Coronary Artery Disease
The nurse is planning to teach a client about coronary angiography. Which information should the nurse include? SATA A) You won't be able to eat or drink for several hours after the procedure. B) Pulses on your feet will need to be checked frequently after the procedure. c) Pressure will be applied to the insertion site after the procedure. D) Yo'll need to remain in bed with your leg straight after the procedure. E) There will be a flushing sensation while the dye is injected during the procedure.
Answer: B, C, D, E Rationale: A coronary angiogram, obtained through a procedure known as cardiac catheterization, is a radiographic study of the circulation of the coronary arteries. The client will be on bedrest for up to 8 hours after the procedure with his leg straight, and pedal pulses will be checked every 15 minutes following the procedure. There will be a flushing sensation while the dye is injected during the procedure. After the procedure, the client will have pressure applied to the insertion site when the sheath is removed. Food and drink are allowed as tolerated.
A client recovering from an acute MI is prescribed aspirin. Which teaching points should the nurse include regarding this prescription? SATA A) Report any itching within 7 days of taking B) Check with your healthcare provider before taking herbal remedies. C) Take a t a different time of today than Warfarin D) Report bleeding or bruising to the healthcare provider. E) Don't skip any scheduled appointments to have blood drawn for labs.
Answer: B, D B) Check with healthcare provider before taking herbal remedies D) Report bleeding or bruising to healthcare provider Rationale: Itching is not a common side effect of aspirin therapy. Herbal remedies such as evening primrose oil, garlic, gingko biloba, or grapeseed extract can increase the effect of the aspirin. Aspirin and Coumadin are not to be taken concurrently. Bleeding and bruising can occur and should be reported to the healthcare provider. Aspirin inhibits platelet aggregation and clot formation. No lab appointments will be made just for aspirin therapy.
The nurse is teaching a client about best practices in managing symptoms of CAD. Which client statement suggests that the nurse's teaching was successful? A) "I will stop taking Lipitor every day in order to decrease my cholesterol." B) "I should take a pain reliever every day for my chest pain." C) "I will take salicylic acid every day to increase blood flow to my heart." D) "Ibuprofen will help increase blood flow to my heart."
Answer: C C) "I will take salicylic acid every day to increase blood flow to my heart." Rationale: To increase the client's blood flow, one goal is to prevent the aggregation of platelets in the arteries. Salicylic acid (aspirin) is a pharmacologic measure to control the aggregation. Statins such as atorvastatin (Lipitor) are used to decrease cholesterol and would be a part of the client's protocol unless the client experienced side effects. Analgesics are not given for chest pain since they do not increase blood flow. Nitrates for angina would increase blood flow. Ibuprofen is not recommended to increase blood flow to the coronary arteries.
The nurse is assessing a client who is ambulating after an MI. Which finding indicates that the client is able to tolerate more activity? A) Respiratory rate changes from 14 to 26 breaths/min B) BP changes from 120/60 to 218/68 mmHg C) Heart rate is consistent at 77 BPM during exercise D) O2 sat changes from 99% to 93%
Answer: C C) Heart rate is consistent at 77 BPM during exercise. Rationale: If the client's heart rate changes by more than 20 beats over the resting heart rate, this indicates that the client should stop and rest. Because the client's heart rate only increased moderately from the resting heart rate, there is no need to stop. After an acute myocardial infarction (AMI), a client's level of exercise should be increased as tolerated. The increases in the blood pressure and breathing rate, and the decrease in O2 saturation are normal during exercise, but excessive changes could mean that the client is not tolerating the activity.
The nurse is teaching a client with coronary artery disease about the therapeutic lifestyle changes (TLC) diet. Which client statement indicates more teaching is needed? A) "I will be able to have a glass of red wine with dinner." B) "I will switch from whole milk to 2% milk." C) "I will miss having avocado slices on toast for breakfast." D) "I will use olive oil to cook with instead of butter."
Answer: C C) I will miss having avocado slices on toast for breakfast. Rationale: Even though 25-35% of a person's daily calorie consumption should come from fat, the TLC diet recommends monounsaturated fats as a person's source of fat. These are found in nuts, olive oil, avocado, and canola oil. Avocados are high in monounsaturated fat, so the client does not have to give up avocados. Switching to lower-fat milk is indicated for this client, as is using olive oil to cook instead of butter. There is research that indicates a benefit to consuming moderate alcohol on the TLC diet.
The nurse is providing care to a female client who is diagnosed with coronary artery disease. The client states to the nurse, "I don't know how this happened." Which response by the nurse is the most appropriate? A) "Women who take oral contraceptives are more likely to develop this disease." B) "Women who have children later in life often develop this disease" C) "Women with a history of sexually transmitted infections are more likely to develop this disease." D) "Women who conceive through the use of in-vitro fertilization are more likely to develop this disease."
A) "Women who take oral contraceptives are more likely to develop this disease." Risk factors for coronary artery disease that are unique to women include premature menopause, oral contraceptive use, and hormone replacement therapy (HRT). Having children later in life, a history of sexually transmitted infections, and the use of in-vitro fertilization do not increase the risk of coronary artery disease for women.
The nurse is providing care to a female client who is diagnosed with CAD. The client states to the nurse, "I don't know how this happened." Which response by the nurse is the most appropriate? A)" women who take oral contraceptives are more likely to develop this disease." B)" Women who have children later in life often develop this disease." C) "Women with a hx of sexually transmitted infections are more likely to develop this disease." D) "Women who conceive through use of in-vitro fertilization are more likely to develop this disease."
A) "Women who take oral contraceptives are more likely to develop this disease." Rationale: Risk factors for coronary artery disease that are unique to women include premature menopause, oral contraceptive use, and hormone replacement therapy (HRT). Having children later in life, a history of sexually transmitted infections, and the use of in-vitro fertilization do not increase the risk of coronary artery disease for women.
The nurse is caring for a client who has had a myocardial infarction. The client states, "I have been smoking for 35 years, what good will quitting do?" Which response is best? A) "Your risk of continued coronary artery disease will decrease by half when you stop." B) "Quitting will enhance the effects of your medications." C) "Your medications will not work if you smoke." D) "Quitting will ensure you don't develop any complications."
A) "Your risk of continued coronary artery disease will decrease by half when you stop." Smoking cessation reduces the risk for coronary heart disease by 50% no matter how long the person has smoked. It will reduce the possibility of lung cancer, decrease complications, and possibly enhance medication effects, but the primary focus for this client is the effect on coronary artery disease.
The nurse is caring for a client who has had a myocardial infarction. The client states, "I have been smoking for 35 years, what good will quitting do?" Which response is best? A) "Your risk of continued coronary artery disease will decrease by half when you stop." B) "Quitting will enhance the effects of your medications." C) "Your medications will not work if you smoke." D) "Quitting will ensure you don't develop any complications."
A) "Your risk of continued coronary artery disease will decrease by half when you stop." Rationale: Smoking cessation reduces the risk for coronary heart disease by 50% no matter how long the person has smoked. It will reduce the possibility of lung cancer, decrease complications, and possibly enhance medication effects, but the primary focus for this client is the effect on coronary artery disease.
What is the most common clinical manifestation of coronary artery disease? A) Chest pain B) Dyspnea C) Irritability D) Tachycardia
A) Chest pain Coronary artery disease is often asymptomatic. When clinical manifestations do occur, the most common indications are angina and myocardial infarction. Angina, acute coronary syndrome, and acute myocardial infarction are all characterized by the presence of chest pain of various intensities. Although dyspnea, irritability, and tachycardia may also be present in some clients, chest pain is the classical manifestation of coronary artery disease.
What is the most common clinical manifestation of CAD? A) Chest pain B) Dyspnea C) Irritability D) Tachycardia
A) Chest pain Coronary artery disease is often asymptomatic. When clinical manifestations do occur, the most common indications are angina and myocardial infarction. Angina, acute coronary syndrome, and acute myocardial infarction are all characterized by the presence of chest pain of various intensities. Although dyspnea, irritability, and tachycardia may also be present in some clients, chest pain is the classical manifestation of coronary artery disease.
For a client with coronary artery disease, what can the nurse recommend to the client to help decrease cardiac workload and sympathetic nervous system stimulation? A) Physical rest B) Psychological rest C) Fluid intake D) Fluid restriction
A) Physical rest For the client with coronary artery disease, physical rest helps decrease cardiac workload and sympathetic nervous system stimulation, promoting comfort. Information and emotional support help decrease anxiety and promote psychological rest. Although fluid overload may increase cardiac workload, the nurse should not restrict fluids unless prescribed by the physician.
For a client with CAD, what can the nurse recommend to the client to help decrease cardiac workload and sympathetic nervous system stimulation? A) Physical rest B) Psychological rest C) Fluid intake D) Fluid restriction
A) Physical rest Rationale: For the client with coronary artery disease, physical rest helps decrease cardiac workload and sympathetic nervous system stimulation, promoting comfort. Information and emotional support help decrease anxiety and promote psychological rest. Although fluid overload may increase cardiac workload, the nurse should not restrict fluids unless prescribed by the physician.
The nurse is assessing a client who has a possible MI. Which finding is consistent with this diagnosis? SATA A) Q wave changes B) ST segment depression C) Tachypnea D) Anxiety E) Vomiting
A) Q wave changes C) Tachypnea D) Anxiety E) Vomiting Rationale: Clinical manifestations of a myocardial infarction (MI) include tachypnea, anxiety, vomiting, and electrocardiogram (ECG) changes in the Q wave. A client experiencing an MI would experience ST segment elevation, not depression.
The nurse is caring for a client with a hx of atherosclerosis. The client has chest pain that occurse with physical exertion or stress and is relieved with sublingual nitroglycerin. Which disorder should the nurse recognize the client is most likely experiencing? A) Stable angina B) Acute coronary syndrome C) Prinzmetal angina D) Myocardial Infarction
A) Stable angina Rationale: Stable angina is a predictable form of angina, which usually occurs when the work of the heart is increased by physical exertion, exposure to cold, or stress. Prinzmetal (variant) angina occurs unpredictably and often at night. The client is currently experiencing a predictable form of angina. Clinical manifestations of myocardial infarction include pain that is less predictable, more prolonged, and unrelieved by sublingual nitroglycerin. Clinical manifestations of acute coronary syndrome include pain that is more severe and longer than previously experienced. The pain is not predictable and is unrelieved by sublingual nitroglycerin.
Which client reaction should the nurse expect during a coronary artery spasm? A) Sudden onset of acute chest pain. B) Gradual increase in peripheral edema. C) Gradual increase in systolic BP D) Acute reduction in level of consciousness
A) Sudden onset of acute chest pain. The nurse should expect a sudden onset of acute chest pain from a coronary artery spasm, which is characteristic of Prinzmetal angina, in which there is an acute reduction in coronary blood flow. An acute reduction in level of consciousness indicates neurologic involvement. A gradual increase in peripheral edema is a sign of heart failure. A gradual increase in systolic blood pressure can have multiple causes.
The nurse is caring for a client who is recovering from a myocardial infarction (MI) who expresses fear. Which response by the nurse is appropriate? SATA A) "Tell me more about what you're worried about." B) "Your body language is telling me something is wrong." C) "If you let your wife help you more, it will decrease your stress." D) "It's normal to feel anxious after what you've been through." E) "What specific questions can I answer about your recovery?"
Answer: A, B, E Rationale: It is important for the nurse to encourage self-care; the client's confidence increases as his dependence on others decreases. Encouraging questions helps provide information and relieve fears when the client may have been reluctant to ask. Telling the client how that his feelings are normal is dismissing how he feels. Acknowledge the client's feelings and encourage expression of those feelings and fears. It is imperative the nurse be able to identify the client's fear using both verbal and nonverbal clues.
The nurse is providing discharge teaching about a cardiac diet to a client following a myocardial infarction. Which client statement indicates that the nurse's teaching has been successful? SATA A) "I'm happy that I won't have to give up my almond butter sandwiches!" B) "I will continue cooking my food in coconut oil because of its many health benefits." C) "I'm going to have a roast beef sandwich for lunch." D) "I don't like vegetable oil spread, so I will seek a different healthy butter alternative." E) "As soon as I get out of here, I'm going to my favorite steakhouse to celebrate."
Answer: A, C, D Rationale: Clients with coronary artery disease (CAD) should reduce their consumption of saturated fats and cholesterol and should increase fiber intake. The goal is to lower the client's low-density lipoprotein (LDL). Roast beef is a lean cut of meat and therefore is appropriate in moderation. Almonds are high in fiber, and almond butter and peanut butter are full of monounsaturated fats, which are recommended to be a client's source of fat. Coconut oil and red meat, like steak, are high in saturated fat and should be avoided. Clients should be encouraged to find alternatives to their favorite foods that work with their prescribed diet.
A client who has a strong family history of CAD asks the nurse, "How can I decrease my chances of developing problems with my arteries?" Which response by the nurse is appropriate? SATA A) "You can reduce your risk b making some changes in your lifestyle, such as moderate exercise." B) There is little you can do except take medication to prevent CAD." C) "Keeping your BP within normal levels will decrease the risk of injury to your arteries." D) "A diet high in fruits, veggies, and unsaturated fats may help protect your arteries." E) "As long as your cholesterol is normal, your arteries will remain clear."
Answer: A, C, D Rationale: The causes of atherosclerosis are not known, but research has shown a connection with modifiable risk factors such as cholesterol, triglycerides, lack of exercise, smoking, obesity, blood pressure, diet, stress, and diabetes. Elevated cholesterol is only one of the factors that can contribute to the development of plaque in the arteries. Excessive pressures within the arterial system can cause injury to the arterial endothelium. Endothelial damage promotes platelet adhesion and aggregation and attracts leukocytes to the area. Risk factors such as age, gender, and heredity cannot be modified. The exact cause is unclear, but it is believed that fruits, vegetables, whole grains, and unsaturated fatty acids have nutrients that help protect the arteries from injury.
The nurse is preparing a bulletin board regarding lifestyle changes to prevent CAD. Which information should the nurse include? SATA A) Stopping smoking will increase HDL levels and help prevent the development of CAD. B) Family hx of CAD is a strong indicator for development of heart-related problems. C) Diabetes affects the tissue that lines the blood vessels, making way for disease like atherosclerosis. D) Walk for 30 minutes for 5 or 6 times a week to lower LDL and triglycerides and to raise HDL levels. E) During menopause, women see a decrease in HDL levels and an increase in LDL levels.
Answer: A, D A) Stopping smoking will increase HDL and help prevent development of CAD D) Walk for 30 minutes for 5 or 6 times a week to lower LDL and triglycerides and to raise HDL. Rationale: Stopping smoking and walking for 30 minutes several times a week represents modifiable risk factors for CAD. Clients can make lifestyle changes in these areas to decrease their risk for developing CAD. Smoking cessation improves HDL levels and lowers LDL levels and also improves the viscosity of blood, so clients should be encouraged to quit smoking. Regular physical exercise lowers very low-density lipoprotein (VLDL), LDL, and triglyceride levels, and it raises HDL levels. Clients are encouraged to participate in 30 minutes of exercise five or six times a week. While understanding about menopause and its associated symptoms is important, it is not information that can be used to effectively change the risk of CAD. Family history is not modifiable and cannot help with needed lifestyle changes. Although understanding the effects of diabetes is also important, it is not an effect of lifestyle change to decrease the risk of CAD.
A female client is undergoing diagnostic testing for coronary heart disease. The nurse should assess for which symptoms that are indicative of heart disease? SATA A) Chronic fatigue B) Headache C) Insomnia D) Abdominal fullness E) Indigestion
Answer: A, D, E A) Chronic fatigue D) Abdominal fullness E) Indigestion Rationale: Women may not have chest pain but may feel discomfort or indigestion. They often present with a triad of symptoms—indigestion or feeling of abdominal fullness, feeling of chronic fatigue despite adequate rest, and feeling unable to catch their breath. Insomnia and headache are not indicative of heart disease.
The school nurse is a guest speaker at a high school talking about CAD. Which statement by the nurse is most beneficial to include in the presentation? A) "If you eat healthy foods you can keep the levels of fat in your blood stream low, which will minimize your risk of CAD." B) "CAD is the leading cause of death in both men and women, which means that all of you are at risk." C) "Some of the things you can do now to minimize your risk of CAD are avoid fatty food, be active, and don't smoke." D) It is much better to learn to prevent CAD, rather than to pay for the related treatments and surgeries."
Answer: C C) Some of the things you can do now to minimize your risk of CAD are avoid fatty food, be active, and don't smoke. Rationale: In this case, it is important for the nurse to highlight the changes that are most easily achievable by the high school audience. Although excess lipids in the bloodstream can contribute to the development of CAD, it is not enough to say that eating healthy foods will keep lipid levels low. Further, high school students are unlikely to be convinced by the cost of CAD care. Telling students that they are all at risk is also unlikely to motivate them to be proactive in avoiding CAD. By warning high school students about their predispositions to the disease and advising them of the modifications they can make to avoid it, the audience is much more likely to be receptive to the information.
The nurse suspects that a client is having a myocardial infarction (MI). Which diagnostic test should the nurse anticipate will be ordered? A) Brain natriuretic peptide (BNP) B) Ankle-brachial blood pressure index (ABI) C) Troponin D) Complete blood count (CBC)
Answer: C C) Troponin Rationale: When the healthcare provider believes that a client has experienced a myocardial infarction (MI), diagnostic tests will include cardiac markers, including a troponin test, which measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged. Additional tests would include a CPK and CK-MB and an electrocardiogram (ECG). A CBC and BNP will not be useful to confirm the diagnosis of an MI. An ABI tests for peripheral vascular disease that may predict coronary artery disease (CAD), so it is not relevant to the diagnosis of an MI.
A client with angina is experiencing acute chest pain. The client rates the pain 7/10. Vitals: BP: 98/63, P: 119, R: 24, T: 99.1 F, SpO2: 89%. Which actions would the nurse implement at this time? SATA A) Administer anti-anxiety medication as prescribed B) Coach in non pharmacological pain management techniques C) Implement bedrest D) Administer Morphine sulfate 2 mg IVP as prescribed E) Administer O2 at 2L/min via nc as prescribed.
Answer: C, D, E Rationale: Interventions for the client experiencing acute chest pain include keeping the client on bedrest, administering morphine sulfate as prescribed, and administering oxygen as prescribed. Antianxiety medications are not effective in acute chest pain. Nonpharmacologic pain management techniques are not appropriate for an episode of acute chest pain.
A community health nurse is providing education to a group of adults regarding myocardial infarction (MI). When discussing ways to prevent the number of MI-related deaths, which statement by the nurse is inappropriate? A) "It is important to learn how to perform cardiopulmonary resuscitation (CPR)." B) "Be sure to take a baby aspirin every day to help prevent an MI." C) "Increase your knowledge of the manifestations of MI." D) "Seek immediate medical attention when you suspect an MI."
B) "Be sure to take a baby aspirin every day to help prevent an MI." When educating clients regarding ways to decrease the number of MI-related deaths, the nurse will stress the importance of prevention. Learning about the manifestations of MI, as well as learning CPR, is appropriate. Clients should be taught to seek immediate medical attention when they suspect an MI. However, instructing all clients to take a baby aspirin every day to help prevent an MI is inappropriate, as not all clients should take this medication.
A community health nurse is providign education to a group of adults regarding MI. When discussing ways to prevent the number of MI-related deaths, which statement by the nurse is inappropriate? A) "It's important to learn how to perform CPR." B) "Be sure to take a baby aspirin every day to help prevent an MI." C) "Increase your knowledge of the manifestations of MI." D) "Seek immediate medical attention when you suspect an MI."
B) "Be sure to take a baby aspirin every day to help prevent an MI." Rationale: When educating clients regarding ways to decrease the number of MI-related deaths, the nurse will stress the importance of prevention. Learning about the manifestations of MI, as well as learning CPR, is appropriate. Clients should be taught to seek immediate medical attention when they suspect an MI. However, instructing all clients to take a baby aspirin every day to help prevent an MI is inappropriate, as not all clients should take this medication.
A nurse is teaching a client about the different types of angina. Which client statement indicate the need for follow up teaching? A) "Stable angina is the most common form of angina." B) "Prinzmetal angina is atypical angina that occurs with strenuous exercise." C) "Unstable angina occurs with increasing frequency, severity, and duration." D) "Clients with unstable angina are at risk for a heart attack."
B) "Prinzmetal angina is atypical angina that occurs with strenuous exercise." Angina results from ischemia and can be a one-time event or a chronic condition. There are three types of angina: stable, unstable, and Prinzmetal. Stable angina is the most common form of angina and is relieved with rest and nitrate medications. Unstable angina occurs with increasing frequency, severity, and duration. Clients with unstable angina are at risk for a heart attack, or myocardial infarction. Prinzmetal angina is atypical angina that is unrelated to activity
A nurse is teaching a client about the different types of angina. Which client statement indicates the need for follow up teaching? A) "Stable angina is the most common form of angina." B) "Prinzmetal angina is atypical angina that occurs with strenuous exercise." C) "Unstable angina occurs with increasing frequency, severity, and duration." D) "Clients with unstable angina are at risk for heart attack."
B) "Prinzmetal angina is atypical angina that occurs with strenuous exercise." Rationale: Angina results from ischemia and can be a one-time event or a chronic condition. There are three types of angina: stable, unstable, and Prinzmetal. Stable angina is the most common form of angina and is relieved with rest and nitrate medications. Unstable angina occurs with increasing frequency, severity, and duration. Clients with unstable angina are at risk for a heart attack, or myocardial infarction. Prinzmetal angina is atypical angina that is unrelated to activity.
A client recovering from an acute myocardial infarction is prescribed aspirin. Which teaching points should the nurse include regarding this prescription? Select all that apply. A) Report any itching after seven days of taking. B) Check with your healthcare provider before taking herbal remedies. C) Take at a different time of day than warfarin. D) Report bleeding or bruising to the healthcare provider. E) Do not skip any scheduled appointments to have blood drawn for labs.
B) Check with your healthcare provider before taking herbal remedies. D) Report bleeding or bruising to the healthcare provider. Itching is not a common side effect of aspirin therapy. Herbal remedies such as evening primrose oil, garlic, gingko biloba, or grapeseed extract can increase the effect of the aspirin. Aspirin and Coumadin are not to be taken concurrently. Bleeding and bruising can occur and should be reported to the healthcare provider. Aspirin inhibits platelet aggregation and clot formation. No lab appointments will be made just for aspirin therapy.
The nurse is assessing a client who started a statin medication. Which finding in most concerning? A) Small skin rash on the right arm. B) Generalized muscular tenderness and pain. C) Nausea when taking the medicine before a meal. D) Dizziness when changing positions quickly.
B) Generalized muscular tenderness and pain. Rationale: Muscular tenderness and pain might indicate myopathy and rhabdomyolysis, which can cause acute kidney injury and death in some clients. These symptoms indicate to the nurse that the statin may need to be discontinued. The rash and nausea are common side effects of taking statins, and although the nurse should follow up with the healthcare provider, they do not indicate that a change in medication is needed. Dizziness is not a side effect of statins.
The nurse is instructing an older adult client about atorvastatin (Lipitor) to treat elevated cholesterol. Which side effects should the nurse advise the client to report to the healthcare provider? A) Headaches and nausea B) Muscle pain and weakness C) Bruising and excessive bleeding D) Shortness of breath and coughing
B) Muscle pain and weakness Clients taking statins, such as atorvastatin (Lipitor), should promptly report muscle pain, tenderness, or weakness; skin rash, hives, or changes in skin color; and abdominal pain, nausea, or vomiting. Headaches, bruising or bleeding, and shortness of breath or coughing are not common side effects that need to be reported to the physician.
The nurse is instructing an older adult client about atorvastatin (Lipitor) to treat elevated cholesterol. Which side effects should the nurse advise the client to report to the healthcare provider? A) Headaches and nausea B) Muscle pain and weakness C) Bruising and excessive bleeding D) Shortness of breath and coughing
B) Muscle pain and weakness Rationale: Clients taking statins, such as atorvastatin (Lipitor), should promptly report muscle pain, tenderness, or weakness; skin rash, hives, or changes in skin color; and abdominal pain, nausea, or vomiting. Headaches, bruising or bleeding, and shortness of breath or coughing are not common side effects that need to be reported to the physician.
The nurse is documenting assessment findings on a client with angina. Which term should the nurse use to describe chest pain that occurs at night and is unrelated to activity? A) Nonanginal pain B) Prinzmetal angina C) Unstable angina D) Stable angina
B) Prinzmetal angina Prinzmetal (variant) angina is unrelated to activity and often occurs at night. Stable angina is induced by exercise and is relieved by rest or nitroglycerin. Unstable angina occurs with increasing frequency, severity, and duration. The pain is unpredictable. The client has been diagnosed with angina, and, therefore, the chest pain the client is experiencing is likely angina, not non-anginal pain.
The nurse is documenting assessment findings on a client with angina. Which term should the nurse use to describe chest pain that occurs at night and is unrelated to activity? A) Non-anginal pain B) Prinzmetal angina C) Unstable angina D) Stable angina
B) Prinzmetal angina Rationale: Prinzmetal (variant) angina is unrelated to activity and often occurs at night. Stable angina is induced by exercise and is relieved by rest or nitroglycerin. Unstable angina occurs with increasing frequency, severity, and duration. The pain is unpredictable. The client has been diagnosed with angina, and, therefore, the chest pain the client is experiencing is likely angina, not non-anginal pain.
A client diagnoses with atherosclerosis asks the nurse, "What can I do to improve my condition?" Which response by the nurse is best? A) "You should decrease your smoking by one pack per day." B) "You should exercise five or six times a week for 30 minutes." C) "You should take statins a prescribed by your healthcare provider." D) "You should eat a diet with a minimum of 40% fat."
B) You should exercise five or six times/week for 30 minutes. Rationale: Conservative treatment would include regular physical exercise such as walking at a brisk pace. Fat should be no more than 35% of the daily diet. The Pritikin diet has a beneficial effect on coronary heart disease and recommends less than 10% fat. Smoking should be totally eliminated, usually through a cessation program or the use of assistive drugs such as nicotine patches. By controlling cholesterol, the client can help control coronary artery disease (CAD), but this will begin with lifestyle changes before medication such as statins are added.
The nurse is caring for a mildly obese older adult client with CAD. Which action should the nurse take to encourage additional physical activity in this client? A) Telling the client that older adults should exercise no more than 15 minutes at a time. B) Telling the client that moderate exercise can lead to 2 pounds of weight loss per week. C) Asking the client what kind of exercise or activities she likes to do. D) Teaching the client to warm up, stretch, and cool down before and after all physical activities.
C) Asking the client what kind of exercise or activities she like to do. Rationale: Clients are more likely to be motivated to increase physical activities that they already like to do, so the nurse should ask about their preferences. The benefits of weight loss should be emphasized instead of how much weight will be lost, especially in an older, obese client. Older adults should get 30 minutes of moderate activity on most days, and they should always stretch, warm up, and cool down before and after activity.
The nurse is teaching a client about the associated health risks of cocaine use. Which statement should the nurse use to describe how cocaine can cause MI? A) Cocaine significantly increases the serum triglyceride level, leading to the development of an atheroma. B) Cocaine alters the body's clotting mechanisms, leading to thrombus formation. C) Cocaine increases sympathetic nervous system stimulation, increasing BP and vasoconstriction. D) Cocaine alters electrolyte balance, leading to arrhythmias.
C) Cocaine increases sympathetic nervous system stimulation, increasing BP and vasoconstriction. Rationale: Acute MI may develop as a result of cocaine intoxication. Cocaine increases sympathetic nervous system activity by both increasing the release of catecholamines from central and peripheral stores and interfering with the reuptake of catecholamines. This increased catecholamine concentration stimulates the heart rate and increases its contractility, increases the automaticity of cardiac tissues and the risk of dysrhythmias, and causes vasoconstriction and hypertension. The other answers do not occur with cocaine intoxication.
The nurse is teaching a client about the associated health risks of cocaine use. Which statement should the nurse use to describe how cocaine can cause myocardial infarction (MI)? A) Cocaine significantly increases the serum triglyceride level, leading to the development of an atheroma. B) Cocaine alters the body's clotting mechanisms, leading to thrombus formation. C) Cocaine increases sympathetic nervous system stimulation, increasing blood pressure and vasoconstriction. D) Cocaine alters electrolyte balance, leading to arrhythmias.
C) Cocaine increases sympathetic nervous system stimulation, increasing blood pressure and vasoconstriction. Acute MI may also develop as a result of cocaine intoxication. Cocaine increases sympathetic nervous system activity by both increasing the release of catecholamines from central and peripheral stores and interfering with the reuptake of catecholamines. This increased catecholamine concentration stimulates the heart rate and increases its contractility, increases the automaticity of cardiac tissues and the risk of dysrhythmias, and causes vasoconstriction and hypertension. The other answers do not occur with cocaine intoxication.
A client with angina is experiencing acute chest pain. The client rates the pain as a 7 out of 10. The client's vital signs include P 119, R 24, BP 98/63, T 99.1°F, and SpO2 89%. Which actions would the nurse implement at this time? Select all that apply. A) Administer antianxiety medication as prescribed. B) Coach in nonpharmacologic pain management techniques. C) Implement bedrest. D) Administer morphine sulfate 2 mg intravenous push as prescribed. E) Administer oxygen at 2 liters/minute via nasal cannula as prescribed.
C) Implement bedrest. D) Administer morphine sulfate 2 mg intravenous push as prescribed. E) Administer oxygen at 2 liters/minute via nasal cannula as prescribed. Interventions for the client experiencing acute chest pain include keeping the client on bedrest, administering morphine sulfate as prescribed, and administering oxygen as prescribed. Antianxiety medications are not effective in acute chest pain. Nonpharmacologic pain management techniques are not appropriate for an episode of acute chest pain.
The nurse is preparing pre-op teaching for a client scheduled for a ventricular assist device (VAD). Which should the nurse include in the teaching instructions? A) Need to stay on bedrest for a week or more. B) Cardiac pain post-op is to be expected C) Risk for postoperative infection. D) Expect to be ambulating the evening of the surgery.
C) Risk for post-op infection. Rationale: Clients with VAD are at considerable risk for infection; strict aseptic technique is used with all invasive catheters and dressing changes. The client may or may not be on bedrest for a week or more after the surgery. Cardiac pain postoperatively is not to be expected and could indicate a myocardial infarction. The client, however, will most likely not be ambulating the evening of the surgery.
The nurse is preparing preoperative teaching for a client scheduled for a ventricular assist device (VAD). Which should the nurse include in these instructions? A) Need to stay on bedrest for a week or more B) Cardiac pain postoperatively is to be expected C) Risk for postoperative infection D) Expect to be ambulating the evening of surgery
C) Risk for postoperative infection Clients with VAD are at considerable risk for infection; strict aseptic technique is used with all invasive catheters and dressing changes. The client may or may not be on bedrest for a week or more after the surgery. Cardiac pain postoperatively is not to be expected and could indicate a myocardial infarction. The client, however, will most likely not be ambulating the evening of the surgery.
The nurse is monitoring a client who is undergoing an exercise stress test on a treadmill. Which assessment finding requires the most rapid action by the nurse? A) Client complaining of feeling tired. B) BP increases from 134/68 to 150/80 mmHg C) ST segment elevation on the ECG monitor D) Pulse change from 80 to 92 BPM
C) ST segment elevation on the ECG monitor Rationale: ECG changes such as ST segment elevation are associated with a myocardial infarction (MI), indicating that the myocardium is not getting adequate oxygen delivery and that the exercise test should be terminated immediately. Increases in both blood pressure and heart rate are normal responses to aerobic exercise. Tiredness is also normal.
The nurse is providing care to a client who has experienced several episodes of angina. Which agent does the nurse anticipate being ordered to reduce the intensity and frequency of an angina episode? A) The client will experience relief of chest pain with therapeutic lifestyle changes. B) The client will experience relief of chest pain with statin therapy. C) The client will experience relief of chest pain with nitrate therapy. D) The client will experience relief of chest pain with anticoagulant therapy
C) The client will experience relief of chest pain with nitrate therapy. A primary goal in the treatment of angina is to reduce the intensity and frequency of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode. Therapeutic lifestyle changes are significant if the client is to maintain a healthy heart. Statins are used to decrease cholesterol levels. Anticoagulant therapy is used to prevent additional thrombi from forming post-myocardial infarction.
The nurse is providing care to a client who has experienced several episodes of angina. Which agent does the nurse anticipate being ordered to reduce the intensity and frequency of an angina episode? A) The client will experience relief of chest pain with therapeutic lifestyle changes. B) The client will experience relief of chest pain with statin therapy. C) The client will experience relief of chest pain with nitrate therapy. D) The client will experience relief of chest pain with anticoagulant therapy.
C) The client will experience relief of chest pain with nitrate therapy. Rationale: A primary goal in the treatment of angina is to reduce the intensity and frequency of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode. Therapeutic lifestyle changes are significant if the client is to maintain a healthy heart. Statins are used to decrease cholesterol levels. Anticoagulant therapy is used to prevent additional thrombi from forming post-myocardial infarction.
The nurse is teaching a client about CAD. Which response by the client indicates the need for further teaching? A) "Damage to the linings of my arteries can cause clots and blockage." B) The increased levels of high-density lipoproteins decrease the risk of atherosclerosis." C) "It's a leading cause of death for men and women in the US." D) "It decreases quality of life but does not increase a person's risk of death."
D) "It decreases quality of life but does not increase a person's risk of death." Rationale: Coronary artery disease is a leading cause of death for men and women in the United States. A lack of oxygenated blood to the coronary arteries will decrease a client's ability to function and increase their risk of death. High-density lipoproteins attract cholesterol, returning it from peripheral tissues to the liver. Endothelial damage causes the body to send platelets to seal the area and leukocytes to fight inflammation. These protective mechanisms also contribute to the formation of fibrous plaque. Fibrous plaque protrudes into the arterial lumen and invades the muscular media layer of the vessel as well as the inner wall of the intima. This results in a decreased ability of the vessel to dilate.
The nurse is caring for a 76 year old client with a hx of angina. What atypical age-related warning sign of a myocardial infarction would the nurse need to include in client teaching? A) Cool, clammy skin B) Chest pain C) Tachycardia D) Abdominal pain
D) Abdominal Pain Rationale: er adults commonly have atypical symptoms of myocardial infarction, such as difficulty breathing, confusion, fainting, dizziness, abdominal pain, or cough. Cool, clammy skin; chest pain; and tachycardia are all symptoms of myocardial infarction that are more common in younger individuals but less common in older individuals
The nurse is caring for a 76-year-old client with a history of angina. What atypical age-related warning sign of a myocardial infarction should the nurse need to include in client teaching? A) Cool, clammy skin B) Chest pain C) Tachycardia D) Abdominal pain
D) Abdominal pain Older adults commonly have atypical symptoms of myocardial infarction, such as difficulty breathing, confusion, fainting, dizziness, abdominal pain, or cough. Cool, clammy skin; chest pain; and tachycardia are all symptoms of myocardial infarction that are more common in younger individuals but less common in older individuals.
A client has constant crushing chest pain related at 9/10 that began 30 minutes ago and is increasing in intensity. The nurse should recognize the client is at risk for which disorder? A) CAD B) Atherosclerosis C) Stable angina D) Myocardial infarction (MI)
D) Myocardial Infarction (MI) Rationale: Stable angina is the predictable form of chest pain that occurs when the heart is exerted or is exposed to cold or stress. In this case, the angina is unstable, and therefore the client is at increased risk for MI. Atherosclerosis is a long-term illness that would not cause the increasing pain and intensity described by the client. CAD is the cause of chest pain but is not a disorder that develops as a result of it.
