Critical Care of Patients With Acute Coronary Syndromes (1)

A patient has undergone percutaneous coronary intervention (PCI) through the right femoral artery and has received bivalirudin infusion during the procedure. What is the nurse's priority action when the patient returns?

Monitor insertion site for bleeding Bivalirudin is a direct thrombin inhibitor used during PCI; by inhibiting thrombin, bleeding may occur. Cough may be a symptom of heart failure, but is not a specific complication of the PCI. The urine output should be monitored as contrast is used during PCI, but observing for hemorrhage is the priority. A local anesthetic is used during PCI, and pain may indicate hematoma; however, observation for bleeding is essential as a large artery is entered for this procedure and anticoagulation is used.

Which statement by a patient scheduled for a percutaneous coronary intervention (PCI) indicates a need for further preoperative teaching?

My angina will be gone for good Reocclusion is possible after PCI. The patient is typically awake, but drowsy, during this procedure. PCI uses a balloon to widen the artery, and the patient will have to lie still after the procedure because of the large-bore venous access. Time is necessary to allow the hole to heal and prevent hemorrhage.

The visiting nurse is seeing a client postoperative for coronary artery bypass graft. Which nursing action should be performed first? 1 Assess coping skills. 2 Assess for postoperative pain at the client's incision site. 3 Monitor for dysrhythmias. 4 Monitor mental status.

Monitor for dysrhythmias. Dysrhythmias are the leading cause of prehospital death; the nurse should monitor the client's heart rhythm. Assessing mental status, coping skills, or postoperative pain is not the priority for this client.

Which task does the nurse delegate to unlicensed assistive personnel (UAP) who is assisting with the care of a female client with anemia? a. Monitor the oral mucosa for pallor, bleeding, or ulceration b. Ask about the amount of blood loss with each menstrual period c. Check for sternal tenderness while applying fingertip pressure d. Count the respiratory rate before and after ambulating 20 feet (6 m)

D

with which client will the nurse apply pressure to an injection site for 5 minutes because of an increased risk for bleeding? a. 28-year-old who has had type 1 diabetes for 15 years b. 42-year-old newly diagnosed with type 2 diabetes c. 58-year-old with chronic hypertension and heart failure d. 62-year-old with extensive liver damage from cirrhosis

D

Which characteristics place women at high risk for myocardial infarction (MI)?

-Increasing age -Family history -Abdominal obesity

When planning care for a client in the emergency department, which interventions are needed in the acute phase of myocardial infarction?

-Morphine sulfate -Oxygen -Nitroglycerin

When planning care for a client in the emergency department, which interventions are needed in the acute phase of myocardial infarction? Select all that apply. 1 Morphine sulfate 2 Oxygen 3 Nitroglycerin 4 Naloxone 5 Acetaminophen 6 Verapamil (Calan, Isoptin)

-Morphine sulfate -Oxygen -Nitroglycerin Morphine is needed to reduce oxygen demand, preload, pain, and anxiety, and nitroglycerin is used to reduce preload and chest pain. Administering oxygen will increase available oxygen for the ischemic myocardium. Naloxone is a narcotic antagonist that is used for overdosage of opiates, not for MI. Acetaminophen may be used for headache related to nitroglycerin. Because of negative inotropic action, calcium channel blockers like verapamil are used for angina, not for MI.

The nurse is preparing to teach a client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion?

-Truncal obesity -Hypercholesterolemia -Glucose intolerance -Client taking losartan (Cozaar)

After reviewing the laboratory test results, the nurse calls the primary care provider about which client? a. A 52-year-old who had a hemorrhage with a reticulocyte count of 0.8% b. A 49-year-old with hemophilia and a platelet count of 150,000/mm3 (150 × 109/L) c. A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L) d. A 44-year-old prescribed warfarin (Coumadin) with an international normalized ratio (INR) of 3.0

C

The nurse is assessing a client for hematologic risks. Which health history question would the nurse ask to determine if the risk cannot be reduced or eliminated? a. "Where do you work?" b. "Tell me what you eat in a day." c. "Does anyone in your family bleed a lot?" d. "Do you seem to have excessive bleeding or bruising?"

C

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? a. Uses a prepared list and finds out the client's food preferences b. Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) c. Has the client write down everything he or she has eaten for the past week d. Determines who prepares the client's meals and plans an interview with him or her

C

The nurse is caring for a group of hospitalized clients. Which client is at highest risk for infection and sepsis? a. A client with hemolytic anemia b. A client with cirrhosis of the liver c. A client who had an emergency splenectomy d. A client with recently diagnosed sickle cell anemia

C

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased laboratory value would be of greatest concern to the nurse because it is not age-related? a. Hemoglobin level b. Red blood cell (RBC) count c. Platelet (thrombocyte) count d. White blood cell (WBC) response

C

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? a. "The doctor will place a small needle in your back and will withdraw some fluid." b. "You will be sedated during the procedure, so you will not be aware of anything." c. "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." d. "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area."

C

Which task does the nurse delegate to unlicensed assistive personnel (UAP)? a. Refer a client with a daily alcohol consumption of 12 beers for counseling b. Obtain a partial thromboplastin time from a saline lock on a client with a pulmonary embolism c. Report any bleeding noted when catheter care is given to a client with a history of hemophilia d. Perform a capillary fragility test to check vascular hemostatic function on a client with liver failure

C

what is the most important precaution for the nurse to teach a client whose platelet counts usually range between 50,000 to 60,000/mm3? a. drink at least 3 L of fluid daily b. take a multiple vitamin that contains iron c. avoid aspirin and aspirin-containing drugs d. increase your intake of dark green, leafy vegetables

C

When assessing a patient with evolving myocardial infarction (MI), for which associated symptom should the nurse be alert?

Vomiting In addition to chest pain, patients sustaining MI may also display dyspnea; ashen, cool, and clammy skin; diaphoresis; nausea, vomiting or epigastric pain; anxiety; and feeling of impending doom or dizziness. Leg pain may occur with fracture or deep vein thrombosis. Denial is the typical response to MI; depression may occur after an MI. An S1 heart sound or "lub" should be present at all times.

When administering morphine sulfate to a patient with a myocardial infarction, the nurse observes for which adverse effects? Select all that apply.

Vomiting Respiratory depression

The visiting nurse is seeing a client postoperative for coronary artery bypass graft. Which nursing action should be performed first?

Monitor for dysrhythmias.

The visiting nurse is seeing a patient postoperative for coronary artery bypass graft. Which nursing action should be performed first?

Monitor for dysrhythmias.

What medications should the nurse assess the patient for prior to administering nitroglycerin for chest pain? Select all that apply.

Tadalafil and sildenafil They are phosphodiesterase inhibitors used for treatment of erectile dysfunction. When given with nitroglycerin, they can cause profound hypotension. Cardizem, carvedilol, and metoprolol are not contraindicated with administration of nitroglycerin.

The nurse is providing health education to a patient with coronary artery disease after surgical intervention. What instructions should the nurse give to this patient? Select all that apply.

"Avoid exercising when your pulse increases more than 20 beats/min. Avoid straining activities Straining activities like lifting and pushups may make the sternum's healing process worse. Stopping exercise when the pulse increases to more than 20 beats/min will decrease the risk of injury and fatigue. Nitroglycerin is used in case of emergency (sudden rise in blood pressure) and should be carried by the patient. Outdoor exercise in good weather is refreshing. A patient's pulse should be checked prior to exercise, and if the pulse rate is higher than it should be, the patient should stop exercising. After exercise, the patient's pulse should be checked to avoid any complications such as shortness of breath and dizziness.

The nursing student is assisting with the care of a patient who has undergone coronary artery bypass grafting (CABG). Which statement by the student about the procedure indicates a need for further teaching by the supervising nurse?

"Best outcomes from CABG occur when coronary arteries have less than a 50% occlusion." In CABG, the vessels to be bypassed typically have 70% or more of the vessel blocked; bypassing vessels with lesser occlusion may result in early obstruction. CABG is used for left main coronary artery disease that is not amenable to stent placement. Quality of life rather than lifespan is improved with CABG. Ninety percent of internal mammary artery grafts remain patent for 12 years.

What statement by the nurse is most important for a patient experiencing a myocardial infarction who is upset and tells the nurse he or she is afraid of dying?

"I am sure you are scared, but I am not going to leave you."

What should a patient do if he has new-onset angina at home?

"Ingest 4 baby aspirins 81 mg each." A patient with new-onset angina at home is advised to chew 325 mg of aspirin, or 4 baby aspirins, 81 mg each, immediately and then call 911. Ingesting 4 baby aspirins 85 mg each; 3 baby aspirins 81 mg each; and 3 baby aspirins 85 mg each, do not meet the recommended dose requirements.

Which statement by a client scheduled for a percutaneous transluminal coronary angioplasty (PTCA) indicates a need for further preoperative teaching?v

"My angina will be gone for good."

A client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct?

"These arteries remain open longer."

A client with unstable angina has received education about acute coronary syndrome. Which statement indicates that the client has understood the teaching?

"This is a big warning; I must modify my lifestyle or risk having a heart attack in the next year."

A client with unstable angina has received education about acute coronary syndrome. Which statement indicates that the client has understood the teaching? 1 "This is a big warning; I must modify my lifestyle or risk having a heart attack in the next year." 2 "Angina is just a temporary interruption of blood flow to my heart." 3 "I need to tell my wife I've had a heart attack." 4 "Because this was temporary, I will not need to take any medications for my heart."

"This is a big warning; I must modify my lifestyle or risk having a heart attack in the next year." Among people who have unstable angina, 10% to 30% have a myocardial infarction within 1 year. Although anginal pain is temporary, it reflects underlying coronary artery disease (CAD), which requires attention, including lifestyle modifications. Unstable angina reflects tissue ischemia, but infarction represents tissue necrosis. Clients with underlying CAD may need medications such as aspirin, lipid-lowering agents, antianginals, or antihypertensives.

During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response?

"Where might you be able to walk?"

During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response? 1 "You are right. Work on your diet then." 2 "You must find someplace to walk." 3 "Walk around the edge of your apartment complex." 4 "Where might you be able to walk?"

"Where might you be able to walk?" Asking the client where he or she might be able to walk calls for cooperation and participation from the client; increased activity is imperative for this client. Telling the client to work on diet is an inappropriate response. Telling the client to find someplace to walk is too demanding to be therapeutic. Telling the client to walk around the apartment complex is domineering and will not likely achieve cooperation from the client.

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? 1 "The doctor will place a small needle in your back and will withdraw some fluid." 2 "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." 3 "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area." 4 "You will be sedated, so you will not be aware of anything."

"You may experience a crunching sound or a scraping sensation as the needle punctures your bone." It is accurate to describe a crunching sound or scraping sensation. Proper expectations minimize the client's fear during the procedure. A very large-bore needle is used for a bone marrow biopsy, not a small needle; the puncture is made in the hip or in the sternum, not the back. The nurse, or sometimes a family member, is available to the client for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site. A local anesthetic agent is injected into the skin around the site. The client may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated.

A client with coronary artery disease (CAD) wants to start an exercise program. What should the client know about physical activity? Select all that apply. 1 Older adults should plan shorter warm-up and cool-down periods 2 Check with the healthcare provider before staring an exercise program 3 Walking less than 30 minutes per day is not beneficial 4 Exercise periods should be at least 40 minutes long with warm-up and cool-down periods 3-4 times per week 5 Walk 30 minutes per day at a comfortable pace if moderate exercise 3-4 times per week is not tolerable

-Check with the healthcare provider before staring an exercise program -Exercise periods should be at least 40 minutes long with warm-up and cool-down periods 3-4 times per week -Walk 30 minutes per day at a comfortable pace if moderate exercise 3-4 times per week is not tolerable The client with CAD should check with their healthcare provider before starting an exercise program. Exercise programs should be at least 40 minutes long with warm-up and cool-down periods, however, older adults should plan longer warm-up and cool-down periods. Their pulse rates may not return to baseline until 30 minutes or longer after exercise. Daily walks for 30 minutes at a comfortable pace is appropriate for the client who cannot tolerate 40 minutes of moderate exercise 3-4 times per week. Any walking distance is beneficial.

The nurse is concerned that a client who had myocardial infarction (MI) has developed cardiogenic shock. Which findings indicate shock?

-Cool, diaphoretic skin -Crackles in the lung fields -Anxiety and restlessness

Which atypical symptoms may be present in a female client experiencing myocardial infarction (MI)?

-Dyspnea -Dizziness -Extreme fatigue

An LPN/LVN is scheduled to work on the inpatient "step-down" cardiac unit. Which client does the charge nurse assign to the LPN/LVN? 1 60-year-old who was admitted today for pacemaker insertion because of third-degree heart block and who is now reporting chest pain 2 62-year-old who underwent open heart surgery 4 days ago for mitral valve replacement and who has a temperature of 38.2° C 3 66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is scheduled for discharge to a group home later today 4 69-year-old who had a stent placed 2 hours ago in the left anterior descending artery and who has bursts of ventricular tachycardia

66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is scheduled for discharge to a group home later today The LPN/LVN scope of practice includes administration of medications to stable clients. Third-degree heart block is characterized by a very low heart rate and usually by required pacemaker insertion; the skills of the RN are needed to care for this client. Fever after surgery requires collaboration with the health care provider, which is more consistent with the role of the RN. The client with a recent stent placement and having bursts of ventricular tachycardia is unstable and is showing ventricular irritability; he will need medications and monitoring beyond the scope of practice of the LPN/LVN.

A patient weighing 165 lbs reports having chest discomfort for the past 50 minutes. The primary health care provider prescribes thrombolytic therapy followed by aspirin and IV heparin. Subcutaneous administration of low-molecular-weight heparin (LMWH) was prescribed followed by the administration of IV heparin. What is the dose of heparin that the nurse should administer? Record your answer using a whole number. ______ mg

75 The dosage of LMWH is based on the weight of the patient (1mg/kg). 165 lbs is equal to 75 kg, so the dosage of LMWH for a patient weighing 165 lbs is 75 mg.

Which is the most suitable body temperature for cardiopulmonary bypass?

96° F

What should be the temperature of warm cardioplegia?

98 o F

Which client does the medical unit charge nurse assign to a licensed practical nurse (LPN)/licensed vocational nurse (LVN)? a. A client with chronic microcytic anemia associated with alcohol use b. A client scheduled for a bone marrow biopsy with conscious sedation c. A client with a history of a splenectomy and a temperature of 100.9°F (38.3°C) d. A client with atrial fibrillation and an international normalized ratio of 6.6

A

An LPN/LVN is scheduled to work on the inpatient "stepdown" cardiac unit. Which client does the charge nurse assign to the LPN/LVN?

A 66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is scheduled for discharge to a group home later today

After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first? The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea The client with percutaneous coronary angioplasty who has a dose of heparin scheduled The client who had bradycardia after a myocardial infarction and now has a paced heart rate of 64 beats/min A client who has first-degree heart block, rate 68 beats/min, after having an inferior myocardial infarction

A. Dyspnea and weight gain are symptoms of left ventricular failure and pulmonary edema; this client needs prompt intervention. A scheduled heparin dose does not take priority over dyspnea; it can be administered after the client with dyspnea is taken care of. The client with a pacemaker and a normal heart rate is not in danger. First-degree heart block is rarely symptomatic, and the client has a normal heart rate; the client with dyspnea should be seen first.

A client with unstable angina has received education about acute coronary syndrome. Which statement indicates that the client has understood the teaching? "This is a big warning; I must modify my lifestyle or risk having a heart attack in the next year." "Angina is just a temporary interruption of blood flow to my heart." "I need to tell my wife I've had a heart attack." "Because this was temporary, I will not need to take any medications for my heart."

A. Among people who have unstable angina, 10% to 30% have a myocardial infarction within 1 year. Although anginal pain is temporary, it reflects underlying coronary artery disease (CAD), which requires attention, including lifestyle modifications. Unstable angina reflects tissue ischemia, but infarction represents tissue necrosis. Clients with underlying CAD may need medications such as aspirin, lipid-lowering agents, anti-anginals, or antihypertensives.

When planning care for a client in the emergency department, which interventions are needed in the acute phase of myocardial infarction? (Select all that apply.) Morphine sulfate Oxygen Nitroglycerin Naloxone Acetaminophen Verapamil (Calan, Isoptin)

A.B.C. used to reduce preload and chest pain. Administering oxygen will increase available oxygen for the ischemic myocardium. Naloxone is a narcotic antagonist that is used for overdosage of opiates, not for MI. Acetaminophen may be used for headache related to nitroglycerin. Because of negative inotropic action, calcium channel blockers such as verapamil are used for angina, not for MI.

The nurse is preparing to teach a client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion? (Select all that apply.) Truncal obesity Hypercholesterolemia Elevated homocysteine levels Glucose intolerance Client taking losartan (Cozaar)

A.B.D.E. A large waist size (excessive abdominal fat causing central obesity)—40 inches (102 cm) or greater for men, 35 inches (88 cm) or greater for women—is a sign of metabolic syndrome. Decreased high-density lipoprotein cholesterol (HDL-C) (usually with high low-density lipoprotein cholesterol)—HDL-C less than 40 mg/dL for men or less than 50 mg/dL for women—or taking an anticholesterol drug is a sign of metabolic syndrome. Increased fasting blood glucose (caused by diabetes, glucose intolerance, or insulin resistance) is included in the constellation of metabolic syndrome. Blood pressure greater than 130/85 mm Hg or taking antihypertensive medication indicates metabolic syndrome. Although elevated homocysteine levels may predispose to atherosclerosis, they are not part of metabolic syndr

What medication is administered prior to nitrates to reduce headache discomfort?

Acetaminophen Acetaminophen is indicated for relief of headache prior to the administration of nitrates. Morphine is not indicated for treating headaches. Ibuprofen is not indicated for headaches in patients taking nitrates. Clopidogrel is not indicated for headaches

A patient has been admitted to the emergency department with chest pain and tightness and shortness of breath. After an initial assessment, the nurse suspects the patient has acute coronary syndrome (ACS). What will the nurse expect the health care provider to do immediately based on the recommendations provided by the American Heart Association (AHA)?

Administer morphine sulphate to the patient.

The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure?

Anterior wall

The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure? 1 Inferior wall 2 Anterior wall 3 Lateral wall 4 Posterior wall

Anterior wall Due to the large size of the anterior wall, the amount of tissue infarction may be large enough to decrease the force of contraction, leading to heart failure. The client with an inferior wall MI is more likely to develop right ventricular MI. Clients with obstruction of the circumflex artery may experience a lateral wall MI and sinus dysrhythmias or a posterior wall MI and sinus dysrhythmias.

An older adult patient, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take?

Assess pulmonary artery wedge pressure Decreased preload as exhibited by decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation; hypotension could cause the graft to collapse. Low blood pressure is not normal in older adults or postoperative patients. The cause of hypotension must be found and treated; further action is needed to determine additional interventions. Hypotension could be caused by hypovolemia; giving loop diuretics increases hypovolemia.

An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take?

Assess pulmonary artery wedge pressure (PAWP).

An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take? 1 No action is required; low blood pressure is normal for older adults. 2 No action is required for postsurgical CABG clients. 3 Assess pulmonary artery wedge pressure (PAWP). 4 Give ordered loop diuretics.

Assess pulmonary artery wedge pressure (PAWP). Decreased preload as exhibited by decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation; hypotension could cause the graft to collapse. Low blood pressure is not normal in older adults or postoperative clients. The cause of hypotension must be found and treated; further action is needed to determine additional interventions. Hypotension could be caused by hypovolemia; giving loop diuretics increases hypovolemia.

A client has a bone marrow biopsy performed. What is the priority postprocedure nursing action? a. Inspect the site for ecchymosis b. Apply pressure to the biopsy site c. Send the biopsy specimens to the laboratory d. Teach the client to avoid vigorous activity

B

The nurse is assessing an adult client's endurance in performing activities of daily living (ADLs). What question would the nurse ask the client? a. "Can you prepare your own meals every day?" b. "How is your energy level compared with last year?" c. "Has your weight changed by 5 pounds (2.3 kg) or more this year?" d. "What medications do you take daily, weekly, and monthly?"

B

The nurse is starting the shift by making rounds. Which client would the nurse assess first? a. A 52-year-old who just had a bone marrow aspiration and is requesting pain medication b. A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism c. A 47-year-old who had a Rumpel-Leede test and asks the nurse to "look at the bruises on my arm" d. A 42-year-old with a diagnosis of anemia who reports shortness of breath when ambulating down the hallway

B

The nurse is teaching a client who is preparing for discharge after a bone marrow aspiration. The nurse provides which discharge instructions to the client? a. "Inspect the site for bleeding every 4 to 6 hours." b. "Place an ice pack over the site to reduce the bruising." c. "Avoid contact sports or activity that may traumatize the site for 24 hours." d. "Take a mild analgesic, such as two aspirin, for pain or discomfort at the site."

B

the nurse performing a hematologic assessment on an older adult client identifies the following findings. which ones does the nurse associate with age-related changes rather than a specific hematologic problem? select all that apply. a. bleeding gums b. dry skin on distal extremities c. pale lips d. smooth tongue e. sparse pubic hair f. bright yellow-tinged sclera

B, E

A client comes to the emergency department with chest discomfort. Which action does the nurse perform first? Administers oxygen therapy Obtains the client's description of the chest discomfort Provides pain relief medication Remains calm and stays with the client

B. A description of the chest discomfort must be obtained first, before further action can be taken. Neither oxygen therapy nor pain medication is the first priority in this situation; an assessment is needed first. Remaining calm and staying with the client are important, but are not matters of highest priority.

After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign? A 1-inch backup of blood in the IV tubing Facial drooping Partial thromboplastin time (PTT) 68 seconds Report of chest pressure during dye injection

B. During and after thrombolytic administration, the nurse observes for any indications of bleeding, including changes in neurologic status, which may indicate intracranial bleeding. A 1-inch backup of blood in the IV tubing may be related to IV positioning. If heparin is used, PTT reflects a therapeutic value. Reports of chest pressure during dye injection or stent deployment are considered an expected result of the procedure.

The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure? Urine output of 1500 mL on the preceding day Crackles in the lung fields Pedal edema Expectoration of yellow sputum

B. Manifestations of left ventricular failure and pulmonary edema are noted by listening for crackles and identifying their locations in the lung fields. A urine output of 1500 mL is normal. Edema is a sign of right ventricular heart failure. Yellow sputum indicates the presence of white blood cells and possible infection.

A client has just returned from coronary artery bypass graft surgery. For which finding does the nurse contact the surgeon? Temperature 98.2° F Chest tube drainage 175 mL last hour Serum potassium 3.9 mEq/L Incisional pain 6 on a scale of 0 to 10

B. Some bleeding is expected after surgery; however, the nurse should report chest drainage over 150 mL/hr to the surgeon. Although hypothermia is a common problem after surgery, a temperature of 98.2° F is a normal finding. Serum potassium of 3.9 mEq/L is a normal finding. Incisional pain of 6 on a scale of 0 to 10 is expected immediately after major surgery; the nurse should administer prescribed analgesics

A newly admitted client has an elevated reticulocyte count. Which condition does the nurse suspect in this client? a. Leukemia b. Aplastic anemia c. Hemolytic anemia d. Infectious process

C

Prompt pain management with myocardial infarction is essential for which reason? The discomfort will increase client anxiety and reduce coping. Pain relief improves oxygen supply and decreases oxygen demand. Relief of pain indicates that the MI is resolving. Pain medication should not be used until a definitive diagnosis has been established.

B. The focus of pain relief is on reducing myocardial oxygen demand. Chest discomfort will increase anxiety, but it may not affect coping. Relief of pain is secondary to the use of opiates or indicates that the tissue infarction is complete. Although it used to be true that pain medication was not to be used for undiagnosed abdominal pain, this does not relate to MI.

The nurse in the coronary care unit is caring for a group of clients who have had myocardial infarction. Which client does the nurse see first? Client with dyspnea on exertion when ambulating to the bathroom Client with third-degree heart block on the monitor Client with normal sinus rhythm and PR interval of 0.28 second Client who refuses to take heparin or nitroglycerin

B. Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system are involved, so the client with the third-degree heart block should be seen first. Third-degree heart block usually requires pacemaker insertion. A normal rhythm with prolonged PR interval indicates first-degree heart block, which usually does not require treatment. The client with dyspnea on exertion when ambulating to the bathroom is not at immediate risk. The client's uncooperative behavior when refusing to take heparin or nitroglycerin may indicate fear or denial; he should be seen after emergency situations have been handled.

he nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure? Inferior wall Anterior wall Lateral wall Posterior wall

B. Due to the large size of the anterior wall, the amount of tissue infarction may be large enough to decrease the force of contraction, leading to heart failure. The client with an inferior wall MI is more likely to develop right ventricular heart failure. Clients with obstruction of the circumflex artery may experience a lateral wall MI and sinus dysrhythmias or a posterior wall MI and sinus dysrhythmias.

Which characteristics place women at high risk for myocardial infarction (MI)? (Select all that apply.) Premenopausal Increasing age Family history Abdominal obesity Breast cancer

B.C.D. Increasing age is a risk factor, especially after 70 years. Family history is a significant risk factor in both men and women. A large waist size and/or abdominal obesity are risk factors for both metabolic syndrome and MI. Premenopausal women are not at higher risk for MI, and breast cancer is not a risk factor for MI.

Which atypical symptoms may be present in a female client experiencing myocardial infarction (MI)? (Select all that apply.) Sharp, inspiratory chest pain Dyspnea Dizziness Extreme fatigue Anorexia

B.C.D. Many women who experience an MI present with dyspnea, light-headedness, and fatigue. Sharp, pleuritic pain is more consistent with pericarditis or pulmonary embolism. Anorexia is neither a typical nor an atypical sign of MI.

The nurse is concerned that a client who had myocardial infarction (MI) has developed cardiogenic shock. Which findings indicate shock? (Select all that apply.) Bradycardia Cool, diaphoretic skin Crackles in the lung fields Respiratory rate of 12 breaths/min Anxiety and restlessness Temperature of 100.4° F

B.C.E. The client with shock has cool, moist skin. Because of extensive tissue necrosis, the left ventricle cannot forward blood adequately, resulting in pulmonary congestion and crackles. Because of poor tissue perfusion, a change in mental status, anxiety, and restlessness are expected. All types of shock (except neurogenic) present with tachycardia, not bradycardia. Due to pulmonary congestion, a client with cardiogenic shock typically has tachypnea. Cardiogenic shock does not present with low-grade fever; this would be more likely to occur in pericarditis.

The nurse is assessing a patient who underwent a coronary artery bypass graft (CABG). Which findings indicated by the nurse need immediate intervention?

Blood pressure: 150/90 mm Hg

A client is scheduled for a bone marrow aspiration. What is the priority nursing action before this procedure is performed? a. Hold the client's hand and ask about concerns. b. Review the client's platelet (thrombocyte) count. c. Verify that the client has given informed consent. d. Clean the biopsy site with an antiseptic or povidone-iodine (Betadine).

C

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action? a. "It will thin my blood." b. "It is used to dissolve blood clots." c. "It should prevent my blood from clotting." d. "It might cause me to get injured more often."

C

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" Which is the nurse's best response to the client? a. "Yes, they do." b. "No, they don't." c. "The number varies with gender, age, and general health." d. "You have fewer red blood cells because you have anemia."

C

The nurse in the coronary care unit is caring for a group of clients who have had myocardial infarction. Which client does the nurse see first?

Client with third-degree heart block on the monitor

An older adult client, 4 hours after coronary artery bypass graft (CABG), has a blood pressure of 80/50 mm Hg. What action does the nurse take? No action is required; low blood pressure is normal for older adults. No action is required for postsurgical CABG clients. Assess pulmonary artery wedge pressure (PAWP). Give ordered loop diuretics.

C. Decreased preload as exhibited by decreased PAWP could indicate hypovolemia secondary to hemorrhage or vasodilation; hypotension could cause the graft to collapse. Low blood pressure is not normal in older adults or postoperative clients. The cause of hypotension must be found and treated; further action is needed to determine additional interventions. Hypotension could be caused by hypovolemia; giving loop diuretics increases hypovolemia.

The visiting nurse is seeing a client postoperative for coronary artery bypass graft. Which nursing action should be performed first? Assess coping skills. Assess for postoperative pain at the client's incision site. Monitor for dysrhythmias. Monitor mental status

C. Dysrhythmias are the leading cause of prehospital death; the nurse should monitor the client's heart rhythm. Assessing mental status, coping skills, or postoperative pain is not the priority for this client.

A client undergoing coronary artery bypass grafting asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct? "This way you will not need to have a leg incision." "The surgeon prefers this approach because it is easier." "These arteries remain open longer." "The surgeon has chosen this approach because of your age."

C. Mammary arteries remain patent much longer than other grafts. Although no leg incision will be made with this approach, veins from the legs do not remain patent as long as the mammary artery graft does. Long-term patency, not ease of the procedure, is the primary concern. Age is not a determining factor in selection of these grafts.

The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity does the nurse suggest? The need to increase activities slowly at home Planning and participating in a walking program Placing a chair in the shower for independent hygiene Consultation with social worker for disability planning

C. Phase 1 begins with the acute illness and ends with discharge from the hospital; it focuses on promoting rest and allowing clients to improve their activities of daily living based on their abilities. Phase 2 begins after discharge and continues through convalescence at home, including consultation with a social worker for long-term planning; it consists of achieving and maintaining a vital and productive life while remaining within the limits of the heart's ability to respond to increases in activity and stress. Phase 3 refers to long-term conditioning, such as a walking program.

An LPN/LVN is scheduled to work on the inpatient "stepdown" cardiac unit. Which client does the charge nurse assign to the LPN/LVN? A 60-year-old who was admitted today for pacemaker insertion because of third-degree heart block and who is now reporting chest pain A 62-year-old who underwent open heart surgery 4 days ago for mitral valve replacement and who has a temperature of 38.2° C A 66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is scheduled for discharge to a group home later today A 69-year-old who had a stent placed 2 hours ago in the left anterior descending artery and who has bursts of ventricular tachycardia

C. The LPN/LVN scope of practice includes administration of medications to stable clients. Third-degree heart block is characterized by a very low heart rate and usually by required pacemaker insertion; the skills of the RN are needed to care for this client. Fever after surgery requires collaboration with the health care provider, which is more consistent with the role of the RN. The client with a recent stent placement and having bursts of ventricular tachycardia is unstable and is showing ventricular irritability; he will need medications and monitoring beyond the scope of practice of the LPN/LVN.

The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize? Reduce abdominal fat. Avoid stress. Do not smoke or chew tobacco. Avoid alcoholic beverages.

C. Tobacco exposure, including secondhand smoke, reduces coronary blood flow; causes vasoconstriction, endothelial dysfunction, and thickening of the vessel walls; increases carbon monoxide; and decreases oxygen. Because it is highly addicting, beginning smoking in the teen years may lead to decades of exposure. Teens are not likely to experience metabolic syndrome from obesity, but are very likely to use tobacco. Avoiding stress is a less modifiable risk factor, which is less likely to cause heart disease in teens. The risk of smoking outweighs the risk of alcohol use.

To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests?

CK-MB and troponin

Which drug is a beta blocker used to treat coronary artery disease (CAD)?

Carvedilol Carvedilol is a beta blocker used to treat CAD. It decreases the size of the infarct and the occurrence of ventricular dysrhythmias. Aspirin is an antiplatelet agent used to treat CAD that inhibits platelet aggregation and vasoconstriction, and decreases the occurrence of thrombosis. Clopidogrel and prasugrel are thienopyridines that prevent platelet aggregation, slowing the rate of clot formation, and are also used in the treatment of CAD.

Which drug is a beta blocker used to treat coronary artery disease (CAD)? 1 Aspirin 2 Carvedilol (Coreg) 3 Clopidogrel (Plavix) 4 Prasugrel (Effient)

Carvedilol (Coreg) Carvedilol is a beta blocker used to treat CAD. It decreases the size of the infarct and the occurrence of ventricular dysrhythmias. Aspirin is an antiplatelet agent used to treat CAD that inhibits platelet aggregation and vasoconstriction, and decreases the occurrence of thrombosis. Clopidogrel and prasugrel are thienopyridines that prevent platelet aggregation, slowing the rate of clot formation, and are also used in the treatment of CAD.

What symptom of cardiac tamponade may occur in a patient after coronary artery bypass graft (CABG) surgery?

Cessation of previously heavy mediastinal drainage

A client has just returned from coronary artery bypass graft surgery. For which finding does the nurse contact the surgeon?

Chest tube drainage 175 mL last hour

A client has just returned from coronary artery bypass graft (CABG) surgery. For which finding does the nurse contact the surgeon? 1 Temperature 98.2° F 2 Chest tube drainage 175 mL last hour 3 Serum potassium 3.9 mEq/L 4 Incisional pain 6 on a scale of 0 to 10

Chest tube drainage 175 mL last hour Some bleeding is expected after surgery; however, the nurse should report chest drainage over 150 mL per hour to the surgeon. Although hypothermia is a common problem after surgery, a temperature of 98.2° F is a normal finding. Serum potassium of 3.9 mEq/L is a normal finding. Incisional pain of 6 on a scale of 0 to 10 is expected immediately after major surgery; the nurse should administer prescribed analgesics.

A patient has just returned from coronary artery bypass graft (CABG) surgery. For which finding does the nurse contact the surgeon?

Chest tube drainage of 175ml last hour Some bleeding is expected after surgery; however, the nurse should report chest drainage over 150 mL per hour to the surgeon. Although hypothermia is a common problem after surgery, a temperature of 98.2° F is a normal finding. Serum potassium of 3.9 mEq/L is a normal finding. Incisional pain of 6 on a scale of 0 to 10 is expected immediately after major surgery; the nurse should administer prescribed analgesics.

Which complementary and alternative therapy can be helpful in preventing coronary atherosclerotic disease? 1 Reducing or stopping smoking 2 Avoiding foods with trans-fatty acids 3 Taking a multivitamin tablet each day 4 Consuming foods high in omega-3 fatty acids

Consuming foods high in omega-3 fatty acids Consuming omega-3 fatty acids from fish and plant sources has been effective in decreasing lipid levels, stabilizing atherosclerotic plaque, and reducing sudden death from myocardial infarction (MI). Smoking reduction or cessation and avoiding trans-fatty acids are standard health promotion recommendations. There is no evidence that taking a multivitamin aids in the prevention of coronary atherosclerotic disease.

The nurse is assessing a patient who has experienced a myocardial infarction (MI). The health care provider is notified when the nurse notes which finding?

Cough with pink frothy, sputum Pink, frothy sputum; wheezing; and tachypnea are symptoms of acute pulmonary edema, a life-threatening form of left ventricular failure that requires immediate intervention. While dysrhythmia is a complication of MI, a slightly lower heart rate during sleep is not emergent. A urine output of 30 mL/hr is expected; a patient making 320 mL of urine over 8 hours is putting out 40 mL/hr, which is acceptable. Stating anxiety about one's diagnosis is positive coping and does not require notification of the provider.

The nurse is assessing a client who has experienced a myocardial infarction (MI). The health care provider is notified when the nurse notes which finding? 1 Cough with pink, frothy sputum 2 Sinus bradycardia, rate of 58 beats/min during sleep 3 Urine output of 320 mL for an 8-hour shift 4 Client anxiety about the diagnosis

Cough with pink, frothy sputum Pink, frothy sputum; wheezing; and tachypnea are symptoms of acute pulmonary edema, a life-threatening form of left ventricular failure that requires immediate intervention. While dysrhythmia is a complication of MI, a slightly lower heart rate during sleep is not emergent. A urine output of 30 mL/hr is expected; a client making 320 mL of urine over 8 hours is putting out 40 mL/hr, which is acceptable. Stating anxiety about one's diagnosis is positive coping and does not require notification of the provider.

The patient in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure?

Crackles in lung field Manifestations of left ventricular failure and pulmonary edema are noted by listening for crackles [1] [2] and identifying their locations in the lung fields. A urine output of 1500 mL is normal. Edema is a sign of right ventricular heart failure. Yellow sputum indicates the presence of white blood cells and possible infection.

The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure?

Crackles in the lung fields

To validate that a patient has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests?

Creatine kinase-MB (CK-MB) and troponin

To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests? 1 Creatine kinase-MB fraction (CK-MB) and alkaline phosphatase 2 Homocysteine and C-reactive protein 3 Total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterols 4 Creatine kinase-MB (CK-MB) and troponin

Creatine kinase-MB (CK-MB) and troponin CK-MB and troponin are the cardiac markers used to determine whether MI has occurred. Alkaline phosphatase is often elevated in liver disease. Homocysteine and C-reactive protein are markers of inflammation, which may represent risk for MI, but they are not diagnostic for MI. Elevated cholesterol levels are risks for MI, but they do not validate that an MI has occurred.

A client with a low platelet count asks the nurse, "Why are platelets important?" Which statement is the nurse's best response? a. "Platelets will make your blood clot." b. "Your platelets finish the clotting process." c. "Blood clotting is prevented by your platelets." d. "The clotting process begins with your platelets."

D

A client with anemia asks the nurse, "Why am I feeling tired all the time?" What is the nurse's best response? a. "You are not getting enough iron." b. "When you are sick you need to rest more." c. "How many hours are you sleeping at night?" d. "Your cells are delivering less oxygen than you need."

D

The nurse is caring for a client 36 hours after coronary artery bypass grafting, with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the client to bed?

Respiratory rate 28 breaths/min

During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response? "You are right. Work on your diet then." "You must find someplace to walk." "Walk around the edge of your apartment complex." "Where might you be able to walk?"

D. Asking the client where he or she might be able to walk calls for cooperation and participation from the client; increased activity is imperative for this client. Telling the client to work on diet is an inappropriate response. Telling the client to find someplace to walk is too demanding to be therapeutic. Telling the client to walk around the apartment complex is domineering and will not likely achieve cooperation from the client.

To validate that a client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests? Creatine kinase-MB fraction (CK-MB) and alkaline phosphatase Homocysteine and C-reactive protein Total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol CK-MB and troponin

D. CK-MB and troponin are the cardiac markers used to determine whether MI has occurred. Alkaline phosphatase is often elevated in liver disease. Homocysteine and C-reactive protein are markers of inflammation, which may represent risk for MI, but they are not diagnostic for MI. Elevated cholesterol levels are risks for MI, but they do not validate that an MI has occurred.

Which statement by a client scheduled for a percutaneous transluminal coronary angioplasty (PTCA) indicates a need for further preoperative teaching? "I will be awake during this procedure." "I will have a balloon in my artery to widen it." "I must lie still after the procedure." "My angina will be gone for good."

D. Reocclusion is possible after PTCA. The client is typically awake, but drowsy, during this procedure. PTCA uses a balloon to widen the artery, and the client will have to lie still after the procedure because of the large-bore venous access. Time is necessary to allow the hole to heal and prevent hemorrhage.

The nurse is assessing a client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI? Chest pain brought on by exertion or stress Substernal chest discomfort occurring at rest Substernal chest discomfort relieved by nitroglycerin or rest Substernal chest pressure relieved only by opioids

D. Substernal chest pressure relieved only by opioids is typically indicative of MI. Substernal chest discomfort that occurs at rest is not necessarily indicative of MI; it could be a sign of unstable angina. Both chest pain brought on by exertion or stress and substernal chest discomfort relieved by nitroglycerin or rest are indicative of angina.

The nurse is caring for a client 36 hours after coronary artery bypass grafting, with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the client to bed? Pulse 60 beats/min and regular Urinary frequency Incisional discomfort Respiratory rate 28 breaths/min

D. Tachypnea and tachycardia reflect activity intolerance; activity should be terminated. Pulse 60 beats/min and regular is a normal finding. Urinary frequency may indicate infection or diuretic use, but not activity intolerance. Pain with activity after surgery is anticipated; pain medication should be available.

Which client activity best reflects the goal of phase 3 cardiac rehabilitation? 1 Beginning a weightlifting program 2 Developing a plan to walk briskly for physical conditioning 3 Resting and possibly ambulating short distances three times daily 4 Returning home and convalescing from the myocardial infarction

Developing a plan to walk briskly for physical conditioning Three phases of cardiac rehabilitation exist. Phase 1 begins with the acute illness and ends with discharge from the hospital. Phase 2 begins after discharge and continues through convalescence at home. Phase 3 refers to long-term conditioning. Weightlifting is not a recommended activity as the client often holds the breath and performs the Valsalva maneuver while lifting, which can cause bradycardia.

The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize?

Do not smoke or chew tobacco.

Which drug is an inotrope that may be used to maintain organ perfusion in a patient who had heart failure after a myocardial infarction (MI)?

Dobutamine Dobutamine is an inotrope that may be used to maintain organ perfusion in a patient who sustained heart failure after an MI. Dobutamine increases the force of cardiac contraction. Nitroglycerin and fenoldopam are nitrates that are used to maintain organ perfusion. Nitrates cause vasodilation of arteries and veins. Milrinone is also an inotrope, but it is also classified as a nitrate because of its vasodilation effects.

Which atypical symptoms may be present in a female patient experiencing myocardial infarction (MI)? Select all that apply.

Dyspnea Dizziness Extreme fatigue

Which fact about unstable angina is correct? 1 It evolves over many hours. 2 It may occur at rest or with activity. 3 It lasts a few minutes and is relieved by rest. 4 It occurs in a pattern the client typically recognizes.

It may occur at rest or with activity. Unstable angina is manifested by an increase in the number and intensity of attacks of chest pain or discomfort; it may occur at rest or with exertion. Chest pain or discomfort occurring over a period of several hours is indicative of myocardial infarction. Stable (not unstable) angina is typically relieved with rest or nitroglycerin, but is of short duration and in a pattern that remains consistent and familiar to the client over several months.

After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign?

Facial drooping

After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign? 1 1-inch backup of blood in the IV tubing 2 Facial drooping 3 Partial thromboplastin time (PTT) 68 seconds 4 Report of chest pressure during dye injection

Facial drooping During and after thrombolytic administration, the nurse observes for any indications of bleeding, including changes in neurologic status, which may indicate intracranial bleeding. A 1-inch backup of blood in the IV tubing may be related to IV positioning. If heparin is used, PTT reflects a therapeutic value. Reports of chest pressure during dye injection or stent deployment are considered an expected result of the procedure.

The nurse is caring for a patient with coronary artery disease (CAD) who has been prescribed metoprolol XR. What action does the nurse perform when caring for the patient?

Hold the medication if the heart rate is less than 50-60 beats/min The nurse should not administer metoprolol if the patient's heart rate is less than 50-60 beats/min because it is a beta blocker. A side effect of beta blockers is bradycardia, and this medication would further decrease the heart rate. Beta blockers are safe to take with sildenafil. Nitrates are not administered with sildenafil because fatal interactions occur between these drugs. Metoprolol XR is an extended-release medication and cannot be crushed; the capsule must be taken whole. Patients taking nitrates, not beta blockers, are taught to lie down on the bed after administration because an upright position intensifies hypotension, which can be fatal.

When planning care for a patient in the emergency department, which interventions are needed in the acute phase of myocardial infarction? Select all that apply.

Nitroglycerin Morphine sulfate Oxygen Morphine is needed to reduce oxygen demand, preload, pain, and anxiety, and nitroglycerin is used to reduce preload and chest pain. Administering oxygen will increase available oxygen for the ischemic myocardium. Naloxone is a narcotic antagonist that is used for overdosage of opiates, not for MI. Acetaminophen may be used for headache related to nitroglycerin. Because of negative inotropic action, calcium channel blockers like verapamil are used for angina, not for MI.

Which is a modifiable risk factor for coronary artery disease? 1 Family history 2 Ethnicity 3 Gender 4 Obesity

Obesity Modifiable risk factors are lifestyle choices that can be controlled by the client such as smoking, obesity, sedentary lifestyle, or diet. Nonmodifiable risk factors are those that the client is unable to change such as age, gender, or family history.

A patient comes to the emergency department with chest discomfort. Which action does the nurse perform first?

Obtain the patients description of chest pain A description of the chest discomfort must be obtained first, before further action can be taken. Pain medication and oxygen therapy are not the first priority in this situation; an assessment is needed first. Remaining calm and staying with the patient is important, but this is not the matter of highest priority.

A client comes to the emergency department with chest discomfort. Which action does the nurse perform first?

Obtains the client's description of the chest discomfort

A client who has had a myocardial infarction is speaking angrily and finding fault with nurses, family members, and hospital employees. What is the best nursing intervention for this client? 1 Request that the health care provider prescribe an antidepressant. 2 Explain the harmful effects of noncompliance to the client. 3 Offer the client the ability to make decisions related to care. 4 Perform activities of daily living for the client until the client's previous disposition returns.

Offer the client the ability to make decisions related to care. Anger represents the client's attempt to regain control of his or her life; providing opportunities for decision making and control will be helpful. An antidepressant may be indicated if depression exists; however, depression is typically a later phase of grief and loss. Noncompliance may accompany the phase of denial; at that time the nurse can explain the consequences of refusing to adhere to recommended treatments. The nurse should not perform activities of daily living for the client unless he or she is physically unable to do so; this undermines the client's rehabilitation, coping, and return to productive life.

A patient who has had a myocardial infarction is speaking angrily and finding fault with nurses, family members, and hospital employees. What is the best nursing intervention for this patient?

Offer the patient the ability to make decisions related to care.

A patient has sustained an ST-segment myocardial infarction (STEMI) to the anterior wall and new-onset third-degree heart block. Which intervention does the nurse anticipate will be prescribed by the health care provider?

Pacemaker Third-degree heart block is a complication of a large myocardial infarction resulting in profound bradycardia; a pacemaker is indicated to restore hemodynamic stability. Defibrillation is indicated in patients with ventricular fibrillation or pulseless ventricular tachycardia. Cardioversion (synchronized electrical energy directed to the heart) is used to correct rapid rhythms such as atrial fibrillation, atrial flutter, or supraventricular tachycardia. Heparin infusion is used in patients with MI to maintain the patency of the coronary artery after thrombolysis or in acute coronary syndrome.

Prompt pain management with myocardial infarction is essential for which reason?

Pain relief improves oxygen supply and decreases oxygen demand.

Prompt pain management with myocardial infarction is essential for which reason? 1 The discomfort will increase client anxiety and reduce coping. 2 Pain relief improves oxygen supply and decreases oxygen demand. 3 Relief of pain indicates that the MI is resolving. 4 Pain medication should not be used until a definitive diagnosis has been established.

Pain relief improves oxygen supply and decreases oxygen demand. The focus of pain relief is on reducing myocardial oxygen demand. Chest discomfort will increase anxiety, but it may not affect coping. Relief of pain is secondary to the use of opiates or indicates that the tissue infarction is complete. Although it used to be true that pain medication was not to be used for undiagnosed abdominal pain, it does not relate to MI.

The nurse is caring for a patient 36 hours after coronary artery bypass grafting (CABG), with a priority problem of intolerance for activity related to imbalance of myocardial oxygen supply and demand. Which finding causes the nurse to terminate an activity and return the patient to bed?

Respiratory rate 28/min Tachypnea and tachycardia reflect activity intolerance; activity should be terminated. Pulse 60 and regular is a normal finding. Urinary frequency may indicate infection or diuretic use, but not activity intolerance. Pain with activity after surgery is anticipated; pain medication should be available.

Two patients suffering from myocardial infarction visit the hospital. The clinical data of the patients are mentioned below. Both patients have similar complaints, but were prescribed different treatments. What are the reasons for this? Select all that apply.

Patient B has postpericardiotomy syndrome Patient A has sternal osteomyelitis Mediastinitis, sternal osteomyelitis, and postpericardiotomy syndrome are postoperative complications of CABG. Patient A was diagnosed with sternal osteomyelitis, so this patient is treated with IV antibiotics for 4 to 6 weeks. Patient B was diagnosed with postpericardiotomy syndrome, and because postpericardiotomy is self-limiting, it may not require any treatment. Patient A with mediastinitis is treated with surgical debridement, irrigation, and IV antibiotics. Patient B with sternal osteomyelitis should be treated with IV antibiotics for 4 to 6 weeks, however, it is mentioned that patient B's condition is self-limiting, and patient A with postpericardiotomy syndrome may not require any treatment because it is self-limiting.

The nurse in the coronary care unit is caring for a group of patients who have had myocardial infarction. Which patient does the nurse see first?

Patient with third-degree heart block on the monitor Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system are involved, so the patient with the third-degree heart block should be seen first. Third-degree heart block usually requires pacemaker insertion. A normal rhythm with prolonged PR interval indicates first-degree heart block, which usually does not require treatment. The patient with dyspnea on exertion when ambulating to the bathroom is not at immediate risk. The patient's uncooperative behavior when refusing to take heparin or nitroglycerin may indicate fear or denial; he should be seen after emergency situations have been handled.

The nurse is caring for a patient who had coronary artery bypass graft (CABG) surgery. What manifestations indicate the presence of postpericardiotomy syndrome in the patient? Select all that apply.

Pericardial and pleural pain Cardiac dysrhythmias

The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity does the nurse suggest?

Placing a chair in the shower for independent hygiene

The patient presents to the emergency room with severe chest pain. After administration of two sublingual nitroglycerin tablets, the patient is now reporting pain of 2 on a scale of 1-10. What action by the nurse is priority?

Prepare to administer a third nitroglycerin tablet Patients can receive three nitroglycerin tablets in 5-minute increments to treat chest pain. The patient indicated pain relief with the first two pills, which would indicate a need to give a third. There is no indication of a need to recheck cardiac enzymes or to repeat an electrocardiogram. It is good to continue to monitor the patient, but the priority is administering nitroglycerin.

The nurse is providing care to a patient two days after the patient underwent cardiac surgery. Assessment findings include the patient reporting chest pain that intensifies during inspiration, an increased white blood cell count, elevated body temperature, and irregular heart rate. What is the likely cause of these symptoms?

Presence of blood in the pericardial sacs The patient is experiencing pleural pain, chest pain, elevated body temperature, increased while blood cell count, and dysrhythmias, which are all indications of postpericardiotomy syndrome. This syndrome may present days or weeks after cardiac surgery and occurs as a result of accumulating blood in the pericardial sac. Glycoprotein IIb may increase risk of bleeding or hypersensitivity reaction. Milrinone may cause dieresis and hypotension. These drugs are not associated with the symptoms the patient is experiencing. Postpericardiotomy syndrome is not a normal consequence and needs immediate medical attention.

A patient diagnosed with evolving myocardial infarction abruptly develops ventricular fibrillation. Which is the priority action for the nurse at this time?

Provide defibrillation The priority for ventricular fibrillation is immediate defibrillation; the patient is apneic, pulseless, and breathless secondary to chaotic and ineffective heart rhythm, and this must be terminated with immediate electrical shock. Monitoring the electrocardiogram (ECG) delays the required defibrillation and restoration of cardiac output. While nitroglycerin is used for myocardial infarction, it has no antidysrhythmic property and will not terminate ventricular fibrillation. Since the patient with ventricular fibrillation is apneic, administering oxygen will not be of use.

A patient with coronary artery disease (CAD) is prescribed carvedilol. What side effect does the nurse monitor for during the assessment?

Shortness of breath

A client with coronary artery disease (CAD) is prescribed carvedilol (Coreg). What side effect does the nurse monitor for during the assessment? 1 Risk for bleeding 2 Shortness of breath 3 Ringing in the ears 4 Gastric irritation

Shortness of breath Carvedilol is a beta blocker that usually causes bronchoconstriction. Shortness of breath is most likely to be observed in a client taking the drug. Clients taking thienopyridines or antiplatelet agents are at risk for bleeding. These drugs prevent platelet aggregation and slow clot formation. Clients taking aspirin may experience ringing in the ears due to aspirin toxicity. Aspirin can also cause gastric irritation if taken on an empty stomach.

The nurse is assessing a client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI?

Substernal chest pressure relieved only by opioids

The nurse is assessing a client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI? 1 Chest pain brought on by exertion or stress 2 Substernal chest discomfort occurring at rest 3 Substernal chest discomfort relieved by nitroglycerin or rest 4 Substernal chest pressure relieved only by opioids

Substernal chest pressure relieved only by opioids Substernal chest pressure relieved only by opioids is typically indicative of MI. Substernal chest discomfort that occurs at rest is not necessarily indicative of MI; it could be a sign of unstable angina. Both chest pain brought on by exertion or stress and substernal chest discomfort relieved by nitroglycerin or rest are indicative of angina.

The nurse is assessing a patient with chest pain to evaluate whether the patient is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI?

Substernal chest pressure relieved only by opioids Substernal chest pressure relieved only by opioids is typically indicative of MI. Substernal chest discomfort that occurs at rest is not necessarily indicative of MI; it could be a sign of unstable angina. Both chest pain brought on by exertion or stress and substernal chest discomfort relieved by nitroglycerin or rest are indicative of angina.

A client with angina reports chest discomfort. Which principle related to angina pain is important for the nurse to remember? 1 The administration of nitroglycerin (NTG) will improve oxygen supply. 2 There will be an ST elevation noted on the electrocardiogram (ECG). 3 The client will have an increase in body temperature. 4 Premature ventricular contractions (PVCs) accompany the pain.

The administration of nitroglycerin (NTG) will improve oxygen supply. The pain of angina is typically relieved by nitroglycerin, which increases the oxygen supply to cardiac tissues. An ST elevation noted on the rhythm of an ECG signifies a myocardial infarction (MI); there are no rhythm changes with angina. An elevation in body temperature occurs for several days after a client experiences an MI. PVCs occur within the first few hours after a client experiences an MI.

After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first?

The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea

After receiving change-of-shift report in the coronary care unit, which client does the nurse assess first? 1 The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea 2 The client with percutaneous coronary angioplasty who has a dose of heparin scheduled 3 The client who had bradycardia after a myocardial infarction and now has a paced heart rate of 64 beats/min 4 A client who has first-degree heart block, rate 68 beats/min, after having an inferior myocardial infarction

The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea Dyspnea and weight gain are symptoms of left ventricular failure and pulmonary edema; this client needs prompt intervention. A scheduled heparin dose does not take priority over dyspnea; it can be administered after the client with dyspnea is taken care of. The client with a pacemaker and a normal heart rate is not in danger. First-degree heart block is rarely symptomatic, and the client has a normal heart rate; the client with dyspnea should be seen first.

22. The client comes to the emergency department with chest discomfort. Which action does the nurse perform first?

b. Obtains the client's description of the chest discomfort

8. When caring for a client with acute myocardial infarction, the nurse recognizes that prompt pain management is essential for which reason?

b. Pain relief improves the oxygen supply and decreases oxygen demand.

16. The client undergoing coronary artery bypass grafting (CABG) asks why the doctor has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct?

c. "These arteries remain open longer."

25. An LPN/LVN is scheduled to work on the inpatient "step-down" cardiac unit where you are the team leader. Which of these clients would be best to assign to the LPN/LVN?

c. A 66-year-old who has a prescription for a nitroglycerin (Nitro-Dur) patch and is scheduled for discharge to a group home later today

20. The older adult client, 4 hours post coronary artery bypass graft (CABG), has a blood pressure of 80/50. What action should the nurse take?

c. Assess pulmonary artery wedge pressure (PAWP).

4. The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize?

c. Do not smoke or chew tobacco.

18. The visiting nurse is seeing a client post coronary artery bypass graft. Which nursing action should be performed first?

c. Monitor for dysrhythmias.

11. The nurse is caring for a client in phase 1 cardiac rehabilitation. Which activity should the nurse suggest?

c. Placing a chair in the shower for independent hygiene

19. During discharge planning after admission for a myocardial infarction, the client says, "I won't be able to increase my activity level. I live in an apartment, and there is no place to walk." What is the nurse's best response?

d. "Where might you be able to walk?"

7. To validate that the client has had a myocardial infarction (MI), the nurse assesses for positive findings on which tests?

d. Myoglobin and troponin

12. The nurse is caring for a client 36 hours post coronary artery bypass grafting (CABG), with a diagnosis of activity intolerance related to imbalance of myocardial oxygen supply and demand. Which of these findings causes the nurse to terminate an activity and return the client to bed?

d. Respiratory rate 28

21. The nurse is assessing the client with chest pain to evaluate whether the client is suffering from angina or myocardial infarction (MI). Which symptom is indicative of an MI?

d. Substernal chest pressure relieved only by opioids

23. Which statement by the client scheduled for a percutaneous transluminal coronary angioplasty indicates a need for further preoperative teaching

e. "My angina will be gone for good."

A patient with myocardial infarction has received tissue plasminogen activator (t-PA). What sign indicates that the patient has had a positive outcome with successful reperfusion?

The monitor shows episodes of ventricular tachycardia.

A patient undergoing coronary artery bypass grafting (CABG) asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct?

These arteries remain open longer Mammary arteries remain patent much longer than other grafts. Although no leg incision will be made with this approach, veins from the legs do not remain patent as long as the mammary artery graft does. Long-term patency, not ease of the procedure, is the primary concern. Age is not a determining factor in selection of these grafts

A patient diagnosed with coronary artery disease (CAD) is prescribed metoprolol. During a follow-up visit, the patient reports weight gain, cough, shortness of breath, and swelling in the legs. The nurse draws which conclusion?

The patient has developed heart failure.

After receiving change-of-shift report in the coronary care unit, which patient does the nurse assess first?

The patient with acute coronary syndrome who has a 3-pound weight gain and dyspnea Dyspnea and weight gain are symptoms of left ventricular failure and pulmonary edema; this patient needs prompt intervention. A scheduled heparin dose does not take priority over dyspnea; it can be administered after the patient with dyspnea is taken care of. The patient with a pacemaker and a normal heart rate is not in danger. First-degree heart block is rarely symptomatic, and the patient has a normal heart rate; the patient with dyspnea should be seen first.

The nurse is caring for a patient following cardiopulmonary bypass surgery. Which finding causes the nurse to intervene immediately?

The patient's temperature is 96.2°F (35.7°C).

1. The client with unstable angina has received education about the acute coronary syndrome. Which of the following indicates that he understood the teaching?

a. "This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year."

9. When planning care for a client in the emergency department, the nurse recognizes that which interventions are needed in the acute phase? Select all that apply

a. Morphine sulfate b. Oxygen c. Nitroglycerin

24. After receiving change-of-shift report in the coronary care unit, which client should you assess first?

a. The client with acute coronary syndrome who has a 3-pound weight gain and dyspneaa. The client with acute coronary syndrome who has a 3-pound weight gain and dyspnea

2. The nurse is caring for a group of clients who have sustained myocardial infarction (MI). The nurse observes the client with which type of MI most carefully for the development of left ventricular heart failure?

b. Anterior wall

17. The client has just returned from coronary artery bypass graft (CABG) surgery. For which finding should the nurse contact the surgeon?

b. Chest tube drainage 175 mL last hour

13. The nurse in the coronary care unit is caring for a group of clients who have had myocardial infarction. Which client should the nurse see first?

b. Client with third-degree heart block on the monitor

15. The nurse is concerned that the client who had myocardial infarction (MI) has developed cardiogenic shock. Which of these findings indicates shock? Select all that apply.

b. Cool, diaphoretic skin c. Crackles in the lung fields e. Anxiety and restlessness

14. The client in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure?

b. Crackles in the lung fields

6. Which of the following atypical symptoms may be present in the female client experiencing myocardial infarction (MI)? Select all that apply.

b. Dyspnea c. Dizziness d. Extreme fatigue

10. After thrombolytic therapy, the nurse working in the cardiac catheterization laboratory would be alarmed to notice which sign?

b. Facial drooping

5. The nurse is teaching the client that metabolic syndrome can increase the risk for myocardial infarction (MI). Which signs of metabolic syndrome should the nurse include in the discussion? Select all that apply.

b. Hypercholesterolemia d. Glucose intolerance e. Client taking losartan (Cozaar)

3. The nurse is providing a cardiac class for a women's group. The nurse emphasizes that which characteristics place women at high risk for myocardial infarction (MI)? Select all that apply.

b. Increasing age c. Family history d. Abdominal obesity