CAD/angina prepU

Which statement would lead the nurse to determine that a client lacks understanding of her acute cardiac illness and the ability to make changes in her lifestyle? "These relaxation tapes sound okay; I will see if they help me." "No more working 10 hours a day for me unless it is an emergency." "I talked with my husband yesterday about working on a new budget together." "I already have my airline ticket, so I will not miss my meeting tomorrow."

"I already have my airline ticket, so I will not miss my meeting tomorrow."

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? "The pain resolved after I ate a sandwich." "The pain lasted about 45 minutes." "The pain occurred while I was mowing the lawn." "The pain got worse when I took a deep breath."

"The pain occurred while I was mowing the lawn."

Which client is at greatest risk for coronary artery disease? a 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L) a 32-year-old female with mitral valve prolapse who quit smoking 10 years ago a 56-year-old male with an HDL of 60 (3.3 mmol/L) who takes atorvastatin a 43-year-old male with a family history of CAD and cholesterol level of 158 (8.8 mmol/L)

65-year old female who is obese with an LDL of 188

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He 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. 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. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician.

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

A client is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? Temperature of 100.2° F (37.9° C) Blood pressure 84/52 mm Hg Pulse rate of 84 beats/minute Respiration 26 breaths/minute

Blood pressure 84/52 mm Hg

A client with chest pain is prescribed intravenous nitroglycerin. Which assessment is of greatest concern for the nurse initiating the nitroglycerin drip? Blood pressure is 88/46 mm Hg. Serum potassium is 3.5 mEq/L (3.5 mmol/L). Heart rate is 61 bpm. ST elevation is present on the electrocardiogram.

Blood pressure is 88/46 mm Hg.

A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take? Slow the I.V. fluid to prevent any more swelling at the puncture site. Document the findings and recheck the client in 1 hour. Contact the physician and report the findings. Encourage the client to perform isometric leg exercise to improve circulation in his legs.

Contact the physician and report the findings.

A client comes to the emergency department complaining of 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 Widened QRS complex Absent Q wave Elevated ST segment

Elevated ST segment

A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol, 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? Blood vessels Bronchi Heart Uterus

Heart

A nurse is reviewing laboratory values for a client diagnosed with hyperlipidemia 6 months ago. Which results indicate that the client has been following his therapeutic regimen? Low density lipoproteins (LDL) increase from 180 mg/dl (4.66 mmol/L to 190 mg/dl (4.92 mmol/L). Total cholesterol level increases from 250 mg/dl to 275 mg/dl (6.48 mmol/L to 7.12 mmol/L). High density lipoproteins (HDL) increase from 25 mg/dl (0.65 mmol/L) to 40 mg/dl (1.03 mmol/L). Triglycerides increase from 225 mg/dl (5.83 mmol/L) to 250 mg/dl (6.47 mmol/L).

High density lipoproteins (HDL) increase from 25 mg/dl (0.65 mmol/L) to 40 mg/dl (1.03 mmol/L).

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How should the nurse intervene? Insert an indwelling urinary catheter as ordered. Administer I.V. fluids as ordered. Administer a vasodilator as ordered. Instruct the client to sit for several minutes before standing.

Instruct the client to sit for several minutes before standing.

Which is the most important initial postprocedure nursing assessment for a client who has had a cardiac catheterization? Monitor skin warmth and turgor. Monitor the laboratory values. Observe the puncture site for swelling and bleeding. Observe neurologic function every 15 minutes.

Observe the puncture site for swelling and bleeding

The nurse is caring for an elderly man who walks 2 miles every morning. The nurse notes that during his morning walk, he called his daughter and stated that he thought that he was having a heart attack. Which symptom, identified by the client, is the most common and consistent with that of a heart attack (myocardial infarction)? Edema Sternal pain Palpitations Dyspnea

Sternal pain

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy? The client requests information regarding smoking cessation. The client exhibits a heart rate within normal limits. The client demonstrates ability to tolerate more activity without chest pain. The client is able to verbalize the action of all his prescribed medications.

The client demonstrates ability to tolerate more activity without chest pain

A nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control? Age, gender, and heredity Diabetes, hypercholesterolemia, and hypertension Diabetes, age, and gender Diabetes, hypercholesterolemia, and heredity

dm, htm, hypercholesterolemia

A client whose condition remains stable after a myocardial infarction gradually increases activity. To determine whether the activity is appropriate for the client the nurse should assess the client for: dyspnea. weight loss. edema. cyanosis.

dyspnea

Which client admitted to the emergency department should the nurse see first? A client: with a blood pressure of 170/95 mm Hg. taking anticoagulants with bloody stool. with a urine output of 240 mL in 12 hours. experiencing a "ripping" sensation in the chest.

experiencing a "ripping" sensation in the chest.

A client who has been experiencing angina has a new prescription for nitroglycerin. The nurse should instruct the client to report having which potential side effect of nitroglycerin? bradycardia hypertension shortness of breath headache

h/a

A client has a total serum cholesterol level of 326 mg/dL (8.44 mmol/L). The nurse explains to the client that this level: is low and requires no further treatment. is borderline normal and may require dietary modification. is high and will require dietary modification. is normal and requires no further treatment.

is high and will require dietary modification.

A client is scheduled for an arteriogram. The nurse should explain to the client that the arteriogram will confirm the diagnosis of occlusive arterial disease by: determining how long the client can walk. using ultrasound to estimate the velocity changes in the blood vessels. showing the location of the obstruction and the collateral circulation. scanning the affected extremity and identifying the areas of volume changes.

showing the location of the obstruction and the collateral circulation.

A client is scheduled to have a graded exercise test. The nurse explains to the client that the test will determine how: well the body reacts to controlled exercise stress. far he or she can walk. to set the incline gradient on a treadmill. long he or she can walk.

well the body reacts to controlled exercise stress

A client is participating in a cardiac research study in which his physician is directly involved. Which statement by the client indicates a need for additional teaching about his rights as a research study participant? "My confidentiality won't be compromised by this study." "I may withdraw from the study at anytime, but if I do, I won't receive the compensation I was promised." "I understand that there may be risks associated with this study." "I'll have to find a new physician if I don't complete this study."

"I'll have to find a new physician if I don't complete this study."

A nurse is preparing a client for cardiac catheterization. The nurse must provide which nursing intervention immediately when the client returns to his room after the procedure? Assess the puncture site frequently for hematoma formation or bleeding. Force fluids for 6 hours after the procedure. Administer the prescribed analgesia. Apply ice to the puncture site for 12 hours post procedure.

Assess the puncture site frequently for hematoma formation or bleeding

Which condition most commonly results in coronary artery disease (CAD)? Myocardial infarction Renal failure Diabetes mellitus Atherosclerosis

Atherosclerosis

Which information about sublingual nitroglycerin tablets should the nurse include when instructing the client with angina? The drug will cause increased urine output. Store the tablets in a tight, light-resistant container. Use the tablets only when the pain is severe. The shelf life of nitroglycerin is up to 2 years.

Store the tablets in a tight, light-resistant container.

The nurse is caring for a client post myocardial infarction (MI). Orders include strict bed rest and a clear, liquid diet. What is the nurse's best response to the client when inquiring about the purpose of the new diet? To reduce the amount of fecal elimination To reduce the metabolic workload of digestion To improve the gastric acidity of the stomach To address the fluctuation in blood sugar

To reduce the metabolic workload of digestion

A client is about to undergo cardiac catheterization for which he signed an informed consent. As the nurse enters the room to administer sedation for the procedure, the client states, "I'm really worried about having this open heart surgery." Based on this statement, how should the nurse proceed? Withhold the medication and notify the physician immediately. Explain that cardiac catheterization does not involve open heart surgery, and then medicate the client. Withhold the medication and cancel the procedure. Medicate the client and document his comment.

Withhold the medication and notify the physician immediately.

Which symptom should the nurse teach the client with unstable angina to report immediately to the health care provider (HCP)? a change in the pattern of the chest pain pain during or after a physical activity pain during an argument pain during sexual activity

a change in the pattern of the chest pain

Which of the following signs and symptoms would the nurse expect in a client with angina? Select all that apply. Chest tightness General muscle aching Bradycardia Chest pressure Jaw pain Slowed respiratory rate

chest tightness chest pressure jaw pain

The nurse is assessing a client who has had a stent inserted in a coronary artery via the right femoral artery. The client is receiving intravenous heparin sodium at 1000 units per hour. During the second postprocedure check, the nurse notes that the puncture site at the groin has begun to steadily ooze blood. The nurse should first: don gloves and apply direct pressure over the site. observe and document the bleeding. notify the health care provider (HCP). prepare protamine sulfate for intravenous administration.

don gloves and apply direct pressure over the site....i think this is the right answer

A client is taking metoprolol and hydrochlorothiazide. The medication is effective if it: decreases dyspnea. increases the heart rate. lowers the blood pressure. improves circulation in the extremities.

lowers the blood pressure.

While the nurse is assisting a client to ambulate as part of a cardiac rehabilitation program, the client has midsternal burning. The nurse should: stop and assess the client further. administer nitroglycerin. call for help and place the client in a wheelchair. measure the client's blood pressure and heart rate.

stop and assess the client further.

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? Lie down or sit in a chair for 5 to 10 minutes after taking the drug. Store the drug in a cool, well-lit place. Restrict alcohol intake to two drinks per day. Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses.

lie down or sit in a chair for 5 to 10 minutes after taking the drug

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl (6.845 mmol/L), low-density lipoprotein (LDL) 139 mg/dl (3.603 mmol/L), and high-density lipoprotein (HDL) 32 mg/dl (0.829 mmol/L). The client asks the nurse how to lower his cholesterol. The nurse should tell the client that: he should take his statin medication and not worry about his cholesterol. he should begin a running program, working up to 2 miles (3.2 km) per day. she'll ask the dietitian to talk with him about modifying his diet. his cholesterol is within the recommended guidelines and he doesn't need to lower it.

she'll ask the dietitian to talk with him about modifying his diet.

A client is scheduled for a cardiac catheterization. The nurse should do which preprocedure tasks? Select all that apply. Administer over-the-counter medications. Verify that written consent has been obtained. Insert a urinary drainage catheter. Check for iodine sensitivity. Withhold food and oral fluids before the procedure.

verify that written consent has been obtained check for iodine sensitivity withhold food and oral fluids before the procedure

A client is admitted with chest pain and kept overnight for stress testing the next morning. Prior to sending the client to the stress test, the nurse reviews the results of the laboratory reports (see lab report). The nurse should report which elevated laboratory value to the health care provider (HCP) prior to the stress test? prothrombin time erythrocyte sedimentation rate troponin cholesterol level

troponin

A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which of the following is the priority intervention? Decrease the anxiety and reduce the workload on the heart. Control the pain and support breathing and oxygenation. Monitor and manage potential complications. Reduce the nausea and vomiting and stabilize the blood glucose.

Control the pain and support breathing and oxygenation

A client with migraine headaches and a history of angina asks the nurse why the physician does not prescribe one of the newer medications for migraine, such as sumatriptan. The nurse responds that: sumatriptan is contraindicated in clients with angina. sumatriptan is used only for prophylactic treatment of migraines. sumatriptan is used only for migraines with aura. these drugs are very expensive.

sumatriptan is contraindicated in clients with angina.

The nurse is coaching an older adult who has been diagnosed with high serum lipids and leads a sedentary life-style. The goal is to increase the amount of exercise this client currently performs. After assessing the client's interests and setting an acceptable goal with the client, which exercise will offer the client the most health benefits while being practical to implement? jogging three to five times per week for 30 to 60 minutes playing golf three times per week for 60 minutes walking three to five times per week for 30 to 60 minutes swimming once a week for 30 minutes

walking three to five times per week for 30 to 60 minutes

The client has had a myocardial infarction, and the nurse has instructed the client to prevent Valsalva's maneuver. The nurse determines the client is following the instructions when the client: drinks fluids through a straw. clenches the teeth while moving in bed. avoids holding the breath during activity. assumes a side-lying position.

avoids holding the breath during activity.

The nurse has given a client a nitroglycerin tablet sublingually for angina. Which vital signs should be assessed following administration of nitroglycerin? blood pressure oxygen saturation pulse rate respiratory rate

blood pressure

Which food should the nurse teach a client with heart failure to limit when following a 2-gram sodium diet? whole wheat bread canned tomato juice beef tenderloin apples

canned tomato juice

After receiving nitroglycerin, a client says his chest pain has diminished. The physician orders transdermal nitroglycerin, 0.2-mg/hour patch, as prophylaxis for angina pectoris. When teaching the client how to apply the transdermal system, which instruction should the nurse provide? "Be sure to report skin irritation or other adverse reactions." "You may touch the medication pad after washing your hands." "Use the same clean, hairless application site each day." "Store your supply of transdermal pads in the refrigerator."

"Be sure to report skin irritation or other adverse reactions."

A client is scheduled to undergo percutaneous transluminal coronary angioplasty (PTCA). Which statement by the nurse best explains the procedure to the client? "PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter." "PTCA involves inserting grafts to divert blood from blocked coronary arteries." "PTCA involves cutting away blockages with a special catheter." "PTCA involves passing a catheter through the coronary arteries to find blocked arteries."

PTCA involves opening a blocked artery with an inflatable balloon located on the end of a catheter

An anxious client who suffered an acute myocardial infarction is transferred from the coronary care unit to the telemetry unit. The client asks the charge nurse if he can have the same nurse care for him every day. How should the charge nurse respond? "It's important for you to receive care from a variety of nurses so you can evaluate your care." "It's our policy to rotate client care assignments to ensure quality care for everyone." "We will try to assign you the same nurse as often as possible." "Different nurses will be assigned to you each day to avoid your becoming dependent on one nurse."

we will try to assign you the same nurse as often as possible

A client has chest pain rated at 8 on a 10-point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and troponin levels are elevated. What should the nurse do first? Monitor daily weights and urine output. Limit visitation by family and friends. Provide client education on medications and diet. Reduce pain and myocardial oxygen demand.

Reduce pain and myocardial oxygen demand.

A client with angina shows the nurse the nitroglycerin that the client carries in a plastic bag in a pocket. The nurse instructs the client that nitroglycerin should be kept in: a cool, moist place. a dark container to shield from light. the refrigerator. a plastic bag where it is readily available.

a dark container to shield from light. the refrigerator.

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? "A burning sensation after administration indicates that the nitroglycerin tablets are potent." "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses."

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

An older adult takes two 81-mg aspirin tablets daily to prevent a heart attack. The client reports having a constant "ringing" in both ears. How should the nurse respond to the client's comment? Tell the client that "ringing" in the ears is associated with the aging process. Refer the client to have a Weber test. Explain to the client that the "ringing" may be related to the aspirin. Schedule the client for audiometric testing.

Explain to the client that the "ringing" may be related to the aspirin.

A client hospitalized with a myocardial infarction (MI) has a blood glucose levels ranging from 12-28 mmol/L (216-504 mg/dL) asks the nurse why the readings are so high even though there are no added sweets on the diet tray. What is the best response by the nurse? "We will need to introduce stress management techniques to reduce the level of stress." "The stress level in your body has increased with the MI, and more glucose is released during stressful times." "Your blood glucose levels must have been high before the MI and could have contributed to the MI." "Your blood glucose levels are increased because of limited activity at this time."

"The stress level in your body has increased with the MI, and more glucose is released during stressful times."