Chapter 14: Nursing Management: Patients With Coronary Vascular Disorders 5-8

Morphine sulfate, oxygen administration, and bed rest

A 45-year-old adult male patient is admitted to emergency after he developed unrelieved chest pain that was present for approximately 20 minutes before he presented to the emergency department. The patient has been subsequently diagnosed with a myocardial infarction (MI). To minimize cardiac damage, what health care provider's order will the nurse expect to see for this patient? Thrombolytics, oxygen administration, and bed rest Morphine sulfate, oxygen administration, and bed rest Oxygen administration, anticoagulants, and bed rest Bed rest, albuterol nebulizer treatments, and oxygen administration

Ischemia of cardiac muscle cells

A 72-year-old woman with a diagnosis of angina pectoris has presented to her nurse practitioner because her chest pain on exertion has become more frequent and longer lasting in recent days. The nurse should understand that this woman's chest pain is directly attributable to which of the following pathophysiological processes? Accumulation of cellular debris in the myocardium after the rupture of atheromas Inflammation and physical irritation of the lumens of coronary arteries Ischemia of cardiac muscle cells Accumulation of lactic acid in cardiac muscle

IV morphine

A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? IV nitroglycerin IV morphine Amlodipine Atenolol

Instruct the client on side effects of flushing, throbbing headache, and tachycardia.

A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? Instruct the client on side effects of flushing, throbbing headache, and tachycardia. Instruct the client not to crush the tablet. Instruct the client to place nitroglycerin tablets in a plastic pill box. Instruct the client to renew the nitroglycerin supply every 3 months.

10 minutes

A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? 5 minutes 10 minutes 15 minutes 20 minutes

Coronary artery spasm.

A client is admitted for treatment of Prinzmetal angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? The same type of activity that caused previous angina episodes. Coronary artery spasm. An unpredictable amount of activity. Activities that increase myocardial oxygen demand.

"The patch should be worn for 12 hours and then removed for 12 hours."

A client is prescribed a nitroglycerin transdermal patch to treat angina. Which statement does the nurse include when reinforcing medication teaching to the client prior to discharge? "Skin irritation is common when the patch is worn for more than 12 hours." "The patch should be worn for 12 hours and then removed for 12 hours." "The medication patch causes headaches so you should remove it daily." "You do not need the effects of nitroglycerine while you sleep."

prior intracranial hemorrhage

A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? prior intracranial hemorrhage recent consumption of a meal shellfish allergy use of heparin

Stable

A client reports chest pain that occurs when playing tennis but resolves when sitting down. The nurse knows these symptoms are common for which type of angina? Stable Intractable Unstable Variant

sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

A client was chopping firewood and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? serial liver enzyme testing, telemetry, and a lidocaine infusion sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry morphine administration, stress testing, and admission to the cardiac care unit streptokinase, aspirin, and morphine administration

anterior. An anterior MI causes left ventricular dysfunction and can lead to manifestations of heart failure, which include pulmonary crackles and dyspnea. Posterior, lateral, and inferior MI aren't usually associated with heart failure.

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? anterior. posterior. lateral. inferior.

"Client will verbalize the intention to stop smoking."

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol." "Client will verbalize the intention to avoid exercise." "Client will verbalize the intention to stop smoking."

6The client is instructed to stop all activity. 5The nurse assesses the client's angina. 4The first set of vital signs are done. 3A 12-lead electrocardiogram (ECG) is performed. 2The client receives the first dose of nitroglycerin. 1The client is transferred to a higher acuity unit.

A client with hypertension is ambulating in the hospital hallway and reports chest pain. In which order would the nurse assess and treat this client? 1The client is transferred to a higher acuity unit. 2The client receives the first dose of nitroglycerin. 3A 12-lead electrocardiogram (ECG) is performed. 4The first set of vital signs are done. 5The nurse assesses the client's angina. 6The client is instructed to stop all activity.

increased liver enzymes

A client's elevated cholesterol levels are being managed with atorvastatin daily. What is a common side effect the nurse will teach the client that will require monitoring? severe muscle pain increased liver enzymes hyperglycemia hyperuricemia

Severe, incapacitating chest pain

A nurse is assigned to care for a recently admitted client who has been diagnosed with refractory angina. What symptom will the nurse expect the client to exhibit? Predictable and consistent pain that occurs on exertion and is relieved by rest Pain that may occur at rest, but the threshold for pain is lower than expected Severe, incapacitating chest pain Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina

Decreases resting heart rate

A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? Decreases cholesterol level Increases cardiac output Decreases resting heart rate Decreases platelet aggregation

Reduces myocardial oxygen consumption Dilates blood vessels Decreases ischemia Relieves pain

A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. Reduces myocardial oxygen consumption Decreases the urge to use tobacco Dilates blood vessels Decreases ischemia Relieves pain

Nitroglycerin

A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication? Amantadine Diphenhydramine Digoxin Nitroglycerin

Assessing the patient for signs and symptoms of hemorrhage

A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment? Assessing the patient's capillary refill time and peripheral pulses Assessing the patient for signs and symptoms of infection Assessing the patient for signs and symptoms of acute renal failure Assessing the patient for signs and symptoms of hemorrhage

above the optimal range.

The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. The nurse recognizes that this value is extremely high. above the optimal range. below the optimal range. within the optimal range.

Heart

The nurse is administering oral metoprolol. Where are the receptor sites mainly located? Uterus Blood vessels Heart Bronchi

Check blood pressure.

The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? Assess pupils for reactiveness. Prepare to administer intravenous fluids. Check blood pressure. Suction the airway.

Examine the legs for color, capillary refill time, and tissue integrity.

The nurse is caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client? Examine for pain around the shoulder and neck region. Examine the client's mental and emotional status. Examine the legs for color, capillary refill time, and tissue integrity. Examine the extremities for skin lesions.

"What time did your chest pain start today?"

The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? "What is your pain level on a scale of 1 to 10?" "How many sublingual nitroglycerin tablets did you take?" "Do your parents have heart disease?" "What time did your chest pain start today?"

adequate cough and gag reflexes acceptable arterial blood gas values breathing without assistance of the ventilator

The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply. adequate cough and gag reflexes inability to speak acceptable arterial blood gas values labile vital signs breathing without assistance of the ventilator

It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms.

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) It is relieved by rest and inactivity. It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms. It is relieved with nitroglycerin.

"You should keep nitroglycerin with you at all times." "You need to follow a low-fat, high-fiber diet." "You need to avoid exercising in extreme temperatures." "Balance rest with your regular daily activities."

The nurse is providing discharge education for a client with angina pectoris. Which information will the nurse include when instructing the client on self-care at home? Select all that apply. "You should keep nitroglycerin with you at all times." "You can return to normal activities when you get home." "You need to follow a low-fat, high-fiber diet." "You need to avoid exercising in extreme temperatures." "Balance rest with your regular daily activities."

Count the respiratory rate for bradypnea.

The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration? Measure the blood pressure for hypertension. Check the radial pulse for dysrhythmias. Measure urinary output for dehydration. Count the respiratory rate for bradypnea.

percutaneous coronary intervention (PCI).

The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with IV heparin. IV nitroglycerin. thrombolytics. percutaneous coronary intervention (PCI).

To restore the flow of blood through the coronary arteries

Thrombolytic therapy is being prepared for administration to an older adult patient who has presented to the emergency department with an ST-segment elevation MI (STEMI). The nurse recognizes that the primary goal of this intervention is: To relieve the patient's symptoms of chest pain and dyspnea To restore function to infarcted myocardial cells To restore the flow of blood through the coronary arteries To prevent the rupture of atheromas

Hypertension

Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? Obesity Hyperlipidemia Hypertension Glucose intolerance

"See if rest relieves the chest pain before using the nitroglycerin."

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? "Place the nitroglycerin tablet between cheek and gum." "See if rest relieves the chest pain before using the nitroglycerin." "Only take one nitroglycerin tablet for each episode of angina." "Call 911 if you develop a headache following nitroglycerin use."

Application of a vascular closure device such as Angio-Seal or VasoSeal

Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? Application of a vascular closure device such as Angio-Seal or VasoSeal Application of a sandbag to the area Application of a pneumatic compression device (e.g., FemoStop) Direct manual pressure

Minimally invasive direct coronary bypass

Which technique is used to surgically revascularize the myocardium? Peripheral bypass Balloon bypass Minimally invasive direct coronary bypass Gastric bypass