chapter 35 Acute coronary disease

what priority question would the nurse ask before administering SL nitroglycerin to a middle-age male client with chest pain?

"have you taken a medication for ED within the past 24-48 hours?"

which statement by the client who had a CABAG surgery indicates to the nurse that his or her pain is related to the sternotomy and is not anginal in origin?

"my pain increases when I cough or take a deep breath"

Which statement by a client indicates to the nurse correct understanding of resuming sexual activity in the presence of angina?

"when I can climb two flights of stairs, it is safe to resume sexual activity"

Which findings would the nurse expect when assessing a client with chronic stable angina (select all that apply) A. chest discomfort that occurs in a pattern that is familiar to the client B. chest discomfort that occurs with moderate to prolonged exertion C. Frequency, duration, and intensity of symptoms remain the same over several months D. result in moderate limitation of activity E. usually treated with rest and nitroglycerin (NTG) F. Pain lasts less than 15 min

A,B,C,E,F

for which manifestations would the nurse monitor when providing care for a lcient. prescribed beta-blocker therapy? (select all that apply): A. depression B. bradycardia C. decreased level of consciousness D. increased urine output E. crackles on wheezes in the lungs F. chest discomfort

A,B,C,E,F

which statements about coronary artery disease and women are accurate? (select all that apply) A. postmenopausal women in their 70s have the same incidence of MI as men B. women have smaller coronary arteries and frequently have plaque that breaks off and travels into the small vessels to form an embolus C. the older a woman is the more likely she is to have CAD D. more men with women die within a year after MI E. women whose parents had CAD are more susceptible to the disease F. many women experience atypical angina as indigestion, pain between the shoulders, aching jaw, and a choking sensation

A,B,C,E,F

which alternative therapies may be helpful in reducing a clients' anxiety about progressive actively postoperatively and during rehabilitation? (select all that apply): A. guided imagery B. progressive muscle relaxation C. acupuncture D. music therapy E. pet therapy F. herbal remedies

A,B,D,E

which signs and symptoms indicate to the nurse that a client with a myocardial infarction and heart failure is going into cariogenic shock? (select all that apply): A. cold, clammy skin with poor peripheral pulses B. pulmonary congestion and tackypnea C. bradycardia and hypertension D. urine output less than 0.5 to 1 ML/kg/hr E. agitation, restlessness, confusion F. systolic BP less than 100mgHg

A,B,D,E

which statement about the use of thrombolytic agents for a client with an acute MI are accurate? (select all that apply): A. clients who cannot receive timely percutaneous coronary intervention (PCI) with indications of ST elevation myocardial infarction (STEMI) should be considered for fibrinolytic therapy B. a client who has received a thrombolytic agent must be carefully monitored before, during, and after the drug is given C. thrombolytic therapy is indicated for chest pain of less than 15min duration that is relieved by nitroglycerin D. the client must be assessed for absolute and relative contraindications before thrombolytic agent is administered E. monitor for bleeding which is a major risk when a client receives thrombolytic therapy F. indication that the clot has been dissolved and the artery re-perfused include sudden onset of ventricular dysrhythmias

A,B,D,E,F

which are characteristics the nurse would expect to find in a client with unstable angina? (select all that apply) A. chest pain occurs at rest or with exertion B. pain causes severe limitation of activities C. includes chronic stable angina, vasospastic angina, and new-onset angina D. presents with ECG changes and elevation of troponin levels E. ischemia does not cause myocardial damage or cell death F. the pain or pressure is poorly relived by nitroglycerin

A,B,E,F

which absolute contraindicates would the nurse assess for when a client is being considered for thrombolytic therapy? (select all that apply): A. any prior intracranial hemorrhage B. history of chronic, severe, poorly controlled HTN C. suspected aortic dissection D. known malignant intracranial neoplasm E. severe uncontrolled HTN on presentation (SBP> 180) F. Active bleeding or bleeding diathesis (excluding menses)

A,C,D,F

which clients are potential candidates for coronary bypass graft (CABAG) surgery? (select all that apply): A. client with angina and greater than 50% occlusion to the left main coronary artery than cannot be stented B. client with unstable angina wiht moderate one-vessel disease appropriate for stenting C. client with valvular disease D. client with coronary vessels unsuitable for percutaneous coronary intervention (PCI) E. client with acute MI that is responding to medical therapy F. client with ischemia or impending MI after angioplasty or PCI

A,C,D,F

which essential preoperative teaching would the nurse provide to a client scheduled for a CABG surgery using the traditional procedures? (select all that apply): A. there will be a sternal incision B. coughing will be avoided to keep stress off the sternal incision C. there will be as many as three chest tubes in place after the surgery D. an indwelling urinary catheter will be in place to drain urine E. you will be on bedrest for up to 48hours after surgery F. an endotracheal tube will prevent talking immediately after surgery

A,C,D,F

which essential points would the nurse include when teaching a client with CAD how to manage activity at home? (select all that apply): A. begin by walking the same distance at home as in the hospital (usually 400ft) three times each day B. check your pulse before and after you exercise C. alway carry a bottle of nitroglycerin with you D. stop your activity if your pulse increases by 10bpm E. exercise outdoors when the weather is pleasant F. avoid straining (lifting, push-ups, and straining bowel movements)

A,C,E,F

which are post administration nursing responsibilities when caring for a client who received thrombolytic therapy? (select all that apply): A. observe all IV sites for bleeding and patency B. document the client's emotional reaction to the thrombolytic therapy C. monitor WBC count and differential D. test stool, urine, and emesis for occult blood E. monitor clotting study values F. observe for signs of internal bleeding

A,D,E,F

which indications of metabolic syndrome would the nurse expect in a client with heart failure? (select all that apply) A. blood pressure of 130/86 while taking beta blocker B. large waist of 35inches or greater for men C. hdl-g greater than 40mg/dL for men D. increased fasting glucose of 100mg/dL or higher E. Increased levels of triglycerides of 150mg/dL or higher F. decreased LDL-c of less than 50mg/dL for women

A,D,E,F

A client with chronic stable angling now has chest pressure, cool, and clammy skin, blood pressure 150/90mm/Hg, HR 100bpm, RR 32 breaths/min. what are the priorities of collaborative care for this client? (select all that apply) A. maintain NPO status B. relieve chest pain C. improve coronary artery perfusion D. draw troponin blood samples E. improve myocardial oxygenation F. relieve nausea

B,C,D,E

which nursing assessment is specific to a client develops mediastinitis after CABG surgery? (select all that apply): A. an anginal type chest pain B. fever continuing beyond the first 4 days after surgery C. bogginess of sternum D. redness and drainage from the suture site E. induration or swelling at the suture site F. decreased WBC count

B,C,D,E

which post procedure medications would the nurse teach about before discharge, to a client who had a percutaneous coronary intervention (PCI)? (select all that apply): A. furosemide B. clopidogrel C. metoprolol D. isosorbide dinitrate E. docusate F. aspirin

B,C,D,F

which interventions would the nurse perform to protect a client from a sternal wound infection after CABAG surgery? (select all that apply) A. shae the client's body from neck to knees B. instruct the client to shower with 4% chlorhexidine gluconate C. prepare the surgery site by clipping hair and then applying chlorhexidine with isopropyl alcohol D. collect and send urine and sputum samples to the lab for C&S E. administer IV antibiotics 1 hour prior to surgical procedure F. wear gloves, a gown, and a mask while preparing the client for surgery

B,C,E

about which associated symptoms would the nurse ask a client with a history of intermittent episodes of chest pain? (select all that apply): A. diarrhea B. nausea C. SOB D. joint pain E. dizziness F. diaphoresis

B,C,E,F

which advantages would the nurse teach a client about with regard to robotic heart surgery? (select all that apply): A. shorter surgical time than traditional CABG surgery B. shorter hospital stay of just 2 to 3 days C. decreased pain due to smaller incisions D. shorter time on the heart-lung bypass machine E. chest tubes are never needed F. ability to reach otherwise inaccessible blockage sites

B,C,E,F

what diagnostic test would the nurse obtain to determine whether a client admitted with acute-onset chest pain and dyspnea had experienced a myocardial infarction? (select all that apply): A. c-reactive protein B. 12-lead ECG C. chest x-ray D. serial troponin T and I E. lipid profile F. exercise stress test

B,D

Which essential points would the nurse include when teaching a client about nitroglycerin tablets (select all that apply) A. if one tablet does not relieve the chest pain after 5 minutes, put two pills under your tongue B. Keep your nitroglycerin pills with you at all times C. The prescription should last about 7 to 8 months before a refill is needed D. you can tell the tablets are active when you feel a tingling after placing one under your tongue E. Keep the tablets in a glass, light-resistant container F. if no immediate pain relief occurs, just wait because the drug will eventually take effect

B,D,E

which finding most strongly indicates left heart failure in a client when the nurse auscultates hear sounds?

S3 gallop

which finding would the nurse expect when a client experiences a non-ST-segment elevation MI (NSTEMI)?

ST depression and T-wave inversion on a 12-lead ECG

which diagnostic test is performed after a client's acute stage of an unstable angina episode to determine if there are cardiac changes that are consistent with ischemia?

exercise tolerance test

what is the best action for the home health nurse to take when visiting a new client with CAD who is experiencing a new onset chest pain and SOB?

have the client chew a 325mg aspirin tablet and call 911

which drug therapy would the nurse expect to be prescribed for a client with acute coronary syndrome (ACS) to decrease the risk of recurrent myocardial infarction, stroke, and mortality?

high-intensity statin therapy

because many sudden cardiac arrest victims die before reaching the hospital, which priority teaching point would the nurse be sure to include in a community presentation about heart disease?

how to operate an automatic external defibrillator (AED) in the workplace

which procedure has shown promise for managing clients with cariogenic shock?

immediate reperfusion

how soon does the nurse expect anginal pain to begin subsiding after administering sublingual nitroglycerin to a client with chronic stable angina?

1-2 minutes

the nurse would teach a client to seek treatment for a symptoms of MI immediately rather than delay. Because physical changes occur in how many hours after. an MI?

6 hours

which type of dysrhythmia would the nurse expect to monitor for when a client experiences an inferior wall MI (IWMI)?

Bradycardia with second-degree heart block

which early reaction is most common in clients with chest discomfort associated with unstable angina or MI?

Denial

for which complication does the nurse monitor when a client with chronic stable angina (CSA) is prescribed a calcium channel blocker?

Hypotension

which nursing assessment is specific to a client who had CABG surgery with the radial artery used as the graft?

assess hand color, temperature, ulnar pulse, and capillary refill every hour initially

which task would the nurse delegate to the assistive personnel when caring for a client in phase 1 cardiac rehabilitation?

assist the client with ambulation to the bathroom

which finding. prompts the nurse to immediately contact the surgeon for a client who had minimally invasive direct coronary artery bypass (MIDCAB)?

client has ECG changes including Q waves and ST-segment and T-wave changes in leads V2 to V6

which client does the nurse expect to have the highest risk for death related to damage to the left ventricle?

client with an anterior wall MI (AWMI)

which manifestation would the nurse expect with a client labeled class 1 on the killip scale for heart failure?

cold, clammy skin with poor peripheral pulses

how would critical care nurse assess for postoperative bleeding in a client who had CABG surgery?

measure mediastinal and pleural chest tube drainage at least once an hour and report drainage amount over 150mL/hr to surgeon

what priority action will the nurse take when providing care for a client with chest pain being treated with IV nitroglycerin?

monitor BP continuously

which assessment would the nurse perform to help prevent harm from graft collapse after CABG surgery?

monitor BP for hypotension

which procedure would the nurse expect to be recommended for a client with discrete, proximal, noncalcified blockage in one coronary artery?

percutaneous coronary intervention (PCI)

an alert and oriented client comes to the walk-in clinic with left-sided chest pain, mild SOB, and diaphoresis. what is the nurses' first priority action?

place the client in semi-fowler position with supplemental oxygen

what is the nurse's next action 5 minutes after administering a sublingual nitroglycerin tablet to a client with chest pain?

recheck pain intensity and vital signs

after administering SL nitroglycerin to a client whose baseline blood pressure is 130/80mm/Hg, for which finding would the nurse immediately notify the health care provider?

systolic pressure is 90mm/Hg

following CABG surgery, a clients body temp is below 96.8F (36C). what measures would the nurse take to rewarm the client?

use lights and thermal blankets to slowly warm the client

when would the nurse be sure to hold the beta blocker drug and notify the HCP?

when the clients HR is less than 50bpm and SBP is less than 100mmHg