Ch. 27: Coronary Vascular Disorders
In order 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? a) 30 minutes b) 6 to 12 months c) 9 days d) 60 minutes
60 minutes Explanation: The 60-minute interval is known as "door-to-balloon time" for performance of PTCA on a diagnosed MI patient. The 30-minute interval is known as "door-to-needle time" for administration of thrombolytics post MI. The time frame of 9 days refers to the time for onset of vasculitis after administration of streptokinase for thrombolysis in an acute MI patient. The 6 to 12 month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.
Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent? a) Beta blockers b) Nitrates c) Antiplatelets d) Calcium channel blockers
Antiplatelets Correct Explanation: Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as Plavix or aspirin. Nitrates, beta blockers, and calcium channel blockers would not be used for this purpose.
A patient complains about chest pain and heavy breathing when exercising or when stressed. Which of the following is a priority nursing intervention for the patient diagnosed with coronary artery disease? a) Assess the physical history of the patient b) Assess the blood pressure and administer aspirin c) Not important to assess the patient or to notify the physician d) Assess chest pain and administer prescribed drugs and oxygen
Assess chest pain and administer prescribed drugs and oxygen Correct Explanation: The nurse assesses the patient for chest pain and administers the prescribed drugs that dilate the coronary arteries. The nurse administers oxygen to improve the oxygen supply to the heart. Assessing the blood pressure or the physical history does not clearly indicate that the patient has CAD. The nurse does not administer aspirin without the physician's prescription.
You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a) Coronary thrombosis b) Arteriosclerosis c) Atherosclerosis d) Raynaud's disease
Atherosclerosis Correct Explanation: Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. The disease correlates with the aging process. The other choices may occur at any age.
A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse? a) CVP reading: 1 mmHg b) Blood pressure: 110/68 mmHg c) Heart rate: 66 bpm d) Pain score: 5/10.
CVP reading: 1 mmHg Correct Explanation: The central venous pressure (CVP) reading of 1 is low (2-6 mmHg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.
A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI? a) Cool, clammy, diaphoretic, and pale appearance b) Chest discomfort not relieved by rest or nitroglycerin c) Intermittent nausea and emesis for 3 days d) Anxiousness, restlessness, and lightheadedness
Chest discomfort not relieved by rest or nitroglycerin Correct Explanation: Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with ACS (acute coronary syndrome) or MI, may also occur with angina and, alone, are not indicative of an MI.
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Amlodipine (Norvasc) b) Clopidogrel (Plavix) c) Felodipine (Plendil) d) Diltiazem (Cardizem)
Clopidogrel (Plavix) Correct Explanation: Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.
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 you suspect in this client? a) Venous occlusive disease b) Cardiogenic shock c) Coronary artery disease d) Raynaud's disease
Coronary artery disease Correct Explanation: The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following? a) Increases cardiac output b) Decreases resting heart rate c) Decreases cholesterol level d) Decreases platelet aggregation
Decreases resting heart rate Correct Explanation: The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce the myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. Generally the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.
You are caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client? a) Examine for pain around the shoulder and neck region. b) Examine the extremities for skin lesions. c) Examine the legs for color, capillary refill time, and tissue integrity. d) Examine the client's mental and emotional status.
Examine the legs for color, capillary refill time, and tissue integrity. Correct Explanation: The nurse examines the extremities and assesses skin color, temperature, capillary refill time, and tissue integrity and not for skin lesions for clients with thrombosis. Examining the client's mental and emotional status or examining for pain around the shoulder and neck region will not assist the nurse in evaluating a client with thrombosis.
A patient presents to the emergency room with characteristics of atherosclerosis. What characteristics would the patient display? a) Fatty deposits in the lumen of arteries b) Blood clots in the arteries c) Emboli in the veins d) Cholesterol plugs in the lumen of veins
Fatty deposits in the lumen of arteries Correct Explanation: Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Therefore, options B, C, and D are incorrect.
The nurse is reviewing the laboratory results for a patient diagnosed with coronary artery disease (CAD). The patient's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as which of the following? a) Critically high b) Low c) Within normal limits d) High
High Explanation: The normal LDL range is 100 mg/dL to 130 mg/dL. A level of 115 mg/dL is considered to be high. The goal of treatment is to decrease the LDL level below 100 mg/dL (less than 70 mg/dL for very high-risk patients).
The lab values of a patient diagnosed with coronary artery disease (CAD) have just come back from the lab. His low-density lipoprotein (LDL) level is 112 mg/dL. This lab value is indicative of which of the following? a) High LDL level b) Normal LDL level c) Low LDL level d) Extremely high LDL level
High LDL level Correct Explanation: If the LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered to be high. The goal is to decrease the LDL level below 100 mg/dL.
When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality? a) Hypercalcemia b) Hyponatremia c) Hyperkalemia d) Hypomagnesemia
Hyperkalemia Explanation: Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T wave formation.
Which of the following in an inconsistent manifestation of metabolic syndrome? a) Hypotension b) Chronic inflammation c) Insulin resistance d) Dyslipidemia
Hypotension Correct Explanation: Metabolic syndrome consists of insulin resistance, dyslipidemia, hypertension, and chronic inflammation.
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? a) Urinary incontinence b) Hypertension c) Hypotension d) Hyperactive bowel sounds
Hypotension Correct Explanation: The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? a) Inability to speak. b) Adequate cough and gag reflex. c) Adequate vital capacity. d) Acceptable arterial blood gas (ABG) values.
Inability to speak. Correct Explanation: Before being extubated, the patient should have cough and gag reflexes and stable vital signs; be able to life the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable ABG levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
When the nurse notes that the post cardiac surgery patient demonstrates low urine output (less than 25 mL per hour) with high specific gravity (greater than 1.025), the nurse suspects which of the following conditions? a) Overhydration b) Anuria c) Inadequate fluid volume d) Normal glomerular filtration
Inadequate fluid volume Correct Explanation: Urine output of less than 25 mL per hour may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 25 mLor greater per hour and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric patient does not produce urine.
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery? a) Blood glucose level b) Activity intolerance c) Inadequate tissue perfusion d) Mental alertness
Inadequate tissue perfusion Correct Explanation: The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.
Which of the following discharge instructions for self-care should the nurse provide to a patient who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? a) Cleanse the site with disinfectants and dress the wound appropriately b) Normal activities of daily living can be resumed the first day post op c) Monitor the site for bleeding or hematoma. d) Refrain from sexual activity for one month
Monitor the site for bleeding or hematoma. Correct Explanation: The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or development of a hard mass indicative of hematoma. A nurse does not advise the patient to clean the site with disinfectants or refrain from sexual activity for one month.
A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a) Nitroglycerin SL b) Chest x-ray c) Ativan 1 mg orally d) Serum electrolytes
Nitroglycerin SL Correct Explanation: Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the patient's chest pain.
The nurse recognizes that the treatment for a non-ST elevation myocardial infarction (NSTEMI) differs from that of a patient with a STEMI, in that a STEMI is more frequently treated with which of the following? a) IV nitroglycerin b) Percutaneous coronary intervention (PCI) c) Thrombolytics d) IV heparin
Percutaneous coronary intervention (PCI) Correct Explanation: The patient with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate PCI. Superior outcomes have been reported with the use of PCI compared to thrombolytics. IV heparin and IV nitroglycerin are used to treat NSTEMI.
Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome? a) Decreased erythrocyte sedimentation rate (ESR) b) Decreased white blood cell (WBC) count c) Hypothermia d) Pericardial friction rub
Pericardial friction rub Correct Explanation: The syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.
During his annual physical exam, a 62-year-old male client reports experiencing chest pain and palpitations during and after his morning jogs. Family history reveals coronary artery disease. The nurse should instruct the client in the following to reduce the client's cardiac risk? a) Smoking cessation b) Antioxidant supplements c) Exercise avoidance d) Protein-rich diet
Smoking cessation Correct Explanation: The first line of defense for clients with CAD is lifestyle changes including smoking cessation, weight loss, stress management, and exercise. Clients with CAD should eat a balanced diet. Clients with CAD should exercise, as tolerated, to maintain a healthy weight. Antioxidant supplements, such as those containing vitamin E, beta carotene, and selenium, are not recommended because clinical trials have failed to confirm beneficial effects from their use.
The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a) Troponin b) CK-MB c) Myoglobin d) Total CK
Troponin Explanation: Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Refractory b) Intractable c) Variant d) Unstable
Unstable Correct Explanation: Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
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? a) Internal bleeding b) Worsening angina c) Thrombocytopenia d) Formation of blood clots
You selected: Worsening angina Correct Explanation: Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or thrombocytopenia.