CH27 Coronary Vascular Disease

Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent? -Beta blockers -Antiplatelets -Calcium channel blockers -Nitrates

Antiplatelets -Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as Plavix or aspirin. Nitrates, beta blockers, and calcium channel blockers would not be used for this purpose.

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?" -"What is your pain level on a scale of 1 to 10?" -"How many sublingual nitroglycerin tablets did you take?"

"What time did your chest pain start today?" The patient may be a candidate for thrombolytic (fibrolytic) therapy. These medications are administered if the patient's chest pain lasts longer than 20 minutes, unrelieved by nitroglycerin, ST-segment elevation in the at least two leads that face the same area of the heart, less than 6 hours from onset of pain. The most appropriate question for the nurse to ask is in relationship to when the chest pain began. The other questions would not aid in determining if the patient is a candidate for thrombolytic therapy.

A client was transferring a load of fire wood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which orders by the physician? -Morphine administration, stress testing, and admission to the cardiac care unit -Serial liver enzyme testing, telemetry, and a lidocaine infusion -Streptokinase, aspirin, and morphine administration -Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

-Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

A client is receiving intravenous heparin to prevent blood clots. The order is for heparin 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL of D5W. At how many milliliters per hour will the nurse infuse this solution? Record your answer using a whole number.

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The nurse has been asked to explain the cause of angina pain to a patient's family. Choose the best statement. The pain is due to: -A lack of oxygen in the heart muscle that causes the death of cells. -Complete closure of an artery. -Incomplete blockage of a major coronary artery. -A destroyed part of the heart muscle.

A lack of oxygen in the heart muscle that causes the death of cells. -Impeded blood flow, due to blockage in a coronary artery, deprives the cardiac muscle cells of oxygen thus leading to a condition known as ischemia.

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 and does not know where he is. After reporting these change in status to the care provider, the nurse should: -reorient the client to place and time. -assess for factors that may be causing the client's delirium. -document the early signs of dementia and ensure the client's safety. -educate the family about how confusion is expected in older adults postoperatively.

Assess for factors that may be causing the client's delirium

Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? -Felodipine -Diltiazem -Amlodipine -Clopidogrel

Clopidogrel -Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine (Duramorph), oxygen, and aspirin. The physician diagnoses acute coronary syndrome. When the client arrives on the unit, his vital signs are stable and he has no complaints of pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order? -Furosemide (Lasix) -Digoxin (Lanoxin) -Nitroprusside (Nipride) -Carvedilol (Coreg)

Carvedilol (Coreg) -A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.

The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI? -CK-MM -Myoglobin level -Creatinine kinase-myoglobin (CK-MB) level -Troponin C level

Creatinine kinase-myoglobin level (CK-MB) -Elevated CK-MB assessment by mass assay is an indicator of acute MI; the levels begin to increase within a few hours and peak within 24 hours of an MI. If the area is reperfused (due to thrombotic therapy or PCI), it peaks earlier. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. There are three isomers of troponin: C, I, and T. Troponin I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury. An increase in myoglobin is not very specific in indicating an acute cardiac event; however, negative results are an excellent parameter for ruling out an acute MI.

The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? -Creates a positive inotropic effect -Increases the heart rate -Decreases the sinoatrial node automaticity -Increases the atrioventricular node conduction

Decrease the sinoatrial node automaticity -Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).

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

High LDL Level -LDL levels above 100 mg/dL are considered high -The goal is to decrease the LDL level below 100 mg/dL.

As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid. -High-density lipoproteins (HDL) -Triglycerides -Low-density lipoproteins (LDL) -Total cholesterol

Low-density lipoproteins (LDL)

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) -Morphine sulfate (Morphine) -Meperidine hydrochloride (Demerol) -Nitroglycerin transdermal patch

Morphine Sulfate -Morphine 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 Isordil) have a large first-pass effect, and transdermal patch is used for long-term management. Demerol is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.

The nurse is caring for a client who is being evaluated for lipid-lowering medication. The client's laboratory results reveal the following: total cholesterol 230 mg/dL, LDL 120 mg/dL, triglyceride level 310 mg/dL. Which class of medications would be most appropriate for the client based on these laboratory findings? -Nicotinic acid -Fibric acid -Bile acid sequestrant -HMG-CoA reductase inhibitor

Nicotinic Acid The most appropriate class of medications based on the patient's laboratory findings would be nicotinic acids. This class of medications is prescribed for patients with: minimally elevated cholesterol and LDL levels or as an adjunct to a statin when the lipid goal has not been has not been achieved and triglyceride (TG) levels are elevated.

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? a) "Contact dermatitis and skin irritations are common when the patch remains on all day." b) "Removing the patch at night prevents drug tolerance while keeping the benefits." c) "Nitroglycerine causes headaches, but removing the patch decreases the incidence." d) "You do not need the effects of nitroglycerine while you sleep."

b) "Removing the patch at night prevents drug tolerance while keeping the benefits." Tolerance to antiangina effects of nitrates can occur when taking these drugs for long periods of time. Therefore, to prevent tolerance and maintain benefits, it is a common regime to remove transdermal patches at night. Common adverse effects of nitroglycerine are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while you rest, there is less demand on the heart but not the primary reason for removing the patch.