Unstable Quiz 4

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). How should the nurse explain the purpose of the heparin to the patient?

"Heparin prevents the development of new clots in the coronary arteries."

Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat) has been effective?

"I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart."

The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed?

"I will have incisions in my leg where they will remove the vein."

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed?

"I will miss being able to eat peanut butter sandwiches."

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?

"I will sit down before I put the nitroglycerin under my tongue."

Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing anginal episodes has been effective?

"It is important not to suddenly stop taking the carvedilol."

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about safely resuming sexual intercourse. Which response by the nurse is best?

"Sexual activity uses about as much energy as climbing two flights of stairs."

Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina?

"The pain goes away after a nitroglycerin tablet."

After having a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make?

"What do you think caused your chest pain?"

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?

"What time did your pain begin?"

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first?

A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI). What should the nurse anticipate teaching the patient?

Additional diagnostic testing will be required.

Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for a patient with a myocardial infarction (MI)?

Ask about chest pain.

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first?

Attach the heart monitor.

A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take as focused follow-up on this symptom?

Auscultate for a pericardial friction rub.

After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider?

Bilateral crackles

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider?

Bilateral crackles in the mid-lower lobes.

Which data indicates to the nurse that the patient with stable angina is experiencing a side effect of metoprolol (Lopressor)?

Blood pressure is 90/54 mm Hg.

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AUMI)S. Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI?

Cardiac-specific troponin

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority?

Decreased cardiac output

The nurse is administering a thrombolytic agent to a patient with an acute myocardial infarction. What patient data indicates that the nurse should stop the drug infusion?

Decreased level of consciousness

Diltiazem (Cardizem) is prescribed for a patient with newly diagnosed Prinzmetal's (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan?

Decreases coronary artery spasms.

To improve the physical activity level for a mildly obese 68-year-old patient, which action should the nurse plan to take?

Determine what kind of physical activities the patient usually enjoys.

The nurse reviews information shown in the accompanying figure from the medical records of a 43-year-old patient. Which risk factor modification for coronary artery disease should the nurse include in patient teaching?

Dietary changes to improve lipid levels

A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one should the nurse arrange to be completed first?

Electrocardiogram (ECG)

The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching session?

Elevated low-density lipoprotein (LDL) level

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider?

Generalized muscle aches and pains

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication?

Give the patient's other medications 2 hours after colesevelam.

The nurse is caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization. What task should the nurse delegate to a licensed practical/vocational nurse (LPN/VN)?

Give the scheduled aspirin and lipid-lowering medication

A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest?

Heart rate increases from 66 to 98 beats/min.

Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes?

Help the patient modify favorite high-fat recipes by using monounsaturated oils.

Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?

No change in the patient's reported level of chest pain

Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider?

Pallor and weakness of the right hand

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. What data would indicate to the nurse that the drug is effective?

Participation in daily activities without chest pain

Which patient at the cardiovascular clinic requires the most immediate action by the nurse?

Patient with stable angina whose chest pain has recently increased in frequency.

A patient with diabetes mellitus and chronic stable angina has a new order for captopril. What should the nurse teach this patient about the primary purpose of captopril?

Prevents changes in heart muscle.

A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?

Reinforcement of teaching about the prescribed medications

A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse?

Report of chest pain

Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider?

ST-segment elevation

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care?

Tadalafil (Cialas)

The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is from an acute myocardial infarction?

The pain has lasted longer than 30 minutes.

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. What should teaching for this patient include today?

When cardiac rehabilitation will begin