds -Vasodilators can cause orthostatic hypotension

ANTIANGINAL MEDICATIONS: NITRATES -6.) Patches & Ointments:

-Wear gloves when applying -DO NOT apply on the chest in the area of defibrillator-cardioverter pad placement b/c skin burns can result if the pads need to be used **INSTRUCT THE PT USING NITROGLYCERIN TABLETS TO CHECK THE EXPIRATION DATE ON THE MED BOTTLE B/C EXPIRATION MAY OCCUR W/IN 6 MOS. OF OBTAINING THE MED. THE TABLETS WILL NOT RELIEVE CHEST PAIN IF THEY HAVE EXPIRED ****

HEART FAILURE MEDICATIONS: 6.) Human B-Type Natriuretic Peptides: -Nursing Considerations:

-hBNPs can cause hypotension, as well as, a # of cardiac effects, including ventricular tachycardia & bradycardia -BNP levels will increase while on this medication -Monitor ECG, BP, and other parameters

CALCIUM CHANNEL BLOCKERS: 1.) State what the therapeutic action of these meds are 2.) What do Ca+ channel blockers promote in the coronary & peripheral vessels? 3.) Used for..? (3) 4.) Should be used w/caution in the pt w/? (3)

1.) Decrease cardiac contractility (negative inotropic effect by relaxing smooth muscle), and the workload of the heart, thus decreasing the need for O2 2.)Promote vasodilation of the coronary & peripheral vessels 3.) Used for: Angina, Dysrhythmias, or HPTN 4.) Should be used w/caution in the pt w/: HF, bradycardia or Atrioventricular block

PRIORITY NURSING ACTIONS: -CHEST PAIN IN A HOSPITALIZED PT W/CARDIAC DX:

1.) Quickly assess the pt, specifically characteristics of pain, HR & rhythm, & BP 2.) Administer a nitroglycerin tablet sublingually 3.) Stay w/the pt 4.) Reassess in 5 mins 5.) Administer another nitroglycerin tablet sublingually if pain is NOT relieved & the BP is stable 6.) Reassess in 5 mins 7.) Administer a 3rd nitroglycerin tablet sublingually if pain is NOT relieved and the BP is stable 8.) Reassess in 5 mins; contact the HCP if the 3rd nitroglycerin tables does NOT relieve the pain 9.) Document the event, actions taken, and the pts response to tx

BETA-ADRENERGIC BLOCKERS: 1.) Beta-adrenergic blockers inhibit response to beta-adrenergic stimulation, thus decrease ___ ____? 2.) What do they block the release of? (3) and what does this therefore end up decreasing? (4) 3.) What are these meds used for? (7) 4.) Who are these meds contraindicated in? 5.)Whom should these meds be used w/caution in? & why should caution be used w/these pts?

1.)Inhibit response to beta-adrenergic stimulation thus decreasing cardiac output 2.) They block the release of: catecholamines, epinephrine, and norepinephrine-->thus, decreasing the HR & BP, they also decrease the workload of the heart & decrease O2 demands 3.) Used for: angina, dysrhythmias, HPTN, migraine HA's, prevention of myocardial infarction, glaucoma 4.) Contraindicated in the pt w/:asthma, bradycardia, HF (w/exceptions), severe renal or hepatic dx, hyperthyroidism, or stroke; carvedilol, metoprolol & bisoprolol have been approved for use in HF once the pt has been stabilized by ACE inhibitor & diuretic therapy 5.) Should be used w/caution in the pt w/DM b/c the med may mask sx's of hypoglycemia**** -a.) Should also be used w/caution in the pt taking antihypertensive meds

The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? a.) The neurovascular status is normal b/c of increased blood flow thru the leg b.) The NV status is moderately impaired, and the surgeon should be called c.) The NV status is slightly deteriorating and should be monitored for another hour d.) The NV status is adequate from an arterial approach, but venous complications are arising

ANSWER=A RATIONALE: An expected outcome of aortoiliac bypass graft surgery is warmth, redness & edema in the surgical extremity b/c of increased blood flow. The remaining options are incorrect interpretations

A client has been experiencing difficulty with completion of daily activities because of underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client progress in meeting goals for this problem? a.) Ambulates 10 feet (3 m) farther each day b.) Verbalizes the benefits of increasing activity c.) Chooses a healthy diet that meets caloric needs d.) Sleeps w/out awakening throughout the night

ANSWER=A RATIONALE: Each of the options indicates a positive outcome on the part of the pt. Both options b.) & the correct one a.) relate to the pt problem of difficulty w/completion of daily activities. However, the questions asks about progress. The correct option (a) is more action-oriented and therefore is the better choice. Option c) would most likely indicate progress if the pt had a problem of inadequate nutritional intake. Option d.) would be a satisfactory outcome for a pt experiencing difficulty sleeping

The nurse is performing an admission assessment on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain at home. During the assessment the client complains of chest pain. The nurse should immediately ask the client which question? a.) Where is the pain located? b.) Are you having any nausea? c.) Are you allergic to any meds? d.) Do you have your nitroglycerin w/you?

ANSWER=A RATIONALE: If a pt complains of chest pain, the initial assessment question is to ask the pt about the pain intensity, location, duration, and quality. Although the questions in the remaining options all may be components of the assessment, none of these questions is the initial assesment question for this pt

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? a.) Sinus tachycardia b.) Sinus bradycardia c.) Sinus dysrhythmia d.) Normal sinus rhythm

ANSWER=A RATIONALE: Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR & QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial & ventricular rates (HR) are greater than >100 bpm

The home care nurse has taught a client with a problem of inadequate cardiac output about helpful lifestyle adaptations to promote health. Which statement by the client best demonstrates an understanding of the information provided? a.) I will eat enough daily fiber to prevent straining at stool b.) I will try to exercise vigorously to strengthen my heart muscle c.) I will drink 3000-3500 mL of fluid daily to promote good kidney fxn d) Drinking 2-3 oz of liquor each night will promote good blood flow by enlarging blood vessels

ANSWER=A RATIONALE: Standard home care instructions for a pt w/this problem include among others: lifestyle changes such as decreased alcohol intake, avoiding activities that increase the demands on the heart, instituting bowel regiment to prevent straining and constipation, and maintaining fluid & electrolyte balance. Consuming 3000-3500 mL of fluid & exercising vigorously will increase the cardiac workload

The nurse is developing a plan of care for a client who will be admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) of the right leg. The nurse develops the plan, expecting that the health care provider (HCP) will most likely prescribe which option? a.) Maintain activity level as prescribed b) Maintain the affected leg in a dependent position c.) Administer an opioid analgesic every 4 hrs around the clock d.) Apply cool packs to the affected leg for 20 mins every 4 hrs

ANSWER=A RATIONALE: Standard management for the pt w/DVT includes: maintaining the activity level as prescribed by the HCP; limb elevation; relief of discomfort w/warm, moist heat; and analgesics as needed. Recent research is showing that ambulation as previously thought, does NOT cause pulmonary embolism & does NOT cause the existing DVT to worsen. Therefore, the nurse should maintain the prescribed activity level, which could be bed rest, or ambulation. Opioid analgesics are NOT required to relieve pain, and pain normally is relieved w/acetaminophen

The nurse is participating in a class on rhythm strip interpretation. Which statement by the nurse indicates an understanding of a PR interval of 0.20? a.) "this is a normal finding" b) "this is indicative of atrial flutter" c.) "this is indicative of atrial fibrillation" d.) "this is indicative of impending reinfarction"

ANSWER=A RATIONALE: The PR interval represents the time it takes for the cardiac impulse to spread from the atria to the ventricles. The normal range for the PR interval is 0.12-0.20 seconds. The remaining options are incorrect and indicate that further education is needed

The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? a.) Listening to lung sounds b) Palpating for organomegaly c.) Assessing for jugular vein distention d.) Assessing for peripheral & sacral edema

ANSWER=A RATIONALE: The pt w/HF may present w/different sx's, depending on whether the right or left side of the heart is failing. Peripheral & sacral edema, jugular vein distention, & organomegaly all are manifestations of problems w/right-sided Heart fxn. Lung sounds constitute an accurate indicator of left-sided heart fxn

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a rapid ventricular rate of 150 beats/minute. The nurse should next assess the client for which finding? a.) Hypotension b) Flat neck veins c.) Complaints of nausea d.) Complaints of HA

ANSWER=A RATIONALE: The pt w/uncontrolled atrial fibrillation w/a ventricular rate greater than 100 bpm is at risk for low CO b/c of loss of atrial kick. The nurse assesses the pt for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, SOB, & distended neck veins

The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention? a.) Keep the legs aligned w/the heart b.) Elevate the legs higher than the heart c.) Clean the skin w/alcohol every hour d.) Position the pt onto the side during every shift

ANSWER=B RATIONALE: In the pt w/a venous disorder, the legs are elevated above the level of the heart to assist w/the return of venous blood to the heart Alcohol is very irritating and drying to tissues & should NOT be used in areas of skin breakdown. Option d.) specifies infrequent care intervals so its not the priority intervention

The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority? a.) BP b.) Status of airway c.) O2 flow rate d.) LOC

ANSWER=B RATIONALE: Nursing responsibilities after cardioversion include maintenance 1st of a patent airway, & then O2 administration, assess of VS, and LOC, & dysrhythmia detection

The nurse has provided dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions? a.) Ill need to become a strict vegetarian b.) I should use polyunsaturated oils in my diet c.) I need to substitute eggs & whole milk for meat d.) I should eliminate all cholesterol & fat from my diet

ANSWER=B RATIONALE: The pt w/coronary artery dx should avoid foods high in saturated fat & cholesterol such as eggs, whole milk & red meat . These foods contribute to increases in LDL lipoproteins. The use of polyunsaturated oils is recommended.to control hypercholesterolemia. It is NOT necessary to eliminate all cholesterol & fat from the diet. Is is NOT necessary to become a strict vegetarian

A client calls the nurse at the clinic and reports that ever since the vein ligation and stripping procedure was performed, she has been experiencing a sensation as though the affected leg is falling asleep. The nurse should make which response to the client? a.) Apply warm packs to the leg b.) Keep the leg elevated as much as possible c.) Your HCP needs to be contacted to report this problem d.) This normally occurs after surgery & will subside when the edema goes down

ANSWER=C RATIONALE: A sensation of pins & needles or feeling as tho the surgical limb is falling asleep may indicate temprorary or permanent nerve damage after surgery. The saphenous vein and the saphenous nerve run close together and damage to the nerve will produce paresthesias. The remaining options are inaccurate responses. An alternative to surgery is endovenous ablation of the saphenous vein. Ablation involves the insertion of a catheter that emits energy. This causes collapse and sclerosis of the vein. Potential complications include: bruising, tightness along the vein, recanalization (reopening of the vein), and paresthesias. Endovenous ablation also may be done in combination w/saphenofemoral ligation or phlebectomy. Transilluminated powdered phlebectomy involves the use of a powdered resector to destroy the varices & then removes the pieces via aspiration

A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client returns to the nursing unit after the procedure, and the nurse provides instructions to the client regarding home care measures. Which statement, if made by the client, indicates an understanding of the instructions? a.) I need to cut down on cigarette smoking b.) I am so relieved that my heart is repaired c.) I need to adhere to my dietary restrictions d.) I am so relieved that I can eat anything I want to now

ANSWER=C RATIONALE: After Angioplasty, the pt needs to be instructed on the specific dietary restrictions that must be followed. Making the recommended dietary & lifestyle changes will assist in preventing further asthersclerosis. Abrupt closure of the artery can occur if the dietary & lifestyle recommendations are not followed. Cigarette smoking needs to be stopped. An angioplasty does NOT repair the heart.

A home care nurse is visiting a client to provide follow-up evaluation and care of a leg ulcer. On removing the dressing from the leg ulcer, the nurse notes that the ulcer is pale and deep and that the surrounding tissue is cool to the touch. The nurse should document that these findings identify which type of ulcer? a.) Stage 1 ulcer b.) A Vascular ulcer c.) An arterial ulcer d.) A venous stasis ulcer

ANSWER=C RATIONALE: Arterial ulcers have a pale deep base & are surrounded by tissue that is cool w/trophic changes such as: dry skin and loss o hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of O2 & nutrients. A Stage 1 ulcer indicates a reddened area w/an intact skin surface. A venous stasis ulcer (vascular) has a dark red base and is surrounded by brown skin w/local edema. This type of ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of venous congestion

The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication? a.) Flat neck veins b.) A pulse rate of 60 bpm c.) Muffled or distant heart sounds d) Wheezing on auscultation of the lungs

ANSWER=C RATIONALE: Assessment findings assoc. w/cardiac tamponade include: tachycardia, distant or muffled heart sounds, jugular vein distention w/clear lung sounds, & a falling BP accompanied by pulsus paradoxus (a drop in inspiratory BP greater than >10 mmHg). The other options are NOT signs of cardiac tamponade

The nurse in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit (ICU). The nurse notes that a cardiac troponin T assay was performed while the client was in the ICU. The nurse determines that this test was performed to assist in diagnosing which condition? a.) HF b.) Atrial fibrillation c.) MI d.) Ventricular tachycardia

ANSWER=C RATIONALE: Cardiac troponin T or cardiac troponin I have been found to be a protein marker in the detection of myocardial infarction, & assay for this protein is used in some institutions to aid in the diagnosis of a MI. The test is NOT used to diagnose HF, ventricular tachycardia or atrial fibrillation

The health care provider (HCP) has written a prescription for a client to have an echocardiogram. Which action should the nurse take to prepare the client for the procedure? a.) Questions the pt about allergies to iodine or shellfish b.) Has the pt sign an informed consent form for an invasive prcoedure c.) Tells the pt that the procedure is painless and takes 30-60 mins d.) Keeps the pt on NPO status for 2 hrs before the procedure

ANSWER=C RATIONALE: Echocardiography is a noninvasive, risk-free, pain-free test that involves no special preparation. It commonly is done at the bedside or on an outpt basis. The pt must lie quietly for 30-60 mins while the procedure is being performed. It is important to provide adequate info to eliminate unnecessary worry on the part of the pt

The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client? a.) Use nail polish to protect the nail beds from injury. b.) Wear gloves for all activities involving the use of both hands. c.) Stop smoking because it causes cutaneous blood vessel spasm. d.) Always wear warm clothing, even in warm climates, to prevent vasoconstriction.

ANSWER=C RATIONALE: Raynaud's dx is peripheral vascular dx characterized by abnormal vasoconstricition in the extremities Smoking cessation is 1 of the MOST important lifestyle changes that the pt must make. The nurse should emphasize the effects of tobacco on the blood vessels and the principles involved in stopping smoking. The nurse needs to provide info to the pt about smoking cessation programs available in the community. It is NOT necessary to wear gloves for all activities, nor should warm clothing be worn in warm climates

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? a.) Call a code b.) Call the HCP c.) Check the pts status and lead placement d.) Press the recorder button on the electrocardiogram console

ANSWER=C RATIONALE: Sudden loss of Electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the pt & equipment is necessary to determine the cause & identify the appropriate intervention. The remaining options are secondary to pt assessment

The nurse is providing instructions to a client with a diagnosis of hypertension regarding high-sodium items to be avoided. The nurse instructs the client to avoid consuming which item? a.) Bananas b.) Broccoli c.) Antacids d.) Cantaloupe

ANSWER=C RATIONALE: The Na+ level can increase w/the use of several types of products, including: toothpaste & mouthwash; OTC meds such as analgesics, antacids, laxatives & sedatives; and softened water & mineral water. Pts are instructed to read labels for Na+ content. water that is bottled, distilled, deionized, or dimineralized may be used for drinking and cooking. Fresh fruits & veggies are low in Na+

The registered nurse (RN) is educating a new RN about the use of oxygen for clients with angina pectoris. Which statement by the new nurse indicates that the teaching has been effective? a.) O2 has a calming effect b.) O2 will prevent the development of any thrombus c.) The pain of angina pectoris occurs b/c of a decreased O2 supply to heart cells d.) O2 dilates the blood vessels so that they can supply more nutrients to the heart muscle

ANSWER=C RATIONALE: The pain assoc. w/angina results from ischemia of myocardial cells. The pain often is precipitated by activity that places more O2 demand on heart muscles. Supplemental O2 will help meet the added demands on the heart muscle. O2 does NOT dilate blood vessels or prevent thrombus formation and does NOT directly calm the pt

A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction should the nurse plan to provide to the client about this procedure? a.) Eat breakfast just before the procedure b.) Wear firm, rigid shoes such as work boots c.) Wear loose clothing w/a shirt that buttons in front d.) Avoid cigarettes for 30 mins before the procedure

ANSWER=C RATIONALE: The pt should wear loose, comfortable clothing for the procedure. ECG lead placement is enhanced if the pt wears a shirt that buttons in front. The pt should receive nothing by mouth (NPO) after bedtime or for a minimum of 2 hours before the test. The pt should wear rubber-soled, supportive shoes, such as athletic training shoes. The pt should avoid smoking, alcohol, and caffeine the day of the test. Inadequate or incorrect preparation can interfere w/the test w/the potential for a false-positive result

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats/minute. Which action should the nurse take? a.) Check VS b.) Check lab test results c.) Notify the HCP d.) Continue to monitor for any rhythm change

ANSWER=D RATIONALE: Normal sinus rhythm is defined as regular rhythm, w/an overall rate of 60-100 bpm. The PR & QRS measurements are normal measuring b/w 0.12-0.20 seconds & 0.4-0.10 seconds, respectively. There are no irregularities in this rhythm currently, so there is no immediate need to check VS or lab results, or to notify the HCP. Therefore, the nurse should continue to monitor the pt for any rhythm change

The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction a.) "I need to be sure not to go barefoot around the house." b.) "If I cut my toenails, I need to be sure that I cut them straight across." c.) "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes." d.) "I need to be sure that I elevate my leg above the level of my heart for at least an hour every day."

ANSWER=D RATIONALE: Foot care instructions for the pt w/peripheral arterial dx are the same as those for a pt w/DM. The pt w/arterial dx, however, should avoid raising the legs above the level of the heart unless instructed to do so as part of an exercise program or if the venous stasis is also present.The pt statements in the remaining options are correct statements, & indicate that the teaching has been effective

A client with a diagnosis of varicose veins is scheduled for treatment by sclerotherapy and is receiving education about the procedure from the nurse. Which statement by the client indicates that the teaching has been effective? a.) "It involves tying off the veins so that circulation is redirected in another area." b.) "It involves surgically removing the varicosity, so anesthesia will be required." c.) "It involves tying off the veins to prevent sluggishness of blood from occurring." d.) "It involves injecting an agent into the vein to damage the vein wall and close it off."

ANSWER=D RATIONALE: Sclerotherapy is the injection of a sclerosing agent into a variscosity. The agent damages the vessel that causes asceptic thrombosis, which results in vein closure. W/no blood flow thru the vessel, distention will NOT occur. The surgical proceudre for varicose veins is vein ligation & stripping. This procedure involves tying off the varicose vein & large tributaries & then removing the vein w/the use of a hook & wires applied thru mulitiple small incisions in the leg. Other tx's include the application of radiofrequency (RF) energy, in which the vein is heated from the inside by the RF energy and shrinks; collateral veins nearby take over. Laser tx is another alternative to surgery; in this tx a laser fiber is used to heat & close the main vessel that is used to contributing to the variscosity

The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should assess which item based on priority? a.) Anxiety level of the pt & family b.)Presence of a MedicAlert card for the pt to carry c.) Knowledge of restrictions on post D/C physical activitiy d.) Activation status of the device, HR cutoff, and # of shocks its programmed to deliver

ANSWER=D RATIONALE: The nurse who is caring for the pt after insertion of an automatic internal cardioverter-defibrillator needs to assess device setting, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know the cutoff above which it will fire, & the # of shocks it is programmed to deliver. The remaining options are also nursing interventions but are NOT the priority

A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? a.) "I should notify my doctor if my feet or legs start to swell." b.) "My doctor told me to call his office if my pulse rate decreases below 60." c.) "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." d.) "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

ANSWER=D RATIONALE: Variant angina, or Prizmetal's angina is prolonged & severe and occurs at the same time each day, most often at rest. The pain is a result of coronary artery spasm. The tx of choice is usually a Ca++ channel blocker, which relaxes & dilates the vascular smooth muscle, thus relieving the coronary artery spasm in variant angina. Adverse effects can include: peripheral edema, hypotension, bradycardia, & HF. Grapefruit juice interacts w/Ca++ Channel blockers & should be avoided. If bradycardia occurs, the pt should contact the HCP. Pts should also be taught to change positions slowly to prevent orthostatic hypotension. Physical exertion does NOT cause this type of angina; therefore, the pt should be able to continue morning walks w/his or her spouse.

The nurse is performing a health screening on a 54-year-old client. The client has a blood pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL (4.9 mmol/L), and fasting blood glucose level of 184 mg/dL (10.2 mmol/L). The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)? a.) Age b.) HPTN c.) Hyperlipidemia d.) Glucose intolerance

ANSWER=D RATIONALE: HPTN, cigarette smoking, and hyperlipidemia are modifiable risk factors that are predictors of CAD. Glucose intolerance, obesity & response to stress are contributing modifiable risk factors for CAD.Age is a nonmodifiable risk factor. The nurse places priority on risk factors that can be modified. In this scenario, the abnormal value is the fasting blood glucose level, indicating glucose intolerance as the priority risk factor

The nurse in the medical unit is assigned to provide discharge teaching to a client with a diagnosis of angina pectoris. The nurse is discussing lifestyle changes that are needed to minimize the effects of the disease process. The client continually changes the subject during the teaching session. The nurse interprets that this client's behavior is most likely related to which problem? a.) Anxiety r/t the need to make lifestyle changes b.) Boredom resulting from having already learned the material c.) An attempt to ignore or deny the need to make lifestyle changes d.) Lack f understanding of the material provided at the teaching session and embarrassment about asking questions

ANSWERS=C RATIONALE: Denial is a defense mechanism that allows the pt to minimize a threat that may be manifested by refusal to discuss what has happened. Denial is a common early rxn assoc. w/chest discomfort, angina or MI. Anxiety usually is manifested by sx's of SNS arousal. No data are provided in the question that would lead the nurse to interpret the pts behavior as boredom or as either understanding or not understanding the material provided at the teaching session

HEART FAILURE MEDICATIONS: 2.) Afterload-Reducing Agents:

After-load reducing agents help the heart pump more easily by altering the resistance to contraction. These are contraindicated for pts who have renal deficiency -Angiotensin-Converting Enzyme (ACE) Inhibitors: such as enalapril & captopril -Angiotensin Receptor II Blockers: such as losartan -Calcium Channel Blockers: such as diltiazem & nifedipine -Phosphodiesterase-3 Inhibitors: such as milrinone

HEART FAILURE MEDICATIONS: 7.) Anticoagulants:

Anticoagulants such as warfarin, can be prescribed if the pt has a hx of thrombus formation

INVASIVE CARDIOVASCULAR PROCEDURES: 1.) Percutaneous Coronary Intervention (PCI) Complications: -b.) Retroperitoneal Bleeding:

Bleeding in the retroperitoneal space (abdominal cavity behind the peritoneum) can occur due to femoral artery puncture NURSING ACTIONS: -Assess for flank pain & hypotension -Notify the HCP immediately -Administer IV fluids & blood products as prescribed PT EDUCATION: -Advise the pt that pressure will be applied to the insertion site -Remind the pt to keep their leg straight -Advise the pt to report chest pain, SOB, cardiac manifestations

INVASIVE CARDIOVASCULAR PROCEDURES: 2.) Coronary Artery Bypass Grafts (CABG): -A.) Description:

CABG is an invasive surgical procedure that aims to restore vascularization of the myocardium: -->Performed to bypass an obstruction in 1 or more of the coronary arteries, CABG does NOT alter the athersclerotic process but improves the QOL for pts restricted by painful coronary artery dx (CAD) -->The procedure is most effective when a pt has sufficient ventricular fxn (ejection fraction greater than >50%) -->Older adult pts are more likely to experience transient neurological changes,

INVASIVE CARDIOVASCULAR PROCEDURES: 1.) Percutaneous Coronary Intervention (PCI) Complications: -c.) Restenosis of Treated Vessel:

Clot formation can occur in the coronary vessel immediately or several days after the procedure NURSING ACTIONS: -Assess ECG patterns and for report of chest pain -Notify the HCP immediately -Prepare the pt for return to the cardiac catheterization laboratory PT EDUCATION: -Advise the pt to notify the HCP of cardiac manifestations and to take meds as prescribed

CARDIOVASCULAR MEDICATIONS: 2.) Positive Inotropic & Cardiotonic Medications:

DOPAMINE: -Used as a: Short-term rescue measure for pts w/severe, acute HF -Increases myocardial contractility thereby improving cardiac performance -Dilates renal blood vessels & increases renal blood flow & urine output DOBUTAMINE: -Used for: short-term management of HF -Increases myocardial contractility thereby improving cardiac performance MILRINONE LACTATE: -Used for: short-term management of HF; may be given BEFORE heart transplantation

INVASIVE CARDIOVASCULAR PROCEDURES: 1.) Percutaneous Coronary Intervention (PCI) Complications: -d.) Acute Kidney Injury:

Damage to the kidneys can result from use of contrast agent, which is nephrotoxic NURSING ACTIONS: -Monitor urine output, BUN, creatinine, & electrolytes -Promote adequate hydration (oral & IV) -Administer acetylcysteine to protect the kidneys before & after the procedure as prescribed **(OTHER 4 COMPLICATIONS ON NOTES IN NCLEX BINDER)

HEART FAILURE MEDICATIONS: 1.) Diuretics:

Diuretics are used to decrease preload (the amount of ventricular stretch at the end of diastole (relaxation) -Loop Diuretics: such as furosemide & bumetanide -Thiazide Diuretics: such as hydrochlorothiazide -Potassium-sparing Diuretics: such as spironolactone

HEART FAILURE MEDICATIONS: 3.) Inotropic Agents:

Inotropic agents such as digoxin, dopamine, dobutamine, and milrinone are used to increase contractility & thereby improve CO

ANTIANGINAL MEDICATIONS: NITRATES -4.) Transdermal Patch:

Instruct the pt to apply the patch to a hairless area, using a new patch and different site each day -As prescribed, instruct the pt to remove the patch after 12-14 hrs, allowing 10-12 "patch-free" hours each day to prevent tolerance

HEART FAILURE MEDICATIONS: 4.) Beta-Adrenergic Blockers (Beta-Blockers)

Medications such as carvedilol and metoprolol can be used to improve the condition of the pt who has sustained increased levels of sympathetic stimulation & catecholamines. This includes pts who have chronic HF

CARDIOVASCULAR MEDICATIONS: 3.) Cardiac Glycosides (Digoxin): -C.) Interventions:

Monitor: -For toxicity as evidenced by anorexia, N/V, visual disturbances (blurred or yellow vision) & dysrhythmias -Serum digoixn level, electrolyte levels, & Renal fxn test results -The K+ level; if hypokalemia occurs , notify the HCP -The pt taking a K+-losing diuretic or corticosteroids closely for hypokalemia b/c the hypokalemia can cause digoxin toxicity* -The apical pulse for 1 full minute; if the apical pulse rate is lower than <60 bpm, the medication should be w/held & the HCP notified -The Optimal Therapuetic range for digoxin is: 0.5-0.8 ng/mL** -An increased risk of toxicity exists in pts w/hypercalcemia, hypokalemia, hypomagnesemia, or hypothyroidism -Instruct the pt to AVOID OTC meds -Note that older pts are more sensitive to digoxin toxicity -Advise the pt to eat foods high in K+, such as fresh and dried fruits, fruit juices, vegetables, & potatoes -Teach the pt how to measure the pulse & to notify the HCP if the pulse rate is lower than <60 bpm or more than >100 bpm -Teach the pt the S/S of toxicity -ANTIDOTE: Digoxin immune Fab is used in EXTREME toxicity***

INVASIVE CARDIOVASCULAR PROCEDURES: 1.) Percutaneous Coronary Intervention (PCI) -B.) Preprocedure Considerations:

NURSING ACTIONS: -Ensure that the pt signs the consent form -Maintain the pt on NPO status for @ least 8 hrs if possible (risk for aspiration when lying flat for the procedure) -Assess that the pt & family understand the procedure -Assess the pt for an iodine/shellfish allergy (contrast dye used instead of contrast media for consistency) -Assess renal fxn prior to introduction of contrast dye -Administer premedications as prescribed (antiplatelet meds) PT. EDUCATION: -Instruct the pt that they might be awake and sedated for the procedure. A local anesthetic might be administered. A small incision is made, often in the groin to insert the catheter. The pt might feel warmth & flushing when the dye is inserted. After the procedure, the pt will be asked to keep the affected leg straight. Pressure (a sandbag) might be placed on the incision to prevent bleeding

INVASIVE CARDIOVASCULAR PROCEDURES: 1.) Percutaneous Coronary Intervention (PCI) -A.) Description:

PCI is a nonsurgical procedure performed to open coronary arteries thru 1 of the following means: -Atherectomy: used to break up & remove plaques w/in cardiac vessels -Stent: Placement of a mesh-wire device to hold an artery open & prevent restenosis -Percutaneous Transluminal Coronary Angioplasty: Also referred to simply as "Angioplasty", this involves inflating a balloon to dilate the arterial lumen & the adhering plaque, thus widening the arterial lumen. This can include stent placement

ANGINA: -Assessment:

Pain: -Can develop slowly or quickly -Pain is usually described as mild or moderate -Substernal, crushing, squeezing pain may occur -Pain may radiate to the shoulders, arms, jaw, neck or back -Pain intensity is unaffected by inspiration & expiration -Pain usually lasts less than: <5 mins; however, pain can last up to: 15-20 mins -Pain is relieved by nitroglycerin or rest -Dyspnea -Pallor -Sweating -Palpitations & Tachycardia -Dizziness & Syncope -HPTN -Digestive disturbances

INVASIVE CARDIOVASCULAR PROCEDURES: 1.) Percutaneous Coronary Intervention (PCI) Complications: -a.) Embolism:

Plaque or a clot can become dislodged NURSING ACTIONS: -Monitor pt for chest pain during & after the procedure -Monitor pts VS & SaO

CARDIOVASCULAR MEDICATIONS: 2.) Positive Inotropic & Cardiotonic Medications: -C.) Interventions:

Positive Inotropic & Cardiotonic Medications are used for IV administration: -For continous IV infusion-->administer w/an infusion pump -STOP THE INFUSION if the pts BP drops or dysrhythmias occur -Inamrinone: SHOULD NOT be mixed w/glucose-containing solutions Monitor: -The Apical pulse & BP -For hypersensitivity -For edema -For relief of HF as noted by: reduction in edema & lessening of dyspnea, orthopnea & fatigue -Electrolyte & Liver Fxn Enzyme levels; Platelet count & Renal Fxn studie; These meds may: decrease K+ and increase liver enzyme levels; Continous Electrocardiographic monitoring is done DURING ADMINISTRATION

HEART FAILURE MEDICATIONS: 1.) Diuretics: -Pt. Education:

Teach pts taking loop or thiazide diuretics to ingest foods and drinks that are high in K+ to counter the effects of hypokalemia

HEART FAILURE MEDICATIONS: 3.) Inotropic Agents: -Pt Education:

Teach pts who are self-administering digoxin to: -Count pulse for 1 min before taking the medication. If the pulse rate is irregular or the pulse rate is outside of the limitations set by the HCP (usually <60/min or >100/min) instruct the pt to hold the dose and contact the HCP -Take the digoxin dose @ the same time each day -Do NOT take digoxin at the same time as antacids. Separate the 2 meds by at least 2 hours. -Report signs of toxicity, including fatigue, muscle weakness, confusion, and loss of appetite -Regularly have digoxin & K+ levels checked

ANTIANGINAL MEDICATIONS: NITRATES 1.) What therapeutic effects do nitrates produce? (3-4) 2.) What pts are nitrates contraindicated in? (4) 3.) What pts should nitrates be used cautiously in? (2) 4.) Pts taking ____-____ preparations of nitrates should avoid abrupt w/drawal to prevent what from occurring?

`1.) Produce vasodilation, decrease preload & afterload & reduce myocardial O2 consumption 2.)Contraindicated in pts w/: significant hypotension, increased ICP and severe anemia, & pt taking meds to treat erectile dysfxn (ED) 3.) Should be used w/caution w/severe renal or hepatic dx 4.) Avoid abrupt w/drawl of long-acting preparations to prevent the rebound efect of severe pain from myocardial ischemia

HEART FAILURE MEDICATIONS: 6.) Human B-Type Natriuretic Peptides:

hBNPs, such as nesiritide, are used to treat acute HF by causing natriuresis (loss of Na+ and vasodilation). They are administered IV