Honan-Chapter 14: Nursing Management: Patients With Coronary Vascular Disorders
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? Uterus Blood vessels Bronchi Heart
Heart Explanation: Metoprolol works at beta 1 -receptor sites. Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? IV morphine IV nitroglycerin Atenolol Amlodipine
IV morphine Explanation: IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.
The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply. Elevated blood pressure Alcohol use Obesity Physical inactivity Increasing age Family history
Elevated blood pressure Alcohol use Obesity Physical inactivity Explanation: Hypertension, obesity, hyperlipidemia, tobacco use, diabetes mellitus, metabolic syndrome, and physical inactivity are modifiable risk factors for CAD. A family history of CAD, increasing age (more than 45 years for men and more than 55 years for women), sex (men develop CAD at an earlier age than women), and race are risk factors for CAD that are nonmodifiable.
The nurse is caring for a patient who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what? Lipids and fibrous tissue WBCs Lipoproteins High-density cholesterol
Lipids and fibrous tissue Explanation: As T-lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue develops. This causes plaques to form on the inner lumen of arterial walls.
What does the nurse recognize as an absolute contraindication for thrombolytic therapy? A. Active bleeding B. Current anticoagulant therapy C. Over age 75 D. Severe hepatic disease
A. Active bleeding RATIONALE Because bleeding is a major complication of thrombolytic therapy, any patient with active bleeding should not be administered this treatment.
The nurse is working a cardiac care unit with a client on a diltiazem intravenous drip for atrial fibrillation. What are electrocardiogram (ECG) changes that suggest the client is responding to the treatment? Select all that apply. an absent P wave slowing heart rate T-wave inversion ST elevation decreasing R to R interval
slowing heart rate decreasing R to R interval Explanation: The ECG changes that occur with an MI are seen in the leads that view the involved surface of the heart. The expected ECG changes are T-wave inversion, ST-segment elevation, and development of an abnormal Q wave. The diltiazem will slow the heart rate and decrease the R to R interval.
A 70-year-old man has been diagnosed with angina pectoris and subsequently prescribed nitroglycerin spray to be used sublingually when he experiences chest pain. This drug will achieve relief of the patient's chest pain by: Blocking sympathetic stimulation of the heart and reducing oxygen demand Increasing contractility and consequent cardiac output Blocking the a-delta pain fibers in the myocardium Dilating the blood vessels and reducing preload
Dilating the blood vessels and reducing preload Explanation: Nitroglycerin is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain. Nitroglycerin dilates primarily the veins and, in higher doses, also the arteries. Dilation of the veins causes venous pooling of blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitrates do not block sympathetic stimulation or pain transmission. As well, nitrates do not have the ability to increase cardiac contractility.
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? Hyperlipidemia Hypertension Glucose intolerance Obesity
Hypertension Explanation: Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impairs the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder.
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: high LDL level. low LDL level. normal LDL level. fasting LDL level.
high LDL level. Explanation: LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL.
A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? 10 minutes 5 minutes 15 minutes 20 minutes
10 minutes Explanation: The ECG provides information that assists in diagnosing acute MI. It should be obtained within 10 minutes from the time a client reports pain or arrives in the emergency department. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored.
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? 12-lead ECG 2 L oxygen via nasal cannula Troponin level Aspirin 325 mg orally
12-lead ECG Explanation: The nurse should complete the 12-lead ECG first. The priority is to determine whether the client is suffering an acute MI and implement appropriate interventions as quickly as possible. The other orders should be completed after the ECG.
The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? 160-190 mg/dL 210-240 mg/dL 250-275 mg/dL 280-300 mg/dL
160-190 mg/dL Explanation: Simvastatin is a statin frequently given as initial therapy for significantly elevated cholesterol and low-density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? 3 minutes 15 minutes 30 minutes 60 minutes
3 minutes Explanation: Nitroglycerin may be given by several routes: sublingual tablet or spray, oral capsule, topical agent, and intravenous (IV) administration. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch) and ideally alleviates the pain of ischemia within 3 minutes.
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? Altered level of consciousness Minimal oozing of blood from the IV site Presence of reperfusion dysrhythmias Chest pain 2 of 10 (on a 1-to-10 pain scale)
Altered level of consciousness Explanation: A client receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding, and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low and indicates the client's chest pain is subsiding, an expected outcome of this therapy.
A patient arrives in the emergency room complaining of nausea, diaphoresis, SOB, and squeezing substernal chest pain that radiates to the left shoulder and jaw. The nurse should perform which interventions? A. Complete admission registration, alert the catheter laboratory team, establish an IV access, and record all vital signs B. Alert the catheter laboratory team, administer oxygen, obtain blood work, and notify the health care provider C. Establish an IV, give sublingual nitroglycerin as ordered, insert a Foley catheter, and alert the catheter laboratory team D. Administer oxygen, apply a cardiac monitor, record patient's vital signs, and give sublingual nitroglycerin as ordered
D. Administer oxygen, apply a cardiac monitor, record patient's vital signs, and give sublingual nitroglycerin as ordered RATIONALE The patient must be assessed before alerting the laboratory team; therefore, vital sign assessment is a priority, and the nurse recalls the mnemonic MONA and anticipates the administration of morphine, oxygen, nitroglycerine (Nitrates), and aspirin.
A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? Instruct the client on side effects of flushing, throbbing headache, and tachycardia. Instruct the client to renew the nitroglycerin supply every 3 months. Instruct the client not to crush the tablet. Instruct the client to place nitroglycerin tablets in a plastic pill box.
Instruct the client on side effects of flushing, throbbing headache, and tachycardia. Explanation: The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.
Which of the following is inconsistent as a condition related to metabolic syndrome? Hypotension Insulin resistance Abdominal obesity Dyslipidemia
Hypotension Explanation: A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? Inadequate tissue perfusion Mental alertness Blood glucose concentration Activity intolerance
Inadequate tissue perfusion Explanation: The nurse must assess the client for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood glucose and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for clients undergoing cardiac surgery.
The nurse reviews laboratory tests for cardiac biomarkers for a client suspected of suffering an MI. What is the earliest marker of an MI? Creatinine kinase-myocardial band (CK-MB) Total creatinine kinase (CK) Myoglobin Troponin I and T
Myoglobin Explanation: Myoglobin is a heme protein that transports oxygen. Its levels can increase as early as 1 hour after an MI. Negative results are an excellent parameter for ruling out an acute MI. The other biomarker choices start to increase in 2 to 4 hours.
The nurse is caring for an adult patient who had symptoms of unstable angina during admission to the hospital. The most appropriate nursing diagnosis for the discomfort associated with angina is what? Deficient knowledge about underlying disease and methods for avoiding complications Anxiety related to fear of death Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Noncompliance related to failure to accept necessary lifestyle changes
Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Explanation: Ineffective cardiopulmonary tissue perfusion describes the symptoms of discomfort associated with angina. Deficient knowledge describes the patient awareness of disease process and treatment. Anxiety identifies psychological effects of angina, while noncompliance is related to a patient's resistance to changing behaviors/patterns necessary to treat and manage the disease.
A patient has recently returned to the cardiac care unit from PACU following coronary artery bypass graft (CABG). During the nurse's assessment of the patient, the patient acknowledges pain that he rates at 9 on a 0-to-10 pain scale. How should the nurse best respond to this assessment finding? Determine how the patient's pain responds to increased physical activity. Explain to the patient that significant pain is expected during the immediate postoperative phase. Teach the patient nonpharmacologic interventions for pain management. Try to differentiate between incisional pain and anginal pain.
Try to differentiate between incisional pain and anginal pain. Explanation: When assessing the pain of a patient who is postoperative following a CABG, it is important to differentiate incisional pain from angina pain. The differing etiologies of these two types of pain have important ramifications for treatment and for the patient's recovery. Increased physical activity is not an option at this early stage of recovery. It would be incorrect to explain away the patient's pain or to perform interventions without sufficient assessment.
Which term refers to preinfarction angina? Stable angina Unstable angina Variant angina Silent ischemia
Unstable angina Explanation: Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs upon exertion and is relieved by rest. Variant angina is exhibited by pain at rest and reversible ST-segment elevation. Silent angina manifests through evidence of ischemia, but the client reports no symptoms.
A nurse is teaching a client about maintaining a healthy heart. What information will the nurse include with the teaching? Smoke in moderation. Use alcohol in moderation. Consume a diet high in saturated fats. Exercise one or two times per week.
Use alcohol in moderation. Explanation: The nurse should advise the client that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in cholesterol and saturated fat, and a sedentary lifestyle are all known risk factors for cardiac disease. The client should be encouraged to quit smoking, exercise three to four times per week, and consume a diet low in cholesterol and saturated fat.
The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply. adequate cough and gag reflexes inability to speak acceptable arterial blood gas values labile vital signs breathing without assistance of the ventilator
adequate cough and gag reflexes acceptable arterial blood gas values breathing without assistance of the ventilator Explanation: Before being extubated, the client should have cough and gag reflexes and stable vital signs; be able to lift the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable arterial blood gas levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates an old MI. an evolving MI. variant angina. a cardiac dysrhythmia.
an old MI. Explanation: An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI.
A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? aspirin or acetaminophen. pentoxifylline or acetaminophen. aspirin or clopidogrel. penicillin V or erythromycin.
aspirin or clopidogrel. Explanation: After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The health care provider may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.
The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD? atherosclerosis diabetes mellitus myocardial infarction renal failure
atherosclerosis Explanation: Atherosclerosis (plaque formation) is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? calcium-channel blocker beta-adrenergic blocker nitrate diuretic
calcium-channel blocker Explanation: Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of a calcium-channel blocker.
A client who has been diagnosed with Prinzmetal's angina will present with which symptom? chest pain that occurs at rest and usually in the middle of the night radiating chest pain that lasts 15 minutes or less prolonged chest pain that accompanies exercise chest pain of increased frequency, severity, and duration
chest pain that occurs at rest and usually in the middle of the night Explanation: A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8:00 AM, is sporadic over 3-6 months, and diminishes over time. Clients with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Clients with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates. Reference:
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is low. high. normal. extremely high.
high. Explanation: If the LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered to be high. The goal is to decrease the LDL level below 100 mg/dL.
The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis? Avoid use of caffeine Encourage use of a multivitamin Addressing obesity Drink at least 2 liters of water a day
Addressing obesity Explanation: Published information by Balistreri et al. (2010) indicated a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests decreasing obesity and body fat stores may help to reduce the risk. Avoiding the use of caffeine, encouraging the use of a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to atherosclerosis.
An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's family members express concern to the nurse that the client is uncharacteristically confused. After reporting this change in status to the health care provider, what additional action should the nurse take? Educate the family about how confusion is expected in older adults postoperatively. Assess for factors that may be causing the client's delirium. Document the early signs of dementia and ensure the client's safety. Reorient the client to place and time.
Assess for factors that may be causing the client's delirium. Explanation: Uncharacteristic changes in cognition following cardiac surgery are suggestive of delirium. Dementia has a gradual onset with organic brain changes and is not an acute response to surgery. Assessment is a higher priority than reorientation, which may or may not be beneficial. Even though delirium is not rare, it is not considered to be an expected part of recovery.
The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? Prepare to administer intravenous fluids. Suction the airway. Check blood pressure. Assess pupils for reactiveness.
Check blood pressure. Explanation: During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? Clopidogrel Amlodipine Diltiazem Felodipine
Clopidogrel Explanation: Clopidogrel or ticlopidine is given to clients who are allergic to aspirin or are given in addition to aspirin to clients who are at high risk for MI. Amlodipine, diltiazem, and felodipine are calcium channel blockers.
A 72-year-old woman with a diagnosis of angina pectoris has presented to her nurse practitioner because her chest pain on exertion has become more frequent and longer lasting in recent days. The nurse should understand that this woman's chest pain is directly attributable to which of the following pathophysiological processes? Inflammation and physical irritation of the lumens of coronary arteries Accumulation of cellular debris in the myocardium after the rupture of atheromas Ischemia of cardiac muscle cells Accumulation of lactic acid in cardiac muscle
Ischemia of cardiac muscle cells Explanation: The impediment to blood flow that is characteristic of angina is usually progressive, causing an inadequate blood supply that deprives the cardiac muscle cells of oxygen needed for their survival. The condition is known as ischemia. Angina pectoris refers to chest pain that is brought about by myocardial ischemia. The pain associated with this condition is not a direct result of inflammation or the accumulation of debris or lactic acid.
The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) It is relieved by rest and inactivity. It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms. It subsides after taking nitroglycerin.
It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms. Explanation: Chest pain that occurs suddenly, continues despite rest and medication, is substernal, and is sometimes viselike and radiating to the shoulders and arms is associated with an MI. Angina pectoris pain is generally relieved by rest and nitroglycerin.
A patient in the cardiac PACU was just extubated, 5 hours after the conclusion of a coronary artery bypass graft (CABG). How can the patient's nurse best promote adequate gas exchange for this patient? Apply continuous positive airway pressure (CPAP) as ordered. Perform deep suctioning q1h. Reposition the patient frequently. Administer nebulized bronchodilators and corticosteroids as ordered.
Reposition the patient frequently. Explanation: When the patient's condition stabilizes and he or she has been extubated, body position is changed every 1 to 2 hours. Frequent changes of patient position provide for optimal pulmonary ventilation and perfusion by allowing the lungs to expand more fully. Suctioning carries a risk of trauma and should be avoided if necessary. CPAP, bronchodilators, and corticosteroids are not normally used postoperatively.
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? The abrupt stop can cause a myocardial infarction. The abrupt stop can lead to formation of blood clots. The abrupt stop will precipitate internal bleeding. The abrupt stop can trigger a migraine headache.
The abrupt stop can cause a myocardial infarction. Explanation: Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or the onset of a migraine headache.
A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? The patient has compromised left ventricular function. The patient has had angina longer than 3 years. The patient has at least a 70% occlusion of a major coronary artery. The patient has an ejection fraction of 65%.
The patient has at least a 70% occlusion of a major coronary artery. Explanation: For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? To dilate coronary arteries To decrease workload of the heart To decrease homocysteine levels To prevent angiotensin II conversion
To decrease workload of the heart Explanation: Beta-adrenergic blockers are used in the treatment of CAD to decrease the myocardial oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.
Thrombolytic therapy is being prepared for administration to an older adult patient who has presented to the emergency department with an ST-segment elevation MI (STEMI). The nurse recognizes that the primary goal of this intervention is: To restore the flow of blood through the coronary arteries To restore function to infarcted myocardial cells To relieve the patient's symptoms of chest pain and dyspnea To prevent the rupture of atheromas
To restore the flow of blood through the coronary arteries Explanation: The purpose of thrombolytics is to dissolve and lyse the thrombus in a coronary artery (thrombolysis), allowing blood to flow through the coronary artery again (reperfusion), minimizing the size of the infarction, and preserving ventricular function. Thrombolytics are not primarily a pain-control measure, and function cannot be restored to infarcted cardiac cells.
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? Myoglobin Troponin Total creatine kinase CK-MB
Troponin Explanation: Troponin remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin peaks within 12 hours after the onset of symptoms. Total creatine kinase (CK) returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? Chest pain is typical Vague symptoms Decreased sensation to pain Gender bias
Vague symptoms Explanation: Often, women and elderly do not have the typical chest pain associated with a myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which can lead to misdiagnosis. Some older adults may experience little or no chest pain. Gender is not a contributing factor for fatal occurrence but rather a result of symptoms association.
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? Inform client of diagnostic tests. Remove hair from skin insertion sites. Assess distal pulses. Withhold anticoagulant therapy.
Withhold anticoagulant therapy. Explanation: The nurse knows to withhold the anticoagulant therapy to decrease chance of hemorrhage during the procedure. The nurse does inform the client of diagnostic test, will assess pulses, and prep the skin prior to the angioplasty, but this is not the most important action to be taken.
A 60-year-old woman has been brought to the emergency department (ED) by ambulance after she experienced a sudden onset of dyspnea and phoned 911. The woman is obese but claims an unremarkable medical history and denies chest pain. When assessing this patient, the nurse in the ED should be aware that: Dyspnea is definitive for a respiratory, rather than cardiac, etiology. The absence of known risk factors usually rules out myocardial infarction (MI) or angina as a cause of dyspnea. Women often present with an MI much differently than do men. Acute coronary syndrome (ACS) manifests with chest pain rather than with shortness of breath.
Women often present with an MI much differently than do men. Explanation: Women often present with symptoms different from those seen in men, therefore a high level of suspicion is associated with vague complaints such as fatigue, shoulder blade discomfort, and/or shortness of breath. Dyspnea is not limited to respiratory problems.
A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? anterior. posterior. lateral. inferior.
anterior. Explanation: An anterior MI causes left ventricular dysfunction and can lead to manifestations of heart failure, which include pulmonary crackles and dyspnea. Posterior, lateral, and inferior MI aren't usually associated with heart failure.
A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? prior intracranial hemorrhage recent consumption of a meal shellfish allergy use of heparin
prior intracranial hemorrhage Explanation: History of a prior intracranial hemorrhage is an absolute contraindication for thrombolytic therapy. An allergy to iodine, shellfish, radiographic dye, and latex are of primary concern before a cardiac catheterization but not a known contraindication for thrombolytic therapy. Administration of a thrombolytic agent with heparin increases risk of bleeding; the primary healthcare provider usually discontinues the heparin until thrombolytic treatment is completed.
The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with percutaneous coronary intervention (PCI). IV heparin. IV nitroglycerin. thrombolytics.
percutaneous coronary intervention (PCI). Explanation: The client with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate PCI. Superior outcomes have been reported with the use of PCI compared to thrombolytics. IV heparin and IV nitroglycerin are used to treat NSTEMI.
A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding? "What color is your urine?" "Is your skin drier than normal?" "Do you have any breathing problems?" "How is your appetite?"
"What color is your urine?" Explanation: The patient receiving anticoagulation therapy should be monitored for signs and symptoms of bleeding, such as changes in the color of the stool or urine. Anticoagulation therapy should not cause dry skin. The anticoagulation therapy should not change the client's breathing or appetite.
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." "Client will verbalize the intention to avoid exercise." "Client will verbalize the intention to stop smoking." "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
"Client will verbalize the intention to stop smoking." Explanation: A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? "I should avoid taking a tub bath until my catheter site heals." "I should expect a low-grade fever and swelling at the site for the next week." "I should avoid prolonged sitting." "I should expect bruising at the catheter site for up to 3 weeks."
"I should expect a low-grade fever and swelling at the site for the next week." Explanation: Fever and swelling at the site are signs of infection and should be reported to the physician. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve.
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers the client to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? "When I finish the rehabilitation program I'll never have to worry about heart trouble again." "I won't be able to jog again even with rehabilitation." "Rehabilitation will help me function as well as I physically can." "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."
"Rehabilitation will help me function as well as I physically can." Explanation: The client demonstrates understanding of cardiac rehabilitation when stating that it helps reach individual activity potential. Coronary artery disease, which typically causes an acute MI, is a chronic condition that isn't cured. Many clients who suffer an acute MI can eventually return to such activities as jogging, depending on the extent of cardiac damage. Cardiac rehabilitation involves physical activity as well as classroom education.
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? "See if rest relieves the chest pain before using the nitroglycerin." "Call 911 if you develop a headache following nitroglycerin use." "Place the nitroglycerin tablet between cheek and gum." "Only take one nitroglycerin tablet for each episode of angina."
"See if rest relieves the chest pain before using the nitroglycerin." Explanation: Decreased activity may relieve chest pain; sitting will prevent injury should the nitroglycerin lower BP and cause fainting. The client should expect to feel dizzy or flushed or to develop a headache following sublingual nitroglycerin use. The client should place one nitroglycerin tablet under the tongue if 2-3 minutes of rest fails to relieve pain. Clients may take up to three nitroglycerin tablets within 5 minutes of each other to relieve angina. However, they should call 911 if the three tablets fail to resolve the chest pain.
A patient who is postoperative day 2 following a coronary artery bypass graft (CABG) has been experiencing significant pain in the region of his sternal incision. What patient teaching should the nurse perform with this patient? "Try to hug a folded blanket across your chest when you move or breathe deeply." "If possible, try to avoid coughing and breathe as shallowly as possible to relieve pressure on your incision." "The less you can move, the less pain you're likely to have in the area of your incision." "Getting you up and mobilizing as soon as possible will help with this problem."
"Try to hug a folded blanket across your chest when you move or breathe deeply." Explanation: Physical support of the incision with a folded bath blanket or small pillow during deep breathing and coughing helps to minimize pain. The patient should then be able to participate in respiratory exercises and to increase self-care progressively. It would be incorrect to recommend shallow breathing or immobility because these measures may predispose the patient to complications. Early mobilization is important, but it does not necessarily address the problem of pain.
The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? "What time did your chest pain start today?" "Do your parents have heart disease?" "How many sublingual nitroglycerin tablets did you take?" "What is your pain level on a scale of 1 to 10?"
"What time did your chest pain start today?" Explanation: The client may be a candidate for thrombolytic (fibrolytic) therapy. These medications are administered if the client's chest pain lasts longer than 20 minutes and is unrelieved by nitroglycerin, if ST-segment elevation is found in at least two leads that face the same area of the heart, and if it has been less than 6 hours since the onset of pain. The most appropriate question for the nurse to ask is in relations to when the chest pain began. The other questions would not aid in determining whether the client is a candidate for thrombolytic therapy.
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. With regards to partial thromboplastin time (PTT), when should the nurse plan to remove the femoral sheath? 50 seconds or less. 75 seconds or less. 100 seconds or less. 125 seconds or less.
50 seconds or less. Explanation: Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 50 seconds or less before the sheath is removed. Removing the sheath before the PTT drops below 50 seconds can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath.
The nurse has just admitted a 66-year-old patient for cardiac surgery. The patient tells the nurse that she is afraid of dying while undergoing the surgery. The nurse should be aware that: A further assessment of anxiety is required. A more complete physical examination is required. Preoperative fears are normal and will be alleviated with time. Teaching should be initiated immediately to alleviate the fears.
A further assessment of anxiety is required. Explanation: An assessment of anxiety levels is required in the patient to assist in identifying fears and developing coping mechanisms for those fears. If anxiety is high, it may interfere with teaching, and surgical outcome is poor. Nothing in the scenario suggests that a more complete physical examination is required. Further assessment should precede teaching. Preoperative fears are normal, but they should not be ignored and will not necessarily abate on their own.
A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Explanation: Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the health care provider before completing the initial assessment is premature.
A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment? Assessing the patient's capillary refill time and peripheral pulses Assessing the patient for signs and symptoms of hemorrhage Assessing the patient for signs and symptoms of acute renal failure Assessing the patient for signs and symptoms of infection
Assessing the patient for signs and symptoms of hemorrhage Explanation: Monitoring the patient for bleeding post-PCI is a priority. Kidney function, peripheral circulation, and infection are also valid assessment parameters but the significant risk of bleeding associated with PCI necessitates that assessments related to this problem be prioritized.
When starting a client on oral or I.V. diltiazem, for which potential complication should the nurse monitor? Flushing Atrioventricular block Renal failure Hypertension
Atrioventricular block Explanation: The chief complications of diltiazem are hypotension, atrioventricular blocks, heart failure, and elevated liver enzyme levels. Other reported reactions include flushing, nocturia, and polyuria, but not renal failure. Although flushing may occur, it's an adverse reaction, not a potential complication.
The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? Digoxin Atropine Protamine sulfate Sodium nitroprusside
Atropine Explanation: Sheath removal and the application of pressure on the vessel insertion site may cause the heart rate to slow and the blood pressure to decrease (vasovagal response). A dose of IV atropine is usually given to treat this response.
Two hours after cardiac catheterization that was accessed via the right femoral artery route, an adult client complains of numbness and pain in the right foot. What action should the nurse take first? A. Call the provider immediately. B. Check the client's peripheral pulses (pedal/posterior tibial). C. Take the client's blood pressure. D. Recognize that this is an expected response and reassess the patient in 1 hour.
B. Check the client's peripheral pulses (pedal/posterior tibial). RATIONALE Complications after accessing the femoral artery are bleeding or clotting of the vessel. Any complaint of the patient's must be assessed immediately. The nurse assesses limb perfusion as the priority intervention and then notifies the health care provider of the results of the findings
The nurse is caring for a nonsmoking female patient with the diagnosis of coronary atherosclerosis who has been admitted to the hospital with angina. The patient states that she never experiences chest pain going down her arm or in the middle of her chest. The nurse is not surprised at this statement and explains to the patient that: A. Women who have ischemia are usually totally asymptomatic. B. Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. C. Chest pain occurs only with strenuous exercise. D. Cigarette smoking is usually the contributing factor to chest pain.
B. Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. RATIONALE Women with acute coronary syndromes report atypical symptoms such as indigestion, nausea, fatigue, and palpitations rather than chest pain.
A 54-year-old man comes to triage complaining of severe, left-sided, pressure-like chest pain and left arm numbness. The pain began 2 hours ago and is unrelieved by rest. The patient is anxious, diaphoretic, and complaining of nausea. Cardiac monitoring is begun, and oxygen is given at 2 L/min. An intermittent infusion device (IID) is in place, and vital signs are as follows: BP of 128/68 mm Hg; pulse, 76 beats/min; respirations easy and regular at 20 breaths/min. ECG reveals normal sinus rhythm with occasional unifocal premature ventricular contractions (PVCs). The nurse suspects an MI based on an elevation in the which lab study? A. CK-MB and LDH B. LDH and troponin I C. CK-MB and troponin I D. Troponin I and SGPT
C. CK-MB and troponin I RATIONALE CK-MB is an enzyme specific to myocardial muscle and is released when there has been damage to the muscle; therefore, it will be present when there has been an MI. Additionally, troponin I is a protein that is released exclusively from the myocardial muscle; therefore, a "positive" troponin I is indicative of an MI.
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? Clopidogrel Isosorbide mononitrate Metoprolol Diltiazem
Clopidogrel Explanation: Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.
A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? Coronary artery disease Raynaud's disease Cardiogenic shock Venous occlusive disease
Coronary artery disease Explanation: The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
A client is admitted for treatment of Prinzmetal angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? Activities that increase myocardial oxygen demand. An unpredictable amount of activity. Coronary artery spasm. The same type of activity that caused previous angina episodes.
Coronary artery spasm. Explanation: Prinzmetal angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; anginal pain becomes increasingly severe.
A patient with cardiovascular disease is being treated with Norvasc, a calcium channel blocking agent. The nurse is aware that calcium channel blockers have a variety of effects. What is one of the therapeutic effects? Decrease sinoatrial node and atrioventricular node conduction and decrease workload of the heart Prevent platelet aggregation and subsequent thrombosis Reduce myocardial oxygen consumption by blocking beta-adrenergic stimulation to the heart Reduce myocardial oxygen consumption thus decreasing ischemia and relieving pain
Decrease sinoatrial node and atrioventricular node conduction and decrease workload of the heart Explanation: Calcium channel blocking agents decrease sinoatrial node automaticity and atrioventricular node conduction resulting in a slower heart rate and a decrease in the strength of the heart muscle contraction. These effects decrease the workload of the heart. They are also used to prevent and treat vasospasm. Antiplatelet and anticoagulation medications are administered to prevent platelet aggregation and subsequent thrombosis that impede blood flow. Beta-blockers reduce myocardial consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced myocardial contractility (force of contraction) to balance the myocardium oxygen needs and supply. Nitrates reduce myocardial oxygen consumption, which decreases ischemia and relieves pain by dilating the veins and in higher doses, the arteries.
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? Decreases resting heart rate Decreases cholesterol level Increases cardiac output Decreases platelet aggregation
Decreases resting heart rate Explanation: The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.
The public health nurse is participating in a health fair, and she interviews a woman with a history of hypertension who is currently smoking one pack of cigarettes per day. She has had no manifestations of coronary artery disease (CAD) but a recent low-density lipoprotein (LDL) level of 154 mg/dL was found. Based on her assessment, the nurse would expect that this patient would be treated in what way? Drug therapy and smoking cessation Diet and drug therapy Diet therapy only Diet therapy and smoking cessation
Diet therapy and smoking cessation Explanation: Diet therapy is indicated for a patient without CAD who has two or more risk factors (hypertension and cigarette smoking) and an LDL level equal to or greater than 130 mg/dL. When the patient's LDL levels are equal to or greater than 160 mg/dL, drug therapy would be added to diet therapy. Cigarette smoking contributes to the development and severity of CAD and is listed as a major risk factor.
A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? Prolonged PR interval Absent Q wave Elevated ST segment Widened QRS complex
Elevated ST segment Explanation: Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.
An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? Leads I, aVL, V5, and V6 Leads II, III, and aVF Leads V1 and V2 Leads V3 and V4
Leads V3 and V4 Explanation: Leads V3 and V4 record electrical events in the septal region of the left ventricle. Leads I, aVL, V5, and V6 record electrical events on the lateral surface of the left ventricle. Leads II, III, and aVF record electrical events on the inferior surface of the left ventricle. Leads V1 and V2 record electrical events on the anterior surface of the right ventricle and the anterior surface of the left ventricle.
The triage nurse in the emergency department assesses a 66-year-old male patient who has presented to the emergency department with complaints of midsternal chest pain that has lasted for the last 5 hours. The care team suspects a myocardial infarction (MI). The nurse is aware that, because of the length of time the patient has been experiencing symptoms, the following may have happened to the myocardium: May have developed an increased area of infarction Will probably not have more damage than if he came in immediately Can have restoration of the area of dead cells with proper treatment Has been damaged already, so immediate treatment is no longer necessary
May have developed an increased area of infarction Explanation: When the patient experiences lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated the more likely the treatment will prevent or minimize myocardial tissue necrosis. Despite the length of time the symptoms have been present, treatment needs to be initiated immediately to minimize further damage.
Which technique is used to surgically revascularize the myocardium? Balloon bypass Peripheral bypass Minimally invasive direct coronary bypass Gastric bypass
Minimally invasive direct coronary bypass Explanation: Several techniques are used to surgically revascularize the myocardium; one of them is minimally invasive direct coronary bypass. Balloon bypass is not used to revascularize the myocardium. If the client is experiencing acute pain in the leg, peripheral bypass is performed. Gastric bypass is a surgical procedure that alters the process of digestion.
Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? Isosorbide mononitrate (Isordil) Meperidine hydrochloride (Demerol) Morphine sulfate (Morphine) Nitroglycerin transdermal patch
Morphine sulfate (Morphine) Explanation: Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.
A 45-year-old adult male patient is admitted to emergency after he developed unrelieved chest pain that was present for approximately 20 minutes before he presented to the emergency department. The patient has been subsequently diagnosed with a myocardial infarction (MI). To minimize cardiac damage, what health care provider's order will the nurse expect to see for this patient? Thrombolytics, oxygen administration, and bed rest Morphine sulfate, oxygen administration, and bed rest Oxygen administration, anticoagulants, and bed rest Bed rest, albuterol nebulizer treatments, and oxygen administration
Morphine sulfate, oxygen administration, and bed rest Explanation: Morphine sulfate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. Thrombolytics and anticoagulants are contraindicated in patients who are bleeding or have a bleeding disorder. Albuterol is a medication used to manage asthma and respiratory conditions and will increase the heart rate
A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication? Amantadine Nitroglycerin Digoxin Diphenhydramine
Nitroglycerin Explanation: A cholinergic blocking agent may cause dry mouth and delay the sublingual absorption of nitroglycerin. The nurse should offer the client sips of water before administering nitroglycerin. Amantadine, digoxin, and diphenhydramine can interact with a cholinergic blocking agent but not through delayed absorption. Amantadine and diphenhydramine enhance the effects of anticholinergic agents.
A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? Nitroglycerin SL Chest x-ray Serum electrolytes Ativan 1 mg orally
Nitroglycerin SL Explanation: Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired, and the nurse should anticipate administering nitroglycerin to assess whether the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the client's chest pain.
While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? Stop the heparin infusion immediately. Notify the health care provider. Administer a coumarin derivative, as ordered, to counteract heparin. Reassure the client that bleeding gums are a normal effect of heparin.
Notify the health care provider. Explanation: Because heparin can cause bleeding gums that may indicate excessive anticoagulation, the nurse should notify the health care provider, who will evaluate the client's condition. The health care provider should order laboratory tests such as partial thromboplastin time before concluding that the client's bleeding is significant. The ordered heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion unless the health care provider orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Heparin doesn't normally cause bleeding gums.
The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? Preload is reduced. More blood returns to the heart. It increases myocardial oxygen consumption. It functions has a vasoconstrictor.
Preload is reduced. Explanation: Nitroglycerin dilates primarily the veins, and in higher dosages, also the arteries. Dilation of the veins causes venous pooling of the blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitroglycerine is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain.
The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received? Protamine sulfate Alteplase Clopidogrel Aspirin
Protamine sulfate Explanation: Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin). Alteplase is a thrombolytic agent. Clopidogrel is an antiplatelet medication that is given to reduce the risk of thrombus formation after coronary stent placement. The antiplatelet effect of aspirin does not reverse the effects of heparin.
A 56-year-old man has been brought to the emergency department by emergency medical services (EMS) and has been diagnosed with a myocardial infarction (MI) based on his presentation and electrocardiogram (ECG). The patient has been identified as a candidate for percutaneous transluminal coronary angioplasty (PTCA). The nurse who is providing care for this patient should recognize that the extent of cardiac damage will primarily depend on: The patient's previous use of antiplatelets and anticoagulants The particular risk factors that contributed to the patient's MI The duration of oxygen deprivation to the patient's cardiac cells The patient's high- and low-density lipoprotein (LDL, HDL) levels prior to MI
The duration of oxygen deprivation to the patient's cardiac cells Explanation: The duration of oxygen deprivation is directly related to the number of cells that die, therefore the time from the patient's arrival in the emergency department to the time percutaneous coronary intervention (PCI) is performed is critical and should be less than 60 minutes. The extent of cardiac damage is not a direct reflection of previous medication use or risk factors such as cholesterol levels.
Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene? The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. The nurse should report the incident to her supervisor immediately. The nurse should instruct the nursing assistants to avoid answering his call light. The nurse should explain that the client most likely wants extra attention.
The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. Explanation: Sometimes clients are concerned about resuming sexual activity but are afraid to ask. Making inappropriate sexual comments provides a forum for asking questions. It isn't necessary to report the incident to the nursing supervisor immediately without investigating the situation further. The client's call light must be answered in a timely fashion. More information is needed before assuming that the client is asking for extra attention.
The nurse is caring for a patient who is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) and who asks what complications can happen during the procedure. What statement should underlie the nurse's response? Complications that can occur during a PTCA include dissection of the ductus arteriosa. Complications that can occur during a PTCA include hyposensitivity of the heart muscle. Complications that can occur during a PTCA include vasospasm of the coronary artery. Complications that can occur during a PTCA include closure of the pulmonary artery.
complications that can occur during a PTCA include vasospasm of the coronary artery. Explanation: Complications that can occur during a percutaneous coronary intervention (PCI) procedure include dissection, perforation, abrupt closure, or vasospasm of the coronary artery, acute myocardial infarction (MI), acute dysrhythmias (e.g., ventricular tachycardia), and cardiac arrest. They do not include dissection of the ductus arteriosa, hyposensitivity of the heart muscle, or closure of the pulmonary artery.
A client was transferring a load of firewood in the morning and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? streptokinase, aspirin, and morphine administration morphine administration, stress testing, and admission to the cardiac care unit serial liver enzyme testing, telemetry, and a lidocaine infusion sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry Explanation: The nurse should anticipate an order for sublingual nitroglycerin, tPA, and telemetry, as the client's chest pain began 4 hours before diagnosis. The preferred choice is tPA, which is more specific for cardiac tissue than streptokinase. Stress testing shouldn't be performed during an MI. The client doesn't exhibit symptoms that indicate the use of lidocaine.