EAQ Chapter 38 Module 3

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?

"Avoid straining activities." "Avoid exercising when your pulse increases more than 20 beats/min."

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? 1 "Best outcomes from CABG occur when coronary arteries have less than a 50% occlusion." 2 "CABG may be used when the left main coronary artery is occluded and a stent cannot be placed." 3 "The quality of the patient's life will be improved by CABG surgery." 4 "Best long-term graft patency results when the internal mammary artery is used." 00:00:56 Question Answer Confidence ButtonsJust a guessPretty sureNailed it

"Best outcomes from CABG occur when coronary arteries have less than a 50% occlusion."

What should a patient do if he has new-onset angina at home? 1 "Ingest 4 low-dose aspirins 81 mg each." 2 "Ingest 3 low-dose aspirins 85 mg each." 3 "Ingest 4 low-dose aspirins 85 mg each." 4 "Ingest 3 baby aspirins 81 mg each."

"Ingest 4 baby aspirins 81 mg each."

A patient with chest discomfort was diagnosed with myocardial infarction, and underwent a coronary artery bypass graft within 48 hrs. The patient encountered hypokalemia postoperatively, and was treated with serum electrolytes. What could be the expected dosage regimen?

50 mEq of potassium mixed with 100mL IV fluid, given at a rate of 40 mEq/hr

An LPN/LVN is scheduled to work on the inpatient "step-down" cardiac unit. Which patient 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 100.8 F° (38.2° C) 3 66-year-old who has a prescription for a nitroglycerin 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 patch and is scheduled for discharge to a group home later today

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.

75mg

Which is the most suitable body temperature for cardiopulmonary bypass?

96

What should be the temperature of warm cardioplegia? 1 90 o F 2 93 o F 3 95 o F 4 98 o F

98

What medication is administered prior to nitrates to reduce headache discomfort? 1 Morphine 2 Ibuprofen 3 Clopidogrel 4 Acetaminophen

Acetominiphen

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...

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

BP 150/90

To validate that a patient 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

What symptom of cardiac tamponade may occur in a patient after coronary artery bypass graft (CABG) surgery 1 Cessation of previously heavy mediastinal drainage 2 Rise in overall body temperature and chills 3 Blood pressure increase of 10 mm Hg higher on inspiration 4 Pulmonary artery wedge pressure greater than the right atrial pressure

Cessation of previously heavy mediastinal drainage

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

Chest tube drainage

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

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

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...

The patient in the cardiac care unit has had a large myocardial infarction. How does the nurse recognize onset of left ventricular failure? 1 Urine output of 1500 mL on the preceding day 2 Crackles in the lung fields 3 Pedal edema 4 Expectoration of yellow sputum

Crackles in lung

Which patient 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

Develop a plan to walk briskly for physical conditioning

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

Which atypical symptoms may be present in a female patient experiencing myocardial infarction (MI)? 1 Sharp, inspiratory chest pain 2 Dyspnea 3 Dizziness 4 Extreme fatigue 5 Anorexia

Dyspnea Dizziness Extreme fatigue

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

Facial drooping

What manifestations does the nurse expect in a patient who has class IV heart failure or cardiogenic shock?

Frothy Tachypnea

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? 1 Instruct the patient to not take sildenafil with this medication. 2 Hold the medication if the heart rate is less than 50-60 beats/min. 3 The medication can be crushed and mixed with pudding. 4 Teach the patient to lie down on the bed 30 minutes after administration.

Hold the medication if the heart rate is less than 50-60 beats/min.

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.

A patient who is undergoing robotic heart surgery for coronary artery disease (CAD) asks the nurse about disadvantages of the surgery. What does the nurse tell the patient? 1 Surgery time is longer. 2 Hospital stay is increased. 3 Postoperative pain is increased. 4 The ability to reach inaccessible sites is reduced.

It increases the surgery time

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

Monitor for dysrhythmias

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 the insertion site for bleeding.

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

Morphine Oxygen Nitro

A patient is having chest pain during a myocardial infarction (MI) that is not relieved by nitroglycerin. Which treatment does the nurse anticipate the health care provider will prescribe?

Morphine sulfate

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

My angina...

What is the disadvantage of off-pump coronary artery bypass (OPCAB) surgery performed on patients with coronary artery disease (CAD)? 1 Longer hospital stays 2 Increased risk for infection 3 Increased cost 4 Need for skilled surgeon

Need for skilled surgeons

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

Obtains patents description of...

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? 1 Request that the health care provider prescribe an antidepressant. 2 Explain the harmful effects of noncompliance to the patient. 3 Offer the patient the ability to make decisions related to care. 4 Perform activities of daily living for the patient until the patient's previous disposition returns.

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? 1 Pacemaker 2 Defibrillation 3 Cardioversion 4 Heparin infusion

Pacemaker

Prompt pain management with myocardial infarction is essential for which reason? 1 The discomfort will increase patient 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.

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?

Patient A has sternal osteomyelitis. Patient B has postpericardiotomy syndrome.

A primary health care provider is reviewing the data in the table. Which patient will show the most effective results from a coronary artery bypass graft (CABG)?

Patient C

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?

Patient has developed HF

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...

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? 1 Pericardial and pleural pain 2 Cardiac dysrhythmias 3 Reduced white blood cell count 4 Bogginess of tissue above the sternum 5 Fever lasting more than 4 days after surgery

Pericardial and pleural pain Cardiac dysrhythmias

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

Placing a chair...

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? 1 Recheck cardiac enzymes. 2 Repeat an electrocardiogram. 3 Continue to monitor the patient. 4 Prepare to administer a third nitroglycerin tablet.

Prepare to administer a third nitroglycerin tablet

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...

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 telemetry nurse is assessing a 12-lead electrocardiogram (ECG) of a patient with coronary artery disease. Which finding indicates the patient has had an acute myocardial infarction (MI)?

Q wave

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?

RR 28

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

SOB

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

What medications should the nurse assess the patient for prior to administering nitroglycerin for chest pain?

Tadalafil Sildenifil

Which statement correctly describes the purpose of the intra-aortic balloon pump (IABP) as treatment for cardiogenic shock? 1 A laser is used to break up clots that have occluded the coronary artery. 2 A balloon is placed in the coronary artery to flatten plaque and improve coronary blood flow. 3 An expandable mesh device is inserted into the coronary artery to maintain patency. 4 The IABP improves coronary blood flow during diastole and reduces afterload during systole.

The IABP improves coronary blood flow during diastole and reduces afterload during systole.

A patient 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 patient will have an increase in body temperature. 4 Premature ventricular contractions (PVCs) accompany the pain.

The administration of nitro will improve oxygen supply.

Which assessment finding takes precedence when a patient returns from percutaneous transluminal coronary angioplasty?

The groin dressing has a 10-cm round bloodstain.

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...

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

A patient undergoing coronary artery bypass grafting (1) asks why the surgeon has chosen to use the internal mammary artery for the surgery. Which response by the nurse is correct? 1 "This way you will not need to have a leg incision." 2 "The surgeon prefers this approach because it is easier." 3 "These arteries remain open longer." 4 "The surgeon has chosen this approach because of your age."

These arteries remain open longer

The cardiac care nurse is administering tissue plasminogen activator (t-PA) to a patient with myocardial infarction. Which finding during administration causes the nurse to notify the health care provider immediately?

Unilateral face drooping

When assessing a patient with evolving myocardial infarction (MI), for which associated symptom should the nurse be alert? 1 Vomiting 2 Leg pain 3 Depression 4 S 1 heart sound

Vomiting

When administering morphine sulfate to a patient with a myocardial infarction, the nurse observes for which adverse effects?

Vomiting Respiratory...