Coronary Vascular Disorders
symptoms of angina
tightness, choking, or a heavy sensation in the chest, pain that radiates to neck, jaw, shoulders, back or arms, anxiety, dyspnea, SOB, dizziness, N&V, pallor, diaphoresis, indigestion
purpose of percutaneous transluminal coronary angioplasty (PTCA)
to improve blood flow within a coronary artery by compressing the atheroma
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. 5 minutes
angina characterized by predictable & consistent pain that occurs & is relieved by rest and/or nitroglycerin
stable (exertional) angina
complications of Coronary artery bypass graft (CABG)
hemorrhage, dysrhythmias, MI, kidney injury (uses contrast dye)
Elevation in the ____ in two contiguous leads is a key diagnostic indicator for MI
ST segment
complete blockage of one of the coronary arteries, completely blocking blood flow to heart
STEMI
manifestations of ACS are due to ____
an imbalance between myocardial O2 supply & demand
A syndrome characterized by episodes or paroxysmal pain or pressure in the anterior chest caused by insufficient coronary blood flow
angina pectoris
angina pectoris complications
- ACS, MI, or both - Arrhythmias and cardiac arrest - Heart failure - Cardiogenic shock
nursing interventions for invasive cardiac procedures
- Assessment of patient - Reduce fear and anxiety - Monitor and manage potential complications - Provide patient education - Maintain cardiac output - Promote adequate gas exchange - Maintain fluid and electrolyte balance - Minimize sensory-perception imbalance - Relieve pain - Maintain adequate tissue perfusion - Maintain body temperature - Promote health and community-based care
medications to treat CAD
- Cholesterol lowering medications - Antiplatelets (first-line agents) - Diuretics (decrease BP) - Nitroglycerin (angina) - ACE inhibitors (decrease BP) - Beta-blockers (HTN & angina) - Calcium-channel blockers (HTN & angina)
classes of lipid-lowering medications
- HMG-CoA reductase inhibitors (statins) - Nicotinic acids (niacin) - Fibric acids (fibrates) - Bile acid sequestrants (resins) - Cholesterol absorption inhibitors - Omega-3 acid-ethyl esters - Proprotein Convertase Subtilisin-Kexin Type 9 (PCSK9) Agents
CAD can result in ____.
- Myocardial infarction - Heart failure - Sudden cardiac death
Factors associated w/ typical anginal pain
- Physical exertion - Exposure to cold, which causes vasoconstriction and elevated BP - Eating a heavy meal - Stress or any emotion-provoking situation
5 types of angina
- Stable angina - Unstable angina - Intractable/refractory angina ·- Variant angina ·- Silent ischemia
difference between stable angina & MI
- Stable angina: precipitated by exertion or stress, pain relieved by rest or nitroglycerin, symptoms last <15 min, not associated w/ epigastric pain, nausea, dyspnea, anxiety, or diaphoresis - MI: can occur w/o cause, pain relieved only by opioids, symptoms last >30 min, associated w/ epigastric pain, nausea, dyspnea, anxiety, or diaphoresis
ECG should be taken within ____ of arrival for suspected ACS
10 min
Total fat should make up ____% of the total calories.
25-30
Total creatine kinase (CK) returns to normal in ____
3 days
typical angina pain lasts ____
5-15 min
The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? A) 160-190 mg/dL B) 210-240 mg/dL C) 250-275 mg/dL D) 280-300 mg/dL
A) 160-190 mg/dL
After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? A) Apply manual pressure at the site of the insertion of the sheath. B) Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. C) Decrease anticoagulant or antiplatelet therapy. D) Notify the health care provider.
A) Apply manual pressure at the site of the insertion of the sheath.
A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication? A) Atelectasis B) Elevated blood glucose level C) Hyperkalemia D) Urinary tract infection (UTI)
A) Atelectasis
Which is a diagnostic marker for inflammation of vascular endothelium? A) C-reactive protein (CRP) B) Low-density lipoprotein (LDL) C) High-density lipoprotein (HDL) D) Triglyceride
A) C-reactive protein (CRP)
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. Decreases resting heart rate
A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? A) Prothrombin time (PT) or international normalized ratio (INR) B) Hourly IV infusion C) Vascular sites for bleeding D) Urine output
A) Prothrombin time (PT) or international normalized ratio (INR)
emergent situation characterized by an acute onset of myocardial ischemia that results in MI if interventions do not occur promptly
Acute Coronary Syndrome (ACS)
The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? A) atherosclerosis B) diabetes mellitus C) myocardial infarction D) renal failure
A) atherosclerosis
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? A) calcium-channel blocker B) beta-adrenergic blocker C) nitrate D) diuretic
A) calcium-channel blocker
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? A) pericardial friction rub B) hypothermia C) decreased white blood cell (WBC) count D) decreased erythrocyte sedimentation rate (ESR)
A) pericardial friction rub
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? A. "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." B. "Both terms refer to the same disorder and can be used interchangeably." C. "Both are disorders in which the lining of the vessels become narrowed due to plaque." D. "Arteriosclerosis is when the vessels become dilated and weakened, whereas atherosclerosis is the deposit of fatty substances in the vessel lining."
A. "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."
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. "See if rest relieves the chest pain before using the nitroglycerin." 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.
A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding? A. "What color is your urine?" B. "Is your skin drier than normal?" C. "Do you have any breathing problems?" D. "How is your appetite?"
A. "What color is your urine?"
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? A. 50 seconds or less. B. 75 seconds or less. C. 100 seconds or less. D. 125 seconds or less.
A. 50 seconds or less. 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.
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? A. Altered level of consciousness B. Minimal oozing of blood from the IV site C. Presence of reperfusion dysrhythmias D. Chest pain 2 of 10 (on a 1-to-10 pain scale)
A. Altered level of consciousness 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.
After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? A. Apply manual pressure at the site of the insertion of the sheath. B. Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. C. Decrease anticoagulant or antiplatelet therapy. D. Notify the health care provider.
A. Apply manual pressure at the site of the insertion of the sheath.
A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? A. Assess the client's level of pain and administer prescribed analgesics. B. Assess the client's level of anxiety and provide emotional support. C. Prepare the client for pulmonary artery catheterization. D. Ensure that the client's family is kept informed of the client's status.
A. Assess the client's level of pain and administer prescribed analgesics. The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and family members should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? A. Clopidogrel B. Amlodipine C. Diltiazem D. Felodipine
A. Clopidogrel
A client comes to the emergency department (ED) reporting precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? A. Coronary artery disease B. Raynaud syndrome C. Cardiogenic shock D. Venous occlusive disease
A. Coronary artery disease The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud syndrome in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
Which of the following is inconsistent as a condition related to metabolic syndrome? A. Hypotension B. Insulin resistance C. Abdominal obesity D. Dyslipidemia
A. Hypotension
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 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.
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? A. Inadequate tissue perfusion B. Mental alertness C. Blood glucose concentration D. Activity intolerance
A. Inadequate tissue perfusion
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. Instruct the client on side effects of flushing, throbbing headache, and tachycardia.
A client reports chest pain that occurs when playing tennis but resolves when sitting down. The nurse knows these symptoms are common for which type of angina? A. Stable B. Variant C. Unstable D. Intractable
A. Stable
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? A. The abrupt stop can cause a myocardial infarction. B. The abrupt stop can lead to formation of blood clots. C. The abrupt stop will precipitate internal bleeding. D. The abrupt stop can trigger a migraine headache.
A. The abrupt stop can cause a myocardial infarction.
A client who has been diagnosed with Prinzmetal's angina will present with which symptom? A. chest pain that occurs at rest and usually in the middle of the night B. radiating chest pain that lasts 15 minutes or less C. prolonged chest pain that accompanies exercise D. chest pain of increased frequency, severity, and duration
A. chest pain that occurs at rest and usually in the middle of the night
A client who had coronary artery bypass surgery is exhibiting signs of heart failure. What medications will the nurse anticipate administering for this client? Select all that apply. A. diuretics B. inotropic agents C. digoxin D. amlodipine E. nitroprusside
A. diuretics B. inotropic agents C. digoxin Medical management of cardiac failure includes digoxin, diuretics, and IV inotropic agents. Amlodipine and calcium channel blockers are not used due to systolic dysfunction. Nitroprusside is a vasodilator that is not used for heart failure.
The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with A. percutaneous coronary intervention (PCI). B. IV heparin. C. IV nitroglycerin. D. thrombolytics.
A. percutaneous coronary intervention (PCI). The client with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate PCI. Superior outcomes have been reported with the use of PCI compared to thrombolytics. IV heparin and IV nitroglycerin are used to treat NSTEMI.
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? A. pericardial friction rub B. hypothermia C. decreased white blood cell (WBC) count D. decreased erythrocyte sedimentation rate (ESR)
A. pericardial friction rub
The most common symptom of CAD
Angina pectoris (chest pain)
medications after a stent is put in place
Aspirin should be continued indefinitely and clopidogrel is continued for 1 year following stent placement
fibrous cap composed of smooth muscle cells that forms over lipid deposits within arterial vessels and protrudes into the lumen of the vessel, narrowing the lumen and obstructing blood flow
Atheroma/plaque
An abnormal accumulation of lipid/fatty substances in the lumen of blood vessels which causes blockage in the coronary arteries
Atherosclerosis
The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration? A) Measure the blood pressure for hypertension. B) Count the respiratory rate for bradypnea. C) Check the radial pulse for dysrhythmias. D) Measure urinary output for dehydration.
B) Count the respiratory rate for bradypnea.
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? A) "I should avoid taking a tub bath until my catheter site heals." B) "I should expect a low-grade fever and swelling at the site for the next week." C) "I should avoid prolonged sitting." D) "I should expect bruising at the catheter site for up to 3 weeks."
B) "I should expect a low-grade fever and swelling at the site for the next week."
To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? A) 30 minutes B) 60 minutes C) 9 days D) 6 to 12 months
B) 60 minutes
An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's family members express concern to the nurse that the client is uncharacteristically confused. After reporting this change in status to the health care provider, what additional action should the nurse take? A) Educate the family about how confusion is expected in older adults postoperatively. B) Assess for factors that may be causing the client's delirium. C) Document the early signs of dementia and ensure the client's safety. D) Reorient the client to place and time.
B) Assess for factors that may be causing the client's delirium.
The nurse is providing education about the nutrient content of the Therapeutic Lifestyle Changes (TLC) diet to a community group. What information will the nurse provide? Select all that apply. A) Cholesterol should be less than 1 gram per day. B) Carbohydrates should make up 50% to 60% of the total calories. C) Dietary fiber should be 20 to 30 grams per day. D) Protein should make up approximately 15% of total calories. E) Total fat should make up only 5% of the total calories.
B) Carbohydrates should make up 50% to 60% of the total calories. C) Dietary fiber should be 20 to 30 grams per day. D) Protein should make up approximately 15% of total calories.
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? A) Myoglobin B) Troponin C) Total creatine kinase D) CK-MB
B) Troponin
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? A. Hyperlipidemia B. Hypertension C. Glucose intolerance D. Obesity
B. Hypertension 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.
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. 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. 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.
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? A. Amantadine B. Nitroglycerin C. Digoxin D. Diphenhydramine
B. Nitroglycerin 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.
While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? A. Stop the heparin infusion immediately. B. Notify the health care provider. C. Administer a coumarin derivative, as ordered, to counteract heparin. D. Reassure the client that bleeding gums are a normal effect of heparin.
B. Notify the health care provider. Because heparin can cause bleeding gums that may indicate excessive anticoagulation, the nurse should notify the health care provider, who will evaluate the client's condition. The health care provider should order laboratory tests such as partial thromboplastin time before concluding that the client's bleeding is significant. The ordered heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion unless the health care provider orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Heparin doesn't normally cause bleeding gums.
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? A. To dilate coronary arteries B. To decrease workload of the heart C. To decrease homocysteine levels D. To prevent angiotensin II conversion
B. To decrease workload of the heart
The nurse knows that women and older adult are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? A. Chest pain is typical B. Vague symptoms C. Decreased sensation to pain D. Gender bias
B. Vague symptoms
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? A. decrease anxiety B. enhance myocardial oxygenation C. administer sublingual nitroglycerin D. educate the client about his symptoms
B. enhance myocardial oxygenation
A client's elevated cholesterol levels are being managed with atorvastatin daily. What is a common side effect the nurse will teach the client that will require monitoring? A. hyperuricemia B. increased liver enzymes C. hyperglycemia D. severe muscle pain
B. increased liver enzymes Myopathy and increased liver enzymes are significant side effects of the statin Lipitor. Hyperuricemia occurs when too much uric acid is present in the blood; it is not a side effect of the statins. Hyperglycemia is increased blood glucose, which is not a side effect of the statins. Severe muscle pain is an adverse effect of statins, but it does not require monitoring.
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? A) "The medication patch causes headaches so you should remove it daily." B) "You do not need the effects of nitroglycerine while you sleep." C) "The patch should be worn for 12 hours and then removed for 12 hours." D) "Skin irritation is common when the patch is worn for more than 12 hours."
C) "The patch should be worn for 12 hours and then removed for 12 hours."
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) Elevated ST segment
A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin? A) Nausea, vomiting, depression, fatigue, and impotence. B) Sedation, nausea, vomiting, constipation, and respiratory depression. C) Headache, hypotension, dizziness, and flushing. D) Flushing, dizziness, headache, and pedal edema.
C) Headache, hypotension, dizziness, and flushing.
The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? A) cerebral bleeding B) I.M. injection C) myocardial necrosis D) skeletal muscle damage due to a recent fall
C) myocardial necrosis
inflammatory marker for cardiovascular risk
C-reactive protein (CRP)
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? A. "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." B. "Client will verbalize the intention to avoid exercise." C. "Client will verbalize the intention to stop smoking." D. "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
C. "Client will verbalize the intention to stop smoking."
A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? A. "Nitroglycerine causes headaches, but removing the patch decreases the incidence." B. "You do not need the effects of nitroglycerine while you sleep." C. "Removing the patch at night prevents drug tolerance while keeping the benefits." D. "Contact dermatitis and skin irritations are common when the patch remains on all day."
C. "Removing the patch at night prevents drug tolerance while keeping the benefits."
The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? A. Prepare to administer intravenous fluids. B. Suction the airway. C. Check blood pressure. D. Assess pupils for reactiveness.
C. Check blood pressure. During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
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. Elevated ST segment
A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? A. Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. B. Store the drug in a cool, well-lit place. C. Lie down or sit in a chair for 5 to 10 minutes after taking the drug. D. Restrict alcohol intake to two drinks per day.
C. Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? A. Isosorbide mononitrate (Isordil) B. Meperidine hydrochloride (Demerol) C. Morphine sulfate (Morphine) D. Nitroglycerin transdermal patch
C. Morphine sulfate (Morphine)
A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? A. Calcium B. Magnesium C. Potassium D. Sodium
C. Potassium
When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? A. Intractable B. Variant C. Unstable D. Refractory
C. Unstable
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? A. aspirin or acetaminophen. B. pentoxifylline or acetaminophen. C. aspirin or clopidogrel. D. penicillin V or erythromycin.
C. aspirin or clopidogrel. 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 patient who has severe chest pain after working outside on a hot day and is brought to the emergency center. The nurse administers nitroglycerin to help alleviate chest pain. What adverse effect should concern the nurse the most? A.Dry mucous membranes B.Heart rate of 88 bpm C.Blood pressure of 86/58 mm Hg D.Complaints of headache
C.Blood pressure of 86/58 mm Hg
increased ____ is an indicator for angina & CAD
CRP
life-threatening condition in which your heart suddenly can't pump enough blood to meet your body's needs
Cardiogenic shock
____ is the leading cause of death in the United States for men and women of all racial and ethnic groups
Cardiovascular disease
surgical procedure in which a blood vessel is grafted to an occluded coronary artery so that blood can flow beyond the occlusion
Coronary artery bypass graft (CABG)
____ is the most prevalent cardiovascular disease in adults
Coronary artery disease (CAD)
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? A) "The pain lasted about 45 minutes." B) "The pain resolved after I ate a sandwich." C) "The pain got worse when I took a deep breath." D) "The pain occurred while I was mowing the lawn."
D) "The pain occurred while I was mowing the lawn."
A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. The client's cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. What is the best response by the nurse? A) Cholesterol is within the recommended guidelines and the client doesn't need to lower it. B) Client should take statin medication and not worry about cholesterol. C) Client should begin a running program, working up to 2 miles per day. D) The nurse will ask the dietitian to talk with the client about modifying the diet.
D) The nurse will ask the dietitian to talk with the client about modifying the diet.
A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also reports 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. 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 alert the cardiac catheterization team.
D. Administer oxygen, attach a cardiac monitor, take vital signs, and alert the cardiac catheterization team. 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.
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? A. Uterus B. Blood vessels C. Bronchi D. Heart
D. Heart
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? A. Inform client of diagnostic tests. B. Remove hair from skin insertion sites. C. Assess distal pulses. D. Withhold anticoagulant therapy.
D. Withhold anticoagulant therapy. 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.
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? A. blood pressure of 129/72 mm Hg B. heart rate of 87 bpm C. hemoglobin of 16 g/dL D. hematocrit of 30%
D. hematocrit of 30%
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? A. streptokinase, aspirin, and morphine administration B. morphine administration, stress testing, and admission to the cardiac care unit C. serial liver enzyme testing, telemetry, and a lidocaine infusion D. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
D. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry 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 caring for a patient after cardiac surgery. Which nursing intervention is appropriate to help prevent complications arising from venous stasis? A.Encourage crossing of legs B.Use pillows in the popliteal space to elevate the knees in the bed C.Discourage exercising D.Apply sequential pneumatic compression devices as prescribed
D.Apply sequential pneumatic compression devices as prescribed
The nurse is caring for a patient with hypercholesterolemia who has been prescribed atorvastatin. What serum levels should be monitored in this patient? A.Complete blood count (CBC) B.Blood cultures C.Na and K levels D.Liver enzymes
D.Liver enzymes
myocardial infarction (MI)
Death of cardiac muscle due to ischemia
time from the patient's arrival in the ED to the time PCI is performed; should be less than 90 min
Door-to-balloon time
angina characterized by severe incapacitating chest pain
Intractable/refractory angina
not a complete blockage of the coronary arteries, less damage
NSTEMI
nursing interventions for ACS/MI
O2, medications, frequent VS, rest w/ HOB elevated, decreased heart workload, monitor tissue perfusion, frequent position changes
Myoglobin peak & duration
Peak: 12 hours Duration: <24 hours
CK-MB peak & duration
Peak: 24 hours Duration: 3-4 days
ECG findings suggesting MI.
T-wave inversion, ST-segment elevation, and abnormal Q wave
____ therapy is initiated when primary PCI is not available or the transport time to a PCI-capable hospital is too long
Thrombolytic
medications that break down blood clots
Thrombolytic (fibrinolytics)
why are stents used
To keep arteries open if they begin to narrow and restrict blood flow
a protein found in myocardial cells that regulates the myocardial contractile process
Troponin
Troponin duration
Troponin I: 7-10 days Troponin T: 10-14 days
elevation in ____ may indicate MI
Troponin, creatine kinase, and myoglobin
type of angina in which symptoms increase in frequency & severity; may not be relieved by rest or nitroglycerin
Unstable (prefarction) angina
angina characterized by pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm
Variant (Prinzmetal's) angina
sudden constriction or narrowing of a coronary artery
Vasospasm
An increase in total CK might occur due to ____
brain injuries such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery
4 major modifiable risk factors for developing CAD
cholesterol abnormalities, tobacco use, HTN, and diabetes
difference between HF & cardiac arrest
cardiac arrest comes on suddenly, HF occurs gradually
The patient with STEMI is taken directly to the ____
cardiac catheterization laboratory for an immediate PCI
Fluid and clots accumulate in the pericardial sac, which compress the heart, preventing blood from filling the ventricles
cardiac tamponade
Acute Coronary Syndrome (ACS) S&S
chest pain, JVD, SOB, crackles, N&V, anxiety, indigestion, cool/pale/moist skin, tachycardia, tachypnea, HTN
Heart disease that results from narrowing of the coronary arteries over time due to atherosclerosis
coronary artery disease (CAD)
In ____, blockages and narrowing of the coronary vessels reduce blood flow to the myocardium
coronary atherosclerosis
silent angina typically occurs in ____
diabetic patients w/ neuropathy
other symptoms of CAD
epigastric distress, pain that radiates to jaw or left arm, SOB, atypical symptoms in women (indigestion, nausea, palpitations, numbness, fatigue, weakness)
S&S of post-pericardiotomy syndrome
fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, arthralgia, leukocytosis (elevated WBCs)
vein most commonly used for CABG
greater saphenous vein, followed by lesser saphenous vein
synonym for myocardial infarction
heart attack
difference between ischemia & infarction
ischemia is reversible, infarction results in permanent damage
diet recommended for preventing CAD
low in fat (20-30 g/d), low in cholesterol (<200 mg/d) & salt (<2 g/day)
A cluster of metabolic abnormalities including insulin resistance, obesity, dyslipidemia, high levels of CRP, prothrombotic state, and HTN that increase the risk of cardiovascular disease
metabolic syndrome
Exercise recommendations for preventing CAD
moderate-intensity aerobic activity of at least 150 minutes per week or vigorous-intensity aerobic activity of at least 75 minutes per week
insufficient tissue oxygenation to the heart
myocardial ischemia
symptoms of CAD are caused by ____.
myocardial ischemia
Cardiac catheterization procedure used to open the occluded coronary artery and promote reperfusion to the area that has been deprived of oxygen; treats the underlying atherosclerotic lesion
percutaneous coronary intervention (PCI)
procedure in which a balloon-tipped catheter is used to open blocked coronary vessels and resolve ischemia
percutaneous transluminal coronary angioplasty (PTCA)
types of PCIs
percutaneous transluminal coronary angioplasty (PTCA), coronary artery stents
pathophysiology of ACS
reduced blood flow in a coronary artery due to rupture of atherosclerotic plaque
process in which the area that has been treated may close off partially or completely after PTCA
restenosis
angina characterized by objective evidence of ischemia (such as electrocardiographic changes w/ a stress test), but patient reports no pain
silent ischemia
metal mesh that provides structural support to a vessel at risk of acute closure
stent
The patient with suspected MI should immediately receive ____
supplemental oxygen, aspirin, nitroglycerin, and morphine
CABG procedure is performed w/ ____
the patient under general anesthesia
if a vasovagal response occurs ____
the pt's legs should be raised above the level of his head and IV fluids & IV atropine should be administered
Arterial grafts are preferred to venous grafts b/c
they do not develop atherosclerotic changes as quickly & remain patent longer
____ angina requires medical intervention
unstable
Range of ACS includes ____
unstable angina, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI)
medications for angina
· *Nitroglycerin · Beta blockers (metoprolol) · Calcium channel blockers (amlodipine, diltiazem) · Antiplatelets & anticoagulants (aspirin, heparin)
nursing interventions for CAD
· Ask the patient to grade the severity of the pain on a scale of 1 to 10 · Administer medications as prescribed · Obtain a 12-lead ECG if the patient experiences angina · Place the patient in a position w/ HOB elevated or in Fowler position to allow for maximum chest expansion · Obtain specimens for laboratory testing, such as serum lipid levels, as ordered. · Auscultate heart and lung sounds for changes · Monitor VS, cardiac status, presence of edema, pulses, pulmonary status, daily weight, I&O, fluid intake
nursing interventions for angina
· Stop activity & rest · Assess VS & ECG · Administer up to 3 doses of nitroglycerin · Reassess pain · Administer O2 2 L/min NC · Reduce anxiety
