PrepU Chapter 27: Management of Patients With Coronary Vascular Disorders

The analgesic of choice for a hospitalized patient with an MI is morphine sulfate. An important nursing responsibility, prior to administering morphine, is to do which of the following?

Count the respiratory rate for bradypnea.

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time?

Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction

A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following?

Decreases resting heart rate

What is a characteristic of atherosclerosis?

Fatty deposits in the lumen of arteries

Which of the following is a nonmodifiable risk factor for coronary artery disease (CAD)?

Gender

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?

Heart

Which of the following is a modifiable risk factor for coronary artery disease (CAD)?

Hyperlipidemia

A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime?

Improve venous return

Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)?

Inability to speak.

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:

Inadequate fluid volume

Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?

Inadequate tissue perfusion

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?

Low blood pressure

Which of the following discharge instructions for self-care should the nurse provide to a patient who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?

Monitor the site for bleeding or hematoma.

Which of the following medications is an antidote to heparin?

Protamine sulfate

During his annual physical exam, a 62-year-old male client reports experiencing chest pain and palpitations during and after his morning jogs. Family history reveals coronary artery disease. The nurse should instruct the client in the following to reduce the client's cardiac risk?

Smoking cessation

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?

The client demonstrates ability to tolerate more activity without chest pain.

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?

Within 6 hours

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?

Worsening angina

During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect:

a drop in the client's heart rate.

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:

aspirin or clopidogrel (Plavix).

A client is admitted for treatment of Prinzmetal's angina. When developing this client's care plan, the nurse should keep in mind that this type of angina can result from:

coronary artery spasm.

Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:

myocardial necrosis.

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:

troponin.

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?

"Client walks 4 miles in 1 hour every day."

A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of developing the disorder. Which is the best response by the nurse?

"Exercise, keep your cholesterol in check, and manage your stress."

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?

"I should expect a low-grade fever and swelling at the site for the next week."

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?

"Removing the patch at night prevents drug tolerance while keeping the benefits."

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?

"The pain occurred while I was mowing the lawn."

A client is receiving morphine to relieve chest pain. The order is for 4 mg IV now. The pharmacy supplies morphine sulfate at 5 mg per mL. How many mL will the nurse give the client? Enter the correct number ONLY.

0.8

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?

160-190 mg/dL

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.

24

A client with suspected acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain?

4 to 6 hours

In order 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)?

60 minutes

In order 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?

60 minutes

Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication?

Angina pectoris

Which of the following methods to induce hemostasis after sheath removal post percutaneous transluminal coronary angioplasty (PTCA) is the least effective?

Application of a sandbag to the area

After percutaneous transluminal coronary angioplasty (PTCA), the nurse suspects that a patient, who is on bed rest, may be experiencing the complication of bleeding. The nurse's initial action should be to do which of the following?

Apply manual pressure at the site of the insertion of the sheath.

A patient complains about chest pain and heavy breathing when exercising or when stressed. Which of the following is a priority nursing intervention for the patient diagnosed with coronary artery disease?

Assess chest pain and administer prescribed drugs and oxygen

You are caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?

Assess the characteristics of chest pain.

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?

Assess the client's level of pain and administer prescribed analgesics.

The nurse plays an important role in monitoring and managing potential complications in the patient who has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which of the following respiratory complications?

Atelectasis

Which condition most commonly results in coronary artery disease (CAD)?

Atherosclerosis

Which diagnostic is a marker for inflammation of vascular endothelium?

C-reactive protein (CRP)

A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse?

CVP reading: 1 mmHg

A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect?

"My chest pain is decreasing."

A nurse reviews an ECG strip for a patient who is admitted with symptoms of an acute MI. The nurse recognizes the classic ECG changes that occur with an MI. Select all that apply.

- Abnormal Q-waves -T-wave hyperactivity and inversions -ST-segment elevations

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.)

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

The nurse is providing education about angina pectoris to a hospitalized client who is about to be discharged. The nurse includes which of the following information about managing this condition? Choose all that apply.

-Balance rest with activity. -Stop smoking. -Carry nitroglycerin at all times.

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 serum BUN of 70 mg/dL

Which nursing diagnosis is most significant in planning the care for a client with Raynaud's disease?

Acute Pain

Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority?

Acute pain

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?

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent?

Antiplatelets

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?

Avoid situations that contribute to ischemic episodes.

The nurse is caring for a patient diagnosed with unstable angina receiving IV heparin. The patient is placed on bleeding precautions. Bleeding precautions include which of the following measures?

Avoiding continuous BP monitoring

Aortic stenosis remains asymptomatic for several decades. However, once a client becomes symptomatic for aortic stenosis, life expectancy without further treatment is only 2 to 3 years. What is the treatment of choice for symptomatic aortic stenosis?

Balloon valvuloplasty

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?

Blood pressure 84/52 mm Hg

A 56-year-old male client with CAD kept his appointment to see a cardiologist for posthospitalization follow up. The client indicates that he thinks the diltiazem (Cardizem) has been making him nauseous. The nurse is aware that diltiazem (Cardizem) is categorized as which type of drug?

Calcium-channel blockers

Which complication of cardiac surgery occurs when there is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles?

Cardiac tamponade

The nurse is aware that a client who has been diagnosed with Prinzmetal's angina will present with which of the following symptoms?

Chest pain that occurs at rest and usually in the middle of the night

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?

Decreases the sinoatrial node automaticity

Dysrhythmias can be fatal to a client during the acute phase following a myocardial infarction. The nurse understands that the primary cause of this event is due to which of the following?

Effects on depolarization and repolarization of the myocardial cells

A female 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:

Elevated troponin levels

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?

Hematocrit of 30%

A 62-year-old male client who works as a stockbroker reports chest pain and palpitations during and after his morning jogs. The client's family history includes CAD. His lipid profile reveals his LDL level to be 122 mg/dL. The nurse is aware that this client has which of the following?

High LDL level

A nurse is caring for a patient post cardiac surgery. Upon assessment, the patient appears restless and is complaining of nausea and weakness. The patient's ECG reveals peaked T waves. The nurse reviews the patient's serum electrolytes anticipating which of the following abnormalities?

Hyperkalemia

When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality?

Hyperkalemia

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply.

Hyperlipidemia -Obesity -Tobacco use

Which of the following is inconsistent as a condition related to metabolic syndrome?

Hypotension

When the nurse notes that the post cardiac surgery patient demonstrates low urine output (less than 25 mL per hour) with high specific gravity (greater than 1.025), the nurse suspects which of the following conditions?

Inadequate fluid volume

A patient has been recently placed on nitroglycerin. Which of the following should be included in the patient teaching plan?

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

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize?

Lie down or sit in a chair for 5 to 10 minutes after taking the drug.

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.

Low-density lipoproteins (LDL

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except

Morphine IV

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except:

Morphine IV

A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders?

Nitroglycerin SL

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?

Pericardial friction rub

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?

Potassium

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.

Potassium level of 6 mEq/L

A 48-year-old female client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must interview the client to determine if she has which of the following absolute contraindications to thrombolytic therapy?

Prior intracranial hemorrhage

The nurse is caring for a patient 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 of the following medications to neutralize the unfractionated heparin the patient received?

Protamine sulfate

A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation?

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:

Relieved by rest and nitroglycerin

A client was transferring a load of fire wood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which orders by the physician?

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

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?

To decrease workload of the heart

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks?

Troponin

When a patient who has been diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina?

Unstable

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina?

Unstable

Which of the following is also termed preinfarction angina?

Unstable angina

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?

Vague symptoms

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:

anticoagulant.

A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse tells the client that, after taking the nitroglycerin, he may experience:

headache, hypotension, dizziness, and flushing.