Chapter 14: PrepU

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? 1- IV morphine 2- IV nitroglycerin 3- Atenolol 4- Amlodipine

1

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? 1- Coronary artery disease 2- Raynaud's disease 3- Cardiogenic shock 4- Venous occlusive disease

1

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? 1- Clopidogrel 2- Isosorbide mononitrate 3- Metoprolol 4- Diltiazem

1

A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication? 1- Atelectasis 2- Elevated blood glucose level 3- Hyperkalemia 4- Urinary tract infection (UTI)

1

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? 1- Nitroglycerin SL 2- Chest x-ray 3- Serum electrolytes 4- Ativan 1 mg orally

1

A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display? 1- Fatty deposits in the lumen of arteries 2- Cholesterol plugs in the lumen of veins 3- Blood clots in the arteries 4- Emboli in the veins

1

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? 1- Assess chest pain and administer prescribed drugs and oxygen 2- Assess blood pressure and administer aspirin 3- It is not important to assess the client or to notify the physician 4- Assess the client's physical history

1

A client who has been diagnosed with Prinzmetal's angina will present with which symptom? 1- chest pain that occurs at rest and usually in the middle of the night 2- radiating chest pain that lasts 15 minutes or less 3- prolonged chest pain that accompanies exercise 4- chest pain of increased frequency, severity, and duration

1

A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? 1- smoking cessation 2- a protein-rich diet 3- exercise avoidance 4- antioxidant supplements

1

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? 1- "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." 2- "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." 3- "A burning sensation after administration indicates that the nitroglycerin tablets are potent." 4- "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses."

1

A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: 1- high LDL level. 2- low LDL level. 3- normal LDL level. 4- fasting LDL level.

1

A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? 1- Chest discomfort not relieved by rest or nitroglycerin 2- Intermittent nausea and emesis for 3 days 3- Cool, clammy skin and a diaphoretic, pale appearance 4- Anxiousness, restlessness, and lightheadedness

1

The nurse is reviewing the laboratory results for a client diagnosed with coronary artery disease (CAD). The client's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as 1- high. 2- low. 3- within normal limits. 4- critically high.

1

When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? 1- Inadequate fluid volume 2- Normal glomerular filtration 3- Overhydration 4- Anuria

1

Which medication is an antidote to heparin? 1- Protamine sulfate 2- Alteplase 3- Clopidogrel 4- Aspirin

1

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.) 1- Abrupt closure of the artery 2- Arterial dissection 3- Coronary artery vasospasm 4- Aortic dissection 5- Nerve root pressure

1,2,3

A patient in the cardiac PACU was just extubated, 5 hours after the conclusion of a coronary artery bypass graft (CABG). How can the patient's nurse best promote adequate gas exchange for this patient? 1- Apply continuous positive airway pressure (CPAP) as ordered. 2- Perform deep suctioning q1h. 3- Reposition the patient frequently. 4- Administer nebulized bronchodilators and corticosteroids as ordered.

3

The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis? 1- Avoid use of caffeine 2- Encourage use of a multivitamin 3- Addressing obesity 4- Drink at least 2 liters of water a day

3

The nurse is caring for an adult patient who had symptoms of unstable angina during admission to the hospital. The most appropriate nursing diagnosis for the discomfort associated with angina is what? 1- Deficient knowledge about underlying disease and methods for avoiding complications 2- Anxiety related to fear of death 3- Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) 4- Noncompliance related to failure to accept necessary lifestyle changes

3

Which technique is used to surgically revascularize the myocardium? 1- Balloon bypass 2- Peripheral bypass 3- Minimally invasive direct coronary bypass 4- Gastric bypass

3

A 70-year-old man has been diagnosed with angina pectoris and subsequently prescribed nitroglycerin spray to be used sublingually when he experiences chest pain. This drug will achieve relief of the patient's chest pain by: 1- Blocking sympathetic stimulation of the heart and reducing oxygen demand 2- Increasing contractility and consequent cardiac output 3- Blocking the a-delta pain fibers in the myocardium 4- Dilating the blood vessels and reducing preload

4

The nurse is explaining the cause of angina pain to a client. What will the nurse say caused the pain? 1- incomplete blockage of a major coronary artery 2- a destroyed part of the heart muscle 3- complete closure of an artery 4- a lack of oxygen in the heart muscle that causes the death of cells

4

A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? 1- 3 minutes 2- 15 minutes 3- 30 minutes 4- 60 minutes

1

A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a goal of rehabilitation for the client with an MI? 1- Improvement in quality of life 2- Limitation of the effects and progression of atherosclerosis 3- Ability to return to work and a preillness functional capacity 4- Prevention of another cardiac event

1

Which is a diagnostic marker for inflammation of vascular endothelium? 1- C-reactive protein (CRP) 2- Low-density lipoprotein (LDL) 3- High-density lipoprotein (HDL) 4- Triglyceride

1

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? 1- Educate the family about how confusion is expected in older adults postoperatively. 2- Assess for factors that may be causing the client's delirium. 3- Document the early signs of dementia and ensure the client's safety. 4- Reorient the client to place and time.

2

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? 1- "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." 2- "Client will verbalize the intention to avoid exercise." 3- "Client will verbalize the intention to stop smoking." 4- "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."

3

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? 1- Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. 2- Store the drug in a cool, well-lit place. 3- Lie down or sit in a chair for 5 to 10 minutes after taking the drug. 4- Restrict alcohol intake to two drinks per day.

3

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? 1- Calcium 2- Magnesium 3- Potassium 4- Sodium

3

A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? 1- Prothrombin time (PT) or international normalized ratio (INR) 2- Hourly IV infusion 3- Vascular sites for bleeding 4- Urine output

1

The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? 1- Preload is reduced. 2- More blood returns to the heart. 3- It increases myocardial oxygen consumption. 4- It functions has a vasoconstrictor.

1

The triage nurse in the emergency department assesses a 66-year-old male patient who has presented to the emergency department with complaints of midsternal chest pain that has lasted for the last 5 hours. The care team suspects a myocardial infarction (MI). The nurse is aware that, because of the length of time the patient has been experiencing symptoms, the following may have happened to the myocardium: 1- May have developed an increased area of infarction 2- Will probably not have more damage than if he came in immediately 3- Can have restoration of the area of dead cells with proper treatment 4- Has been damaged already, so immediate treatment is no longer necessary

1

Thrombolytic therapy is being prepared for administration to an older adult patient who has presented to the emergency department with an ST-segment elevation MI (STEMI). The nurse recognizes that the primary goal of this intervention is: 1- To restore the flow of blood through the coronary arteries 2- To restore function to infarcted myocardial cells 3- To relieve the patient's symptoms of chest pain and dyspnea 4- To prevent the rupture of atheromas

1

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? 1- "See if rest relieves the chest pain before using the nitroglycerin." 2- "Call 911 if you develop a headache following nitroglycerin use." 3- "Place the nitroglycerin tablet between cheek and gum." 4- "Only take one nitroglycerin tablet for each episode of angina."

1

Which client with a venous stasis ulcer is a candidate for topical hyperbaric oxygen therapy? 1- a client with a chronic, nonhealing skin lesion 2- a client whose ulcer includes necrotic tissue 3- a client with an infected stasis ulcer 4- a nonambulatory client

1

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? 1- "I should avoid taking a tub bath until my catheter site heals." 2- "I should expect a low-grade fever and swelling at the site for the next week." 3- "I should avoid prolonged sitting." 4- "I should expect bruising at the catheter site for up to 3 weeks."

2

A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? 1- Prolonged PR interval 2- Absent Q wave 3- Elevated ST segment 4- Widened QRS complex

3

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug? 1- aspirin or acetaminophen. 2- pentoxifylline or acetaminophen. 3- aspirin or clopidogrel. 4- penicillin V or erythromycin.

3

A 70-year-old man has been diagnosed with angina pectoris and subsequently prescribed nitroglycerin spray to be used sublingually when he experiences chest pain. This drug will achieve relief of the patient's chest pain by: 1- Blocking sympathetic stimulation of the heart and reducing oxygen demand 2- Increasing contractility and consequent cardiac output 3- Blocking the a-delta pain fibers in the myocardium 4- Dilating the blood vessels and reducing preload

4

The public health nurse is participating in a health fair, and she interviews a woman with a history of hypertension who is currently smoking one pack of cigarettes per day. She has had no manifestations of coronary artery disease (CAD) but a recent low-density lipoprotein (LDL) level of 154 mg/dL was found. Based on her assessment, the nurse would expect that this patient would be treated in what way? 1- Drug therapy and smoking cessation 2- Diet and drug therapy 3- Diet therapy only 4- Diet therapy and smoking cessation

4

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? 1- Inform client of diagnostic tests. 2- Remove hair from skin insertion sites. 3- Assess distal pulses. 4- Withhold anticoagulant therapy.

4

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? 1- Report changes in the usual pattern of chest pain. 2- Avoid situations that contribute to ischemic episodes. 3- Avoid fatty foods and exercise. 4- Take over-the-counter decongestants.

2

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)? 1- 30 minutes 2- 60 minutes 3- 9 days 4- 6 to 12 months

2

Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? 1- Inadequate tissue perfusion 2- Mental alertness 3- Blood glucose concentration 4- Activity intolerance

1

Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? 1- Clopidogrel 2- Amlodipine 3- Diltiazem 4- Felodipine

1

Which of the following is inconsistent as a condition related to metabolic syndrome? 1- Hypotension 2- Insulin resistance 3- Abdominal obesity 4- Dyslipidemia

1

A patient with cardiovascular disease is being treated with Norvasc, a calcium channel blocking agent. The nurse is aware that calcium channel blockers have a variety of effects. What is one of the therapeutic effects? 1- Decrease sinoatrial node and atrioventricular node conduction and decrease workload of the heart 2- Prevent platelet aggregation and subsequent thrombosis 3- Reduce myocardial oxygen consumption by blocking beta-adrenergic stimulation to the heart 4- Reduce myocardial oxygen consumption thus decreasing ischemia and relieving pain

1

The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation provided by the nurse? 1- "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis." 2- "Arteriosclerosis and atherosclerosis are the same disorder. The terms are interchangeable." 3- "Atherosclerosis and arteriosclerosis are disorders in which the lining of the vessels become narrowed due to plaque formation." 4- "Arteriosclerosis is when the vessels become dilated and weakened,whereas atherosclerosis is the deposit of fatty substances in the vessel lining."

1

The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? 1- "What time did your chest pain start today?" 2- "Do your parents have heart disease?" 3- "How many sublingual nitroglycerin tablets did you take?" 4- "What is your pain level on a scale of 1 to 10?"

1

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? 1- Protamine sulfate 2- Alteplase 3- Clopidogrel 4- Aspirin

1

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? 1- ST elevation 2- Isolated premature ventricular contractions (PVCs) 3- Sinus tachycardia 4- Frequent premature atrial contractions (PACs)

1

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? 1- prior intracranial hemorrhage 2- recent consumption of a meal 3- shellfish allergy 4- use of heparin

1

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? 1- Altered level of consciousness 2- Minimal oozing of blood from the IV site 3- Presence of reperfusion dysrhythmias 4- Chest pain 2 of 10 (on a 1-to-10 pain scale)

1

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? 1- Apply manual pressure at the site of the insertion of the sheath. 2- Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. 3- Decrease anticoagulant or antiplatelet therapy. 4- Notify the health care provider.

1

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? 1- Creatinine kinase-myoglobin (CK-MB) level 2- Troponin C level 3- Myoglobin level 4- CK-MM

1

The nurse is caring for a patient who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what? 1- Lipids and fibrous tissue 2- WBCs 3- Lipoproteins 4- High-density cholesterol

1

The nurse is presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would the nurse name as the most common cause of peripheral arterial problems in the older adult? 1- Arteriosclerosis 2- Coronary thrombosis 3- Atherosclerosis 4- Raynaud's disease

3

The nurse reviews laboratory tests for cardiac biomarkers for a client suspected of suffering an MI. What is the earliest marker of an MI? 1- Creatinine kinase-myocardial band (CK-MB) 2- Total creatinine kinase (CK) 3- Myoglobin 4- Troponin I and T

3

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? 1- Hypotension 2- Urinary incontinence 3- Hyperactive bowel sounds 4- Hypertension

1

A nurse is caring for a client after cardiac surgery. Upon assessment, the client appears restless and reports nausea and weakness. The client's ECG reveals peaked T waves. The nurse reviews the client's serum electrolytes, anticipating which abnormality? 1- Hyperkalemia 2- Hypercalcemia 3- Hypomagnesemia 4- Hyponatremia

1

Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? 1- Cleanse the site with disinfectants and dress the wound appropriately 2- Refrain from sexual activity for 1 month 3- Monitor the site for bleeding or hematoma. 4- Normal activities of daily living can be resumed the first day after surgery

3

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? 1- Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. 2- Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider. 3- Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. 4- Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

4

A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime? 1- Improve arterial flow 2- Strengthen venous valves 3- Increase venous congestion 4- Improve venous return

4

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? 1- Digoxin 2- Atropine 3- Protamine sulfate 4- Sodium nitroprusside

2

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? 1- Chest pain is typical 2- Vague symptoms 3- Decreased sensation to pain 4- Gender bias

2

Which is a nonmodifiable risk factor for coronary artery disease (CAD)? 1- Hypertension 2- Gender 3- Diabetes mellitus 4- Obesity

2

Which term refers to preinfarction angina? 1- Stable angina 2- Unstable angina 3- Variant angina 4- Silent ischemia

2

When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? 1- Intractable 2- Variant 3- Unstable 4- Refractory

3

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? 1- Cholesterol, 280 mg/dL 2- Low density lipoprotein (LDL), 160 mg/dL 3- High-density lipoprotein (HDL), 80 mg/dL 4- A ratio of LDL to HDL, 4.5 to 1.0

3

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? 1- 50 seconds or less. 2- 75 seconds or less. 3- 100 seconds or less. 4- 125 seconds or less.

1

Thrombolytic therapy is being prepared for administration to an older adult patient who has presented to the emergency department with an ST-segment elevation MI (STEMI). The nurse recognizes that the primary goal of this intervention is: 1- To restore the flow of blood through the coronary arteries 2- To restore function to infarcted myocardial cells 3- To relieve the patient's symptoms of chest pain and dyspnea 4- To prevent the rupture of atheromas

1

Which is a modifiable risk factor for coronary artery disease (CAD)? 1- Diabetes mellitus 2- Gender 3- Race 4- Increasing age

1

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? 1- "The pain lasted about 45 minutes." 2- "The pain resolved after I ate a sandwich." 3- "The pain got worse when I took a deep breath." 4- "The pain occurred while I was mowing the lawn."

4

A client was transferring a load of firewood in the morning and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? 1- streptokinase, aspirin, and morphine administration 2- morphine administration, stress testing, and admission to the cardiac care unit 3- serial liver enzyme testing, telemetry, and a lidocaine infusion 4- sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry

4

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. The client's cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. What is the best response by the nurse? 1- Cholesterol is within the recommended guidelines and the client doesn't need to lower it. 2- Client should take statin medication and not worry about cholesterol. 3- Client should begin a running program, working up to 2 miles per day. 4- The nurse will ask the dietitian to talk with the client about modifying the diet.

4

A 45-year-old adult male patient is admitted to emergency after he developed unrelieved chest pain that was present for approximately 20 minutes before he presented to the emergency department. The patient has been subsequently diagnosed with a myocardial infarction (MI). To minimize cardiac damage, what health care provider's order will the nurse expect to see for this patient? 1- Thrombolytics, oxygen administration, and bed rest 2- Morphine sulfate, oxygen administration, and bed rest 3- Oxygen administration, anticoagulants, and bed rest 4- Bed rest, albuterol nebulizer treatments, and oxygen administration

2

A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment? 1- Assessing the patient's capillary refill time and peripheral pulses 2- Assessing the patient for signs and symptoms of hemorrhage 3- Assessing the patient for signs and symptoms of acute renal failure 4- Assessing the patient for signs and symptoms of infection

2

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? 1- Digoxin 2- Atropine 3- Protamine sulfate 4- Sodium nitroprusside

2

A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? 1- Prolonged PR interval 2- Absent Q wave 3- Elevated ST segment 4- Widened QRS complex

3

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? 1- "Nitroglycerine causes headaches, but removing the patch decreases the incidence." 2- "You do not need the effects of nitroglycerine while you sleep." 3- "Removing the patch at night prevents drug tolerance while keeping the benefits." 4- "Contact dermatitis and skin irritations are common when the patch remains on all day."

3

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? 1- "When I finish the rehabilitation program I'll never have to worry about heart trouble again." 2- "I won't be able to jog again even with rehabilitation." 3- "Rehabilitation will help me function as well as I physically can." 4- "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."

3

A patient has recently returned to the cardiac care unit from PACU following coronary artery bypass graft (CABG). During the nurse's assessment of the patient, the patient acknowledges pain that he rates at 9 on a 0-to-10 pain scale. How should the nurse best respond to this assessment finding? 1- Determine how the patient's pain responds to increased physical activity. 2- Explain to the patient that significant pain is expected during the immediate postoperative phase. 3- Teach the patient nonpharmacologic interventions for pain management. 4- Try to differentiate between incisional pain and anginal pain.

4

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? 1- Assess the client's level of pain and administer prescribed analgesics. 2- Assess the client's level of anxiety and provide emotional support. 3- Prepare the client for pulmonary artery catheterization. 4- Ensure that the client's family is kept informed of the client's status.

1

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)? 1- The patient has compromised left ventricular function. 2- The patient has had angina longer than 3 years. 3- The patient has at least a 70% occlusion of a major coronary artery. 4- The patient has an ejection fraction of 65%.

3

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? 1- Isosorbide mononitrate (Isordil) 2- Meperidine hydrochloride (Demerol) 3- Morphine sulfate (Morphine) 4- Nitroglycerin transdermal patch

3

The nurse is caring for a patient who is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) and who asks what complications can happen during the procedure. What statement should underlie the nurse's response? 1- Complications that can occur during a PTCA include dissection of the ductus arteriosa. 2- Complications that can occur during a PTCA include hyposensitivity of the heart muscle. 3- Complications that can occur during a PTCA include vasospasm of the coronary artery. 4- Complications that can occur during a PTCA include closure of the pulmonary artery.

3