Chapter 23 PREPU: Management of Patients with Coronary Vascular Disorders

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.

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The nurse is caring for a client who is post-varicose vein surgery. The nurse would include which teaching measure(s)? Select all that apply. a. Lower the extremities. b. Stand rather than sit. c. Exercise d. Cool compresses e. Elastic stockings f. Take warm showers in the morning.

- Elastic stockings - Exercise Movement/exercise and use of elastic stocking aid in venous return. Cool compresses can cause vasoconstriction, which can diminish arterial blood flow. Elevation of legs can be helpful in aiding venous return. Standing or sitting for prolonged periods of time should be avoided. Showers in the morning can dilate blood vessels and contribute to venous congestion and edema.

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.

0.80 (4 mg/5 mg) X 1 mL = 0.8 mL.

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

12-lead ECG The nurse should complete the 12-lead ECG first. The priority is to determine whether the client is suffering an acute MI and implement appropriate interventions as quickly as possible. The other orders should be completed after the ECG.

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. 100 seconds or less. b. 125 seconds or less. c. 75 seconds or less. d. 50 seconds or less.

50 seconds or less. Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 50 seconds or less before the sheath is removed. Removing the sheath before the PTT drops below 50 seconds can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath.

A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: a. normal LDL level. b. high LDL level. c. low LDL level. d. fasting LDL level.

high LDL level.

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. serial liver enzyme testing, telemetry, and lidocaine infusion b. streptokinase, aspirin, and morphine administration c. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry d. morphine administration, stress testing, and admission to the cardiac care unit

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

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? a. "A burning sensation after administration indicates that the nitroglycerin tablets are potent." b. "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." c. "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." d. "You may take a sublingual nitroglycerin tablet every 30 minutes if needed. You may take as many as four doses."

"Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up."

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

"Client will verbalize the intention to stop smoking." A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).

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

"I should expect a low-grade fever and swelling at the site for the next week." Fever and swelling at the site are signs of infection and should be reported to the physician. Percutaneous transluminal coronary angioplasty = blowing up a balloon in the coronary artery to widen atherosclerosis blockage. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve.

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

"Rehabilitation will help me function as well as I physically can." The client demonstrates an understanding of cardiac rehabilitation when he states that it helps the client reach his activity potential. Coronary artery disease, which typically causes an acute MI, is a chronic condition that isn't cured. Many clients who suffer an acute MI can eventually return to such activities as jogging, depending on the extent of cardiac damage. Cardiac rehabilitation involves physical activity as well as classroom education.

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

"Removing the patch at night prevents drug tolerance while keeping the benefits." Tolerance to antiangina effects of nitrates can occur when taking these drugs for long periods of time. Therefore, to prevent tolerance and maintain benefits, it is a common regime to remove transdermal patches at night. Common adverse effects of nitroglycerin are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while the client rests, there is less demand on the heart but not the primary reason for removing the patch.

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. "Place the nitroglycerin tablet between cheek and gum." c. "Call 911 if you develop a headache following nitroglycerin use." d. "See if rest relieves the chest pain before using the nitroglycerin."

"See if rest relieves the chest pain before using the nitroglycerin." Decreased activity may relieve chest pain; sitting will prevent injury should the nitroglycerin lower BP and cause fainting. The client should expect to feel dizzy or flushed or to develop a headache following sublingual nitroglycerin use. The client should place one nitroglycerin tablet under the tongue if 2-3 minutes of rest fails to relieve pain. Clients may take up to three nitroglycerin tablets within 5 minutes of each other to relieve angina. However, they should call 911 if the three tablets fail to resolve the chest pain.

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

"The pain occurred while I was mowing the lawn." Decreased oxygen supply to the myocardium causes angina pectoris. Lawn mowing increases the cardiac workload, which increases the heart's need for oxygen and may precipitate chest pain. Anginal pain typically is self-limiting, lasting 5 to 15 minutes. Food consumption doesn't reduce angina pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain.

A client is prescribed a nitroglycerin transdermal patch to treat angina. Which statement does the nurse include when reinforcing medication teaching to the client prior to discharge? a. "The patch should be worn for 12 hours and then removed for 12 hours." b. "Skin irritation is common when the patch is worn for more than 12 hours." c. "You do not need the effects of nitroglycerine while you sleep." d. "The medication patch causes headaches so you should remove it daily."

"The patch should be worn for 12 hours and then removed for 12 hours."

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. Altered level of consciousness c. Presence of reperfusion dysrhythmias d. Minimal oozing of blood from the IV site

Altered level of consciousness A client receiving fibrinolytic therapy is at risk for complications associated with bleeding. An altered level of consciousness may indicate hypoxia and intracranial bleeding, and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low and indicates the client's chest pain is subsiding, an expected outcome of this therapy.

Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? a. Clopidogrel b. Amlodipine c. Diltiazem d. Felodipine

Clopidogrel Clopidogrel or ticlopidine is given to clients who are allergic to aspirin or is given in addition to aspirin to clients who are at high risk for MI. Amlodipine, diltiazem, and felodipine are calcium channel blockers.

Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? a. Application of a pneumatic compression device (e.g., FemoStop) b. Direct manual pressure c. Application of a vascular closure device such as Angio-Seal or VasoSeal d. Application of a sandbag to the area

Application of a vascular closure device such as Angio-Seal or VasoSeal Application of a vascular closure device has been demonstrated to be very effective. Direct manual pressure to the sheath introduction site and application of a pneumatic compression device after PTCA have been demonstrated to be effective; the former was the first method used to induce hemostasis after PTCA. Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding.

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 healthcare provider, what additional action should the nurse take? a. Assess for factors that may be causing the client's delirium. b. Document the early signs of dementia and ensure the client's safety. c. Reorient the client to place and time. d. Educate the family about how confusion is expected in older adults postoperatively.

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

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? a. Assess the client's level of anxiety and provide emotional support. b. Prepare the client for pulmonary artery catheterization. c. Ensure that the client's family is kept informed of the client's status. d. Assess the client's level of pain and administer prescribed analgesics.

Assess the client's level of pain and administer prescribed analgesics. The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and family members should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.

The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? a. Avoid situations that contribute to ischemic episodes. b. Avoid fatty foods and exercise. c. Take over-the-counter decongestants. d. Report changes in the usual pattern of chest pain.

Avoid situations that contribute to ischemic episodes.

A client is receiving nitroglycerin ointment 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? a. Pulse rate of 84 beats/minute b. Temperature of 100.2° F (37.9° C) c. Blood pressure 84/52 mm Hg d. Respiration 26 breaths/minute

Blood pressure 84/52 mm Hg Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.

A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? a. beta-adrenergic blocker b. diuretic c. nitrate d. calcium-channel blocker

Calcium channel blocker Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of a calcium channel blocker.

Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? a. Fluid overload b. Hypertension c. Hypothermia d. Cardiac tamponade

Cardiac tamponade

The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? a. Prepare to administer intravenous fluids. b. Assess pupils for reactiveness. c. Check blood pressure. d. Suction the airway.

Check blood pressure. During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to ensure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.

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

Clopidogrel Because of the risk of thrombus formation following coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.

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. Raynaud syndrome c. Cardiogenic shock d. Coronary artery disease

Coronary artery disease 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 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. An unpredictable amount of activity. b. The same type of activity that caused previous angina episodes. c. Activities that increase myocardial oxygen demand. d. Coronary artery spasm.

Coronary artery spasm. Prinzmetal's angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; anginal pain becomes increasingly severe.

A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? a. Relieved by rest and nitroglycerin b. Associated with nausea and vomiting c. Accompanied by diaphoresis and dyspnea d. Described as crushing and substernal

Relieved by rest and nitroglycerin One characteristic that can differentiate the pain of angina from myocardial infarction is pain that is relieved by rest and nitroglycerine. There may be some exceptions (unstable angina), but the distinction is helpful especially when combined with other assessment data.

The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration? a. Measure urinary output for dehydration. b. Measure the blood pressure for hypertension. c. Check the radial pulse for dysrhythmias. d. Count the respiratory rate for bradypnea.

Count the respiratory rate for bradypnea. The nurse should always check the respiratory rate prior to administering morphine sulfate. The drug should be withheld, and the health care provider notified if the respiratory rate is below 16 breaths/minute.

A nurse is monitoring the vital signs and blood results of a client who is receiving anticoagulation therapy. What does the nurse identify as a major indication of concern? a. blood pressure of 129/72 mm Hg b. hematocrit of 30% c. heart rate of 87 bpm d. hemoglobin of 16 g/dL

hematocrit of 30% Hematocrit is a measurement of the proportion of blood volume that is occupied by red blood cells. A lower hematocrit can imply internal bleeding. Blood pressure of 129/72 and heart rate of 87 bpm are normal. A hemoglobin count of 16 g/dL is also normal.

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 resting heart rate b. Decreases cholesterol level c. Increases cardiac output d. Decreases platelet aggregation

Decreases resting heart rate

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? a. Increases the atrioventricular node conduction b. Creates a positive inotropic effect c. Decreases the sinoatrial node automaticity d. Increases the heart rate

Decreases the sinoatrial node automaticity Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).

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. Low-density lipoprotein (LDL), 160 mg/dL b. High-density lipoprotein (HDL), 80 mg/dL c. A ratio of LDL to HDL, 4.5 to 1.0 d. Cholesterol, 280 mg/dL

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

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. Hyperlipidemia b. Hypertension c. Glucose intolerance d. Obesity

Hypertension Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impair the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder.

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

IV morphine

Which is the most important post-operative assessment parameter for a client recovering from cardiac surgery? a. Inadequate tissue perfusion b. Activity intolerance c. Mental alertness d. Blood glucose concentration

Inadequate tissue perfusion The nurse must assess the client 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 glucose 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 clients undergoing cardiac surgery.

The nurse notes that the post-cardiac surgery client demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025). What will the nurse anticipate the health care provider will order? a. Irrigate the urinary catheter b. Increase intravenous fluids c. Prepare the client for dialysis d. Decrease intravenous fluids

Increase intravenous fluids Urine output of less than 25 mL/hr may indicate a decrease in cardiac output. A high specific gravity indicates an increased concentration of solutes in the urine, which occurs with inadequate fluid volume. The health care provider may increase intravenous fluids. Irrigating the urinary catheter will be done if there is a suspected blockage. Dialysis is not indicated by urinary volumes.

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 to renew the nitroglycerin supply every 3 months. c. Instruct the client not to crush the tablet. d. Instruct the client on side effects of flushing, throbbing headache, and tachycardia.

Instruct the client on side effects of flushing, throbbing headache, and tachycardia. The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.

A client's elevated cholesterol levels are being managed with atorvastatin daily. What is a common side effect the nurse will teach the client that will require monitoring? a. hyperglycemia b. increased liver enzymes c. hyperuricemia d. severe muscle pain

increased liver enzymes Myopathy and increased liver enzymes are significant side effects of the statin Lipitor. Hyperuricemia occurs when too much uric acid is present in the blood; it is not a side effect of the statins. Hyperglycemia is increased blood glucose, which is not a side effect of the statins. Severe muscle pain is an adverse effect of statins, but it does not require monitoring.

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 subsides after taking nitroglycerin. b. It is viselike and radiates to the shoulders and arms. c. It is sudden in onset and prolonged in duration. d. It is relieved by rest and inactivity. e. It is sub-sternal in location.

It is sub-sternal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms.

An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? a. Leads II, III, and aVF b. Leads I, aVL, V5, and V6 c. Leads V3 and V4 d. Leads V1 and V2

Leads V3 and V4 Leads V3 and V4 record electrical events in the septal region of the left ventricle. Leads I, aVL, V5, and V6 record electrical events on the lateral surface of the left ventricle. Leads II, III, and aVF record electrical events on the inferior surface of the left ventricle. Leads V1 and V2 record electrical events on the anterior surface of the right ventricle and the anterior surface of the left ventricle.

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

Lie down or sit in a chair for 5 to 10 minutes after taking the drug. Explanation: Nitrates act primarily to relax coronary smooth muscle and produce vasodilation. They can cause hypotension, which makes the client dizzy and weak. The nurse should instruct the client to lie down or sit in a chair for 5 to 10 minutes after taking the drug. Nitrates are taken at the first sign of chest pain and before activities that might induce chest pain. Sublingual nitroglycerin is taken every 5 minutes for three doses. If the pain persists, the client should seek medical assistance immediately. Nitrates must be stored in a dark place in a closed container because sunlight causes the medication to lose its effectiveness. Alcohol is prohibited because nitrates may enhance the effects of the alcohol.

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. Nitroglycerin transdermal patch c. Morphine sulfate (Morphine) d. Meperidine hydrochloride (Demerol)

Morphine sulfate (Morphine)

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. shellfish allergy b. recent consumption of a meal c. prior intracranial hemorrhage d. use of heparin

prior intracranial hemorrhage

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. Physical inactivity Obesity Family history Alcohol use Elevated blood pressure Increasing age

Physical inactivity Obesity Alcohol use Elevated blood pressure

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? a. Calcium b. Magnesium c. Sodium d. Potassium

Potassium

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. Pulmonary artery wedge pressure (PAWP) of 6 mm Hg b. Heart rate of 60 bpm c. A blood pressure reading of 130/95 mm Hg d. Central venous pressure (CVP) reading of 8 mm Hg

Pulmonary artery wedge pressure (PAWP) of 6 mm Hg In the presence of hypovolemia, the circulating blood volume would be significantly decreased. Therefore, the PAWP would be lower than 8 to 10 mm Hg. The normal CVP reading (2 to 8 mm Hg) would be decreased. The heart rate would be increased and the blood pressure would decrease.

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

Reduce risk through education, support, and physical activity.

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. Isolated premature ventricular contractions (PVCs) b. ST elevation c. Frequent premature atrial contractions (PACs) d. Sinus tachycardia

ST elevation The first signs of an acute MI are usually seen in the T wave & ST segment. The T wave becomes inverted; the ST segment elevates (it is usually flat). An elevated ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e., ST-elevation MI). This client requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.

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 will precipitate internal bleeding. b. The abrupt stop can trigger a migraine headache. c. The abrupt stop can cause a myocardial infarction. d. The abrupt stop can lead to the formation of blood clots.

The abrupt stop can cause a myocardial infarction. 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 the onset of a migraine headache.

A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy? a. The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking. b. The client demonstrates the ability to tolerate more activity without chest pain. c. The client states that sublingual nitroglycerin usually relieves his chest pain. d. The client exhibits a heart rate above 100 beats/minute.

The client demonstrates ability to tolerate more activity without chest pain. The ability to tolerate more activity without chest pain indicates a favorable response to therapy in a client who is recovering from an MI or who has a history of coronary artery disease. The client should have a normal electrocardiogram with no arrhythmias and a regular heart rate of 60 to 100 beats/minute. Smoking is a cardiovascular risk factor that the client must be willing to eliminate. A client who responds favorably to therapy shouldn't have chest pain.

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is the primary purpose of using beta-adrenergic blockers in the nursing management of CAD? a. To prevent angiotensin II conversion b. To decrease the workload of the heart c. To dilate coronary arteries d. To decrease homocysteine levels

To decrease the workload of the heart Beta-adrenergic blockers are used in the treatment of CAD to decrease myocardial oxygen by reducing the heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? a. Myoglobin b. Total creatine kinase c. Troponin d. CK-MB

Troponin Troponin remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin peaks within 12 hours after the onset of symptoms. Total creatine kinase (CK) returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.

A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? a. Within 5 to 7 days b. Within 6 hours c. Within 12 hours d. Within 24 to 48 hours

Within 6 hours For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after the onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Healthcare providers initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.

The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? a. an hourly urine output of 50 to 70 mL b. a serum BUN of 70 mg/dL c. a urine specific gravity reading of 1.021 d. a serum creatinine of 1.0 mg/dL

a serum BUN of 70 mg/dL

The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? a. a serum creatinine of 1.0 mg/dL b. a urine specific gravity reading of 1.021 c. an hourly urine output of 50 to 70 mL d. a serum BUN of 70 mg/dL

a serum BUN of 70 mg/dL These four laboratory results should always be assessed after cardiac surgery. Serum osmolality (N = >800 mOsm/kg) should also be included. A BUN reading of greater than 21 mg/dL is abnormal; a reading of greater than 60 mg/dL is indicative of renal failure. Urine output needs to be greater than 30 mL/hr. Normal urine specific gravity is 1.005-1.030. Normal serum creatinine values are between 0.5-1.2 mg/dL.

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. below the optimal range. c. above the optimal range. d. within the optimal range.

above the optimal range.

The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criteria for extubation for the client? Select all that apply. a. breathing without assistance of the ventilator b. inability to speak c. acceptable arterial blood gas values d. adequate cough and gag reflexes e. labile vital signs

adequate cough and gag reflexes acceptable arterial blood gas values breathing without the assistance of the ventilator Explanation: Before being extubated, the client should have cough and gag reflexes and stable vital signs; be able to lift 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 arterial blood gas levels while breathing without the assistance of the ventilator. The inability to talk is expected when intubated with an endotracheal tube.

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 old MI. b. variant angina. c. an evolving MI. d. a cardiac dysrhythmia.

an old MI. An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI.

What is a modifiable risk factor for the development of atherosclerosis? a. consumption of a high-fat diet b. gender c. history of rheumatic fever d. prior infection with Chlamydia pneumoniae

consumption of a high-fat diet

The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond? a. fatty deposits in the lumen of arteries b. cholesterol plugs in the lumen of veins c. blood clots in the arteries d. emboli in the veins

fatty deposits in the lumen of arteries Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. The plaque does not involve blood clots in arteries, emboli in veins or cholesterol plugs in veins.