prep u ch 27

The nurse notes that the post cardiac surgery client demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025). What will the nurse anticipate the health care provider will order?

Increase intravenous fluids

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 decrease workload of the heart

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply.

Hyperlipidemia Tobacco use Obesity

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. When teaching the client about nitroglycerin administration, which instruction should the nurse provide?

"Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."

A client comes to the health care provider's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction?

"Client walks 4 miles in 1 hour every day."

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse?

"Removing the patch at night prevents drug tolerance while keeping the benefits."

A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) immediately following confirmed diagnosis of acute myocardial infarction. The client is overtly anxious and crying. Which response by the nurse is most appropriate?

"Tell me what concerns you most."

The nurse is teaching the client about coronary artery damage after an abnormal fasting lipid profile. The client asks the nurse what type of lipid is most troublesome. What is the nurse's best response?

"The low-density lipoproteins (LDL) pose a threat to plague formation and can cause a heart attack of stroke."

To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)?

60 minutes

The nurse is explaining the cause of angina pain to a client. What will the nurse say caused the pain?

A lack of oxygen in the heart muscle that causes the death of cells.

The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure?

A serum BUN of 70 mg/dL

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?

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action?

Apply manual pressure at the site of the insertion of the sheath.

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 clopidogrel.

The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack?

Avoid situations that contribute to ischemic episodes.

A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse?

CVP reading: 1 mmHg

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order?

Carvedilol

When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality?

Hyperkalemia

The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration?

Count the respiratory rate for bradypnea.

A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin?

Flushing, dizziness, headache, and pedal edema.

A client diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes which overall goal as a focus of rehabilitation for a client who has had an MI?

Improvement the quality of life

When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition?

Inadequate fluid volume

Which medication is an antidote to heparin?

Protamine sulfate

A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation?

Prothrombin time (PT) or international normalized ratio (INR)

After undergoing cardiac surgery, a client discovers a painless lump and reports this to the nurse. What is the most important nursing intervention for this client?

Reassure the patient by informing him or her that the lump will disappear with time.

A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to to the client? Select all that apply.

Remove the transdermal patch at night and reapply in the morning. Store the patch in its original container when not in use.

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. The client's cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. What is the best response by the nurse?

The nurse will ask the dietitian to talk with the client about modifying the diet.

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 at least a 70% occlusion of a major coronary artery.

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?

Vague symptoms

A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?

Within 6 hours

A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug?

calcium-channel blocker

A nurse is caring for a client after cardiac surgery. Upon assessment, the client appears restless and reports nausea and weakness. The client's ECG reveals peaked T waves. The nurse reviews the client's serum electrolytes, anticipating which abnormality?

hyperkalemia

A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display?

fatty deposits in the lumen of arteries

A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a:

high LDL level.

The nurse is assessing a client with suspected postpericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome?

pericardial friction rub

A client has a blockage in the proximal portion of a coronary artery and decides to undergo percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse expect to administer during the procedure?

ticagrelor

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks?

troponin