Critical Care Exam Study Guide Chapter 27 Prep U
A client who has been diagnosed with Prinzmetal's angina will present with which symptom? a) chest pain that occurs at rest and usually in the middle of the night b) prolonged chest pain that accompanies exercise c) chest pain of increased frequency, severity, and duration d) radiating chest pain that lasts 15 minutes or less
a) chest pain that occurs at rest and usually in the middle of the night
As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid. a) High-density lipoproteins (HDL) b) Low-density lipoproteins (LDL) c) Triglycerides d) Total cholesterol
b) Low-density lipoproteins (LDL)
Which s the analgesic of choice for acute myocardial infarction (MI)? a) Ibuprofen b) Morphine c) Aspirin d) Meperidine
b) Morphine
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 experieincing 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) Serum electrolytes b) Nitroglycerin SL c) Chest x-ray d) Ativan 1 mg orally
b) Nitroglycerin SL
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? a) "Do your parents have heart disease?" b) "What is your pain level on a scale of 1 to 10?" c) "What time did your chest pain start today?" d) "How many sublingual nitroglycerin tablets did you take?"
c) "What time did your chest pain start today?"
The nurse has been asked to explain the cause of angina pain to a patient's family. Choose the best statement. The pain is due to: a) A destroyed part of the heart muscle. b) Complete closure of an artery. c) A lack of oxygen in the heart muscle that causes the death of cells. d) Incomplete blockage of a major coronary artery.
c) A lack of oxygen in the heart muscle that causes the death of cells.
A client is receiving intravenous heparin to prevent blood clots. The order is for heparin 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL of D5W. At how many mL per hour will the nurse infuse this solution? Enter the correct number ONLY. ____________ mL per hour
24 mL per hour
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? a) "I should expect bruising at the catheter site for up to 3 weeks." b) "I should expect a low-grade fever and swelling at the site for the next week." c) "I should avoid prolonged sitting." d) "I should avoid taking a tub bath until my catheter site heals."
a) "I should expect bruising at the catheter site for up to 3 weeks."
Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent? a) Antiplatelets b) Beta blockers c) Nitrates d) Calcium channel blockers
a) Antiplatelets
Which condition most commonly results in coronary artery disease (CAD)? a) Atherosclerosis b) Diabetes mellitus c) Renal failure d) Myocardial infarction
a) Atherosclerosis
A client comes to the Emergency Department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client? a) Coronary artery disease b) Cardiogenic shock c) Raynaud's disease d) Venous occlusive disease
a) Coronary artery disease
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) Potassium b) Calcium c) Sodium d) Magnesium
a) Potassium
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) Vague symptoms b) Chest pain is typical c) Gender bias d) Decreased sensation to pain
a) Vague symptoms
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) "Removing the patch at night prevents drug tolerance while keeping the benefits." c) "Contact dermatitis and skin irritations are common when the patch remains on all day." d) "You do not need the effects of nitroglycerine while you sleep."
b) "Removing the patch at night prevents drug tolerance while keeping the benefits."
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
b) 60 minutes
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. b) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. c) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. d) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team.
b) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD? a) Assess for any kind of drug abuse. b) Assess the characteristics of chest pain. c) Assess the client's mental and emotional status. d) Assess the skin of the client.
b) Assess the characteristics of chest pain.
A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? a) It is not important to assess the client or to notify the physician b) Assess the client's physical history c) Assess chest pain and administer prescribed drugs and oxygen d) Assess blood pressure and administer aspirin
c) Assess chest pain and administer prescribed drugs and oxygen
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? a) Anxiousness, restlessness, and lightheadedness b) Intermittent nausea and emesis for 3 days c) Chest discomfort not relieved by rest or nitroglycerin d) Cool, clammy skin and a diaphoretic, pale appearance
c) Chest discomfort not relieved by rest or nitroglycerin
A client comes to the Emergency Department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client? a) Cardiogenic shock b) Venous occlusive disease c) Coronary artery disease d) Raynaud's disease
c) Coronary artery disease
A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display? a) Emboli in the veins b) Cholesterol plugs in the lumen of veins c) Fatty deposits in the lumen of arteries d) Blood clots in the arteries
c) Fatty deposits in the lumen of arteries
A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern? a) Heart rate of 87 bpm b) Hemoglobin of 16 g/dL c) Hematocrit of 30% d) Blood pressure of 129/72 mm Hg
c) Hematocrit of 30%
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) Anuria b) Overhydration c) Inadequate fluid volume d) Normal glomerular filtration
c) Inadequate fluid volume
A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? a) Hyperuricemia b) Gastrointestinal distress c) Increased liver enzymes d) Hyperglycemia
c) Increased liver enzymes
The nurse is caring for a client who is being evaluated for lipid-lowering medication. The client's laboratory results reveal the following: total cholesterol 230 mg/dL, LDL 120 mg/dL, triglyceride level 310 mg/dL. Which class of medications would be most appropriate for the client based on these laboratory findings? a) Bile acid sequestrant b) HMG-CoA reductase inhibitor c) Nicotinic acid d) Fibric acid
c) Nicotinic acid
The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported. a) Weight gain of 6 ounces b) Serum glucose of 124 mg/dL c) Potassium level of 6 mEq/L d) Bilateral rales and rhonchi
c) Potassium level of 6 mEq/L
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? a) Total creatine kinase b) CK-MB c) Troponin d) Myoglobin
c) Troponin
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? a) "The pain lasted about 45 minutes." b) "The pain resolved after I ate a sandwich." c) "The pain got worse when I took a deep breath." d) "The pain occurred while I was mowing the lawn."
d) "The pain occurred while I was mowing the lawn."
The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). What results display the effectiveness of the medication? a) 250-275 mg/dL b) 210-240 mg/dL c) 280-300 mg/dL d) 160-190 mg/dL
d) 160-190 mg/dL
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: a) fasting LDL level. b) low LDL level. c) normal LDL level. d) high LDL level.
d) high LDL level.
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. This nurses recognizes that this value is a) normal. b) low. c) extremely high. d) high.
d) high.
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: a) skeletal muscle damage due to a recent fall. b) cerebral bleeding. c) I.M. injection. d) myocardial necrosis.
d) myocardial necrosis.
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) a protein-rich diet b) exercise avoidance c) antioxidant supplements d) smoking cessation
d) smoking cessation
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a) Morphine IV b) Angiotensin-converting enzyme (ACE) inhibitor c) Statin d) Aspirin
a) Morphine IV
The nurse is caring for a client who is being evaluated for lipid-lowering medication. The client's laboratory results reveal the following: total cholesterol 230 mg/dL, LDL 120 mg/dL, triglyceride level 310 mg/dL. Which class of medications would be most appropriate for the client based on these laboratory findings? a) Nicotinic acid b) Fibric acid c) HMG-CoA reductase inhibitor d) Bile acid sequestrant
a) Nicotinic acid
A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac: a) creatine kinase. b) myoglobin. c) lactate dehydrogenase. d) troponin.
d) troponin.
A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? a) Cardiogenic shock b) Coronary artery disease c) Venous occlusive disease d) Raynaud's disease
b) Coronary artery disease
A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? a) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. b) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. c) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician.
a) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? a) Chest discomfort not relieved by rest or nitroglycerin b) Anxiousness, restlessness, and lightheadedness c) Cool, clammy skin and a diaphoretic, pale appearance d) Intermittent nausea and emesis for 3 days
a) Chest discomfort not relieved by rest or nitroglycerin
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? a) Clopidogrel b) Felodipine c) Diltiazem d) Amlodipine
a) Clopidogrel
The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI? a) Creatinine kinase-myoglobin (CK-MB) level b) Myoglobin level c) Troponin C level d) CK-MM
a) Creatinine kinase-myoglobin (CK-MB) level
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? a) Heart b) Lungs c) d)
a) Heart
A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? a) Lie down or sit in a chair for 5 to 10 minutes after taking the drug. b) Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. c) Restrict alcohol intake to two drinks per day. d) Store the drug in a cool, well-lit place.
a) Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
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
a) Prothrombin time (PT) or international normalized ratio (INR)
The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is: a) Relieved by rest and nitroglycerin b) Associated with nausea and vomiting c) Described as crushing and substernal d) Accompanied by diaphoresis and dyspnea
a) Relieved by rest and nitroglycerin
Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene? a) The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. b) The nurse should explain that the client most likely wants extra attention. c) The nurse should report the incident to her supervisor immediately. d) The nurse should instruct the nursing assistants to avoid answering his call light.
a) The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask.
A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a) Within 6 hours b) Within 12 hours c) Within 24 to 48 hours d) Within 5 to 7 days
a) Within 6 hours
A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: a) anticoagulant. b) antibiotic. c) antihypertensive. d) anticonvulsant.
a) anticoagulant.
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) Blood pressure 110/68 mm Hg b) Central venous pressure reading of 1 c) Heart rate 66 bpm d) Pain score 5/10
b) Central venous pressure reading of 1
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? a) "Client verbalizes an understanding of the need to seek emergency help if his heart rate increases markedly while at rest." b) "Client walks 4 miles in 1 hour every day." c) "Client's 24-hour dietary recall reveals low intake of fat and cholesterol." d) "Client performs relaxation exercises three times per day to reduce stress."
b) "Client walks 4 miles in 1 hour every day."
A nurse who works in a busy emergency department provides care for numerous patients who present with complaints of chest pain. Which of the following questions is most likely to help the nurse differentiate between chest pain that is attributable to angina and chest pain due to myocardial infarction (MI)? a) "Have you ever been diagnosed with high blood pressure or diabetes?" b) "Does resting and remaining still help your chest pain to decrease?" c) "When was the first time that you recall having chest pain?" d) "Does your chest pain make it difficult to move around like you normally would?"
b) "Does resting and remaining still help your chest pain to decrease?"
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? a) Chest pain 2 of 10 (on a 1-to-10 pain scale) b) Altered level of consciousness c) Presence of reperfusion dysrhythmias d) Minimal oozing of blood from the IV site
b) Altered level of consciousness
A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a) Prepare the client for pulmonary artery catheterization. b) Assess the client's level of pain and administer prescribed analgesics. c) Assess the client's level of anxiety and provide emotional support. d) Ensure that the client's family is kept informed of his status.
b) Assess the client's level of pain and administer prescribed analgesics.
Which is a diagnostic marker for inflammation of vascular endothelium? a) Low-density lipoprotein (LDL) b) C-reactive protein (CRP) c) Triglyceride d) High-density lipoprotein (HDL)
b) C-reactive protein (CRP)
A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? a) Disabled family coping related to knowledge deficit and a temporary change in family dynamics b) Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction c) Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time d) Anxiety related to an actual threat to health status, invasive procedures, and pain
b) Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction
The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? a) Increases the heart rate b) Decreases the sinoatrial node automaticity c) Increases the atrioventricular node conduction d) Creates a positive inotropic effect
b) Decreases the sinoatrial node automaticity
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? a) Blood vessels b) Heart c) Bronchi d) Uterus
b) Heart
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? a) Mental alertness b) Inadequate tissue perfusion c) Activity intolerance d) Blood glucose concentration
b) Inadequate tissue perfusion
The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received? a) Alteplase b) Protamine sulfate c) Aspirin d) Clopidogrel
b) Protamine sulfate
Which medication is an antidote to heparin? a) Clopidogrel b) Protamine sulfate c) Alteplase d) Aspirin
b) Protamine sulfate
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 at least a 70% occlusion of a major coronary artery. c) The patient has an ejection fraction of 65%. d) The patient has had angina longer than 3 years.
b) The patient has at least a 70% occlusion of a major coronary artery.
A patient with angina is beginning nitroglycerin. Before administering the drug, the nurse informs the patient that, immediately after administration, the patient may experience what? a) Nervousness or paresthesia b) Throbbing headache or dizziness c) Tinnitus or diplopia d) Drowsiness or blurred vision
b) Throbbing headache or dizziness
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? a) To prevent angiotensin II conversion b) To decrease workload of the heart c) To decrease homocysteine levels d) To dilate coronary arteries
b) To decrease workload of the heart
The nurse is reevaluating a client 2 hours after a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which assessment finding may indicate the client is experiencing a complication of the procedure? a) Heart rate of 100 bpm b) Urine output of 40 mL c) Potassium level of 4.0 mE/qL d) Dried blood at the puncture site
b) Urine output of 40 mL
During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect: a) the client's pupils to become dilated. b) a drop in the client's heart rate. c) a decrease in the client's gastric secretions. d) the client to experience bronchodilation.
b) a drop in the client's heart rate.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? a) nitrate b) calcium-channel blocker c) beta-adrenergic blocker d) diuretic
b) calcium-channel blocker
The public health nurse is participating in a health fair, and she interviews a woman with a history of hypertension who is currently smoking one pack of cigarettes per day. She has had no manifestations of coronary artery disease (CAD) but a recent low-density lipoprotein (LDL) level of 154 mg/dL was found. Based on her assessment, the nurse would expect that this patient would be treated in what way? a) Diet and drug therapy b) Drug therapy and smoking cessation c) Diet therapy and smoking cessation d) Diet therapy only
c) Diet therapy and smoking cessation
A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? a) Absent Q wave b) Widened QRS complex c) Elevated ST segment d) Prolonged PR interval
c) Elevated ST segment
A nurse is caring for a client after cardiac surgery. Upon assessment, the client appears restless and reports nausea and weakness. The client's ECG reveals peaked T waves. The nurse reviews the client's serum electrolytes, anticipating which abnormality? a) Hypercalcemia b) Hypomagnesemia c) Hyperkalemia d) Hyponatremia
c) Hyperkalemia
Which of the following is inconsistent as a condition related to metabolic syndrome? a) Insulin resistance b) Dyslipidemia c) Hypotension d) Abdominal obesity
c) Hypotension
When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025), the nurse suspects: a) Normal glomerular filtration b) Anuria c) Inadequate fluid volume d) Overhydration
c) Inadequate fluid volume
A client is receiving nitroglycerin ointment (Nitro-Dur) 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) Temperature of 100.2° F (37.9° C) d) Blood pressure 84/52 mm Hg
d) Blood pressure 84/52 mm Hg
The triage nurse in the emergency department assesses a 66-year-old male patient who has presented to the emergency department with complaints of midsternal chest pain that has lasted for the last 5 hours. The care team suspects a myocardial infarction (MI). The nurse is aware that, because of the length of time the patient has been experiencing symptoms, the following may have happened to the myocardium: a) Has been damaged already, so immediate treatment is no longer necessary b) Will probably not have more damage than if he came in immediately c) May have developed an increased area of infarction d) Can have restoration of the area of dead cells with proper treatment
c) May have developed an increased area of infarction
Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome? a) Hypothermia b) Decreased white blood cell (WBC) count c) Pericardial friction rub d) Decreased erythrocyte sedimentation rate (ESR)
c) Pericardial friction rub
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) Frequent premature atrial contractions (PACs) b) Sinus tachycardia c) ST elevation d) Isolated premature ventricular contractions (PVCs)
c) ST elevation
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? a) To dilate coronary arteries b) To decrease homocysteine levels c) To decrease workload of the heart d) To prevent angiotensin II conversion
c) To decrease workload of the heart
When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? a) Refractory b) Intractable c) Unstable d) Variant
c) Unstable
Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? a) Formation of blood clots b) Thrombocytopenia c) Worsening angina d) Internal bleeding
c) Worsening angina
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of: a) penicillin V or erythromycin (E-Mycin). b) aspirin or acetaminophen (Tylenol). c) aspirin or clopidogrel (Plavix). d) pentoxifylline (Trental) or acetaminophen (Tylenol).
c) aspirin or clopidogrel (Plavix).
A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac: a) creatine kinase. b) myoglobin. c) troponin. d) lactate dehydrogenase.
c) troponin.
A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? a) "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." b) "A burning sensation after administration indicates that the nitroglycerin tablets are potent." c) "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses." d) "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."
d) "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."
Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure. a) A urine specific gravity reading of 1.021 b) An hourly urine output of 50 to 70 mL c) A serum creatinine of 1.0 mg/dL d) A serum BUN of 70 mg/dL
d) A serum BUN of 70 mg/dL
The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? a) Take over-the-counter decongestants. b) Report changes in the usual pattern of chest pain. c) Avoid fatty foods and exercise. d) Avoid situations that contribute to ischemic episodes.
d) Avoid situations that contribute to ischemic episodes.
The nurse is caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client? a) Examine the extremities for skin lesions. b) Examine the client's mental and emotional status. c) Examine for pain around the shoulder and neck region. d) Examine the legs for color, capillary refill time, and tissue integrity.
d) Examine the legs for color, capillary refill time, and tissue integrity.
The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a) A ratio of LDL to HDL, 4.5 to 1.0 b) Low density lipoprotein (LDL), 160 mg/dL c) Cholesterol, 280 mg/dL d) High-density lipoprotein (HDL), 80 mg/dL
d) High-density lipoprotein (HDL), 80 mg/dL
A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? a) Hypertension b) Hyperactive bowel sounds c) Urinary incontinence d) Hypotension
d) Hypotension
A client diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes which overall goal as a focus of rehabilitation for a client who has had an MI? a) Return to work and the lifestyle experienced before the illness b) Prevention of another cardiac event c) Limit to the effects and progression of atherosclerosis d) Improved quality of life
d) Improved quality of life
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? a) Acceptable arterial blood gas (ABG) values. b) Adequate vital capacity. c) Adequate cough and gag reflex. d) Inability to speak.
d) Inability to speak.
A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? a) Decreased heart rate b) High blood pressure c) Elevated hematocrit d) Low blood pressure
d) Low blood pressure
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) Nitroglycerin transdermal patch b) Meperidine hydrochloride (Demerol) c) Isosorbide mononitrate (Isordil) d) Morphine sulfate (Morphine)
d) Morphine sulfate (Morphine)
A nurse is assigned to care for a recently admitted patient who has been diagnosed with refractory angina. Before meeting the patient, the nurse expects her to exhibit the following symptoms: a) Predictable and consistent pain that occurs on exertion and is relieved by rest b) Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina c) Pain that may occur at rest, but the threshold for pain is lower than expected d) Severe, incapacitating chest pain
d) Severe, incapacitating chest pain
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 had angina longer than 3 years. b) The patient has an ejection fraction of 65%. c) The patient has compromised left ventricular function. d) The patient has at least a 70% occlusion of a major coronary artery.
d) The patient has at least a 70% occlusion of a major coronary artery.
A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The specific type of MI the client had is most probably: a) posterior. b) lateral. c) inferior. d) anterior.
d) anterior.
A client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: a) increased C-reactive protein levels. b) decreased LDH levels. c) decreased myoglobin levels. d) elevated troponin levels.
d) elevated troponin levels.
