Chapter 25: Disorders of Coronary and Peripheral Blood Vessels

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? "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." "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."

The nurse is teaching a client who is being discharged post vein stripping for varicose veins. Which client statement indicates the client requires additional self-care instructions? "I should call the doctor if I get a cut on my foot." "So it's OK for me to return to my job right away as a hairdresser." "I should try not to cross my knees when I'm sitting." "I'll need to wear these support stockings every day."

"So it's OK for me to return to my job right away as a hairdresser."

The nurse providing care for a client post PTCA knows to monitor the client closely. For what complications should the nurse monitor the client? Select all that apply. Arterial occlusion Venous insufficiency Abrupt closure of the coronary artery Retroperitoneal bleeding Bleeding at the insertion site

Arterial occlusion Abrupt closure of the coronary artery Retroperitoneal bleeding Bleeding at the insertion site

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?

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

A client who has undergone a femoral to popliteal bypass graft surgery returns to the surgical unit. Which assessments should the nurse perform during the first postoperative day? Assess pulse of affected extremity every 15 minutes at first. Palpate the affected leg for pain during every assessment. Perform Doppler evaluation once daily. Assess the client for signs and symptoms of compartment syndrome every 2 hours.

Assess pulse of affected extremity every 15 minutes at first.

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment?

Assess the client's level of pain and administer prescribed analgesics.

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? Prepare the client for pulmonary artery catheterization. Assess the client's level of anxiety and provide emotional support. Assess the client's level of pain and administer prescribed analgesics. Ensure that the client's family is kept informed of the client's status.

Assess the client's level of pain and administer prescribed analgesics.

A patient with a diagnosis of deep vein thrombosis (DVT) is being treated with unfractionated heparin, which is being administered intravenously. The nurse who is providing care for this patient should consequently prioritize what assessments? Assessing the patient for internal or external hemorrhage Monitoring the patient's intake and output, and assessing for signs of fluid volume deficit Assessing the patient for adventitious lung sounds and assessing SaO2 levels Assessing the patient's pain levels

Assessing the patient for internal or external hemorrhage

The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments? Maximizing cardiac output while minimizing heart rate Balancing myocardial oxygen supply with demand Increasing the size of the myocardial muscle Decreasing energy expenditure of the myocardium

Balancing myocardial oxygen supply with demand

A client presents to the ED reporting severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU? Auscultate lung fields. Begin ECG monitoring. Obtain information about family history of heart disease. Determine if the client smokes.

Begin ECG monitoring.

A client with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The client is admitted to the cardiac critical care unit after the PTCA. The complications for which the nurse should monitor the client include which of the following? Left ventricular hypertrophy Pulmonary edema Peripheral edema Bleeding at insertion site

Bleeding at insertion site

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? Isosorbide mononitrate Metoprolol Diltiazem Clopidogrel

C. Clopidogrel 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 in the cardiac step-down unit has begun bleeding from the percutaneous coronary intervention (PCI) access site in the femoral region. What is the nurse's most appropriate action? Promptly remove the femoral sheath. Call for help and apply pressure to the access site. Call for assistance and initiate cardiopulmonary resuscitation. Reposition the client's leg in a nondependent position.

Call for help and apply pressure to the access site. Feedback: The femoral sheath produces pressure on the access site. Pressure will temporarily reduce bleeding and allow for subsequent interventions. Removing the sheath would exacerbate bleeding and repositioning would not halt it. CPR is not indicated unless there is evidence of respiratory or cardiac arrest.

A client is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What intervention best addresses this risk? Client's consistent performance of deep-breathing and coughing exercises Client's active participation in the cardiac rehabilitation program Administration of bronchodilators by nebulizer Administration of inhaled corticosteroids by metered dose inhaler (MDI)

Client's consistent performance of deep-breathing and coughing exercises

A client who is postoperative day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurse's most appropriate action? Contact the dietitian and suggest the need for increased oral fluid intake. Increase the infusion rate of the client's IV fluid to prompt an increase in renal function. Document the client's low urine output and monitor closely for the next several hours. Contact the client's health care provider and continue to assess fluid balance and renal function.

Contact the client's health care provider and continue to assess fluid balance and renal function.

The nurse has just admitted a client for cardiac surgery. The client tearfully describes feeling afraid of dying while undergoing the surgery. What is the nurse's best response? Explore the factors underlying the client's anxiety. Obtain an order for a PRN benzodiazepine. Teach the client guided imagery techniques. Describe the procedure in greater detail.

Explore the factors underlying the client's anxiety.

When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse position a patient who has leg ulcers that are venous in origin? Elevate the patient's lower extremities. Hang the patient's legs over the side of the bed Keep the patient's knees at a 45-degree angle. Keep the patient's legs flat without the knees raised.

Elevate the patient's lower extremities.

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? Elevated ST segment Absent Q wave Widened QRS complex Prolonged PR interval

Elevated ST segment

Which statement is accurate regarding Raynaud disease? Episodes may be triggered by unusual sensitivity to cold. It affects more than two digits on each hand or foot. It is most common in men 16 to 40 years of age. The disease generally affects the client trilaterally.

Episodes may be triggered by unusual sensitivity to cold.

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. Sedation, nausea, vomiting, constipation, and respiratory depression. Nausea, vomiting, depression, fatigue, and impotence. Headache, hypotension, dizziness, and flushing.

Headache, hypotension, dizziness, and flushing.

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? Anxiety related to fear of death Noncompliance related to failure to accept necessary lifestyle changes Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Deficient knowledge about underlying disease and methods for avoiding complications

Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD)

A postsurgical client has illuminated the call light to inform the nurse of a sudden onset of lower leg pain. On inspection, the nurse observes that the client's left leg is visibly swollen and reddened. Which action by the nurse would be most appropriate? Massage the client's lower leg to temporarily restore venous return. Mobilize the client promptly to dislodge any thrombi in the client's lower leg. Administer a PRN dose of subcutaneous heparin. Inform the health care provider that the client has signs and symptoms of venous thromboembolism (VTE).

Inform the health care provider that the client has signs and symptoms of venous thromboembolism (VTE).

The nurse is taking a health history on a new patient. The patient reports experiencing pain in the left lower leg and foot when walking, but claims that the pain is relieved with rest. The nurse notes that the patient's left lower leg is slightly edematous and hairless. What should the nurse suspect that the patient may be experiencing? Coronary artery disease (CAD) Arterial embolus Intermittent claudication Raynaud's disease

Intermittent claudication

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? Intermittent claudication Acute limb ischemia Vertigo Dizziness

Intermittent claudication

The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis. Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels? International normalized ratio (INR) between 2 and 3 Partial thromboplastin time (PTT) within normal reference range Hematocrit of 32% Prothrombin time (PT) 8 to 10 times the control

International normalized ratio (INR) between 2 and 3

A client is undergoing lipid profile studies in an effort to determine a proper nutritional balance for CAD. The client's lipid profile reveals LDL greater than HDL. This is a risk factor for this client because the: HDL carries cholesterol to the liver. LDL sticks to arteries. HDL sticks to arteries. LDL carries cholesterol to the liver.

LDL sticks to arteries.

The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest? Elevating the limb above heart level Lowering the limb so that it is dependent Placing the limb in a plane horizontal to the body Massaging the limb after application of cold compresses

Lowering the limb so that it is dependent

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? Aspirin Protamine sulfate Clopidogrel Alteplase

Protamine sulfate 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 triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? Accompanied by diaphoresis and dyspnea Relieved by rest and nitroglycerin Associated with nausea and vomiting Described as crushing and substernal

Relieved by rest and nitroglycerin

Which of the following is the most effective intervention for preventing progression of vascular disease? Use neutral soaps Avoid trauma Wear sturdy shoes Risk factor modification

Risk factor modification

What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis? Inform the physician if the client's temperature remains low. Teach the client how to apply a graduated compression stocking. Offer cold applications to promote comfort and to enhance circulation. Avoid elevating the area.

Teach the client how to apply a graduated compression stocking.

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 verbalizes the intention of making all necessary lifestyle changes except for stopping smoking. The client states that sublingual nitroglycerin usually relieves his chest pain. The client exhibits a heart rate above 100 beats/minute. The client demonstrates ability to tolerate more activity without chest pain.

The client demonstrates ability to tolerate more activity without chest pain.

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 an ejection fraction of 65%. The patient has at least a 70% occlusion of a major coronary artery.

The patient has at least a 70% occlusion of a major coronary artery.

Family members bring a client to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data? The symptoms indicate angina and should be treated as such. The symptoms indicate an acute coronary episode and should be treated as such. Treatment should be determined pending the results of an exercise stress test. The symptoms indicate a pulmonary etiology rather than a cardiac etiology.

The symptoms indicate an acute coronary episode and should be treated as such.

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? CK-MB Total creatine kinase Troponin Myoglobin

Troponin

The nurse is caring for a patient with venous insufficiency. For what should the nurse assess the patient's lower extremities? Rubor Cellulitis Dermatitis Ulceration

Ulceration

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? Loose and wrinkled skin Cyanosis Evident scaring Ulcers and infection in the edematous area

Ulcers and infection in the edematous area

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 Within 24 to 48 hours Within 12 hours Within 5 to 7 days

Within 6 hours For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Health care providers initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.

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: 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. The absence of known risk factors usually rules out myocardial infarction (MI) or angina as a cause of dyspnea. Dyspnea is definitive for a respiratory, rather than cardiac, etiology.

Women often present with an MI much differently than do men.

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? penicillin V or erythromycin. pentoxifylline or acetaminophen. aspirin or acetaminophen. aspirin or clopidogrel.

aspirin or clopidogrel.

The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? skeletal muscle damage due to a recent fall I.M. injection myocardial necrosis cerebral bleeding

myocardial necrosis An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injuries such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.

The nurse is assessing a client who is experiencing symptoms of an arterial embolism of the right arm. Which assessment findings indicate to the nurse that the client has this condition? Select all that apply. Pain Pallor Paralysis Palpitations Pulselessness

pain, pallor, paralysis, pulselessness

The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the emergency room. What is the most important cardiac marker for the client? troponin myoglobin creatine kinase lactate dehydrogenase

troponin