Chapter 27: Management of Patients with Coronary Vascular Disorders

The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond? A.) fatty deposits in the lumen of arteries B.) cholesterol plugs in the lumen of veins C.) blood clots in the arteries D.) emboli in the veins

Answer: A.) fatty deposits in the lumen of arteries

The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the emergency room. What is the most important cardiac marker for the client? A.) creatine kinase B.) lactate dehydrogenase C.) myoglobin D.) troponin

Answer D.) troponin Rationale: This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase, and myoglobin tests can show evidence of muscle injury, but the studies are less specific indicators of myocardial damage than troponin.

The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which measures should the nurse complete to prevent the development of deep venous thrombosis (DVT) and possible pulmonary embolism (PE)? Select all that apply. - Place pillows in the popliteal space. - Apply antiembolism stockings. - Encourage the client to cross their legs. - Avoid elevating the knees on the bed. - Initiate passive exercises.

Answer: - Apply antiembolism stockings. - Avoid elevating the knees on the bed. - Initiate passive exercises. Rationale: Preventive measures used to prevent venous stasis include application of sequential pneumatic compression devices; discouraging crossing of legs; avoiding elevating the knees on the bed; omitting pillows in the popliteal space; and beginning passive exercises followed by active exercises to promote circulation and prevent venous stasis.

The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. - morphine - atorvastatin - enalapril - aspirin - sildenafil

Answer: - atorvastatin - enalapril - aspirin Rationale: Upon client discharge, there needs to be documentation that the client was discharged on a statin (atorvastatin), an ACE or angiotensin receptor blocking agent (enalapril), and aspirin. Morphine is used to reduce the client's pain and anxiety. Sildenafil is a medication used for pulmonary hypertension.

A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding? A.) "What color is your urine?" B.) "Is your skin drier than normal?" C.) "Do you have any breathing problems?" D.) "How is your appetite?"

Answer: A.) "What color is your urine?" Rationale: The patient receiving anticoagulation therapy should be monitored for signs and symptoms of bleeding, such as changes in the color of the stool or urine. Anticoagulation therapy should not cause dry skin. The anticoagulation therapy should not change the client's breathing or appetite.

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? A.) Altered level of consciousness B.) Minimal oozing of blood from the IV site C.) Presence of reperfusion dysrhythmias D.) Chest pain 2 of 10 (on a 1-to-10 pain scale)

Answer: A.) Altered level of consciousness Rationale: A client receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding, and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low and indicates the client's chest pain is subsiding, an expected outcome of this therapy.

A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication? A.) Atelectasis B.) Elevated blood glucose level C.) Hyperkalemia D.) Urinary tract infection (UTI)

Answer: A.) Atelectasis Rationale: Respiratory complications that may occur include atelectasis. An incentive spirometer and the use of deep breathing exercises are necessary to prevent atelectasis and pneumonia. Elevated blood sugar levels, hyperkalemia, UTI, and are complications that can occur but are unrelated to the respiratory system.

Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? A.) Cardiac tamponade B.) Fluid overload C.) Hypertension D.) Hypothermia

Answer: A.) Cardiac tamponade Rationale: Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high pulmonary artery wedge pressure, central venous pressure, and pulmonary artery diastolic pressure, as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.

A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? A.) calcium-channel blocker B.) beta-adrenergic blocker C.) nitrate D.) diuretic

Answer: A.) calcium-channel blocker Rationale: Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of a calcium-channel blocker.

A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse? A.) Central venous pressure reading of 1 B.) Pain score 5/10 C.) Blood pressure 110/68 mm Hg D.) Heart rate 66 bpm

Answer: A.) Central venous pressure reading of 1 Rationale: The central venous pressure (CVP) reading of 1 is low (2-6 mm Hg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.

Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? A.) Clopidogrel B.) Amlodipine C.) Diltiazem D.) Felodipine

Answer: A.) Clopidogrel Rationale: Clopidogrel or ticlopidine is given to clients who are allergic to aspirin or are given in addition to aspirin to clients who are at high risk for MI. Amlodipine, diltiazem, and felodipine are calcium channel blockers.

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? A.) Clopidogrel B.) Isosorbide mononitrate C.) Metoprolol D.) Diltiazem

Answer: A.) Clopidogrel Rationale; Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.

Which of the following is inconsistent as a condition related to metabolic syndrome? A.) Hypotension B.) Insulin resistance C.) Abdominal obesity D.) Dyslipidemia

Answer: A.) Hypotension Rationale: A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.

When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? A.) Inadequate fluid volume B.) Normal glomerular filtration C.) Overhydration D.) Anuria

Answer: A.) Inadequate fluid volume Rationale: Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric client does not produce urine.

A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? A.) Prothrombin time (PT) or international normalized ratio (INR) B.) Hourly IV infusion C.) Vascular sites for bleeding D.) Urine output

Answer: A.) Prothrombin time (PT) or international normalized ratio (INR) Rationale: The nurse should monitor PT or INR when oral anticoagulation is prescribed. Vascular sites for bleeding, urine output, and hourly IV infusions are generally monitored in all clients.

The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? A.) ST elevation B.) Isolated premature ventricular contractions (PVCs) C.) Sinus tachycardia D.) Frequent premature atrial contractions (PACs)

Answer: A.) ST elevation Rationale: The first signs of an acute MI are usually seen in the T wave and the ST segment. The T wave becomes inverted; the ST segment elevates (it is usually flat). An elevated ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e., ST-elevation MI). This client requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.

The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? A.) The abrupt stop can cause a myocardial infarction. B.) The abrupt stop can lead to formation of blood clots. C.) The abrupt stop will precipitate internal bleeding. D.) The abrupt stop can trigger a migraine headache.

Answer: A.) The abrupt stop can cause a myocardial infarction. Rationale: Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or the onset of a migraine headache.

An client who has been diagnosed with arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is: A.) an expected part of the aging process. B.) a vascular occlusive disease. C.) a condition in which the lumen of arteries fill with scar tissue. D.) high level of blood fat.

Answer: A.) an expected part of the aging process. Rationale: Arteriosclerosis is loss of elasticity or hardening of the arteries that accompanies the aging process. While arteriosclerosis is a contributing factor to vascular occlusive disease, it is a term that refers to a loss of elasticity or hardening of the arteries that accompanies the aging process. Arteriosclerosis does not involve scar tissue formation. Hyperlipidemia, or high levels of blood fat, triggers atherosclerotic changes.

A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates A.) an old MI. B.) an evolving MI. C.) variant angina. D.) a cardiac dysrhythmia.

Answer: A.) an old MI. Rationale: An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI.

The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? A.) atherosclerosis B.) diabetes mellitus C.) myocardial infarction D.) renal failure

Answer: A.) atherosclerosis Rationale: Atherosclerosis (plaque formation) is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.

The nurse is reviewing the laboratory results for a client diagnosed with coronary artery disease (CAD). The client's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as A.) high. B.) low. C.) within normal limits. D.) critically high.

Answer: A.) high. Rationale: Treatment of blood cholesterol to reduce cardiovascular risk in adults calls for a fasting lipid profile to demonstrate an LDL value below 100 mg/dL (or less than 70 mg/dL for very high-risk clients). An LDL level of 115 mg/dL is higher than the target for treatment.

A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? A.) smoking cessation B.) a protein-rich diet C.) exercise avoidance D.) antioxidant supplements

Answer: A.) smoking cessation Rationale: The first line of defense for clients with CAD is lifestyle changes including smoking cessation, weight loss, stress management, and exercise. Clients with CAD should eat a balanced diet. Clients with CAD should exercise, as tolerated, to maintain a healthy weight. Antioxidant supplements, such as those containing vitamin E, beta carotene, and selenium, are not recommended because clinical trials have failed to confirm beneficial effects from their use.

To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? A.) 30 minutes B.) 60 minutes C.) 9 days D.) 6 to 12 months

Answer: B.) 60 minutes Rationale: The 60-minute interval is known as "door-to-balloon time" in which a PTCA can be performed on a client with a diagnosed MI. The 30-minute interval is known as "door-to-needle time" for the administration of thrombolytics after MI. The time frame of 9 days refers to the time until the onset of vasculitis after administration of streptokinase for thrombolysis in a client with an acute MI. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same client for acute MI.

An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's family members express concern to the nurse that the client is uncharacteristically confused. After reporting this change in status to the health care provider, what additional action should the nurse take? A.) Educate the family about how confusion is expected in older adults postoperatively. B.) Assess for factors that may be causing the client's delirium. C.) Document the early signs of dementia and ensure the client's safety. D.) Reorient the client to place and time.

Answer: B.) Assess for factors that may be causing the client's delirium. Rationale: Uncharacteristic changes in cognition following cardiac surgery are suggestive of delirium. Dementia has a gradual onset with organic brain changes and is not an acute response to surgery. Assessment is a higher priority than reorientation, which may or may not be beneficial. Even though delirium is not rare, it is not considered to be an expected part of recovery.

Which is a diagnostic marker for inflammation of vascular endothelium? A.) Low-density lipoprotein (LDL) B.) C-reactive protein (CRP) C.) High-density lipoprotein (HDL) D.) Triglyceride

Answer: B.) C-reactive protein (CRP) Rationale: CRP is a marker for inflammation of the vascular endothelium. LDL, HDL, and triglycerides are not markers of vascular endothelial inflammation. They are elements of fat metabolism.

After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? A.) Troponin I B.) Myoglobin C.) WBC (white blood cell) count D.) C-reactive protein

Answer: B.) Myoglobin Rationale: Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage. Troponin is the gold standard for determining heart damage, but troponin I levels due not rise until 4 to 6 hours after MI. WBCs and C-reactive protein levels will rise but not until about day 3.

The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? A.) Chest pain is typical B.) Vague symptoms C.) Decreased sensation to pain D.) Gender bias

Answer: B.) Vague symptoms Rationale: Often, women and elderly do not have the typical chest pain associated with a myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which can lead to misdiagnosis. Some older adults may experience little or no chest pain. Gender is not a contributing factor for fatal occurrence but rather a result of symptoms association.

A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? A.) Within 12 hours B.) Within 6 hours C.) Within 24 to 48 hours D.) Within 5 to 7 days

Answer: B.) Within 6 hours Rationale: For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Health care providers initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? A.) "Nitroglycerine causes headaches, but removing the patch decreases the incidence." B.) "You do not need the effects of nitroglycerine while you sleep." C.) "Removing the patch at night prevents drug tolerance while keeping the benefits." D.) "Contact dermatitis and skin irritations are common when the patch remains on all day."

Answer: C.) "Removing the patch at night prevents drug tolerance while keeping the benefits." Rationale: Tolerance to antianginal effects of nitrates can occur when taking these drugs for long periods of time. Therefore, to prevent tolerance and maintain benefits, it is a common regime to remove transdermal patches at night. Common adverse effects of nitroglycerin are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while the client rests, there is less demand on the heart but not the primary reason for removing the patch.

The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? A.) 210-240 mg/dL B.) 250-275 mg/dL C.) 160-190 mg/dL D.) 280-300 mg/dL

Answer: C.) 160-190 mg/dL Rationale: Simvastatin is a statin frequently given as initial therapy for significantly elevated cholesterol and low-density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.

The nurse is teaching a client with suspected acute myocardial infarction about serial isoenzyme testing. When is it best to have isoenzyme creatinine kinase of myocardial muscle (CK-MB) tested? A.) 30 minutes to 1 hour after pain B.) 2 to 3 hours after admission C.) 4 to 6 hours after pain D.) 12 to 18 hours after admission

Answer: C.) 4 to 6 hours after pain Rationale: Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.

After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? A.) Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. B.) Decrease anticoagulant or antiplatelet therapy. C.) Apply manual pressure at the site of the insertion of the sheath. D.) Notify the health care provider.

Answer: C.) Apply manual pressure at the site of the insertion of the sheath. Rationale: The immediate nursing action would be to apply pressure to the femoral site. Reviewing blood studies will not stop the bleeding. The nurse cannot decrease anticoagulation therapy independently. If the bleeding does not stop, the health care provider needs to be notified.

A client is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? A.) Pulse rate of 84 beats/minute B.) Respiration 26 breaths/minute C.) Blood pressure 84/52 mm Hg D.) Temperature of 100.2° F (37.9° C)

Answer: C.) Blood pressure 84/52 mm Hg Rationale: Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.

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? A.) Prepare to administer intravenous fluids. B.) Suction the airway. C.) Check blood pressure. D.) Assess pupils for reactiveness.

Answer: C.) Check blood pressure. Rationale: During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.

Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? A.) Isosorbide mononitrate (Isordil) B.) Meperidine hydrochloride (Demerol) C.) Morphine sulfate (Morphine) D.) Nitroglycerin transdermal patch

Answer: C.) Morphine sulfate (Morphine) Rationale: Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.

A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? A.) Chest x-ray B.) Serum electrolytes C.) Nitroglycerin SL D.) Ativan 1 mg orally

Answer: C.) Nitroglycerin SL Rationale: Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired, and the nurse should anticipate administering nitroglycerin to assess whether the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the client's chest pain.

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? A.) Calcium B.) Magnesium C.) Potassium D.) Sodium

Answer: C.) Potassium Rationale: Hyperkalemia (high potassium) can result in the following ECG changes: tall peaked T waves, wide QRS, and bradycardia. The nurse should be prepared to administer a diuretic or an ion-exchange resin (sodium polystyrene sulfonate [Kayexalate]); IV sodium bicarbonate, or IV insulin and glucose. Imbalances in the other electrolytes listed would not result in peaked T waves.

A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? A.) The patient has compromised left ventricular function. B.) The patient has had angina longer than 3 years. C.) The patient has at least a 70% occlusion of a major coronary artery. D.) The patient has an ejection fraction of 65%.

Answer: C.) The patient has at least a 70% occlusion of a major coronary artery.

The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? A.) an hourly urine output of 50 to 70 mL B.) a urine specific gravity reading of 1.021 C.) a serum BUN of 70 mg/dL D.) a serum creatinine of 1.0 mg/dL

Answer: C.) a serum BUN of 70 mg/dL Rationale: These four laboratory results should always be assessed after cardiac surgery. Serum osmolality (N = >800 mOsm/kg) should also be included. A BUN reading of greater than 21 mg/dL is abnormal; a reading of greater than 60 mg/dL is indicative of renal failure. Urine output needs to be greater than 30 mL/hr. Normal urine specific gravity is 1.005-1.030. Normal serum creatinine values are between 0.5-1.2 mg/dL.

A client comes to the health care provider's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction? A.) "Client performs relaxation exercises three times per day to reduce stress." B.) "Client's 24-hour dietary recall reveals low intake of fat and cholesterol." C.) "Client verbalizes an understanding of the need to seek emergency help if heart rate increases markedly while at rest." D.) "Client walks 4 miles in 1 hour every day."

Answer: D.) "Client walks 4 miles in 1 hour every day." Rationale: Four weeks after an MI, a client's walking program should aim for a goal of 2 miles in less than 1 hour. Walking 4 miles in 1 hour is excessive and may induce another MI by increasing the heart's oxygen demands. Therefore, this client requires appropriate exercise guidelines and precautions. Performing relaxation exercises, following a low-fat, low-cholesterol diet, and seeking emergency help if the heart rate increases markedly at rest indicate understanding of the cardiac rehabilitation program. For example, the client should reduce stress, which speeds the heart rate and thus increases myocardial oxygen demands. Reducing dietary fat and cholesterol intake helps lower risk of atherosclerosis. A sudden rise in the heart rate while at rest warrants emergency medical attention because it may signal a life-threatening arrhythmia and increase myocardial oxygen demands.

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

Answer: D.) Heart Rationale: Metoprolol works at beta 1 -receptor sites. Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. The client's cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. What is the best response by the nurse? A.) Cholesterol is within the recommended guidelines and the client doesn't need to lower it. B.) Client should take statin medication and not worry about cholesterol. C.) Client should begin a running program, working up to 2 miles per day. D.) The nurse will ask the dietitian to talk with the client about modifying the diet.

Answer: D.) The nurse will ask the dietitian to talk with the client about modifying the diet. Rationale: A dietitian can help the client decrease the fat in the diet and make other beneficial dietary modifications. This client's total cholesterol isn't within the recommended guidelines; it should be less than 200 mg/dl. LDL should be less than 79 mg/dl, and HDL should be greater than 40 mg/dl. Although this client should take statin medication, the client should still be concerned about cholesterol levels and make other lifestyle changes, such as dietary changes, to help lower it. The client should increase activity level, but doesn't need to run 2 miles per day.

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? A.) Inform client of diagnostic tests. B.) Remove hair from skin insertion sites. C.) Assess distal pulses. D.) Withhold anticoagulant therapy.

Answer: D.) Withhold anticoagulant therapy. Rationale: The nurse knows to withhold the anticoagulant therapy to decrease chance of hemorrhage during the procedure. The nurse does inform the client of diagnostic test, will assess pulses, and prep the skin prior to the angioplasty, but this is not the most important action to be taken.

The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain? A.) incomplete blockage of a major coronary artery B.) a destroyed part of the heart muscle C.) complete closure of an artery D.) a lack of oxygen in the heart muscle cells

Answer: D.) a lack of oxygen in the heart muscle cells Rationale: Angina pectoris refers to chest pain that is brought about by myocardial ischemia. It is the result of cardiac muscle cells being deprived of oxygen due to the progressive symptoms of coronary artery disease. Artery blockage or closure leads to myocardial death. The destroyed part of the heart (death of heart tissue) is a myocardial infarction.

A nurse is monitoring the vital signs and blood results of a client who is receiving anticoagulation therapy. What does nurse identify as a major indication of concern? A.) blood pressure of 129/72 mm Hg B.) heart rate of 87 bpm C.) hemoglobin of 16 g/dL D.) hematocrit of 30%

Answer: D.) hematocrit of 30% Rationale; Hematocrit is a measurement of the proportion of blood volume that is occupied by red blood cells. A lower hematocrit can imply internal bleeding. Blood pressure of 129/72 and heart rate of 87 bpm are normal. A hemoglobin count of 16 g/dL is also normal.