Chapter 14 : Nursing Management Patients with Coronary Vascular Disorders
The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation the nurse can give to the client? "Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque." "Both terms refer to the same disorder and can be used interchangeably." "Both are disorders in which the lining of the vessels become narrowed due to plaque." "Arteriosclerosis is when the vessels become dilated and weakened, whereas atherosclerosis is the deposit of fatty substances in the vessel lining."
"Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque." Explanation: Arteriosclerosis refers to the loss of elasticity or hardening of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the lumen of arteries fills with fatty deposits called plaque. The two terms do not refer to the same disorder, nor can they be used interchangeably. The other responses provide the client with inaccurate information.
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." "Client will verbalize the intention to avoid exercise." "Client will verbalize the intention to stop smoking." "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
"Client will verbalize the intention to stop smoking." Explanation: A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).
The nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? "I can take nitroglycerin before sex so I won't develop chest pain". "After taking two tablets with no relief, I should call EMS." "I can put the nitroglycerin tablets in my daily pill dispenser with my other medications". "Side effects of nitroglycerin include flushing, throbbing headache, and hypertension".
"I can take nitroglycerin before sex so I won't develop chest pain". Explanation: Nitroglycerin can be taken in anticipation of any activity that may produce pain. Because nitroglycerin increases tolerance for exercise and stress when taken prophylactically (i.e., before an angina-producing activity such as exercise, stair-climbing, or sexual intercourse), it is best taken before pain develops. The client is instructed to take three tablets 5 minutes apart; if the chest pain is not relieved, emergency medical services should be contacted. Nitroglycerin is very unstable; it should be carried securely in its original container (e.g., a capped dark glass bottle), and tablets should never be removed and stored in metal or plastic pillboxes. Side effects of nitroglycerin include flushing, throbbing headache, hypotension, and tachycardia.
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 avoid taking a tub bath until my catheter site heals." "I should expect a low-grade fever and swelling at the site for the next week." "I should avoid prolonged sitting." "I should expect bruising at the catheter site for up to 3 weeks."
"I should expect a low-grade fever and swelling at the site for the next week." Explanation: Fever and swelling at the site are signs of infection and should be reported to the physician. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve.
A client is prescribed a nitroglycerin transdermal patch to treat angina. Which statement does the nurse include when reinforcing medication teaching to the client prior to discharge? "The medication patch causes headaches so you should remove it daily." "You do not need the effects of nitroglycerine while you sleep." "The patch should be worn for 12 hours and then removed for 12 hours." "Skin irritation is common when the patch is worn for more than 12 hours."
"The patch should be worn for 12 hours and then removed for 12 hours." Explanation: A transdermal nitroglycerin patch is prescribed for the prevention of angina pectoris. Nitroglycerin transdermal patches are typically applied for 12 to 14 hours, and then removed for the same amount of time. Though it is true that common adverse effects of nitroglycerin are headaches and contact dermatitis and that there is less demand on the heart when the client rests, these are not the reasons for applying and removing the patch for the same length of time in a 24-hour period.
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? 5 minutes 15 minutes 30 minutes 60 minutes
5 minutes Explanation: Nitroglycerin may be given by several routes: sublingual tablet or spray, oral capsule, topical agent, and intravenous (IV) administration. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch). The nurse should instruct the client to take a second dose five minutes after the first if pain persists. The nurse should instruct the client to take a third dose five minutes after the second if pain still persists. The nurse should advise the client to call 911 if pressure or pain is not releived in 15 minutes by taking 3 tablets at 5-minute intervals.
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. With regards to partial thromboplastin time (PTT), when should the nurse plan to remove the femoral sheath? 50 seconds or less. 75 seconds or less. 100 seconds or less. 125 seconds or less.
50 seconds or less. Explanation: Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 50 seconds or less before the sheath is removed. Removing the sheath before the PTT drops below 50 seconds can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath.
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)? 30 minutes 60 minutes 9 days 6 to 12 months
60 minutes Explanation: The 60-minute interval is known as "door-to-balloon time" in which to perform PTCA on a client diagnosed with MI. The 30-minute interval is known as "door-to-needle time" for 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.
Which is a diagnostic marker for inflammation of vascular endothelium? C-reactive protein (CRP) Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Triglyceride
C-reactive protein (CRP) Explanation: 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.
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? Altered level of consciousness Minimal oozing of blood from the IV site Presence of reperfusion dysrhythmias Chest pain 2 of 10 (on a 1-to-10 pain scale)
Altered level of consciousness Explanation: 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.
The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD? Assess the client's mental and emotional status. Assess the skin of the client. Assess the characteristics of chest pain. Assess for any kind of drug abuse.
Assess the characteristics of chest pain. Explanation: The nurse should assess the characteristics of chest pain for a client with CAD. Assessing the client's mental and emotional status, skin, or for drug abuse will not assist the nurse in evaluating the client for CAD. The assessment should be aimed at evaluating for adequate blood flow to the heart.
A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment? Assessing the patient's capillary refill time and peripheral pulses Assessing the patient for signs and symptoms of hemorrhage Assessing the patient for signs and symptoms of acute renal failure Assessing the patient for signs and symptoms of infection
Assessing the patient for signs and symptoms of hemorrhage Explanation: Monitoring the patient for bleeding post-PCI is a priority. Kidney function, peripheral circulation, and infection are also valid assessment parameters but the significant risk of bleeding associated with PCI necessitates that assessments related to this problem be prioritized.
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? Pulse rate of 84 beats/minute Respiration 26 breaths/minute Blood pressure 84/52 mm Hg Temperature of 100.2° F (37.9° C)
Blood pressure 84/52 mm Hg Explanation: 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.
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? Cardiac tamponade Fluid overload Hypertension Hypothermia
Cardiac tamponade Explanation: 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 patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? Cardiac tamponade Elevated central venous pressure Hypertension Hypothermia
Cardiac tamponade Explanation: Preload alterations occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Excessive postoperative bleeding can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of cardiopulmonary bypass, trauma from the surgery, and anticoagulation. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is also altered if too much volume returns to the heart, causing fluid overload.
The nurse is caring for a patient who is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) and who asks what complications can happen during the procedure. What statement should underlie the nurse's response? Complications that can occur during a PTCA include dissection of the ductus arteriosa. Complications that can occur during a PTCA include hyposensitivity of the heart muscle. Complications that can occur during a PTCA include vasospasm of the coronary artery. Complications that can occur during a PTCA include closure of the pulmonary artery.
Complications that can occur during a PTCA include vasospasm of the coronary artery. Explanation: Complications that can occur during a percutaneous coronary intervention (PCI) procedure include dissection, perforation, abrupt closure, or vasospasm of the coronary artery, acute myocardial infarction (MI), acute dysrhythmias (e.g., ventricular tachycardia), and cardiac arrest. They do not include dissection of the ductus arteriosa, hyposensitivity of the heart muscle, or closure of the pulmonary artery.
A client is admitted for treatment of Prinzmetal angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? Activities that increase myocardial oxygen demand. An unpredictable amount of activity. Coronary artery spasm. The same type of activity that caused previous angina episodes.
Coronary artery spasm. Explanation: Prinzmetal angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; anginal pain becomes increasingly severe.
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? Creatine kinase-myoglobin (CK-MB) level Troponin C level Myoglobin level CK-MM
Creatine kinase-myoglobin (CK-MB) level Explanation: Elevated CK-MB assessment by mass assay is an indicator of acute MI; the levels begin to increase within a few hours and peak within 24 hours of an MI. If the area is reperfused (as a result of thrombotic therapy or PCI), it peaks earlier. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. Three isomers of troponin exist: C, I, and T. Troponins I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury. An increase in myoglobin is not very specific in indicating an acute cardiac event; however, negative results are an excellent parameter for ruling out an acute MI.
A patient with cardiovascular disease is being treated with Norvasc, a calcium channel blocking agent. The nurse is aware that calcium channel blockers have a variety of effects. What is one of the therapeutic effects? Decrease sinoatrial node and atrioventricular node conduction and decrease workload of the heart Prevent platelet aggregation and subsequent thrombosis Reduce myocardial oxygen consumption by blocking beta-adrenergic stimulation to the heart Reduce myocardial oxygen consumption thus decreasing ischemia and relieving pain
Decrease sinoatrial node and atrioventricular node conduction and decrease workload of the heart Explanation: Calcium channel blocking agents decrease sinoatrial node automaticity and atrioventricular node conduction resulting in a slower heart rate and a decrease in the strength of the heart muscle contraction. These effects decrease the workload of the heart. They are also used to prevent and treat vasospasm. Antiplatelet and anticoagulation medications are administered to prevent platelet aggregation and subsequent thrombosis that impede blood flow. Beta-blockers reduce myocardial consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced myocardial contractility (force of contraction) to balance the myocardium oxygen needs and supply. Nitrates reduce myocardial oxygen consumption, which decreases ischemia and relieves pain by dilating the veins and in higher doses, the arteries.
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? Decreases resting heart rate Decreases cholesterol level Increases cardiac output Decreases platelet aggregation
Decreases resting heart rate Explanation: The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.
A 70-year-old man has been diagnosed with angina pectoris and subsequently prescribed nitroglycerin spray to be used sublingually when he experiences chest pain. This drug will achieve relief of the patient's chest pain by: Blocking sympathetic stimulation of the heart and reducing oxygen demand Increasing contractility and consequent cardiac output Blocking the a-delta pain fibers in the myocardium Dilating the blood vessels and reducing preload
Dilating the blood vessels and reducing preload Explanation: Nitroglycerin is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain. Nitroglycerin dilates primarily the veins and, in higher doses, also the arteries. Dilation of the veins causes venous pooling of blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitrates do not block sympathetic stimulation or pain transmission. As well, nitrates do not have the ability to increase cardiac contractility.
The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply. Elevated blood pressure Alcohol use Obesity Physical inactivity Increasing age Family history
Elevated blood pressure Alcohol use Obesity Physical inactivity Explanation: Hypertension, obesity, hyperlipidemia, tobacco use, diabetes mellitus, metabolic syndrome, and physical inactivity are modifiable risk factors for CAD. A family history of CAD, increasing age (more than 45 years for men and more than 55 years for women), sex (men develop CAD at an earlier age than women), and race are risk factors for CAD that are nonmodifiable.
The nurse is caring for a client who is post-varicose vein surgery. The nurse would include which teaching measure(s)? Select all that apply. Exercise Cool compresses Elastic stockings Lower the extremities. Stand rather than sit. Take warm showers in the morning.
Exercise Elastic stockings Explanation: Movement/exercise and use of elastic stocking aid in venous return. Cool compresses can cause vasoconstriction, which can diminish arterial blood flow. Elevation of legs can be helpful in aiding venous return. Standing or sitting for prolonged periods of time should be avoided. Showers in the morning can dilate blood vessels and contribute to venous congestion and edema.
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? Uterus Blood vessels Bronchi Heart
Heart Explanation: 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.
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? Cholesterol, 280 mg/dL Low density lipoprotein (LDL), 160 mg/dL High-density lipoprotein (HDL), 80 mg/dL A ratio of LDL to HDL, 4.5 to 1.0
High-density lipoprotein (HDL), 80 mg/dL Explanation: A fasting lipid profile should demonstrate the following values (Alberti et al., 2009): LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients); total cholesterol less than 200 mg/dL; HDL cholesterol greater than 40 mg/dL for males and greater than 50 mg/dL for females; and triglycerides less than 150 mg/dL.
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? Hyperlipidemia Hypertension Glucose intolerance Obesity
Hypertension Explanation: Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impairs the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder.
Which of the following is inconsistent as a condition related to metabolic syndrome? Hypotension Insulin resistance Abdominal obesity Dyslipidemia
Hypotension Explanation: A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.
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? Hypotension Urinary incontinence Hyperactive bowel sounds Hypertension
Hypotension Explanation: The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? IV morphine IV nitroglycerin Atenolol Amlodipine
IV morphine Explanation: IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.
The nurse is caring for an adult patient who had symptoms of unstable angina during admission to the hospital. The most appropriate nursing diagnosis for the discomfort associated with angina is what? Deficient knowledge about underlying disease and methods for avoiding complications Anxiety related to fear of death Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Noncompliance related to failure to accept necessary lifestyle changes
Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Explanation: Ineffective cardiopulmonary tissue perfusion describes the symptoms of discomfort associated with angina. Deficient knowledge describes the patient awareness of disease process and treatment. Anxiety identifies psychological effects of angina, while noncompliance is related to a patient's resistance to changing behaviors/patterns necessary to treat and manage the disease.
A 72-year-old woman with a diagnosis of angina pectoris has presented to her nurse practitioner because her chest pain on exertion has become more frequent and longer lasting in recent days. The nurse should understand that this woman's chest pain is directly attributable to which of the following pathophysiological processes? Inflammation and physical irritation of the lumens of coronary arteries Accumulation of cellular debris in the myocardium after the rupture of atheromas Ischemia of cardiac muscle cells Accumulation of lactic acid in cardiac muscle
Ischemia of cardiac muscle cells Explanation: The impediment to blood flow that is characteristic of angina is usually progressive, causing an inadequate blood supply that deprives the cardiac muscle cells of oxygen needed for their survival. The condition is known as ischemia. Angina pectoris refers to chest pain that is brought about by myocardial ischemia. The pain associated with this condition is not a direct result of inflammation or the accumulation of debris or lactic acid.
A 45-year-old adult male patient is admitted to emergency after he developed unrelieved chest pain that was present for approximately 20 minutes before he presented to the emergency department. The patient has been subsequently diagnosed with a myocardial infarction (MI). To minimize cardiac damage, what health care provider's order will the nurse expect to see for this patient? Thrombolytics, oxygen administration, and bed rest Morphine sulfate, oxygen administration, and bed rest Oxygen administration, anticoagulants, and bed rest Bed rest, albuterol nebulizer treatments, and oxygen administration
Morphine sulfate, oxygen administration, and bed rest Explanation: Morphine sulfate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. Thrombolytics and anticoagulants are contraindicated in patients who are bleeding or have a bleeding disorder. Albuterol is a medication used to manage asthma and respiratory conditions and will increase the heart rate.
A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication? Amantadine Nitroglycerin Digoxin Diphenhydramine
Nitroglycerin Explanation: A cholinergic blocking agent may cause dry mouth and delay the sublingual absorption of nitroglycerin. The nurse should offer the client sips of water before administering nitroglycerin. Amantadine, digoxin, and diphenhydramine can interact with a cholinergic blocking agent but not through delayed absorption. Amantadine and diphenhydramine enhance the effects of anticholinergic agents.
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? Nitroglycerin SL Chest x-ray Serum electrolytes Ativan 1 mg orally
Nitroglycerin SL Explanation: 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? Calcium Magnesium Potassium Sodium
Potassium Explanation: 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 client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? Prothrombin time (PT) or international normalized ratio (INR) Hourly IV infusion Vascular sites for bleeding Urine output
Prothrombin time (PT) or international normalized ratio (INR) Explanation: 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.
A 58-year-old patient's electrocardiogram (ECG) and presentation are suggestive of a myocardial infarction (MI), and treatment has been promptly initiated. The nurse who is part of the patient's care team should anticipate and facilitate which of the following interventions?Select all that apply. Providing the patient with supplementary oxygen Administering morphine by IV Administering oral warfarin (Coumadin) Administering a bolus of 0.9% NaCl Teaching the patient deep breathing and coughing techniques
Providing the patient with supplementary oxygen Administering morphine by IV Explanation: The primary treatments for acute MI involve morphine, oxygen, nitrates, and aspirin. A bolus of normal saline and administration of warfarin are not typical interventions. Teaching deep breathing and coughing techniques is premature at this acute stage.
A patient in the cardiac PACU was just extubated, 5 hours after the conclusion of a coronary artery bypass graft (CABG). How can the patient's nurse best promote adequate gas exchange for this patient? Apply continuous positive airway pressure (CPAP) as ordered. Perform deep suctioning q1h. Reposition the patient frequently. Administer nebulized bronchodilators and corticosteroids as ordered.
Reposition the patient frequently. Explanation: When the patient's condition stabilizes and he or she has been extubated, body position is changed every 1 to 2 hours. Frequent changes of patient position provide for optimal pulmonary ventilation and perfusion by allowing the lungs to expand more fully. Suctioning carries a risk of trauma and should be avoided if necessary. CPAP, bronchodilators, and corticosteroids are not normally used postoperatively.
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? ST elevation Isolated premature ventricular contractions (PVCs) Sinus tachycardia Frequent premature atrial contractions (PACs)
ST elevation Explanation: 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? The abrupt stop can cause a myocardial infarction. The abrupt stop can lead to formation of blood clots. The abrupt stop will precipitate internal bleeding. The abrupt stop can trigger a migraine headache.
The abrupt stop can cause a myocardial infarction. Explanation: 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.
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 dilate coronary arteries To decrease workload of the heart To decrease homocysteine levels To prevent angiotensin II conversion
To decrease workload of the heart Explanation: Beta-adrenergic blockers are used in the treatment of CAD to decrease the consumption of myocardial oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.
Thrombolytic therapy is being prepared for administration to an older adult patient who has presented to the emergency department with an ST-segment elevation MI (STEMI). The nurse recognizes that the primary goal of this intervention is: To restore the flow of blood through the coronary arteries To restore function to infarcted myocardial cells To relieve the patient's symptoms of chest pain and dyspnea To prevent the rupture of atheromas
To restore the flow of blood through the coronary arteries Explanation: The purpose of thrombolytics is to dissolve and lyse the thrombus in a coronary artery (thrombolysis), allowing blood to flow through the coronary artery again (reperfusion), minimizing the size of the infarction, and preserving ventricular function. Thrombolytics are not primarily a pain-control measure, and function cannot be restored to infarcted cardiac cells.
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? Myoglobin Troponin Total creatine kinase CK-MB
Troponin Explanation: Troponin remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin peaks within 12 hours after the onset of symptoms. Total creatine kinase (CK) returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
A patient has recently returned to the cardiac care unit from PACU following coronary artery bypass graft (CABG). During the nurse's assessment of the patient, the patient acknowledges pain that he rates at 9 on a 0-to-10 pain scale. How should the nurse best respond to this assessment finding? Determine how the patient's pain responds to increased physical activity. Explain to the patient that significant pain is expected during the immediate postoperative phase. Teach the patient nonpharmacologic interventions for pain management. Try to differentiate between incisional pain and anginal pain.
Try to differentiate between incisional pain and anginal pain. Explanation: When assessing the pain of a patient who is postoperative following a CABG, it is important to differentiate incisional pain from angina pain. The differing etiologies of these two types of pain have important ramifications for treatment and for the patient's recovery. Increased physical activity is not an option at this early stage of recovery. It would be incorrect to explain away the patient's pain or to perform interventions without sufficient assessment.
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? Intractable Variant Unstable Refractory
Unstable Explanation: Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
Which term refers to preinfarction angina? Stable angina Unstable angina Variant angina Silent ischemia
Unstable angina Explanation: Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs upon exertion and is relieved by rest. Variant angina is exhibited by pain at rest and reversible ST-segment elevation. Silent angina manifests through evidence of ischemia, but the client reports no symptoms.
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? Urine output of 40 mL Potassium level of 4.0 mEq/L Heart rate of 100 bpm Dried blood at the puncture site
Urine output of 40 mL Explanation: Complications that may occur following a PTCA include myocardial ischemia, bleeding and hematoma formation, retroperitoneal hematoma, arterial occlusion, pseudoaneurysm formation, arteriovenous fistula formation, and acute renal failure. The urine output of 40 mL over a 2-hour period may indicate acute renal failure. The client is expected to have a minimum urine output of 30 mL/h. Dried blood at the insertion site is a finding that warrants no acute intervention. A serum potassium level of 4.0 mEq/L is within the normal range. The heart rate of 100 bpm is within the normal range and indicates no acute distress.
A nurse is teaching a client about maintaining a healthy heart. What information will the nurse include with the teaching? Smoke in moderation. Use alcohol in moderation. Consume a diet high in saturated fats. Exercise one or two times per week.
Use alcohol in moderation. Explanation: The nurse should advise the client that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in cholesterol and saturated fat, and a sedentary lifestyle are all known risk factors for cardiac disease. The client should be encouraged to quit smoking, exercise three to four times per week, and consume a diet low in cholesterol and saturated fat.
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? Inform client of diagnostic tests. Remove hair from skin insertion sites. Assess distal pulses. Withhold anticoagulant therapy.
Withhold anticoagulant therapy. Explanation: 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 laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. The nurse recognizes that this value is below the optimal range. above the optimal range. within the optimal range. extremely high.
above the optimal range. Explanation: If the fasting LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered above the optimal range. The ideal is to decrease the LDL level below 100 mg/dL (< 70 mg/dL for very high-risk patients).
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 be prescribed long-term administration of which drug? aspirin or acetaminophen. pentoxifylline or acetaminophen. aspirin or clopidogrel. penicillin V or erythromycin.
aspirin or clopidogrel. Explanation: After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The health care provider may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.
The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? atherosclerosis diabetes mellitus myocardial infarction renal failure
atherosclerosis Explanation: 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.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? calcium-channel blocker beta-adrenergic blocker nitrate diuretic
calcium-channel blocker Explanation: 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 client who has been diagnosed with Prinzmetal's angina will present with which symptom? chest pain that occurs at rest and usually in the middle of the night radiating chest pain that lasts 15 minutes or less prolonged chest pain that accompanies exercise chest pain of increased frequency, severity, and duration
chest pain that occurs at rest and usually in the middle of the night Explanation: A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8:00 AM, is sporadic over 3-6 months, and diminishes over time. Clients with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Clients with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? decrease anxiety enhance myocardial oxygenation administer sublingual nitroglycerin educate the client about his symptoms
enhance myocardial oxygenation Explanation: Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care, neither is a priority when a client is compromised.
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? blood pressure of 129/72 mm Hg heart rate of 87 bpm hemoglobin of 16 g/dL hematocrit of 30%
hematocrit of 30% Explanation: 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.
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: high LDL level. low LDL level. normal LDL level. fasting LDL level.
high LDL level. Explanation: LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL.
A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? prior intracranial hemorrhage recent consumption of a meal shellfish allergy use of heparin
prior intracranial hemorrhage Explanation: History of a prior intracranial hemorrhage is an absolute contraindication for thrombolytic therapy. An allergy to iodine, shellfish, radiographic dye, and latex are of primary concern before a cardiac catheterization but not a known contraindication for thrombolytic therapy. Administration of a thrombolytic agent with heparin increases risk of bleeding; the primary healthcare provider usually discontinues the heparin until thrombolytic treatment is completed.
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? smoking cessation a protein-rich diet exercise avoidance antioxidant supplements
smoking cessation Explanation: 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.
The client is asking the nurse about heart-healthy food choices for lunch. What are foods that are heart healthy? Select all that apply. soy yogurt baked chicken leg white rice with butter broiled trout blueberries
soy yogurt broiled trout blueberries Explanation: Heart-healthy foods include soy products, fish high in omega-3s, and fruit. The chicken leg has more fat than a chicken breast. The white rice does not have enough fiber, so brown rice is a better option.
A client was chopping firewood and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? streptokinase, aspirin, and morphine administration morphine administration, stress testing, and admission to the cardiac care unit serial liver enzyme testing, telemetry, and a lidocaine infusion sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry Explanation: The nurse should anticipate an order for sublingual nitroglycerin, tPA, and telemetry, as the client's chest pain began 4 hours before diagnosis. The preferred choice is tPA, which is more specific for cardiac tissue than streptokinase. Stress testing shouldn't be performed during an MI. The client doesn't exhibit symptoms that indicate the use of lidocaine.
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? creatine kinase lactate dehydrogenase myoglobin troponin
troponin Explanation: 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.
