Prep U [cardiac 27]

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? "Nitroglycerine causes headaches, but removing the patch decreases the incidence." "You do not need the effects of nitroglycerine while you sleep." "Removing the patch at night prevents drug tolerance while keeping the benefits." "Contact dermatitis and skin irritations are common when the patch remains on all day."

"Removing the patch at night prevents drug tolerance while keeping the benefits."

A client is receiving morphine to relieve chest pain. The order is for 4 mg IV now. The pharmacy supplies morphine sulfate at 5 mg per mL. How many mL will the nurse give the client? Enter the correct number ONLY.

0.8

The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). 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

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? Protamine sulfate Alteplase Clopidogrel Aspirin

Protamine sulfate

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

To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? 30 minutes 60 minutes 9 days 6 to 12 months

60 minutes

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

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

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? Assess chest pain and administer prescribed drugs and oxygen Assess blood pressure and administer aspirin It is not important to assess the client or to notify the physician Assess the client's physical history

Assess chest pain and administer prescribed drugs and oxygen

When starting a client on oral or I.V. diltiazem (Cardizem), for which potential complication should the nurse monitor? Flushing Atrioventricular block Renal failure Hypertension

Atrioventricular block

Which medication should a nurse have on hand when removing a sheath after cardiac catheterization? Heparin Atropine Protamine sulfate Adenosine (Adenocard)

Atropine

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.

A client is receiving nitroglycerin ointment (Nitro-Dur) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? Pulse rate of 84 beats/minute Respiration 26 breaths/minute Blood pressure 84/52 mm Hg Temperature of 100.2° F (37.9° C)

Blood pressure 84/52 mm Hg

Which is a diagnostic marker for inflammation of vascular endothelium? C-reactive protein (CRP) Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Triglyceride

C-reactive protein (CRP)

A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse? Central venous pressure reading of 1 Pain score 5/10 Blood pressure 110/68 mm Hg Heart rate 66 bpm

Central venous pressure reading of 1

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

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

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

A client comes to the emergency department complaining of 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

A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? Uterus Blood vessels Bronchi Heart

Heart

A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern? Blood pressure of 129/72 mm Hg Heart rate of 87 bpm Hemoglobin of 16 g/dL Hematocrit of 30%

Hematocrit of 30%

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

Hyperlipidemia Obesity Tobacco use

When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025), the nurse suspects: 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 patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? Hyperuricemia Increased liver enzymes Hyperglycemia Gastrointestinal distress

Increased liver enzymes

A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? Low blood pressure High blood pressure Decreased heart rate Elevated hematocrit

Low blood pressure

As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid. Total cholesterol Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Triglycerides

Low-density lipoproteins (LDL)

Which s the analgesic of choice for acute myocardial infarction (MI)? Morphine Aspirin Meperidine Ibuprofen

Morphine

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: Morphine IV Statin Angiotensin-converting enzyme (ACE) inhibitor Aspirin

Morphine IV

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 experieincing 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 S erum electrolytes Ativan 1 mg orally

Nitroglycerin SL

After undergoing cardiac surgery, a patient discovers a painless lump and complains to the nurse about the same. Which of the following is the most important nursing intervention for this patient? Reassure the patient by informing him or her that the lump will disappear with time. Inform the patient that the lump will be removed by the surgeon. Reassure the patient by informing him or her that the lump will disappear after a course of drug therapy. Reassure the patient and direct the patient to the physician.

Reassure the patient by informing him or her that the lump will disappear with time.

The nurse is educating the patient about administering nitroglycerin prior to discharge from the hospital. What information should the nurse include in the instructions? Take a nitroglycerin and if the pain is not relieved, drive to the nearest emergency department. Take 2 nitroglycerins and if the pain is not relieved, go to the emergency department. Take a nitroglycerin and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. If pain is not relieved, activate the emergency medical system. Take 2 nitroglycerins every 10 minutes until a total of 6 pills are taken. If pain is not relieved, activate the emergency medical system.

Take a nitroglycerin and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. If pain is not relieved, activate the emergency medical system.

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

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

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

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

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

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? Worsening angina Formation of blood clots Internal bleeding Thrombocytopenia

Worsening angina

During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect: the client's pupils to become dilated. the client to experience bronchodilation. a decrease in the client's gastric secretions. a drop in the client's heart rate.

a drop in the client's heart rate.

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