Chapter 25: Caring for Clients with Disorders of Coronary and Peripheral Blood Vessels

Which is the analgesic of choice for acute myocardial infarction (MI)? a. Morphine b. Aspirin c. Meperidine d. Ibuprofen

a The analgesic of choice for acute MI is morphine administered in IV boluses to reduce pain and anxiety. Aspirin is an antiplatelet medication. Meperidine and Ibuprofen are not the analgesics of choice.

Which of the following assessment results is considered a major risk factor for PAD? a. LDL of 100 mg/dL b. BP of 160/110 mm Hg c. Cholesterol of 200 mg/dL d. Triglyceride level of 150 mg/dL

b Hypertension is considered a major risk factor for PAD. Blood pressure should be less than 130/90 mm Hg. The other laboratory results are within the recommended range of normal to high normal.

A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: a. high LDL level. b. low LDL level. c. normal LDL level. d. fasting LDL level.

a LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL.

The ED nurse is caring for a client with a suspected MI. What drug should the nurse anticipate administering to this client? a. Oxycodone b. Warfarin c. Morphine d. Acetaminophen

c The client with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta- blocker, and other medications, as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.

The nurse is assessing a woman who is pregnant at 27 weeks' gestation. The client is concerned about the recent emergence of varicose veins on the backs of her calves. What is the nurse's best action? a. Facilitate a referral to a vascular surgeon. b. Assess the client's ankle-brachial index (ABI) and perform Doppler ultrasound testing. c. Encourage the client to increase her activity level. d. Teach the client that circulatory changes during pregnancy frequently cause varicose veins.

d Pregnancy may cause varicosities because of hormonal effects related to decreased venous outflow, increased pressure by the gravid uterus, and increased blood volume. In most cases, no intervention or referral is necessary. This finding is not an indication for ABI assessment and increased activity will not likely resolve the problem.

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: a. pallor and coolness of the left foot. b. a decrease in the left pedal pulse. c. loss of hair on the lower portion of the left leg. d. left calf circumference 1" (2.5 cm) larger than the right.

d Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

Which class of medication lyses and dissolves thrombi? a. Fibrinolytic b. Anticoagulant c. Platelet inhibitors d. Factor XA inhibitors

a Thrombolytic (fibrinolytic) therapy lyses and dissolves thrombi in 50% of clients. Anticoagulants, platelet inhibitors, and factor XA inhibitors do not lyse or dissolve thrombi.

The hospital nurse is caring for a client who tells the nurse that he has an angina attack beginning. What is the nurse's most appropriate initial action? a. Have the client sit down and put his head between his knees. b. Have the client perform pursed-lip breathing. c. Have the client stand still and bend over at the waist. d. Place the client on bed rest in a semi-Fowler position.

d When a client experiences angina, the client is directed to stop all activities and sit or rest in bed in a semi-Fowler position to reduce the oxygen requirements of the ischemic myocardium. Pursed-lip breathing and standing will not reduce workload to the same extent. There is no need to have the client put his head between his legs because cerebral perfusion is not lacking

When assessing venous disease in a client's lower extremities, the nurse knows that what test will most likely be prescribed? a. Duplex ultrasonography b. Echocardiography c. Positron emission tomography (PET) d. Radiography

a Duplex ultrasound may be used to determine the level and extent of venous disease as well as its chronicity. Radiographs (x-rays), PET scanning, and echocardiography are never used for this purpose as they do not allow visualization of blood flow.

Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA), with insertion of a stent, for a femoral artery lesion, includes assessment for the most serious complication of: a. Hemorrhage. b. Thrombosis of the graft. c. Decreased motor function. d. Stent dislodgement.

a All choices are serious and require medical/surgical intervention. However, hemorrhage is the most serious complication that requires immediate attention.

A patient is admitted to a special critical care unit for the treatment of an arterial thrombus. The nurse is aware that the preferred drug of choice for clot removal, unless contraindicated, would be: a. Alteplase. b. Reteplase. c. Urokinase. d. Streptokinase

a Alteplase has fewer disadvantages than the other thrombolytic agents. Refer to Table 18-2 in the text.

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 a. low. b. high. c. normal. d. extremely high.

b If the fasting LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered high. The goal is to decrease the LDL level below 100 mg/dL (< 70 mg/dL for very high-risk patients).

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? a. prior intracranial hemorrhage b. recent consumption of a meal c. shellfish allergy d. use of heparin

a 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 asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? a. 5 minutes b. 15 minutes c. 30 minutes d. 60 minutes

a 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.

A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? a. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. b. Instruct the client to renew the nitroglycerin supply every 3 months. c. Instruct the client not to crush the tablet. d. Instruct the client to place nitroglycerin tablets in a plastic pill box.

a The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.

Which is a characteristic of arterial insufficiency? a. Diminished or absent pulses b. Superficial ulcer c. Aching, cramping pain d. Pulses are present but may be difficult to palpate

a A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.

The nurse is assessing a hospital client who has low albumin levels due to liver disease. What assessment finding should the nurse attribute to the client's low albumin levels? a. There is severe edema to the client's legs and abdomen. b. The client has had two episodes of epistaxis (nosebleeds) in the past 24 hours. c. The client reports uncharacteristic levels of fatigue. d. The client is short of breath on exertion, with an expiratory wheeze.

a Albumin helps to keep fluids within the vascular space. Deficiencies, as a result, cause the release of fluid into interstitial spaces, causing edema. Hypoalbuminemia does not cause excessive bleeding, reduced energy or respiratory difficulties.

Family members bring a client to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data? a. The symptoms indicate angina and should be treated as such. b. The symptoms indicate a pulmonary etiology rather than a cardiac etiology. c. The symptoms indicate an acute coronary episode and should be treated as such. d. Treatment should be determined pending the results of an exercise stress test.

a Angina and MI have similar symptoms and are considered the same process, but are on different points along a continuum. That the patient's symptoms are unrelieved by rest suggests an acute coronary episode rather than angina. Pale cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be initiated immediately regardless of diagnosis.

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? a. Arterial insufficiency b. Venous insufficiency c. Neither venous nor arterial d. Trauma

a Characteristics of arterial insufficiency ulcers include location at the tips of the toes, extreme painfulness, and circular shape with pale to black ulcer bases. Ulcers caused by venous insufficiency will be irregular in shape, minimal pain if superficial (can be painful), and usually located around the ankles or the anterior tibial area.

The nurse at a long-term care facility is conducting an admission assessment of a new male resident who is Caucasian. On inspection of the resident's lower extremities, the nurse notes that his shins and ankles have a gray-brown color tone and are visibly shiny. The nurse should conduct further assessments in light of the possibility that the resident may have: a. Venous insufficiency b. An arterial occlusion c. Raynaud's disease d. A deep vein thrombosis

a Classic signs of venous disease are edema and pigmentation of the skin termed hemosiderosis. Because of the poor venous return, there is extravasation of red blood cells (RBCs), which break down and deposit hemosiderin (gives RBCs their color), staining the skin a gray-brown color. This pattern of pigmentation is not characteristic of Raynaud's disease, an arterial occlusion, or DVT.

The nurse is reevaluating a client 2 hours after a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which assessment finding may indicate the client is experiencing a complication of the procedure? a. Urine output of 40 mL b. Potassium level of 4.0 mEq/L c. Heart rate of 100 bpm d. Dried blood at the puncture site

a 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.

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? a. "See if rest relieves the chest pain before using the nitroglycerin." b. "Call 911 if you develop a headache following nitroglycerin use." c. "Place the nitroglycerin tablet between cheek and gum." d. "Only take one nitroglycerin tablet for each episode of angina."

a Decreased activity may relieve chest pain; sitting will prevent injury should the nitroglycerin lower BP and cause fainting. The client should expect to feel dizzy or flushed or to develop a headache following sublingual nitroglycerin use. The client should place one nitroglycerin tablet under the tongue if 2-3 minutes of rest fails to relieve pain. Clients may take up to three nitroglycerin tablets within 5 minutes of each other to relieve angina. However, they should call 911 if the three tablets fail to resolve the chest pain.

The public health nurse is participating in a health fair, and she interviews a woman with a history of hypertension who is currently smoking one pack of cigarettes per day. She has had no manifestations of coronary artery disease (CAD) but a recent low-density lipoprotein (LDL) level of 154 mg/dL was found. Based on her assessment, the nurse would expect that this patient would be treated in what way? a. Drug therapy and smoking cessation b. Diet and drug therapy c. Diet therapy only d. Diet therapy and smoking cessation

a Diet therapy is indicated for a patient without CAD who has two or more risk factors (hypertension and cigarette smoking) and an LDL level equal to or greater than 130 mg/dL. When the patient's LDL levels are equal to or greater than 160 mg/dL, drug therapy would be added to diet therapy. Cigarette smoking contributes to the development and severity of CAD and is listed as a major risk factor.

The public health nurse is participating in a health fair and interviews a client with a history of hypertension, who is currently smoking one pack of cigarettes per day. The client denies any of the most common manifestations of CAD. The nurse should expect the focuses of CAD treatment to be: a. drug therapy and smoking cessation. b. diet and drug therapy. c. diet therapy only. d. diet therapy and smoking cessation.

a Due to the absence of symptoms, dietary therapy would likely be selected as the first-line treatment for possible CAD. Drug therapy would be determined based on a number of considerations and diagnostics findings, but would not be directly indicated. Smoking cessation is always indicated, regardless of the presence or absence of symptoms.

The nurse is teaching a client who is being discharged post vein stripping for varicose veins. Which client statement indicates the client requires additional self-care instructions? a. "So it's OK for me to return to my job right away as a hairdresser." b. "I should call the doctor if I get a cut on my foot." c. "I should try not to cross my knees when I'm sitting." d. "I'll need to wear these support stockings every day."

a Following vein stripping, clients should avoid standing or sitting for prolonged periods. The nurse describes appropriate foot and nail care to facilitate tissue integrity, explaining that any open areas on the feet or lower legs require examination and treatment by the physician. Following vein stripping, clients should avoid sitting with the knees crossed. Clients should wear elastic antiembolism stockings to decrease potential thrombosis.

A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg? a. Dorsiflex the foot while the leg is elevated to check for calf pain. b. Elevate the patient's legs for 20 minutes and then lower them slowly while checking for areas of inadequate blood return. c. Extend the leg, plantar flex the foot, and check for the patency of the dorsalis pedis pulse. d. Lower the patient's legs and massage the calf muscles to note any areas of tenderness.

a Homan's sign is indicated by pain in the calf after the foot is sharply dorsiflexed.

A patient with a diagnosis of deep vein thrombosis (DVT) is being treated with unfractionated heparin, which is being administered intravenously. The nurse who is providing care for this patient should consequently prioritize what assessments? a. Assessing the patient for internal or external hemorrhage b. Monitoring the patient's intake and output, and assessing for signs of fluid volume deficit c. Assessing the patient for adventitious lung sounds and assessing SaO2 levels d. Assessing the patient's pain levels

a IV heparin administration creates a significant risk of bleeding. Consequently, assessments for hemorrhage would be prioritized over fluid balance, oxygenation, and pain, although each of these assessment domains is necessary.

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? a. IV morphine b. IV nitroglycerin c. Atenolol d. Amlodipine

a 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.

What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis? a. Teach the client how to apply a graduated compression stocking. b. Inform the physician if the client's temperature remains low. c. Avoid elevating the area. d. Offer cold applications to promote comfort and to enhance circulation.

a In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the client how to apply a graduated compression stocking. The nurse informs the physician if the client's temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

What should the nurse do to manage the persistent swelling in a client with severe lymphangitis and lymphadenitis? a. Teach the client how to apply an elastic sleeve b. Inform the physician if the client's temperature remains low c. Avoid elevating the area d. Offer cold applications to promote comfort and to enhance circulation

a In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the client how to apply an elastic sleeve or stocking. The nurse informs the physician if the client's temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

The nurse is preparing a teaching plan for a patient with venous insufficiency and plans to address measures to prevent complications from venous insufficiency. What is one measure the nurse should include in the plan? a. Avoiding tight-fitting socks b. Reducing activity c. Sleeping with legs dependent d. Avoiding pressure stockings

a Measures to take to prevent complications include avoiding tight fitting socks and panty girdles, and maintaining activities such as walking, sleeping with legs elevated, and using pressure stockings. Not included in the teaching plan for venous insufficiency would be reducing activity, sleeping with legs dependent, and avoiding pressure stockings.

A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? a. Moderate to severe arterial insufficiency b. No arterial insufficiency c. Very mild arterial insufficiency d. Tissue loss to that foot

a Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

The nurse assessing a client who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which characteristic? a. Diminished or absent pulses b. Superficial ulcer c. Aching, cramping pain d. Pulses that are present but difficult to palpate

a Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency.

The nurse is caring for a client who has undergone percutaneous transluminal coronary angioplasty (PTCA). What is the major indicator of success for this procedure? a. Increase in the size of the artery's lumen b. Decrease in arterial blood flow in relation to venous flow c. Increase in the client's resting heart rate d. Increase in the client's level of consciousness (LOC)

a PTCA is used to open blocked coronary vessels and resolve ischemia. The procedure may result in beneficial changes to the client's LOC or heart rate, but these are not the overarching goals of PTCA. Increased arterial flow is the focus of the procedures.

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a. Increased abdominal and back pain b. Decreased pulse rate and blood pressure c. Retrosternal back pain radiating to the left arm d. Elevated blood pressure and rapid respirations

a Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

The nurse is caring for a client who is scheduled for cardiac surgery. What should the nurse include in preoperative care? a. With the client, clarify the surgical procedure that will be performed. b. Withhold the client's scheduled medications for at least 12 hours preoperatively. c. Inform the client that health teaching will begin as soon as possible after surgery. d. Avoid discussing the client's fears as not to exacerbate them.

a Preoperatively, it is necessary to evaluate the client's understanding of the surgical procedure, informed consent, and adherence to treatment protocols. Teaching would begin on admission or even prior to admission. The physician would write orders to alter the client's medication regimen, if necessary; this will vary from client to client. Fears should be addressed directly and empathically.

The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received? a. Protamine sulfate b. Alteplase c. Clopidogrel d. Aspirin

a Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin). Alteplase is a thrombolytic agent. Clopidogrel is an antiplatelet medication that is given to reduce the risk of thrombus formation after coronary stent placement. The antiplatelet effect of aspirin does not reverse the effects of heparin.

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? a. Taking daily walks b. Engaging in anaerobic exercise c. Reducing daily fat intake to less than 45% of total calories d. Abstaining from foods that increase levels of high-density lipoproteins (HDLs)

a Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not abstain from, foods that raise HDL levels.

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

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

a 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.

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: a. To restore the flow of blood through the coronary arteries b. To restore function to infarcted myocardial cells c. To relieve the patient's symptoms of chest pain and dyspnea d. To prevent the rupture of atheromas

a 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.

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? a. Decreases resting heart rate b. Decreases cholesterol level c. Increases cardiac output d. Decreases platelet aggregation

a 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.

Pentoxifylline (Trental) is a medication used for which of the following conditions? a. Claudication b. Thromboemboli c. Hypertension d. Elevated triglycerides

a Trental and Pletal are the only medications specifically indicated for the treatment of claudication. Thromboemboli, hypertension, and elevated triglycerides are not indications for using Trental.

A patient is suspected to have a thoracic aortic aneurysm. What diagnostic test(s) does the nurse anticipate preparing the patient for? (Select all that apply.) a. Computed tomography b. Transesophageal echocardiography c. X-ray d. Electroencephalogram e. Electrocardiogram (ECG)

a, b, c Diagnosis of a thoracic aortic aneurysm is principally made by chest x-ray, computed tomography angiography (CTA), and transesophageal echocardiography (TEE).

The nurse is evaluating a client's diagnosis of arterial insufficiency with reference to the adequacy of the client's blood flow. On what physiologic variables does adequate blood flow depend? Select all that apply. a. Efficiency of heart as a pump b. Adequacy of circulating blood volume c. Ratio of platelets to red blood cells d. Size of red blood cells e. Patency and responsiveness of the blood vessels

a, b, e Adequate blood flow depends on the efficiency of the heart as a pump, the patency and responsiveness of the blood vessels, and the adequacy of circulating blood volume. Adequacy of blood flow does not primarily depend on the size of red cells or their ratio to the number of platelets.

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

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

A community health nurse is providing an educational event at the local seniors' center. The topic the nurse is speaking about is varicose veins. What would the nurse suggest as proactive preventative measure for varicose veins? a. Sitting with crossed legs to promote relaxation b. Walking for several minutes every hour to promote circulation c. Elevating the legs when tired d. Wearing tight ankle socks to decrease edema

b A proactive approach to preventing varicose veins would be to walk for several minutes every hour to promote circulation. It is measurable, increases blood return to the heart, and promotes overall wellness. Sitting with crossed legs may promote relaxation but it is contraindicated for patients with or at risk for varicose veins. Elevating the legs only helps blood passively return to the heart and does not help maintain the competency of the valves in the veins. Wearing tight ankle socks is contraindicated for patients with or at risk for varicose veins; socks that are below the muscles of calf do not promote venous return because the socks simply capture the blood and promote venous stasis.

Which diagnostic test is used to quantify venous reflux and calf muscle pump ejection? a. Contrast phlebography b. Air plethysmography c. Lymphangiography d. Lymphoscintigraphy

b Air plethysmography is used to quantify venous reflux and calf muscle pump action. Contrast phlebography involves injecting a radiopaque contrast agent into the venous system. Lymphoscintigraphy is done when a radioactively labeled colloid is injected subcutaneously in the second interdigital space. The extremity is then exercised to facilitate the uptake of the colloid by the lymphatic system, and serial images are obtained at preset intervals. Lymphangiography provides a way to detect lymph node involvement resulting from metastatic carcinoma, lymphoma, or infection in sites that are otherwise inaccessible to the examiner except by surgery.

A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug? a. Ibuprofen b. Clopidogrel c. Dipyridamole d. Acetaminophen

b Because of the risk of thrombus formation within the stent, the client receives antiplatelet medications, usually aspirin and clopidogrel. Ibuprofen and acetaminophen are not antiplatelet drugs. Dipyridamole is not the drug of choice following stent placement.

Which aneurysm results in bleeding into the layers of the arterial wall? a. Saccular b. Dissecting c. False d. Anastomotic

b Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma. An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? a. Decrease the heparin infusion rate. b. Prepare to administer protamine sulfate. c. Monitor the partial thromboplastin time (PTT). d. Start an I.V. infusion of dextrose 5% in water (D5W).

b Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.

A client is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in client teaching before discharge? a. Adequate carbohydrate intake b. Application of graduated compression stockings c. Prophylactic antibiotic therapy d. Methods of keeping the wound area dry

b Graduated compression stockings usually are prescribed for clients with venous insufficiency. The required pressure gradient is determined by the amount and severity of venous disease. Graduated compression stockings are designed to apply 100% of the prescribed pressure gradient at the ankle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing flow in the deep veins. These stockings may be knee high, thigh high, or pantyhose.

A client with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the client about what potential adverse effects? a. Nervousness or paresthesia b. Throbbing headache or dizziness c. Drowsiness or blurred vision d. Tinnitus or diplopia

b Headache and dizziness commonly occur when nitroglycerin is taken at the beginning of therapy. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not typically occur as a result of nitroglycerin therapy.

The nurse is caring for an older adult client who is in cardiac rehabilitation following heart surgery. The client has been walking on a regular basis for about a week and walks for 15 minutes 3 times a day. The client states that he has cramp-like pain in the legs every time he walks and that the pain gets "better when I rest." The client's care plan should address what problem? a. Decreased mobility related to VTE b. Acute pain related to intermittent claudication c. Decreased mobility related to venous insufficiency d. Acute pain related to vasculitis

b Intermittent claudication presents as a muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest. Clients with peripheral arterial insufficiency often complain of intermittent claudication due to a lack of oxygen to muscle tissue. Venous insufficiency presents as a disorder of venous blood reflux and does not present with cramp-type pain with exercise. Vasculitis is an inflammation of the blood vessels and presents with weakness, fever, and fatigue, but does not present with cramp-type pain with exercise. The pain associated with VTE does not have this clinical presentation.

Which is a nonmodifiable risk factor for coronary artery disease (CAD)? a. Hypertension b. Gender c. Diabetes mellitus d. Obesity

b Other nonmodifiable risk factors for coronary artery disease (CAD) include family history, older age, and race. Hypertension, diabetes mellitus, and obesity are all modifiable risk factors.

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? a. Digoxin b. Atropine c. Protamine sulfate d. Sodium nitroprusside

b Sheath removal and the application of pressure on the vessel insertion site may cause the heart rate to slow and the blood pressure to decrease (vasovagal response). A dose of IV atropine is usually given to treat this response.

The nurse is caring for a client who is believed to have just experienced an MI. The nurse notes changes in the ECG of the patient. What change on an ECG most strongly suggests to the nurse that ischemia is occurring? a. P wave inversion b. T wave inversion c. Q wave changes with no change in ST or T wave d. P wave enlargement

b T-wave inversion is an indicator of ischemic damage to myocardium. Typically, few changes to P waves occur during or after an MI, whereas Q-wave changes with no change in the ST or T wave indicate an old MI.

A nurse has written a plan of care for a man diagnosed with peripheral arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral tissue perfusion related to compromised circulation. What is the most appropriate intervention for this diagnosis? a. Elevate his legs and arms above his heart when resting. b. Encourage the client to engage in a moderate amount of exercise. c. Encourage extended periods of sitting or standing. d. Discourage walking in order to limit pain.

b The nursing diagnosis of altered peripheral tissue perfusion related to compromised circulation requires interventions that focus on improving circulation. Encouraging the client to engage in a moderate amount of exercise serves to improve circulation. Elevating his legs and arms above his heart when resting would be passive and fails to promote circulation. Encouraging long periods of sitting or standing would further compromise circulation. The nurse should encourage, not discourage, walking to increase circulation and decrease pain.

The nurse explains to a patient that the primary cause of a varicose vein is: a. Phlebothrombosis. b. An incompetent venous valve. c. Venospasm. d. Venous occlusion.

b Varicose veins are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves.

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.) a. It is relieved by rest and inactivity. b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms. e. It subsides after taking nitroglycerin.

b, c, d Chest pain that occurs suddenly, continues despite rest and medication, is substernal, and is sometimes viselike and radiating to the shoulders and arms is associated with an MI. Angina pectoris pain is generally relieved by rest and nitroglycerin.

The nurse is caring for a client who is known to have a high risk for venous thromboembolism. What preventive actions should the nurse recommend? Select all that apply. a. High-protein diet b. Weight loss c. Regular exercise d. Smoking cessation e. Calcium and vitamin D supplementation

b, c, d Clients at risk for VTE should be advised to make lifestyle changes, as appropriate, which may include weight loss, smoking cessation, and regular exercise. Increased protein intake and supplementation with vitamin D and calcium do not address the main risk factors for VTE.

A client in the emergency department states, "I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." Based on this statement, which priority assessment should the nurse complete? a. Check for the presence of tortuous veins bilaterally on the legs. b. Ask about any changes in skin color that occur in response to cold. c. Attempt to palpate the dorsalis pedis and posterior tibial pulses. d. Assess for unilateral swelling and tenderness of either leg.

c Intermittent claudication is a sign of peripheral arterial insufficiency. The nurse should assess for other clinical manifestations of peripheral arterial disease in a client who describes intermittent claudication. A thorough assessment of the client's skin color and temperature and the character of the peripheral pulses are important in the diagnosis of arterial disorders.

A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? a. Prolonged PR interval b. Absent Q wave c. Elevated ST segment d. Widened QRS complex

c Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.

The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? a. Cholesterol, 280 mg/dL b. Low density lipoprotein (LDL), 160 mg/dL c. High-density lipoprotein (HDL), 80 mg/dL d. A ratio of LDL to HDL, 4.5 to 1.0

c 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.

A 79-year-old man is admitted to the medical unit with digital gangrene. The man states that his problems first began when he stubbed his toe going to the bathroom in the dark. In addition to this trauma, the nurse should suspect that the client has a history of what health problem? a. Raynaud phenomenon b. Coronary artery disease c. Arterial insufficiency d. Varicose veins

c Arterial insufficiency may result in gangrene of the toe (digital gangrene), which usually is caused by trauma. The toe is stubbed and then turns black. Raynaud disease, CAD and varicose veins are not the usual causes of digital gangrene in the elderly.

The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments? a. Maximizing cardiac output while minimizing heart rate b. Decreasing energy expenditure of the myocardium c. Balancing myocardial oxygen supply with demand d. Increasing the size of the myocardial muscle

c Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the client with ACS. Treatment is not aimed directly at minimizing heart rate because some clients experience bradycardia. Increasing the size of the myocardium is never a goal. Reducing the myocardium's energy expenditure is often beneficial, but this must be balanced with productivity.

The triage nurse in the ED is assessing a client who reports pain and swelling in her right lower leg. The client's pain became much worse last night and appeared along with fever, chills, and sweating. The client states, "I hit my leg on the car door 4 or 5 days ago and it has been sore ever since." The client has a history of chronic venous insufficiency. What intervention should the nurse anticipate for this client? a. Platelet transfusion to treat thrombocytopenia b. Warfarin to treat arterial insufficiency c. Antibiotics to treat cellulitis d. Heparin IV to treat VTE

c Cellulitis is the most common infectious cause of limb swelling. The signs and symptoms include acute onset of swelling, localized redness, and pain; it is frequently associated with systemic signs of fever, chills, and sweating. The client may be able to identify a trauma that accounts for the source of infection. Thrombocytopenia is a loss or decrease in platelets and increases a client's risk of bleeding; this problem would not cause these symptoms. Arterial insufficiency would present with ongoing pain related to activity. This client does not have signs and symptoms of VTE.

A client is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What intervention best addresses this risk? a. Administration of bronchodilators by nebulizer b. Administration of inhaled corticosteroids by metered dose inhaler (MDI) c. Client's consistent performance of deep-breathing and coughing exercises d. Client's active participation in the cardiac rehabilitation program

c Clearance of pulmonary secretions is accomplished by frequent repositioning of the client, suctioning, and chest physical therapy, as well as educating and encouraging the client to breathe deeply and cough. Medications are not normally used to achieve this goal. Rehabilitation is important, but will not necessarily aid the mobilization of respiratory secretions.

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a. Decreasing blood pressure and increasing mobility b. Increasing blood pressure and reducing mobility c. Stabilizing heart rate and blood pressure and easing anxiety d. Increasing blood pressure and monitoring fluid intake and output

c For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. What option for treatment is available to increase diffusion of oxygen to the hypoxic wound? a. Surgical debridement b. Enzymatic debridement c. Hyperbaric oxygen d. Vacuum-assisted closure device

c Hyperbaric oxygenation (HBO) may be beneficial as an adjunct treatment in patients with diabetes with no signs of wound healing after 30 days of standard wound treatment. HBO is accomplished by placing the patient into a chamber that increases barometric pressure while the patient is breathing 100% oxygen. Treatment regimens vary from 90 to 120 minutes once daily for 30 to 90 sessions. The process by which HBO is thought to work involves several factors. The edema in the wound area is decreased because high oxygen tension facilitates vasoconstriction and enhances the ability of leukocytes to phagocytize and kill bacteria. In addition, HBO is thought to increase diffusion of oxygen to the hypoxic wound, thereby enhancing epithelial migration and improving collagen production.

The nurse is assessing a client who was admitted to the critical care unit 3 hours ago following cardiac surgery. The nurse's most recent assessment reveals that the client's left pedal pulses are not palpable and that the right pedal pulses are rated at +2. What is the nurse's best action? a. Document this expected assessment finding during the initial postoperative period. b. Reposition the client with his left leg in a dependent position. c. Inform the client's health care provider of this assessment finding. d. Administer an ordered dose of subcutaneous heparin.

c If a pulse is absent in any extremity, the cause may be prior catheterization of that extremity, chronic peripheral vascular disease, or a thromboembolic obstruction. The nurse immediately reports newly identified absence of any pulse.

The nurse is caring for an acutely ill client who is on anticoagulant therapy. The client has a comorbidity of renal insufficiency. How will this client's renal status affect heparin therapy? a. Heparin is contraindicated in the treatment of this client. b. Heparin may be given subcutaneously, but not IV. c. Lower doses of heparin are required for this client. d. Warfarin will be substituted for heparin.

c If renal insufficiency exists, lower doses of heparin are required. Warfarin cannot be safely and effectively used as a substitute and there is no contraindication for IV administration.

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? a. Deficient knowledge about underlying disease and methods for avoiding complications b. Anxiety related to fear of death c. Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) d. Noncompliance related to failure to accept necessary lifestyle changes

c 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.

The nurse is caring for an adult client who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina? a. Ineffective breathing pattern related to decreased cardiac output b. Anxiety related to fear of death c. Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) d. Impaired skin integrity related to CAD

c Ineffective cardiopulmonary tissue perfusion directly results in the symptoms of discomfort associated with angina. Anxiety and ineffective breathing may result from angina chest pain, but they are not the causes. Skin integrity is not impaired by the effects of angina.

A nurse on a medical unit is caring for a client who has been diagnosed with lymphangitis. When reviewing this client's medication administration record, the nurse should anticipate which of the following? a. Warfarin b. Furosemide c. An antibiotic d. An antiplatelet aggregator

c Lymphangitis is an acute inflammation of the lymphatic channels caused by an infectious process. Antibiotics are always a component of treatment. Diuretics are of nominal use. Anticoagulants and antiplatelet aggregators are not indicated in this form of infection.

Which risk factor is related to venous stasis for deep vein thrombosis (DVT) and pulmonary embolism (PE)? a. Trauma b. Pacing wires c. Obesity d. Surgery

c Obesity is a risk factor for DVT and PE related to venous stasis. Trauma, pacing wires, and surgery are related to endothelial damage as a risk factor for DCAT and PE.

A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which laboratory value indicates that anticoagulation is adequate and enoxaparin can be discontinued? a. Activated partial thromboplastin time (aPPT) is half of the control value b. Prothrombin time (PT) is 0.5 times normal. c. International normalized ratio (INR) is 2.5. d. K+ level is 3.5.

c Oral anticoagulants such as warfarin are monitored by PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)

When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse position a patient who has leg ulcers that are venous in origin? a. Keep the patient's legs flat without the knees raised. b. Keep the patient's knees at a 45-degree angle. c. Elevate the patient's lower extremities. d. Hang the patient's legs over the side of the bed

c Positioning of the legs depends on whether the ulcer is of arterial or venous origin. If there is venous insufficiency, dependent edema can be avoided by elevating the lower extremities. Bending the knees, keeping the legs flat, and dangling the patient's legs may exacerbate the condition.

How should the nurse best position a client who has leg ulcers that are venous in origin? a. Keep the client's legs flat and straight. b. Keep the client's knees bent to 45-degree angle and supported with pillows. c. Elevate the client's lower extremities. d. Dangle the client's legs over the side of the bed.

c Positioning of the legs depends on whether the ulcer is of arterial or venous origin. With venous insufficiency, dependent edema can be avoided by elevating the lower extremities. Dangling the client's legs and applying pillows may further compromise venous return.

The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis (DVT). Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels? a. Partial thromboplastin time (PTT) within normal reference range b. Prothrombin time (PT) 8 to 10 times the control c. International normalized ratio (INR) between 2 and 3 d. Hematocrit of 32%

c The INR is most often used to determine if warfarin is at a therapeutic level; an INR of 2 to 3 is considered therapeutic. Warfarin is also considered to be at therapeutic levels when the client's PT is 1.5 to 2 times the control. Higher values indicate increased risk of bleeding and hemorrhage, whereas lower values indicate increased risk of blood clot formation. Heparin, not warfarin, prolongs PTT. Hematocrit does not provide information on the effectiveness of warfarin; however, a falling hematocrit in a client taking warfarin may be a sign of hemorrhage.

A 56-year-old man has been brought to the emergency department by emergency medical services (EMS) and has been diagnosed with a myocardial infarction (MI) based on his presentation and electrocardiogram (ECG). The patient has been identified as a candidate for percutaneous transluminal coronary angioplasty (PTCA). The nurse who is providing care for this patient should recognize that the extent of cardiac damage will primarily depend on: a. The patient's previous use of antiplatelets and anticoagulants b. The particular risk factors that contributed to the patient's MI c. The duration of oxygen deprivation to the patient's cardiac cells d. The patient's high- and low-density lipoprotein (LDL, HDL) levels prior to MI

c The duration of oxygen deprivation is directly related to the number of cells that die, therefore the time from the patient's arrival in the emergency department to the time percutaneous coronary intervention (PCI) is performed is critical and should be less than 60 minutes. The extent of cardiac damage is not a direct reflection of previous medication use or risk factors such as cholesterol levels.

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? a. "As soon as you feel pain, we will go back and elevate your legs." b. "If you feel pain during the walk, keep walking until the end of the hallway is reached." c. "Walk to the point of pain, rest until the pain subsides, then resume ambulation." d. "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

c The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.

Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? a. Cleanse the site with disinfectants and dress the wound appropriately b. Refrain from sexual activity for 1 month c. Monitor the site for bleeding or hematoma. d. Normal activities of daily living can be resumed the first day after surgery

c The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or the development of a hard mass indicative of hematoma. A nurse does not advise the client to clean the site with disinfectants or refrain from sexual activity for 1 month.

A client is going home with a prescription for nitroglycerin (Nitrostat) for his anginal symptoms. Which of the following statements indicates the client understands the information needed to safely self-medicate? a. "I will store the nitroglycerin in the refrigerator." b. "I will take one tablet every 15 minutes when I have angina." c. "I should sit down or lie down before taking the nitroglycerin." d. "I am to swallow the nitroglycerin tablet after I put it in my mouth"

c The nurse should encourage the client to sit down or lie down during episodes of angina. Nitroglycerin relaxes smooth muscles and dilates vascular beds; therefore, nitroglycerin causes hypotension and the client could fall, causing injury. Nitroglycerin should be stored in a dark container. It should be taken once every 5 minutes for three doses and is placed sublingually, not swallowed.

The nurse working on the coronary care unit is caring for a client with ACS. How can the nurse best meet the client's psychosocial needs? a. Reinforce the fact that treatment will be successful. b. Facilitate a referral to a chaplain or spiritual leader. c. Increase the client's participation in rehabilitation activities. d. Directly address the client's anxieties and fears.

d Alleviating anxiety and decreasing fear are important nursing functions that reduce the sympathetic stress response. Referrals to spiritual care may or may not be appropriate, and this does not relieve the nurse of responsibility for addressing the client's psychosocial needs. Treatment is not always successful, and false hope should never be fostered. Participation in rehabilitation may alleviate anxiety for some clients, but it may exacerbate it for others.

A nurse is admitting a 45-year-old man to the medical unit who has a history of PAD. While providing his health history, the client reveals that he smokes about two packs of cigarettes a day, has a history of alcohol abuse, and does not exercise. What would be the priority health education for this client? a. The lack of exercise, which is the main cause of PAD b. The likelihood that heavy alcohol intake is a significant risk factor for PAD c. Cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause or aggravate PAD. d. Alcohol suppresses the immune system, creates high glucose levels, and may cause PAD.

c Tobacco is powerful vasoconstrictor; its use with PAD is highly detrimental, and clients are strongly advised to stop using tobacco. Sedentary lifestyle is also a risk factor, but smoking is likely a more significant risk factor that the nurse should address. Alcohol use is less likely to cause PAD, although it carries numerous health risks.

When being assessed by her new nurse practitioner, a woman states that she has had Raynaud's disease for many years, a problem that occasionally affects her quality of life. When performing health education surrounding this problem, what should the nurse emphasize? a. Teaching the woman about atherosclerosis and its role in Raynaud's disease b. Teaching the woman about the correct use of anticoagulants c. Helping the woman identify and avoid the specific triggers of her problem d. Teaching the woman the signs and symptoms of deep vein thrombosis

c With appropriate patient teaching and lifestyle modifications, Raynaud's disease is generally benign and self-limiting. The patient is instructed to avoid the stimuli (e.g., cold, tobacco) that provoke vasoconstriction. Raynaud's is not caused by atherosclerosis, and it is not a risk factor for DVT. Anticoagulants do not address the signs, symptoms, or etiology of the disease.

A 60-year-old woman has been brought to the emergency department (ED) by ambulance after she experienced a sudden onset of dyspnea and phoned 911. The woman is obese but claims an unremarkable medical history and denies chest pain. When assessing this patient, the nurse in the ED should be aware that: a. Dyspnea is definitive for a respiratory, rather than cardiac, etiology. b. The absence of known risk factors usually rules out myocardial infarction (MI) or angina as a cause of dyspnea. c. Women often present with an MI much differently than do men. d. Acute coronary syndrome (ACS) manifests with chest pain rather than with shortness of breath.

c Women often present with symptoms different from those seen in men, therefore a high level of suspicion is associated with vague complaints such as fatigue, shoulder blade discomfort, and/or shortness of breath. Dyspnea is not limited to respiratory problems.

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? a. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. b. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider. c. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

d Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the health care provider before completing the initial assessment is premature.

An older adult client has been treated for a venous ulcer and a plan is in place to prevent the occurrence of future ulcers. What should the nurse include in this plan? a. Use of supplementary oxygen to aid tissue oxygenation b. Daily use of normal saline compresses on the lower limbs c. Daily administration of prophylactic antibiotics d. A high-protein diet that is rich in vitamins

d A diet that is high in protein, vitamins C and A, iron, and zinc is encouraged to promote healing and prevent future ulcers. Prophylactic antibiotics and saline compresses are not used to prevent ulcers. Oxygen supplementation does not prevent ulcer formation.

Graduated compression stockings have been prescribed to treat a client's venous insufficiency. What education should the nurse prioritize when introducing this intervention to the client? a. The need to take anticoagulants concurrent with using compression stockings b. The need to wear the stockings on a "one day on, one day off" schedule c. The importance of wearing the stockings around the clock to ensure maximum benefit d. The importance of ensuring the stockings are applied evenly with no pressure points

d Any type of stocking can inadvertently become a tourniquet if applied incorrectly (i.e., rolled tightly at the top). In such instances, the stockings produce rather than prevent stasis. For ambulatory clients, graduated compression stockings are removed at night and reapplied before the legs are lowered from the bed to the floor in the morning. They are used daily, not on alternating days. Anticoagulants are not always indicated in clients who are using compression stockings.

A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? a. Urine output of 15 ml/hour and 2+ hematuria b. Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute c. Urine output of 150 ml/hour and heart rate of 45 beats/minute d. Blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute

d Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses. Hematuria, increased urine output, and bradycardia aren't signs of bleeding from aneurysm repair or recurring dissection.

Which statement is accurate regarding Raynaud disease? a. The disease generally affects the client trilaterally. b. It affects more than two digits on each hand or foot. c. It is most common in men 16 to 40 years of age. d. Episodes may be triggered by unusual sensitivity to cold.

d Episodes of Raynaud disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.

A nurse working in a long-term care facility is performing the admission assessment of a newly admitted, 85-year-old resident. During inspection of the resident's feet, the nurse notes early evidence of gangrene on one of the resident's great toes. The nurse should assess for further evidence of what health problem? a. Chronic venous insufficiency b. Raynaud phenomenon c. Venous thromboembolism d. Peripheral artery disease (PAD)

d In elderly people, symptoms of PAD may be more pronounced than in younger people. In elderly clients who are inactive, gangrene may be the first sign of disease. Venous insufficiency does not normally manifest with gangrene. Similarly, VTE and Raynaud phenomenon do not cause the ischemia that underlies gangrene.

A client presents to the clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client that angina is most often attributable to what cause? a. Decreased cardiac output b. Decreased cardiac contractility c. Infarction of the myocardium d. Coronary arteriosclerosis

d In most cases, angina pectoris is due to arteriosclerosis. The disease is not a result of impaired cardiac output or contractility. Infarction may result from untreated angina, but it is not a cause of the disease.

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? a. Impaired gas exchange related to increased blood flow b. Excess fluid volume related to peripheral vascular disease c. Risk for injury related to edema d. Ineffective peripheral tissue perfusion related to venous congestion

d Ineffective peripheral tissue perfusion related to venous congestion takes highest priority because venous inflammation and clot formation impede blood flow in a client with DVT. Impaired gas exchange related to increased blood flow is incorrect because impaired gas exchange is related to decreased, not increased, blood flow. Excess fluid volume related to peripheral vascular disease is inappropriate because there's no evidence that this client has an excess fluid volume. Risk for injury related to edema may be warranted but is secondary to ineffective tissue perfusion.

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: a. Blocking sympathetic stimulation of the heart and reducing oxygen demand b. Increasing contractility and consequent cardiac output c. Blocking the a-delta pain fibers in the myocardium d. Dilating the blood vessels and reducing preload

d 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.

Following abdominal surgery, which factor predisposes a client to deep vein thrombosis? a. The client is 5' 9" tall and weighs 128 lb (58 kg). b. The client has been pregnant four times. c. The client usually walks 3 miles a day. d. The client will be immobile during and shortly after surgery.

d Postoperative immobility and subsequent venous stasis predispose the client to deep vein thrombosis. Other predisposing factors for this condition include obesity and current pregnancy, which don't apply to this client. Exercise isn't a risk factor for deep vein thrombosis.

An OR nurse is preparing to assist with a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used as source for a CABG is what? a. Brachial artery b. Brachial vein c. Femoral artery d. Greater saphenous vein

d The greater saphenous vein is the most commonly used graft site for CABG. The right and left internal mammary arteries, radial arteries, and gastroepiploic artery are other graft sites used, though not as frequently. The femoral artery, brachial artery, and brachial vein are never harvested.

The nurse is caring for a patient with venous insufficiency. For what should the nurse assess the patient's lower extremities? a. Rubor b. Cellulitis c. Dermatitis d. Ulceration

d Venous ulceration is the most serious complication of chronic venous insufficiency and can be associated with other conditions affecting the circulation of the lower extremities. Cellulitis or dermatitis may complicate the care of chronic venous insufficiency and venous ulcerations.