Chapter 25: Caring for Clients with Disorders of Coronary and Peripheral Blood Vessels

A nurse who works in a busy emergency department provides care for numerous patients who present with complaints of chest pain. Which of the following questions is most likely to help the nurse differentiate between chest pain that is attributable to angina and chest pain due to myocardial infarction (MI)? "Does resting and remaining still help your chest pain to decrease?" "Have you ever been diagnosed with high blood pressure or diabetes?" "When was the first time that you recall having chest pain?" "Does your chest pain make it difficult to move around like you normally would?"

"Does resting and remaining still help your chest pain to decrease?"

A community health nurse teaches a group of older adults about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which statement? "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." "The older I get the higher my risk for peripheral arterial disease gets." "Because my family is from Italy, I have a higher risk of developing peripheral arterial disease."

"I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet."

In preparation for cardiac surgery, a client was taught about measures to prevent venous thromboembolism. What statement indicates that the client clearly understood this education? "I'll try to stay in bed for the first few days to allow myself to heal." "I'll make sure that I don't cross my legs when I'm resting in bed." "I'll keep pillows under my knees to help my blood circulate better." "I'll put on those compression stockings if I get pain in my calves."

"I'll make sure that I don't cross my legs when I'm resting in bed."

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

"See if rest relieves the chest pain before using the nitroglycerin."

The nurse is teaching a client who is being discharged post vein stripping for varicose veins. Which client statement indicates the client requires additional self-care instructions? "So it's OK for me to return to my job right away as a hairdresser." "I should call the doctor if I get a cut on my foot." "I should try not to cross my knees when I'm sitting." "I'll need to wear these support stockings every day."

"So it's OK for me to return to my job right away as a hairdresser."

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? "As soon as you feel pain, we will go back and elevate your legs." "If you feel pain during the walk, keep walking until the end of the hallway is reached." "Walk to the point of pain, rest until the pain subsides, then resume ambulation." "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

"Walk to the point of pain, rest until the pain subsides, then resume ambulation."

The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? 160-190 mg/dL 210-240 mg/dL 250-275 mg/dL 280-300 mg/dL

160-190 mg/dL

A medical nurse has admitted four clients over the course of a 12-hour shift. For which client would assessment of ankle-brachial index (ABI) be most clearly warranted? A client who has peripheral edema secondary to chronic heart failure An older adult client who has a diagnosis of unstable angina A client with poorly controlled type 1 diabetes who is a smoker A client who has community-acquired pneumonia and a history of COPD

A client with poorly controlled type 1 diabetes who is a smoker

The nurse has just admitted a 66-year-old patient for cardiac surgery. The patient tells the nurse that she is afraid of dying while undergoing the surgery. The nurse should be aware that: A further assessment of anxiety is required. A more complete physical examination is required. Preoperative fears are normal and will be alleviated with time. Teaching should be initiated immediately to alleviate the fears.

A further assessment of anxiety is required.

A nurse suspects the presence of an abdominal aortic aneurysm. What assessment data would the nurse correlate with a diagnosis of abdominal aortic aneurysm? (Select all that apply.) A pulsatile abdominal mass Low back pain Lower abdominal pain Decreased bowel sounds Diarrhea

A pulsatile abdominal mass Low back pain Lower abdominal pain

The nurse providing care for a client post PTCA knows to monitor the client closely. For what complications should the nurse monitor the client? Select all that apply. Abrupt closure of the coronary artery Venous insufficiency Bleeding at the insertion site Retroperitoneal bleeding Arterial occlusion

Abrupt closure of the coronary artery Bleeding at the insertion site Retroperitoneal bleeding Arterial occlusion

The nurse is creating a plan of care for a client with acute coronary syndrome. What nursing action should be included in the client's care plan? Facilitate daily arterial blood gas (ABG) sampling. Administer supplementary oxygen, as needed. Have client maintain supine positioning when in bed. Perform chest physiotherapy, as indicated.

Administer supplementary oxygen, as needed.

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? Arterial insufficiency Venous insufficiency Neither venous nor arterial Trauma

Arterial insufficiency

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

Assess the client's level of pain and administer prescribed analgesics.

A patient with a diagnosis of deep vein thrombosis (DVT) is being treated with unfractionated heparin, which is being administered intravenously. The nurse who is providing care for this patient should consequently prioritize what assessments? Assessing the patient for internal or external hemorrhage Monitoring the patient's intake and output, and assessing for signs of fluid volume deficit Assessing the patient for adventitious lung sounds and assessing SaO2 levels Assessing the patient's pain levels

Assessing the patient for internal or external hemorrhage

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? Digoxin Atropine Protamine sulfate Sodium nitroprusside

Atropine

The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments? Maximizing cardiac output while minimizing heart rate Decreasing energy expenditure of the myocardium Balancing myocardial oxygen supply with demand Increasing the size of the myocardial muscle

Balancing myocardial oxygen supply with demand

A client reports "achy legs" and fatigue but blames it on recently beginning a new job as a waitress. What is the most appropriate diagnostic test for this client? Brodie-Trendelenburg test Homan's sign C-reactive protein (HS-CRP) Stress test

Brodie-Trendelenburg test

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

C-reactive protein (CRP)

A client in the cardiac step-down unit has begun bleeding from the percutaneous coronary intervention (PCI) access site in the femoral region. What is the nurse's most appropriate action? Call for assistance and initiate cardiopulmonary resuscitation. Reposition the client's leg in a nondependent position. Promptly remove the femoral sheath. Call for help and apply pressure to the access site.

Call for help and apply pressure to the access site.

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

Central venous pressure reading of 1

The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified? Gender, obesity, family history, and smoking Inactivity, stress, gender, and smoking Cholesterol levels, hypertension, and smoking Stress, family history, and obesity

Cholesterol levels, hypertension, and smoking

A nurse is admitting a 45-year-old man to the medical unit who has a history of PAD. While providing his health history, the client reveals that he smokes about two packs of cigarettes a day, has a history of alcohol abuse, and does not exercise. What would be the priority health education for this client? The lack of exercise, which is the main cause of PAD The likelihood that heavy alcohol intake is a significant risk factor for PAD Cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause or aggravate PAD. Alcohol suppresses the immune system, creates high glucose levels, and may cause PAD.

Cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause or aggravate PAD.

A client is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What intervention best addresses this risk? Administration of bronchodilators by nebulizer Administration of inhaled corticosteroids by metered dose inhaler (MDI) Client's consistent performance of deep-breathing and coughing exercises Client's active participation in the cardiac rehabilitation program

Client's consistent performance of deep-breathing and coughing exercises

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

Clopidogrel

A client who is postoperative day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurse's most appropriate action? Document the client's low urine output and monitor closely for the next several hours. Contact the dietitian and suggest the need for increased oral fluid intake. Contact the client's health care provider and continue to assess fluid balance and renal function. Increase the infusion rate of the client's IV fluid to prompt an increase in renal function

Contact the client's health care provider and continue to assess fluid balance and renal function.

The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is air plethysmography. contrast phlebography. lymphangiography. lymphoscintigraphy.

Contrast phlebography.

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) Cool and cyanotic skin Initial absence of edema Sharp pain that may be relieved by the elevation of the extremity Full superficial veins Brisk capillary refill of the toes

Cool and cyanotic skin Sharp pain that may be relieved by the elevation of the extremity Full superficial veins

The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? Decreases the sinoatrial node automaticity Increases the atrioventricular node conduction Increases the heart rate Creates a positive inotropic effect

Decreases the sinoatrial node automaticity

The public health nurse is participating in a health fair and interviews a client with a history of hypertension, who is currently smoking one pack of cigarettes per day. The client denies any of the most common manifestations of CAD. The nurse should expect the focuses of CAD treatment to be: drug therapy and smoking cessation. diet and drug therapy. diet therapy only. diet therapy and smoking cessation.

Diet therapy and smoking cessation.

The nurse assessing a client who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which characteristic? Diminished or absent pulses Superficial ulcer Aching, cramping pain Pulses that are present but difficult to palpate

Diminished or absent pulses

Which is a characteristic of arterial insufficiency? Diminished or absent pulses Superficial ulcer Aching, cramping pain Pulses are present but may be difficult to palpate

Diminished or absent pulses

The nurse is admitting a 32-year-old woman to the presurgical unit. The nurse learns during the admission assessment that the client takes oral contraceptives. The nurse's postoperative plan of care should include what intervention? Early ambulation and leg exercises Cessation of the oral contraceptives until 3 weeks postoperative Doppler ultrasound of peripheral circulation twice daily Dependent positioning of the client's extremities when at rest

Early ambulation and leg exercises

How should the nurse best position a client who has leg ulcers that are venous in origin? Keep the client's legs flat and straight. Keep the client's knees bent to 45-degree angle and supported with pillows. Elevate the client's lower extremities. Dangle the client's legs over the side of the bed.

Elevate the client's lower extremities.

When discussing angina pectoris secondary to atherosclerotic disease with a client, the client asks why he tends to experience chest pain when he exerts himself. The nurse should describe which of the following phenomena? Exercise increases the heart's oxygen demands. Exercise causes vasoconstriction of the coronary arteries. Exercise shunts blood flow from the heart to the mesenteric area. Exercise increases the metabolism of cardiac medications.

Exercise increases the heart's oxygen demands.

The nurse has just admitted a client for cardiac surgery. The client tearfully describes feeling afraid of dying while undergoing the surgery. What is the nurse's best response? Explore the factors underlying the client's anxiety. Teach the client guided imagery techniques. Obtain an order for a PRN benzodiazepine. Describe the procedure in greater detail.

Explore the factors underlying the client's anxiety.

Which is a nonmodifiable risk factor for coronary artery disease (CAD)? Hypertension Gender Diabetes mellitus Obesity

Gender

An OR nurse is preparing to assist with a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used as source for a CABG is what? Brachial artery Brachial vein Femoral artery Greater saphenous vein

Greater saphenous vein

A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin? Nausea, vomiting, depression, fatigue, and impotence. Sedation, nausea, vomiting, constipation, and respiratory depression. Headache, hypotension, dizziness, and flushing. Flushing, dizziness, headache, and pedal edema.

Headache, hypotension, dizziness, and flushing

When being assessed by her new nurse practitioner, a woman states that she has had Raynaud's disease for many years, a problem that occasionally affects her quality of life. When performing health education surrounding this problem, what should the nurse emphasize? Teaching the woman about atherosclerosis and its role in Raynaud's disease Teaching the woman about the correct use of anticoagulants Helping the woman identify and avoid the specific triggers of her problem Teaching the woman the signs and symptoms of deep vein thrombosis

Helping the woman identify and avoid the specific triggers of her problem

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? Hyperkalemia Hypercalcemia Hypomagnesemia Hyponatremia

Hyperkalemia

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? Within 12 hours Within the first 24 hours In 2 days In 3 to 5 days

In 3 to 5 days

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? Deficient knowledge about underlying disease and methods for avoiding complications Anxiety related to fear of death Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Noncompliance related to failure to accept necessary lifestyle changes

Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD)

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? Impaired gas exchange related to increased blood flow Excess fluid volume related to peripheral vascular disease Risk for injury related to edema Ineffective peripheral tissue perfusion related to venous congestion

Ineffective peripheral tissue perfusion related to venous congestion

A postsurgical client has illuminated her call light to inform the nurse of a sudden onset of lower leg pain. On inspection, the nurse observes that the client's left leg is visibly swollen and reddened. What is the nurse's most appropriate action? Administer a PRN dose of subcutaneous heparin. Inform the health care provider that the client has signs and symptoms of VTE. Mobilize the patient promptly to dislodge any thrombi in the client's lower leg. Massage the client's lower leg to temporarily restore venous return.

Inform the health care provider that the client has signs and symptoms of VTE.

The nurse is taking a health history of a new client who reports pain in his left lower leg and foot when walking. This pain is relieved with rest and the nurse observes that the left lower leg is slightly edematous and is hairless. When planning this client's care, the nurse should most likely address what health problem? Coronary artery disease (CAD) Intermittent claudication Arterial embolus Raynaud disease

Intermittent claudication

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? Intermittent claudication Acute limb ischemia Dizziness Vertigo

Intermittent claudication

The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis (DVT). Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels? Partial thromboplastin time (PTT) within normal reference range Prothrombin time (PT) 8 to 10 times the control International normalized ratio (INR) between 2 and 3 Hematocrit of 32%

International normalized ratio (INR) between 2 and 3

A client is undergoing lipid profile studies in an effort to determine a proper nutritional balance for CAD. The client's lipid profile reveals LDL greater than HDL. This is a risk factor for this client because the: LDL sticks to arteries. HDL sticks to arteries. LDL carries cholesterol to the liver. HDL carries cholesterol to the liver.

LDL sticks to arteries.

The nurse is caring for a client 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? Lipids and fibrous tissue White blood cells Lipoproteins High-density cholesterol

Lipids and fibrous tissue

The nurse is providing care for a client with high cholesterol and triglyceride values. In teaching the client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following? High HDL values and high triglyceride values Absence of detectable total cholesterol levels Elevated blood lipids, fasting glucose less than 100 Low LDL values and high HDL values

Low LDL values and high HDL values

Which term refers to enlarged, red, and tender lymph nodes? Lymphadenitis Lymphangitis Lymphedema Elephantiasis

Lymphadenitis

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: May have developed an increased area of infarction Will probably not have more damage than if he came in immediately Can have restoration of the area of dead cells with proper treatment Has been damaged already, so immediate treatment is no longer necessary

May have developed an increased area of infarction

An adult client is admitted to the ED with chest pain. The client states that he had unrelieved chest pain for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions? Thrombolytics (fibrinolytics), oxygen administration, and nonsteroidal anti-inflammatories Morphine sulphate, oxygen, and bed rest Oxygen and beta-adrenergic blockers Bed rest, albuterol nebulizer treatments, and oxygen

Morphine sulphate, oxygen, and bed rest

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 experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician? Nitroglycerin SL Chest x-ray Serum electrolytes Ativan 1 mg orally

Nitroglycerin SL

A nurse working in a long-term care facility is performing the admission assessment of a newly admitted, 85-year-old resident. During inspection of the resident's feet, the nurse notes early evidence of gangrene on one of the resident's great toes. The nurse should assess for further evidence of what health problem? Chronic venous insufficiency Raynaud phenomenon Venous thromboembolism Peripheral artery disease (PAD)

Peripheral artery disease (PAD)

A nurse is caring for a client following an arterial vascular bypass graft in the leg. What should the nurse plan to assess over the next 24 hours? Peripheral pulses every 15 minutes after surgery Ankle-arm indices every 12 hours Blood pressure every 2 hours Color of the leg every 4 hours

Peripheral pulses every 15 minutes after surgery

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? Decrease the heparin infusion rate. Prepare to administer protamine sulfate. Monitor the partial thromboplastin time (PTT). Start an I.V. infusion of dextrose 5% in water (D5W).

Prepare to administer protamine sulfate.

A client presents to the ED in distress and reporting "crushing" chest pain. What is the nurse's priority for assessment? Prompt initiation of an ECG Auscultation of the client's point of maximal impulse (PMI) Rapid assessment of the client's peripheral pulses Palpation of the client's cardiac apex

Prompt initiation of an ECG

A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description? Phytonadione (vitamin K) Protamine sulfate Thrombin Plasma protein fraction

Protamine Sulfate

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? Peripheral vascular disease Raynaud's disease Arterial occlusive diseases Buerger's disease

Raynaud's disease

A client with cardiovascular disease is being treated with amlodipine, which is intended to cause what therapeutic effect? Reducing the heart's workload by decreasing heart rate and myocardial contraction Preventing platelet aggregation and subsequent thrombosis Reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart Increasing the efficiency of myocardial oxygen consumption, thus decreasing ischemia and relieving pain

Reducing the heart's workload by decreasing heart rate and myocardial contraction

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? Described as crushing and substernal Associated with nausea and vomiting Relieved by rest and nitroglycerin Accompanied by diaphoresis and dyspnea

Relieved by rest and nitroglycerin

The nurse is caring for a client who is believed to have just experienced an MI. The nurse notes changes in the ECG of the patient. What change on an ECG most strongly suggests to the nurse that ischemia is occurring? P wave inversion T wave inversion Q wave changes with no change in ST or T wave P wave enlargement

T wave inversion

A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause? The aneurysm has become obstructed. The aneurysm may be preparing to rupture. The client is experiencing inflammation of the aneurysm. The client is experiencing normal sensations associated with this condition.

The aneurysm may be preparing to rupture

When assessing a client diagnosed with angina pectoris, it is most important for the nurse to gather what information? The client's activities limitations and level of consciousness after the attacks The client's symptoms and the activities that precipitate attacks The client's understanding of the pathology of angina The client's coping strategies surrounding the attacks

The client's symptoms and the activities that precipitate attacks

A 56-year-old man has been brought to the emergency department by emergency medical services (EMS) and has been diagnosed with a myocardial infarction (MI) based on his presentation and electrocardiogram (ECG). The patient has been identified as a candidate for percutaneous transluminal coronary angioplasty (PTCA). The nurse who is providing care for this patient should recognize that the extent of cardiac damage will primarily depend on: The patient's previous use of antiplatelets and anticoagulants The particular risk factors that contributed to the patient's MI The duration of oxygen deprivation to the patient's cardiac cells The patient's high- and low-density lipoprotein (LDL, HDL) levels prior to MI

The duration of oxygen deprivation to the patient's cardiac cells

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? Cholesterol is within the recommended guidelines and the client doesn't need to lower it. Client should take statin medication and not worry about cholesterol. Client should begin a running program, working up to 2 miles per day. The nurse will ask the dietitian to talk with the client about modifying the diet.

The nurse will ask the dietitian to talk with the client about modifiying the diet.

A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? The patient has compromised left ventricular function. The patient has had angina longer than 3 years. The patient has at least a 70% occlusion of a major coronary artery. The patient has an ejection fraction of 65%.

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

Family members bring a client to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data? The symptoms indicate angina and should be treated as such. The symptoms indicate a pulmonary etiology rather than a cardiac etiology. The symptoms indicate an acute coronary episode and should be treated as such. Treatment should be determined pending the results of an exercise stress test.

The symptoms indicate an acute coronary episode and should be treated as such.

Which of the following is the most common site for a dissecting aneurysm? Thoracic area Lumbar area Sacral area Cervical area

Thoracic area

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

Troponin

The nurse is caring for a patient with venous insufficiency. For what should the nurse assess the patient's lower extremities? Rubor Cellulitis Dermatitis Ulceration

Ulceration

The nurse is providing care for a client who has just been diagnosed with peripheral arterial occlusive disease (PAD). What assessment finding is most consistent with this diagnosis? Numbness and tingling in the distal extremities Unequal peripheral pulses between extremities Visible clubbing of the fingers and toes Reddened extremities with muscle atrophy

Unequal peripheral pulses between extremities

A client presents to the clinic reporting the inability to grasp objects with her right hand. The client's right arm is cool and has a difference in blood pressure of more than 20 mm Hg compared with her left arm. The nurse should expect that the primary provider may diagnose the woman with what health problem? Lymphedema Raynaud phenomenon Upper extremity arterial occlusive disease Upper extremity VTE

Upper extremity arterial occlusive disease

The nurse is reevaluating a client 2 hours after a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which assessment finding may indicate the client is experiencing a complication of the procedure? Urine output of 40 mL Potassium level of 4.0 mEq/L Heart rate of 100 bpm Dried blood at the puncture site

Urine output of 40 mL

A nurse is assessing a new client who is diagnosed with PAD. The nurse cannot feel the pulse in the client's left foot. How should the nurse proceed with assessment? Have the primary care provider prescribe a CT. Apply a tourniquet for 3 to 5 minutes and then reassess. Elevate the extremity and attempt to palpate the pulses. Use Doppler ultrasound to identify the pulses.

Use Doppler ultrasound to identify the pulses.

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gaiter area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? Arterial insufficiency Venous insufficiency Neither venous nor arterial insufficiency Trauma

Venous insufficiency

The nurse at a long-term care facility is conducting an admission assessment of a new male resident who is Caucasian. On inspection of the resident's lower extremities, the nurse notes that his shins and ankles have a gray-brown color tone and are visibly shiny. The nurse should conduct further assessments in light of the possibility that the resident may have: Venous insufficiency An arterial occlusion Raynaud's disease A deep vein thrombosis

Venous insufficiency

The nurse is caring for a client who is scheduled for cardiac surgery. What should the nurse include in preoperative care? With the client, clarify the surgical procedure that will be performed. Withhold the client's scheduled medications for at least 12 hours preoperatively. Inform the client that health teaching will begin as soon as possible after surgery. Avoid discussing the client's fears as not to exacerbate them.

With the client, clarify the surgical procedure that will be performed.

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? Within 6 hours Within 12 hours Within 24 to 48 hours Within 5 to 7 days

Within 6 hours

A 60-year-old woman has been brought to the emergency department (ED) by ambulance after she experienced a sudden onset of dyspnea and phoned 911. The woman is obese but claims an unremarkable medical history and denies chest pain. When assessing this patient, the nurse in the ED should be aware that: Dyspnea is definitive for a respiratory, rather than cardiac, etiology. The absence of known risk factors usually rules out myocardial infarction (MI) or angina as a cause of dyspnea. Women often present with an MI much differently than do men. Acute coronary syndrome (ACS) manifests with chest pain rather than with shortness of breath.

Women often present with an MI much differently than do men.

The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain? incomplete blockage of a major coronary artery a destroyed part of the heart muscle complete closure of an artery a lack of oxygen in the heart muscle cells

a lack of oxygen in the heart muscle cells

A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD? ankle-brachial index exercise electrocardiography electron beam computed tomography photoplethysmography

ankle-brachial index

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

calcium-channel blocker

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? "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." "A burning sensation after administration indicates that the nitroglycerin tablets are potent." "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 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? Prolonged PR interval Absent Q wave Elevated ST segment Widened QRS complex

Elevated ST segment

A nurse has written a plan of care for a man diagnosed with peripheral arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral tissue perfusion related to compromised circulation. What is the most appropriate intervention for this diagnosis? Elevate his legs and arms above his heart when resting. Encourage the client to engage in a moderate amount of exercise. Encourage extended periods of sitting or standing. Discourage walking in order to limit pain.

Encourage the client to engage in a moderate amount of exercise.

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? Increased abdominal and back pain Decreased pulse rate and blood pressure Retrosternal back pain radiating to the left arm Elevated blood pressure and rapid respirations

Increased abdominal and back pain

Which risk factor is related to venous stasis for deep vein thrombosis (DVT) and pulmonary embolism (PE)? Trauma Pacing wires Obesity Surgery

Obesity

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? Taking daily walks Engaging in anaerobic exercise Reducing daily fat intake to less than 45% of total calories Abstaining from foods that increase levels of high-density lipoproteins (HDLs)

Taking daily walks

What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis? Teach the client how to apply a graduated compression stocking. Inform the physician if the client's temperature remains low. Avoid elevating the area. Offer cold applications to promote comfort and to enhance circulation.

Teach the client how to apply a graduated compression stocking.

A client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: elevated troponin levels. decreased LDH levels. decreased myoglobin levels. increased C-reactive protein levels.

elevated troponin levels.

The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? decrease anxiety enhance myocardial oxygenation administer sublingual nitroglycerin educate the client about his symptoms

enhance myocardial oxygenation

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: encouraging ambulation to prevent pooling of blood. providing warmth to the extremity. elevating the extremity to prevent pooling of blood. forcing blood into the deep venous system.

forcing blood into the deep venous system.

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

high LDL level

The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? cerebral bleeding I.M. injection myocardial necrosis skeletal muscle damage due to a recent fall

myocardial necrosis

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? Calcium Magnesium Potassium Sodium

potassium

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? smoking cessation a protein-rich diet exercise avoidance antioxidant supplements

smoking cessation

A client with severe angina pectoris and ST-segment elevation on an electrocardiogram is being seen in the emergency department. In terms of diagnostic laboratory testing, it's most important for the nurse to advocate ordering a: creatine kinase level. hemoglobin (Hb) level. troponin level. liver panel.

troponin level.