Genitourinary

A client with a history of angina pectoris tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. What type of angina should the nurse determine that the client is experiencing? A. Stable B. Variant C. Unstable D. Intractable

A. Rationale: Stable angina is triggered by a predictable amount of effort or emotion. Variant angina is triggered by coronary artery spasm; the attacks are of longer duration than in classic angina and tend to occur early in the day and at rest. Unstable angina is triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time. Intractable angina is chronic and incapacitating and is refractory to medical therapy.

A client with no history of heart disease has experienced acute myocardial infarction and has been given thrombolytic therapy with tissue plasminogen activator. What assessment finding should the nurse identify as the most likely indicator that the client is experiencing complications of this therapy? A. Tarry stools B. Nausea and vomiting C. Orange-colored urine D. Decreased urine output

A Rationale: Thrombolytic agents are used to dissolve existing thrombi, and the nurse should monitor the client for obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the gastrointestinal (GI) tract, urinary system, and skin. It also includes Hematest testing of secretions for occult blood. The correct option is the only one that indicates the presence of blood.

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 medications?" D. "Do you have your nitroglycerin with you?"

A. "Where is the pain located?" Rationale: If a client complains of chest pain, the initial assessment question would be to ask the client about the pain intensity, location, duration, and quality. Although options 2, 3, and 4 all may be components of the assessment, none of these questions would be the initial assessment question with this client.

A client is admitted to the visiting nurse service for assessment and follow-up after being discharged from the hospital with new-onset heart failure (HF). The nurse teaches the client about the dietary restrictions required with HF. Which statement by the client indicates that further teaching is needed? A. "I'm not supposed to eat cold cuts." B. "I can have most fresh fruits and vegetables." C. "I'm going to weigh myself daily to be sure I don't gain too much fluid." D. "I'm going to have a ham and cheese sandwich and potato chips for lunch."

D. "I'm going to have a ham and cheese sandwich and potato chips for lunch." Rationale: When a client has HF, the goal is to reduce fluid accumulation. One way that this is accomplished is through sodium reduction. Ham (and most cold cuts), cheese, and potato chips are high in sodium. Daily weighing is an appropriate intervention to help the client monitor fluid overload. Most fresh fruits and vegetables are low in sodium.

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 to 3500 mL of fluid daily to promote good kidney function." D."Drinking 2 to 3 oz of liquor each night will promote blood flow by enlarging blood vessels."

A. "I will eat enough daily fiber to prevent straining at stool." Rationale: Standard home care instructions for a client with this problem include, among others, lifestyle changes such as decreased alcohol intake, avoiding activities that increase the demands on the heart, instituting a bowel regimen to prevent straining and constipation, and maintaining fluid and electrolyte balance. Consuming 3000 to 3500 mL of fluid and exercising vigorously will increase the cardiac workload.

The nurse is reviewing the electrocardiogram (ECG) rhythm strip obtained on a client with a diagnosis of myocardial infarction. The nurse notes that the PR interval is 0.20 second. The nurse should make which interpretation about this finding? A. A normal finding B. Indicative of atrial flutter C. Indicative of atrial fibrillation D. Indicative of impending reinfarction

A. A normal finding 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 to 0.20 second. Options 2, 3, and 4 are incorrect.

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 farther each day B. Verbalizes the benefits of increasing activity C. Chooses a healthy diet that meets caloric needs D. Sleeps without awakening throughout the night

A. Ambulates 10 feet farther each day Rationale: Each of the options indicates a positive outcome on the part of the client. Both options 2 and the correct one relate to the client problem of difficulty with completion of daily activities. However, the question asks about progress. The correct option is more action-oriented and therefore is the better choice. Option 3 would most likely indicate progress if the client had a problem of inadequate nutritional intake. Option 4 would be a satisfactory outcome for a client experiencing difficulty sleeping.

A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery disease. The nurse places highest priority on telling the client to report which sensation during the procedure? A. Chest pain B. Urge to cough C. Warm, flushed feeling D. Pressure at the insertion site

A. Chest pain Rationale: The client is taught to report chest pain or any unusual sensations immediately. The client also is told that he or she may be asked to cough or breathe deeply from time to time during the procedure. The client is informed that a warm, flushed feeling may accompany dye injection and is normal. Because a local anesthetic is used, the client is expected to feel pressure at the insertion site.

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 ventricular rate of 150 beats/min. The nurse should next assess the client for which finding? A. Hypotension B. Flat neck veins C. Complaints of nausea D. Complaints of headache

A. Hypotension Rationale: The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output owing to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

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. Monitoring for organomegaly C. Assessing for jugular vein distention D. Assessing for peripheral and sacral edema

A.Listening to lung sounds Rationale: The client with heart failure may present with different symptoms, depending on whether the right or the left side of the heart is failing. Peripheral and sacral edema, jugular vein distention, and organomegaly all are manifestations of problems with right-sided heart function. Lung sounds constitute an accurate indicator of left-sided heart function.

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 will most likely prescribe which option? A.Maintain bed rest. B. Maintain the affected leg in a dependent position. C.Administer an opioid analgesic every 4 hours around the clock. D.Apply cool packs to the affected leg for 20 minutes every 4 hours.

A.Maintain bed rest. Rationale Standard management for the client with DVT includes bed rest; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Ambulation is contraindicated because such activity can cause the thrombus to dislodge and travel to the lungs. Opioid analgesics are not required to relieve pain, and pain normally is relieved with acetaminophen (Tylenol).

The nurse is teaching the client with angina pectoris about disease management and lifestyle changes that are necessary to control disease progression. Which statement by the client indicates a need for further teaching? A. "I will avoid using table salt with meals." B. "It is best to exercise once a week for 1 hour." C. "I will take nitroglycerin whenever chest discomfort begins." D. "I will use muscle relaxation to cope with stressful situations."

B Rationale: Exercise is most effective when done at least 3 times a week for 20 to 30 minutes to reach a target heart rate. Other healthful habits include limiting salt and fat in the diet and using stress management techniques. The client also should be taught to take nitroglycerin before any activity that previously caused the pain and to take the medication at the first sign of chest discomfort.

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. "I'll need to become a strict vegetarian." B. "I should use polyunsaturated oils in my diet." C. "I need to substitute eggs and whole milk for meat." D. "I should eliminate all cholesterol and fat from my diet."

B. "I should use polyunsaturated oils in my diet." Rationale: The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hypercholesterolemia. It is not necessary to eliminate all cholesterol and fat from the diet. It is not necessary to become a strict vegetarian.

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 with the heart. B. Elevate the legs higher than the heart. C. Clean the skin with alcohol every hour. D. Position the client onto the side every shift.

B. Elevate the legs higher than the heart. Rationale: In the client with a venous disorder, the legs are elevated above the level of the heart to assist with the return of venous blood to the heart. Alcohol is very irritating and drying to tissues and should not be used in areas of skin breakdown. Option 4 specifies infrequent care intervals, so it is not the priority intervention.

A client recovering from pulmonary edema is preparing for discharge. What should the nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge? A. Sleep with the head of bed flat. B. Weigh himself or herself on a daily basis. C. Take a double dose of the diuretic if peripheral edema is noted. D. Withhold prescribed digoxin (Lanoxin) if slight respiratory distress occurs.

B. Weigh himself or herself on a daily basis. Rationale: The client can best determine fluid status at home by weighing himself or herself on a daily basis. Increases of 2 to 3 lb in a short period are reported to the health care provider (HCP). The client should sleep with the head of the bed elevated. During recumbent sleep, fluid (which has seeped into the interstitium with the assistance of the effects of gravity) is rapidly reabsorbed into the systemic circulation. Sleeping with the head of the bed flat is therefore avoided. The client does not modify medication dosages without consulting the HCP.

A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit. What activity level should the nurse encourage for the client immediately after transfer? A. Ad lib activities as tolerated B. Strict bed rest for 24 hours after transfer C. Bathroom privileges and self-care activities D. Unsupervised hallway ambulation for distances up to 200 feet

C Rationale: On transfer from CCU to an intermediate care or general medical unit, the client is allowed self-care activities and bathroom privileges. Activities ad lib as tolerated is premature at this time and potentially harmful for this client. It is unnecessary and possibly harmful to limit the client to bed rest. The client should ambulate with supervision in the hall for brief distances, with the distances being gradually increased to 50, 100, and 200 feet.

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 workboots. C. Wear loose clothing with a shirt that buttons in front. D. Avoid cigarettes for 30 minutes before the procedure.

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

The nurse working in a long-term care facility is assessing a client who is experiencing chest pain. The nurse should interpret that the pain is most likely caused by myocardial infarction (MI) on the basis of what assessment finding? A. The client is not experiencing dyspnea. B. The client is not experiencing nausea or vomiting. C. The pain has not been relieved by rest and nitroglycerin tablets. D. The client says the pain began while she was trying to open a stuck dresser drawer.

C Rationale: The pain of MI is not relieved by rest and nitroglycerin and requires opioid analgesics, such as morphine sulfate, for relief. The pain of angina may radiate to the left shoulder, arm, neck, or jaw. It often is precipitated by exertion or stress, is accompanied by few associated symptoms, and is relieved by rest and nitroglycerin. The pain of MI also may radiate to the left arm, shoulder, jaw, and neck. It typically begins spontaneously, lasts longer than 30 minutes, and frequently is accompanied by associated symptoms (such as nausea, vomiting, dyspnea, diaphoresis, or anxiety).

A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain. The nurse knows that which ECG finding would be an indication of first-degree heart block? A. Presence of Q waves B. Tall, peaked T waves C. Prolonged PR interval D. Widened QRS complex

C. Rationale: A prolonged PR interval indicates first-degree heart block. The development of Q waves indicates myocardial necrosis. Tall, peaked T waves may indicate hyperkalemia. A widened QRS complex indicates a delay in intraventricular conduction, such as bundle branch block. An ECG taken during a pain episode is intended to capture ischemic changes, which also include ST-segment elevation or depression.

A female 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. "Contact your health care provider right away to report this problem." D. "This normally occurs after surgery and will subside when the edema goes down."

C. "Contact your health care provider right away to report this problem." Rationale: A sensation of pins and needles or feeling as though the surgical limb is falling asleep may indicate temporary or permanent nerve damage after surgery. The saphenous vein and the saphenous nerve run close together, and damage to the nerve will produce paresthesias. Options 1, 2, and 4 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 paresthesia. Endovenous ablation also may be done in combination with saphenofemoral ligation or phlebectomy. Transilluminated powdered phlebectomy involves the use of a powdered resector to destroy the varices and then removes the pieces via aspiration.

The nurse is trying to determine the ability of the client with myocardial infarction (MI) to manage independently at home after discharge. Which statement by the client is the strongest indicator of the potential for difficulty after discharge? A. "I need to start exercising more to improve my health." B. "I will be sure to keep my appointment with the cardiologist." C. "I don't have anyone to help me with doing heavy housework at home." D. "I think I have a good understanding of what all my medications are for."

C. "I don't have anyone to help me with doing heavy housework at home." Rationale: To ensure the best outcome, clients should be able to comply with instructions related to activity, diet, medications, and follow-up health care on discharge from the hospital after an MI. All of the options except the correct option indicate that the client will be successful in these areas.

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."

C. "I need to adhere to my dietary restrictions." Rationale: After angioplasty, the client needs to be instructed regarding the specific dietary restrictions that must be followed. Making the recommended dietary and lifestyle changes will assist in preventing further atherosclerosis. Abrupt closure of the artery can occur if the dietary and 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.. A stage 1 ulcer B. A vascular ulcer C. An arterial ulcer D. A venous stasis ulcer

C. An arterial ulcer Rationale: Arterial ulcers have a pale deep base and are surrounded by tissue that is cool with trophic changes such as dry skin and loss of hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply of oxygen and nutrients. A stage 1 ulcer indicates a reddened area with an intact skin surface. A venous stasis ulcer (vascular) has a dark red base and is surrounded by brown skin with 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 in the medical unit is reviewing the laboratory test results for a client who has been transferred from the intensive care unit. The nurse notes that a cardiac troponin T level assay was performed while the client was in the intensive care unit. The nurse determines that this test was performed to assist in diagnosing which condition? A. Heart failure B. Atrial fibrillation C. Myocardial infarction D. Ventricular tachycardia

C. Myocardial infarction Rationale: Cardiac troponin T or cardiac troponin I has been found to be a protein marker in the detection of myocardial infarction, and assay for this protein is used in some institutions to aid in the diagnosis of a myocardial infarction. The test is not used to diagnose heart failure, ventricular tachycardia, or atrial fibrillation.

The health care provider 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 client about allergies to iodine or shellfish B. Has the client sign an informed consent form for an invasive procedure C. Tells the client that the procedure is painless and takes 30 to 60 minutes D. Keeps the client on nothing-by-mouth (NPO) status for 2 hours before the procedure

C. Tells the client that the procedure is painless and takes 30 to 60 minutes 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 outpatient basis. The client must lie quietly for 30 to 60 minutes while the procedure is being performed. It is important to provide adequate information to eliminate unnecessary worry on the part of the client.

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 related to 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 of understanding of the material provided at the teaching session and embarrassment about asking questions

C.An attempt to ignore or deny the need to make lifestyle changes Rationale: Denial is a defense mechanism that allows the client to minimize a threat that may be manifested by refusal to discuss what has happened. Denial is a common early reaction associated with chest discomfort, angina, or myocardial infarction (MI). Anxiety usually is manifested by symptoms of sympathetic nervous system arousal. No data are provided in the question that would lead the nurse to interpret the client's behavior as boredom or as either understanding or not understanding the material provided at the teaching session.

A client admitted to the hospital with coronary artery disease complains of dyspnea at rest. The nurse caring for the client uses which item as the best means to monitor respiratory status on an ongoing basis? A. Apnea monitor B.Oxygen flowmeter C.Telemetry cardiac monitor D.Oxygen saturation monitor

D Rationale: Dyspnea in the cardiac client often is accompanied by hypoxemia. *Hypoxemia can be detected by an oxygen saturation monitor, especially if it is used continuously.* An apnea monitor detects apnea episodes, such as when the client has stopped breathing briefly. An oxygen flowmeter is part of the setup for delivering oxygen therapy. Cardiac monitors detect dysrhythmias.

The ambulatory care nurse is working with a client who has been diagnosed with Prinzmetal's (variant) angina. What should the nurse plan to teach the client about this type of angina? A. It is most effectively managed by β-blocking agents. B. It has the same risk factors as stable and unstable angina. C. It can be controlled with a low-sodium, high-potassium diet. D. Generally it is treated with calcium-channel-blocking agents

D Rationale: Prinzmetal's angina results from spasm of the coronary vessels and is treated with calcium-channel blockers. β-Blockers are contraindicated because they may actually worsen the spasm. The risk factors are unknown, and this type of angina is relatively unresponsive to nitrates. Diet therapy is not specifically indicated.

The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking? A. "None of the cardiovascular effects are reversible, but quitting might prevent lung cancer." B. "Because most of the damage has already been done, it will be all right to cut down a little at a time." C. "If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year." D. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."

D Rationale: The risks to the cardiovascular system from smoking are noncumulative and are not permanent. Three to 4 years after cessation, a client's cardiovascular risk is similar to that of a person who never smoked. In addition, tobacco use and passive smoking from "secondhand smoke" (also called environmental smoke) substantially reduce blood flow in the coronary arteries. Options 1, 2, and 3 are incorrect.

A client is scheduled to undergo cardiac catheterization for the first time, and the nurse provides instructions to the client. Which client statement indicates an understanding of the instructions? A. "It will really hurt when the catheter is first put in." B. "I will receive general anesthesia for the procedure." C. "I will have to go to the operating room for this procedure." D. "I probably will feel tired after the test from lying on a hard x-ray table for a few hours."

D. "I probably will feel tired after the test from lying on a hard x-ray table for a few hours." Rationale: It is common for the client to feel fatigued after the cardiac catheterization procedure. A local anesthetic is used, so little to no pain is experienced with catheter insertion. General anesthesia is not used. Other preprocedure teaching points include the fact that the procedure is done in a darkened cardiac catheterization room. The x-ray table is hard and may be tilted periodically, and the procedure may take 1 to 2 hours. The client may feel various sensations with catheter passage and dye injection

A client with a diagnosis of varicose veins is scheduled for treatment by sclerotherapy and asks the nurse to describe the procedure. Which response should the nurse make? 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."

D. "It involves injecting an agent into the vein to damage the vein wall and close it off." Rationale: Sclerotherapy is the injection of a sclerosing agent into a varicosity. The agent damages the vessel and causes aseptic thrombosis, which results in vein closure. With no blood flow through the vessel, distention will not occur. The surgical procedure for varicose veins is vein ligation and stripping. This procedure involves tying off the varicose vein and large tributaries and then removing the vein with the use of a hook and wires applied through multiple small incisions in the leg. Other treatments 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 treatment is another alternative to surgery; in this treatment a laser fiber is used to heat and close the main vessel that is contributing to the varicosity.

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, and fasting blood glucose level of 184 mg/dL. The nurse interprets this to mean that the client has which modifiable risk factor for coronary artery disease (CAD)? A. Age B. Hypertension C. Hyperlipidemia D. Glucose intolerance

D. Glucose intolerance Rationale: Hypertension, cigarette smoking, and hyperlipidemia are modifiable risk factors that are predictors of CAD. Glucose intolerance, obesity, and response to stress are contributing modifiable risk factors to CAD. Age greater than 40 years 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 is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage should the nurse instruct the client to select from the menu? A. Tea B.Cola C.Coffee D.Raspberry juice

D.Raspberry juice Rationale: A client with a diagnosis of MI should not consume caffeinated beverages. Caffeinated products can produce a vasoconstrictive effect, leading to further cardiac ischemia. Coffee, tea, and cola all contain caffeine and need to be avoided in the client with MI.

The nurse is caring for a client who has been hospitalized with a diagnosis of angina pectoris. The client is receiving oxygen via nasal cannula at 2 L/min. The client asks why the oxygen is necessary. The nurse should provide which information to the client? A. Oxygen has a calming effect. B. Oxygen will prevent the development of any thrombus. C. Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle. D.The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells.

D.The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells. Rationale: The pain associated with angina results from ischemia of myocardial cells. The pain often is precipitated by activity that places more oxygen demand on heart muscle. Supplemental oxygen will help to meet the added demands on the heart muscle. Oxygen does not dilate blood vessels or prevent thrombus formation and does not directly calm the client.