chapter 27- med surg
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." "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." "A burning sensation after administration indicates that the nitroglycerin tablets are potent." "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 client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." "Client will verbalize the intention to avoid exercise." "Client will verbalize the intention to stop smoking." "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
"Client will verbalize the intention to stop smoking."
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? "I should avoid taking a tub bath until my catheter site heals." "I should expect a low-grade fever and swelling at the site for the next week." "I should avoid prolonged sitting." "I should expect bruising at the catheter site for up to 3 weeks."
"I should expect a low-grade fever and swelling at the site for the next week."
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? Altered level of consciousness Minimal oozing of blood from the IV site Presence of reperfusion dysrhythmias Chest pain 2 of 10 (on a 1-to-10 pain scale)
Altered level of consciousness- indicates hypoxia and intracranial bleeding and the infusion should be discontinued immediately
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? Report changes in the usual pattern of chest pain. Avoid situations that contribute to ischemic episodes. Avoid fatty foods and exercise. Take over-the-counter decongestants.
Avoid situations that contribute to ischemic episodes.
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply. Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all times and be accessible quickly, when needed. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. Renew the supply every 6 months. Take the tablet in anticipation of any activity that can produce pain. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.
Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. Take the tablet in anticipation of any activity that can produce pain. Renew the supply every 6 months. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed.
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? Chest discomfort not relieved by rest or nitroglycerin Intermittent nausea and emesis for 3 days Cool, clammy skin and a diaphoretic, pale appearance Anxiousness, restlessness, and lightheadedness
Chest discomfort not relieved by rest or nitroglycerin
The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration? Measure the blood pressure for hypertension. Count the respiratory rate for bradypnea. Check the radial pulse for dysrhythmias. Measure urinary output for dehydration.
Count the respiratory rate for bradypnea.-
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? Decreases resting heart rate Decreases cholesterol level Increases cardiac output Decreases platelet aggregation
Decreases resting heart rate
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? Decreases the sinoatrial node automaticity Increases the atrioventricular node conduction Increases the heart rate Creates a positive inotropic effect
Decreases the sinoatrial node automaticity- resulting in slow heart rate and decrease in strength of myocardial contraction
In providing nursing management to a client post-varicose vein surgery, the nurse would include which of the following teaching measures? Select all that apply. Exercise Cool compresses Elastic stockings Lower the extremities. Stand rather than sit. Take warm showers in the morning.
Elastic stockings Exercise
The nurse is developing a teaching plan for the client to address modifiable risk factors for coronary artery disease (CAD), the nurse will include which factor(s)? Select all that apply. Elevated blood pressure Alcohol use Obesity Physical inactivity Increasing age Family history
Elevated blood pressure Alcohol use Obesity Physical inactivity
The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD? Cholesterol, 280 mg/dL Low density lipoprotein (LDL), 160 mg/dL High-density lipoprotein (HDL), 80 mg/dL A ratio of LDL to HDL, 4.5 to 1.0
High-density lipoprotein (HDL), 80 mg/dL
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 Decrease intravenous fluids Irrigate the urinary catheter Prepare the client for dialysis
Increase intravenous fluids
A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? Instruct the client on side effects of flushing, throbbing headache, and tachycardia. Instruct the client to renew the nitroglycerin supply every 3 months. Instruct the client not to crush the tablet. Instruct the client to place nitroglycerin tablets in a plastic pill box.
Instruct the client on side effects of flushing, throbbing headache, and tachycardia.
Which technique is used to surgically revascularize the myocardium? Balloon bypass Peripheral bypass Minimally invasive direct coronary bypass Gastric bypass
Minimally invasive direct coronary bypass
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) Meperidine hydrochloride (Demerol) Morphine sulfate (Morphine) Nitroglycerin transdermal patch
Morphine sulfate (Morphine)
A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? Nitroglycerin SL Chest x-ray Serum electrolytes Ativan 1 mg orally
Nitroglycerin SL
The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis? Avoid use of caffeine Encourage use of a multivitamin Addressing obesity Drink at least 2 liters of water a day
addressing obesity
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 acetaminophen. pentoxifylline or acetaminophen. aspirin or clopidogrel. penicillin V or erythromycin.
aspirin or clopidogrel.
A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication? Atelectasis Elevated blood glucose level Hyperkalemia Urinary tract infection (UTI)
atelectasis-
The nurse is removing a client's femoral sheath after cardiac catheterization. What medication will the nurse have available? heparin atropine sulfate protamine sulfate adenosine
atropine sulfate-removing the sheat causes vasovagal response including bradycardia and this med will increase the clients heart rate
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? Uterus Blood vessels Bronchi Heart
heart
Which of the following is inconsistent as a condition related to metabolic syndrome? Hypotension Insulin resistance Abdominal obesity Dyslipidemia
hypotension
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 dilate coronary arteries To decrease workload of the heart To decrease homocysteine levels To prevent angiotensin II conversion
to decrease workload of the heart which decreases myocardial oxygen
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? Myoglobin Troponin Total creatine kinase CK-MB
troponin remains elevated for as long as 2 weeks, myoglobin peaks within 12 hours after onset, total creatine kinase returns to normal in 3 days
Which term refers to preinfarction angina? Stable angina Unstable angina Variant angina
unstable angina
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? Chest pain is typical Vague symptoms Decreased sensation to pain Gender bias
vague symptoms
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? Clopidogrel Amlodipine Diltiazem Felodipine
clopidogrel-
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? Clopidogrel Isosorbide mononitrate Metoprolol Diltiazem
clopidogrel- antiplatelet
A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? Coronary artery disease Raynaud's disease Cardiogenic shock Venous occlusive disease
coronary artery disease- most common symptom is chest pain angina or discomfort during activity or stress, usually sudden
A client is admitted for treatment of Prinzmetal angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? Activities that increase myocardial oxygen demand. An unpredictable amount of activity. Coronary artery spasm. The same type of activity that caused previous angina episodes.
coronary artery spasm
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: high LDL level. low LDL level. normal LDL level. fasting LDL level.
high LDL level- LDL above 100 are considered high
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? "See if rest relieves the chest pain before using the nitroglycerin." "Call 911 if you develop a headache following nitroglycerin use." "Place the nitroglycerin tablet between cheek and gum." "Only take one nitroglycerin tablet for each episode of angina."
"See if rest relieves the chest pain before using the nitroglycerin."
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 lasted about 45 minutes." "The pain resolved after I ate a sandwich." "The pain got worse when I took a deep breath." "The pain occurred while I was mowing the lawn."
"The pain occurred while I was mowing the lawn."
A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding? "What color is your urine?" "Is your skin drier than normal?" "Do you have any breathing problems?" "How is your appetite?"
"what color is your urine"
The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? 160-190 mg/dL 210-240 mg/dL 250-275 mg/dL 280-300 mg/dL
160-190 mg/dl normal total cholesterol is less than 200 mg/dl
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.
24 (1200 units/25000 units ) x 500 ml
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. With regards to partial thromboplastin time (PTT), when should the nurse plan to remove the femoral sheath? 50 seconds or less. 75 seconds or less. 100 seconds or less. 125 seconds or less.
50 seconds or less
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? Nausea, vomiting, depression, fatigue, and impotence. Sedation, nausea, vomiting, constipation, and respiratory depression. Headache, hypotension, dizziness, and flushing. Flushing, dizziness, headache, and pedal edema.
Headache, hypotension, dizziness, and flushing.
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? IV morphine IV nitroglycerin Atenolol Amlodipine
IV morphine- analgesic of choice for treatment of an acute MI, given to reduce anxiety and pain, also reduces preload and afterload, which decreases the workload of the heart
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 demonstrates ability to tolerate more activity without chest pain. The client exhibits a heart rate above 100 beats/minute. 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 demonstrates ability to tolerate more activity without chest pain.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? calcium-channel blocker beta-adrenergic blocker nitrate diuretic
calcium-channel blocker
The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? Prepare to administer intravenous fluids. Suction the airway. Check blood pressure. Assess pupils for reactiveness.
check the blood pressure
A client who has been diagnosed with Prinzmetal's angina will present with which symptom? chest pain that occurs at rest and usually in the middle of the night radiating chest pain that lasts 15 minutes or less prolonged chest pain that accompanies exercise chest pain of increased frequency, severity, and duration
chest pain that occurs at rest and usually in the middle of the night
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? Prolonged PR interval Absent Q wave Elevated ST segment Widened QRS complex
elevated ST segment
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? decrease anxiety enhance myocardial oxygenation administer sublingual nitroglycerin educate the client about his symptoms
enhance myocardial oxygenation
The nurse is reviewing the laboratory results for a client diagnosed with coronary artery disease (CAD). The client's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as high. low. within normal limits. critically high.
high- an LDL of 115 is too high, want it to be below 100
A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? Hypotension Urinary incontinence Hyperactive bowel sounds Hypertension
hypotension-adverse effects of opioids include respiratory depression, hypotension, ileus, or urinary retention
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 Normal glomerular filtration Overhydration Anuria
inadequate fluid volume
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? Inadequate tissue perfusion Mental alertness Blood glucose concentration Activity intolerance
inadequate tissue perfusion
A nurse completed a client physical examination for an insurance company. The nurse determined the client has increased blood pressure, increased blood glucose, levels and obesity. What condition for coronary artery disease does the nurse consider next? congestive heart failure hypolipidemia metabolic syndrome diabetes mellitus
metabolic syndrome
The nurse reviews laboratory tests for cardiac biomarkers for a client suspected of suffering an MI. What is the earliest marker of an MI? Creatinine kinase-myocardial band (CK-MB) Total creatinine kinase (CK) Myoglobin Troponin I and T
myoglobin- heme protein that transports oxygen
The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with percutaneous coronary intervention (PCI). IV heparin. IV nitroglycerin. thrombolytics.
percutaneous coronary intervention (PCI).
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? pericardial friction rub hypothermia decreased white blood cell (WBC) count decreased erythrocyte sedimentation rate (ESR)
pericardial friction rub
The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? weight gain of 6 ounces serum glucose of 124 mg/dL potassium level of 6 mEq/L bilateral rales and rhonchi
potassium level of 6 mEq/L
A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? prior intracranial hemorrhage recent consumption of a meal shellfish allergy use of heparin
prior intracranial hemorrhage
The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) It is relieved by rest and inactivity. It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms. It subsides after taking nitroglycerin.
t is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms. It is substernal in location.
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 Gender Obesity Race Tobacco use
Tobacco use Hyperlipidemia Obesity
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? Inform client of diagnostic tests. Remove hair from skin insertion sites. Assess distal pulses. Withhold anticoagulant therapy.
Withhold anticoagulant therapy.
The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? an hourly urine output of 50 to 70 mL a urine specific gravity reading of 1.021 a serum BUN of 70 mg/dL a serum creatinine of 1.0 mg/dL
a serum BUN of 70 mg/dl
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. The nurse recognizes that this value is below the optimal range. above the optimal range. within the optimal range. extremely high.
above the optimal range
A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a long-term goal of rehabilitation for the client with an MI? Improvement in quality of life Limitation of the effects and progression of atherosclerosis Ability to return to work and a pre-illness functional capacity Prevention of another cardiac event
Improvement in quality of life
A nurse reviews an ECG strip for a client who is admitted with symptoms of an acute MI. The nurse should recognize what classic ECG changes that occur with an MI? Select all that apply. Absent P-waves Abnormal Q-waves T-wave hyperactivity and inversions ST-segment elevations U-wave elevations
ST-segment elevations Abnormal Q-waves T-wave hyperactivity and inversions
The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply. adequate cough and gag reflexes inability to speak acceptable arterial blood gas values labile vital signs breathing without assistance of the ventilator
acceptable arterial blood gas values adequate cough and gag reflexes breathing without assistance of the ventilator
