Chapter 13 cardiovascular alterations

The nurse is providing care to a patient on fibrinolytic therapy. Which statement from the patient warrants further assessment and intervention by the critical care nurse? A. "I have an incredible headache!" B. "There is blood on my toothbrush!" C. "Look at the bruises on my arms!" D. "My arm is bleeding where my IV is!"

A. "I have an incredible headache!"

The patient tells the nurse, "I didn't think I was having a heart attack because the pain was in my neck and back." The nurse explains: (Select all that apply.) A. "Pain can occur anywhere in the chest, neck, arms, or back. Don't hesitate to call the emergency medical services if you think it's a heart attack." B. "For many people chest pain from a heart attack occurs in the center of the chest, behind the breastbone." C. "The sooner the patient can get medical help, the less damage is likely to occur in case of a heart attack." D. "You need to make sure it's a heart attack before you call the emergency response personnel." E. "Often symptoms can be treated with nitroglycerin, so be sure to take several before calling 911."

A. "Pain can occur anywhere in the chest, neck, arms, or back. Don't hesitate to call the emergency medical services if you think it's a heart attack." B. "For many people chest pain from a heart attack occurs in the center of the chest, behind the breastbone." C. "The sooner the patient can get medical help, the less damage is likely to occur in case of a heart attack."

A patient is admitted to the emergency department with clinical indications of an acute myocardial infarction. Symptoms began 3 hours ago. The facility does not have the capability for percutaneous coronary intervention. Given this scenario, what is the priority intervention in the treatment and nursing management of this patient? A. Administer thrombolytic therapy unless contraindicated B. Diurese aggressively and monitor daily weight C. Keep oxygen saturation levels to at least 88% D. Maintain heart rate above 100 beats/min

A. Administer thrombolytic therapy unless contraindicated

Identify the priority interventions for managing symptoms of an acute myocardial infarction (AMI) in the ED. (Select all that apply.) A. Administration of morphine B. Administration of nitroglycerin (NTG) C. Dopamine infusion D. Oxygen therapy E. Transfusion of packed red blood cells

A. Administration of morphine B. Administration of nitroglycerin (NTG) D. Oxygen therapy

A patient is admitted with an acute myocardial infarction (AMI). The nurse monitors for which potential complications? (Select all that apply.) A. Cardiac dysrhythmias B. Heart failure C. Pericarditis D. Ventricular rupture E. Chest pain

A. Cardiac dysrhythmias B. Heart failure C. Pericarditis D. Ventricular rupture

The patient presents to the ED with severe chest discomfort. A cardiac catheterization and angiography shows an 80% occlusion of the left main coronary artery. Which procedure will be most likely performed on this patient? A. Coronary artery bypass graft surgery B. Intracoronary stent placement C. Percutaneous transluminal coronary angioplasty (PTCA) D. Transmyocardial revascularization

A. Coronary artery bypass graft surgery

A patient with a 10-year history of heart failure presents to the emergency department reporting severe shortness of breath. Assessment reveals crackles throughout the lung fields and labored breathing. The patient takes beta blockers, ACE inhibitors, and diuretics as directed. What treatment strategies does the nurse plan to implement for immediate short-term management? (Select all that apply.) A. Dobutamine B. Intraaortic balloon pump C. Nesiritide D. Ventricular assist device E. Biventricular pacemaker

A. Dobutamine B. Intraaortic balloon pump C. Nesiritide

Which statements are true regarding the symptoms of an AMI? (Select all that apply.) A. Dysrhythmias are common occurrences. B. Men have more atypical symptoms than women. C. Midsternal chest pain is a common presenting symptom. D. Some patients are asymptomatic. E. Patients may complain of jaw or back pain

A. Dysrhythmias are common occurrences. C. Midsternal chest pain is a common presenting symptom. D. Some patients are asymptomatic. E. Patients may complain of jaw or back pain

A patient presents to the emergency department (ED) with chest pain that he has had for the past 2 hours. The patient is nauseated and diaphoretic, with dusky skin color. The electrocardiogram shows ST elevation in leads II, III, and aVF. Which therapeutic intervention would the nurse question? A. Emergent pacemaker insertion B. Emergent percutaneous coronary intervention C. Emergent thrombolytic therapy D. Immediate coronary artery bypass graft surgery

A. Emergent pacemaker insertion

A patient has been diagnosed with Marfan syndrome. What information does the nurse plan to teach the patient about this condition? A. It is an autosomal dominant inherited disorder of connective tissue. B. It is caused by a random genetic mutation and is not familial. C. There are no drugs that help symptoms of the disease. D. Contact sports are permitted if precautions against concussion are taken

A. It is an autosomal dominant inherited disorder of connective tissue.

Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.) A. Jugular venous distension B. Peripheral edema C. Crackles audible in the lungs D. Weak peripheral pulses E. Hepatomegaly

A. Jugular venous distension B. Peripheral edema E. Hepatomegaly

The patient is admitted with a suspected acute myocardial infarction (AMI). In assessing the 12-lead electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the process of an evolving Q wave myocardial infarction (MI)? A. ST-segment elevation on ECG and elevated CPK-MB or troponin levels B. Depressed ST-segment on ECG and elevated total CPK C. Depressed ST-segment on ECG and normal cardiac enzymes D. Q wave on ECG with normal enzymes and troponin levels

A. ST-segment elevation on ECG and elevated CPK-MB or troponin levels

A patient presents to the ED complaining of severe substernal chest pressure radiating to the left shoulder and back that started about 12 hours ago. The patient delayed coming to the ED, hoping the pain would go away. The patient's 12-lead ECG shows ST-segment depression in the inferior leads. Troponin and CK-MB are both elevated. What does the nurse understand about thrombolysis in this patient? A. The patient is not a candidate for thrombolysis. B. The patient's history makes him a good candidate for thrombolysis. C. Thrombolysis is appropriate for a candidate having a non-Q wave MI. D. Thrombolysis should be started immediately.

A. The patient is not a candidate for thrombolysis.

A patient has been prescribed nitroglycerin (NTG) in the ED for chest pain. In taking the health history, the nurse will be sure to verify whether the patient has taken medications before admission for: A. erectile dysfunction. B. prostate enlargement. C. asthma. D. peripheral vascular disease.

A. erectile dysfunction

The patient's spouse is feeling overwhelmed about cooking different dinners for the patient and the rest of the family to satisfy a cholesterol-reducing diet. Which response by the nurse is best? A. "It will be worth it to have a healthy spouse, won't it?" B. "The low-cholesterol diet is one from which everyone can benefit." C. "As long as you change at least a few things in the diet, it will be okay." D. "You can go on the diet with him, and then let the children eat whatever they want."

B. "The low-cholesterol diet is one from which everyone can benefit."

Which comment by the patient indicates a good understanding of a diagnosis of coronary heart disease? A. "I had a heart attack because I work too hard, and it puts too much strain on my heart." B. "The pain in my chest gets worse each time it happens. I think that there is more damage to my heart vessels as time goes on." C. "If I change my diet and exercise more, I should get over this and be healthy." D. "What kind of pills can you give me to get me over this and back to my lifestyle?"

B. "The pain in my chest gets worse each time it happens. I think that there is more damage to my heart vessels as time goes on."

A patient is having a stent and asks why it is necessary after having an angioplasty. Which response by the nurse is best? A. "The angioplasty was a failure, and so this procedure has to be done to fix the heart vessel." B. "The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again." C. "This procedure is being done instead of using clot-dissolving medication to help keep the heart vessel open." D. "The stent will remove any clots that are in the vessel and protect the heart muscle from damage."

B. "The stent is inserted to enhance the results of the angioplasty, by helping to keep the vessel open and prevent it from closing again."

Which nursing interventions would be appropriate after angioplasty? (Select all that apply.) A. Elevate the head of the bed by 45 degrees for 6 hours. B. Assess pedal pulses on the involved limb every 15 minutes for 1 to 2 hours. C. Monitor the vascular hemostatic device for signs of bleeding. D. Instruct the patient to bend his or her knee every 15 minutes while the sheath is in place. E. Maintain NPO status for 12 hours.

B. Assess pedal pulses on the involved limb every 15 minutes for 1 to 2 hours. C. Monitor the vascular hemostatic device for signs of bleeding.

The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia? A. Second-degree heart block B. Atrial fibrillation or flutter C. Ventricular ectopy D. Premature junctional contractions

B. Atrial fibrillation or flutter

A patient was admitted in terminal heart failure and is not eligible for transplant. The family wants everything possible done to maintain life. Which procedure might be offered to the patient for this condition to increase the patient's quality of life? A. Intraaortic balloon pump (IABP) B. Left ventricular assist device (LVAD) C. Nothing, because the patient is in terminal heart failure D. Nothing additional; medical management is the only option

B. Left ventricular assist device (LVAD)

The patient is admitted with an acute myocardial infarction (AMI). Three days later the nurse is concerned that the patient may have a papillary muscle rupture. Which assessment data may indicate a papillary muscle rupture? A. Gallop rhythm B. New murmur C. S1 heart sound D. S3 heart sound

B. New murmur

Which of the following cardiac diagnostic tests would include monitoring the gag reflex before giving the patient anything to eat or drink? A. Barium swallow B. Transesophageal echocardiogram C. MUGA scan D. Stress test

B. Transesophageal echocardiogram

An essential aspect of teaching that may prevent recurrence of heart failure is A. notifying the provider if a 2-lb weight gain occurs in 24 hours. B. compliance with diuretic therapy. C. taking nitroglycerin if chest pain occurs. D. assessment of an apical pulse.

B. compliance with diuretic therapy

While instructing a patient on what occurs with a myocardial infarction, the nurse plans to explain which process? A. Coronary artery spasm. B. Decreased blood flow (ischemia). C. Death of cardiac muscle from lack of oxygen (tissue necrosis). D. Sporadic decrease in oxygen to the heart (transient oxygen imbalance).

C. Death of cardiac muscle from lack of oxygen (tissue necrosis).

The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find? A. Dependent edema B. Distended neck veins C. Dyspnea and crackles D. nausea and vomiting

C. Dyspnea and crackles

A patient is having a cardiac evaluation to assess for possible valvular disease. Which study best identifies valvular function and measures the size of the cardiac chambers? A. 12-lead electrocardiogram B. Cardiac catheterization C. Echocardiogram D. Electrophysiology study

C. Echocardiogram

A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an angiotensin-converting enzyme (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process? A. Myocardial stunning B. Hibernating myocardium C. Myocardial remodeling D. Tachycardia

C. Myocardial remodeling

A patient is admitted with angina. The nurse anticipates which drug regimen to be initiated? A. ACE inhibitors and diuretics B. Morphine sulfate and oxygen C. Nitroglycerin, oxygen, and beta blockers D. Statins, bile acid, and nicotinic acid

C. Nitroglycerin, oxygen, and beta blockers

Acute myocardial infarction (AMI) can be classified as which of the following? (Select all that apply.) A. Angina B. Nonischemic C. Non-Q wave D. Q wave E. Frequent PVCs

C. Non-Q wave D. Q wave

A patient is admitted with the diagnosis of unstable angina. The nurse knows that the physiological mechanism present is most likely which of the following? A. Complete occlusion of a coronary artery B. Fatty streak within the intima of a coronary artery C. Partial occlusion of a coronary artery with a thrombus D. Vasospasm of a coronary artery

C. Partial occlusion of a coronary artery with a thrombus

The patient is admitted with recurrent supraventricular tachycardia that the cardiologist believes to be related to an accessory conduction pathway or a reentry pathway. The nurse anticipates which procedure to be planned for this patient? A. Implantable cardioverter-defibrillator placement B. Permanent pacemaker insertion C. Radiofrequency catheter ablation D. Temporary transvenous pacemaker placement

C. Radiofrequency catheter ablation

A 72-year-old woman is brought to the ED by her family. The family states that she's "just not herself." Her respirations are slightly labored, and her heart monitor shows sinus tachycardia (rate 110 beats/min) with frequent premature ventricular contractions (PVCs). She denies any chest pain, jaw pain, back discomfort, or nausea. Her troponin levels are elevated, and her 12-lead electrocardiogram (ECG) shows elevated ST segments in leads II, III, and aVF. The nurse knows that these symptoms are most likely associated with which diagnosis? A. Hypokalemia B. Non-Q wave MI C. Silent myocardial infarction D. Unstable angina

C. Silent myocardial infarction

The provider prescribes a pharmacological stress test for a patient with activity intolerance. The nurse would anticipate that the drug of choice would be A. dopamine. B. dobutamine. C. adenosine. D. atropine.

C. adenosine

The patient presents to the ED with sudden, severe sharp chest discomfort, radiating to the back and down both arms, as well as numbness in the left arm. While taking the patient's vital signs, the nurse notices a 30-point discrepancy in systolic blood pressure between the right and left arm. Based on these findings, the nurse should: A. contact the physician and report the cardiac enzyme results. B. contact the physician and prepare the patient for thrombolytic therapy. C. contact the physician immediately and begin prepping the patient for surgery. D. give the patient aspirin and heparin.

C. contact the physician immediately and begin prepping the patient for surgery.

A patient is having an emergent coronary intervention, and the nurse is starting an infusion of abciximab. The patient asks what the purpose of this drug is. What response by the nurse is best? A. "This will help prevent chest pain until the intervention is complete." B. "This medication dries oral and respiratory secretions during the procedure." C. "This is a mild sedative and amnesic agent, so you'll be very relaxed." D. "This drug helps prevent blood clotting and is often used for this procedure."

D. "This drug helps prevent blood clotting and is often used for this procedure."

Percutaneous coronary intervention is contraindicated for patients with lesions in which coronary artery? A. Right coronary artery B. Left coronary artery C. Circumflex D. Left main coronary artery

D. Left main coronary artery

A patient has elevated blood lipids. The nurse anticipates which classification of drugs to be prescribed for the patient? A. Bile acid resins B. Nicotinic acid C. Nitroglycerin D. Statins

D. Statins