coronary vascular diseases

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? A) 75 seconds or less. B) 50 seconds or less. C) 125 seconds or less. D) 100 seconds or less.

B) 50 seconds or less.

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? A) prior intracranial hemorrhage B) use of heparin C) recent consumption of a meal D) shellfish allergy

A) prior intracranial hemorrhage

A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to the client? Select all that apply. A) Remove the transdermal patch at night and reapply in the morning. B) Store the patch in its original container when not in use. C) Cover the patch in plastic wrap after applying. D) Seek emergency treatment if flushing or nausea occurs.

A, B

The nurse is working a cardiac care unit with a client on a diltiazem intravenous drip for atrial fibrillation. What are electrocardiogram (ECG) changes that suggest the client is responding to the treatment? Select all that apply. A) decreasing R to R interval B) slowing heart rate C) T-wave inversion D) ST elevation E) an absent P wave

A, B

A client who had coronary artery bypass surgery is exhibiting signs of heart failure. What medications will the nurse anticipate administering for this client? Select all that apply. A) diuretics B) inotropic agents C) digoxin D) amlodipine E) nitroprusside

A, B, C

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.) A) It is substernal in location. B) It is sudden in onset and prolonged in duration. C) It is viselike and radiates to the shoulders and arms. D) It is relieved by rest and inactivity. E) It subsides after taking nitroglycerin.

A, B, C

A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which risk factors will the nurse include in the discussion? Select all that apply. A) Family history of coronary heart disease B) Elevated C-reactive protein C) Age greater than 55 years for women D) Age greater than 45 years for men E) Body mass index (BMI) of 23

A, B, D

The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) A) Aortic dissection B) Abrupt closure of the artery C) Nerve root pressure D) Coronary artery vasospasm E) Arterial dissection

A, B, D

A client recovering from percutaneous transluminal coronary angioplasty (PTCA) develops chest pain and an arrhythmia on the electrocardiogram (ECG). Which action(s) will the nurse take to help this client? Select all that apply. A) Administer oxygen B) Give meperidine as prescribed C) Provide nitroglycerine D) Obtain a 12-lead ECG E) Notify the primary healthcare provider

A, C, D, E

After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? A) Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. B) Apply manual pressure at the site of the insertion of the sheath. C) Decrease anticoagulant or antiplatelet therapy. D) Notify the health care provider.

B) Apply manual pressure at the site of the insertion of the sheath.

A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? A) Elevated central venous pressure B) Cardiac tamponade C) Hypertension D) Hypothermia

B) Cardiac tamponade

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? A) Furosemide B) Carvedilol C) Nitroprusside D) Digoxin

B) Carvedilol

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

B) Clopidogrel

A client comes to the emergency department (ED) reporting 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? A) Venous occlusive disease B) Coronary artery disease C) Cardiogenic shock D) Raynaud syndrome

B) Coronary artery disease

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? A) Activities that increase myocardial oxygen demand. B) Coronary artery spasm. C) An unpredictable amount of activity. D) The same type of activity that caused previous angina episodes.

B) Coronary artery spasm.

When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which electrolyte imbalance? A) Hypomagnesemia B) Hypermagnesemia C) Hypokalemia D) Hyperkalemia

B) Hypermagnesemia

Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? A) Glucose intolerance B) Hypertension C) Hyperlipidemia D) Obesity

B) Hypertension

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? A) "Only take one nitroglycerin tablet for each episode of angina." B) "See if rest relieves the chest pain before using the nitroglycerin." C) "Place the nitroglycerin tablet between cheek and gum." D) "Call 911 if you develop a headache following nitroglycerin use."

B) "See if rest relieves the chest pain before using the nitroglycerin."

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 A) IV nitroglycerin. B) thrombolytics. C) IV heparin. D) percutaneous coronary intervention (PCI).

D) percutaneous coronary intervention (PCI).

A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? A) Instruct the client to place nitroglycerin tablets in a plastic pill box. B) Instruct the client on side effects of flushing, throbbing headache, and tachycardia. C) Instruct the client not to crush the tablet. D) Instruct the client to renew the nitroglycerin supply every 3 months.

B) Instruct the client on side effects of flushing, throbbing headache, and tachycardia.

A female patient is being seen in the ER complaining of fatigue and shoulder blade discomfort. She is also short of breath. Based on these symptoms, what will the nurse suspect? A) Deep vein thrombosis (DVT) B) Myocardial infarction (MI) C) Intracerebral hemorrhage D) Stroke

B) Myocardial infarction (MI)

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 A) below the optimal range. B) above the optimal range. C) extremely high. D) within the optimal range.

B) above the optimal range.

A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates A) an evolving MI. B) an old MI. C) a cardiac dysrhythmia. D) variant angina.

B) an old MI.

The nurse is removing a client's femoral sheath after cardiac catheterization. What medication will the nurse have available? A) heparin B) atropine sulfate C) protamine sulfate D) adenosine

B) atropine sulfate

The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? A) decreased erythrocyte sedimentation rate (ESR) B) pericardial friction rub C) decreased white blood cell (WBC) count D) hypothermia

B) pericardial friction rub

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. A) Absent P-waves B) Abnormal Q-waves C) T-wave hyperactivity and inversions D) ST-segment elevations E) U-wave elevations

B, C, D

The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. A) morphine B) atorvastatin C) enalapril D) aspirin E) sildenafil

B, C, D

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. A) inability to speak B) acceptable arterial blood gas values C) adequate cough and gag reflexes D) breathing without assistance of the ventilator E) labile vital signs

B, C, D

The nurse is providing discharge education for a client with angina pectoris. Which information will the nurse include when instructing the client on self-care at home? Select all that apply. A) "You can return to normal activities when you get home." B) "Balance rest with your regular daily activities." C) "You need to avoid exercising in extreme temperatures." D) "You need to follow a low-fat, high-fiber diet." E) "You should keep nitroglycerin with you at all times."

B, C, D, E

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. A) Family history B) Obesity C) Elevated blood pressure D) Physical inactivity E) Increasing age F) Alcohol use

B, C, D, F

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. A) 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. B) Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. C) Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. D) Renew the supply every 6 months. E) Take the tablet in anticipation of any activity that can produce pain. F) Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.

B, D, E, F

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 A) extremely high. B) within the optimal range. C) below the optimal range. D) above the optimal range.

D) above the optimal range.

A client who has been diagnosed with Prinzmetal's angina will present with which symptom? A) prolonged chest pain that accompanies exercise B) chest pain of increased frequency, severity, and duration C) radiating chest pain that lasts 15 minutes or less D) chest pain that occurs at rest and usually in the middle of the night

D) chest pain that occurs at rest and usually in the middle of the night

The nurse is caring for a client diagnosed with unstable angina who is receiving IV heparin. The client requires bleeding precautions. Bleeding precautions include which measure? A) Avoid continuous BP monitoring B) Use an electric toothbrush C) Avoid subcutaneous injections D) Avoid the use of nail clippers

A) Avoid continuous BP monitoring

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? A) High-density lipoprotein (HDL), 80 mg/dL B) Low density lipoprotein (LDL), 160 mg/dL C) Cholesterol, 280 mg/dL D) A ratio of LDL to HDL, 4.5 to 1.0

A) High-density lipoprotein (HDL), 80 mg/dL

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? A) IV morphine B) Atenolol C) Amlodipine D) IV nitroglycerin

A) IV morphine

The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? A) ST elevation B) Frequent premature atrial contractions (PACs) C) Isolated premature ventricular contractions (PVCs) D) Sinus tachycardia

A) ST elevation

The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? A) The abrupt stop can cause a myocardial infarction. B) The abrupt stop can lead to formation of blood clots. C) The abrupt stop will precipitate internal bleeding. D) The abrupt stop can trigger a migraine headache.

A) The abrupt stop can cause a myocardial infarction.

A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) immediately following confirmed diagnosis of acute myocardial infarction. The client is overtly anxious and crying. Which response by the nurse is most appropriate? A) "Tell me what concerns you most." B) "Don't cry; you have the best team of doctors." C) "Everything will be fine. Your family is here for you." D) "Would you like something to calm your nerves?"

A) "Tell me what concerns you most."

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also reports nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? A) Administer oxygen, attach a cardiac monitor, take vital signs, and alert the cardiac catheterization team. B) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. C) Administer oxygen, attach a cardiac monitor, and notify the health care provider. D) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs.

A) Administer oxygen, attach a cardiac monitor, take vital signs, and alert the cardiac catheterization team.

A client is beginning to have more breathlessness with aortic stenosis. What is the treatment does the nurse anticipate for the client? A) balloon valvuloplasty B) balloon angioplasty C) cardiac catheterization D) cardiac graft procedure

A) balloon valvuloplasty

The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation the nurse can give to the client? A) "Both terms refer to the same disorder and can be used interchangeably." B) "Arteriosclerosis is when the vessels become dilated and weakened, whereas atherosclerosis is the deposit of fatty substances in the vessel lining." C) "Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque." D) "Both are disorders in which the lining of the vessels become narrowed due to plaque."

C) "Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque."

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? A) "Client will verbalize the intention to avoid exercise." B) "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." C) "Client will verbalize the intention to stop smoking." D) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."

C) "Client will verbalize the intention to stop smoking."

The nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? A) "I can put the nitroglycerin tablets in my daily pill dispenser with my other medications". B) "Side effects of nitroglycerin include flushing, throbbing headache, and hypertension". C) "I can take nitroglycerin before sex so I won't develop chest pain". D) "After taking two tablets with no relief, I should call EMS."

C) "I can take nitroglycerin before sex so I won't develop chest pain".

A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers the client to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? A) "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor." B) "I won't be able to jog again even with rehabilitation." C) "Rehabilitation will help me function as well as I physically can." D) "When I finish the rehabilitation program I'll never have to worry about heart trouble again."

C) "Rehabilitation will help me function as well as I physically can."

A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? A) Aspirin 325 mg orally B) Troponin level C) 12-lead ECG D) Monitor intake and output

C) 12-lead ECG

Following a percutaneous coronary intervention (PCI), a client is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which method to induce hemostasis after sheath is contraindicated? A) Application of a mechanical compression device B) Application of a vascular closure device C) Application of a sandbag to the area D) Direct manual pressure

C) Application of a sandbag to the area

A nurse is caring for a client who experienced an MI. The client is ordered to receive metoprolol. The nurse understands that this medication has which therapeutic effect? A) Decreases platelet aggregation B) Increases cardiac output C) Decreases resting heart rate D) Decreases cholesterol level

C) Decreases resting heart rate

The nurse is administering oral metoprolol. Where are the receptor sites mainly located? A) Bronchi B) Uterus C) Heart D) Blood vessels

C) Heart

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? A) Isosorbide mononitrate (Isordil) B) Meperidine hydrochloride (Demerol) C) Morphine sulfate (Morphine) D) Nitroglycerin transdermal patch

C) Morphine sulfate (Morphine)

While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? A) Stop the heparin infusion immediately. B) Reassure the client that bleeding gums are a normal effect of heparin. C) Notify the health care provider. D) Administer a coumarin derivative, as ordered, to counteract heparin.

C) Notify the health care provider.

A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? A) Vascular sites for bleeding B) Urine output C) Prothrombin time (PT) or international normalized ratio (INR) D) Hourly IV infusion

C) Prothrombin time (PT) or international normalized ratio (INR)

Following cardiac surgery, the nurse assesses the client for any common complication of hypovolemia. What significant indication of a complication should the nurse monitor? A) Heart rate of 60 bpm B) Central venous pressure (CVP) reading of 8 mm Hg C) Pulmonary artery wedge pressure (PAWP) of 6 mm Hg D) Blood pressure reading of 130/95 mm Hg

C) Pulmonary artery wedge pressure (PAWP) of 6 mm Hg

A client diagnosed with a myocardial infarction (MI) has begun a cardiac rehabilitation program. The nurse recognizes which overall goal as a focus of rehabilitation for a client who has had an MI? A) Return to work and the lifestyle experienced before the illness B) Eliminate the effects of atherosclerosis and lower blood pressure C) Reduce risk through education, support, and physical activity D) Increase the low-density lipopproteins and reduce high-density lipoportiens

C) Reduce risk through education, support, and physical activity

A nurse is assigned to care for a recently admitted client who has been diagnosed with refractory angina. What symptom will the nurse expect the client to exhibit? A) Predictable and consistent pain that occurs on exertion and is relieved by rest B) Pain that may occur at rest, but the threshold for pain is lower than expected C) Severe, incapacitating chest pain D) Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina

C) Severe, incapacitating chest pain

Which term refers to preinfarction angina? A) Variant angina B) Silent ischemia C) Unstable angina D) Stable angina

C) Unstable angina

A client was chopping firewood and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the healthcare provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? A) morphine administration, stress testing, and admission to the cardiac care unit B) streptokinase, aspirin, and morphine administration C) sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry D) serial liver enzyme testing, telemetry, and a lidocaine infusion

C) sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain? A) a destroyed part of the heart muscle B) complete closure of an artery C) incomplete blockage of a major coronary artery D) a lack of oxygen in the heart muscle cells

D) a lack of oxygen in the heart muscle cells

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? A) "I should avoid prolonged sitting." B) "I should expect bruising at the catheter site for up to 3 weeks." C) "I should avoid taking a tub bath until my catheter site heals." D) "I should expect a low-grade fever and swelling at the site for the next week."

D) "I should expect a low-grade fever and swelling at the site for the next week."

The nurse provides care to a menopausal client, who states, "I read a news article that says I am at risk for coronary vascular disease due to inflammation." Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis? A) Drinking at least 2 liters of water a day B) Taking a daily multivitamin C) Avoiding use of caffeine D) Addressing obesity

D) Addressing obesity

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? A) Chest pain 2 of 10 (on a 1-to-10 pain scale) B) Minimal oozing of blood from the IV site C) Presence of reperfusion dysrhythmias D) Altered level of consciousness

D) Altered level of consciousness

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? A) Reorient the client to place and time. B) Educate the family about how confusion is expected in older adults postoperatively. C) Document the early signs of dementia and ensure the client's safety. D) Assess for factors that may be causing the client's delirium.

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

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? A) Troponin C level B) CK-MM C) Myoglobin level D) Creatine kinase-myoglobin (CK-MB) level

D) Creatine kinase-myoglobin (CK-MB) level

The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? A) It increases myocardial oxygen consumption. B) More blood returns to the heart. C) It functions as a vasoconstrictor. D) Preload is reduced.

D) Preload is reduced.