Med/Surg CH 27 PU

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

1. "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." Nitroglycerin commonly causes orthostatic hypotension and dizziness. To minimize these problems, the nurse should teach the client to take safety precautions, such as changing to an upright position slowly, climbing up and down stairs carefully, and lying down at the first sign of dizziness. To ensure the freshness of sublingual nitroglycerin, the client should replace tablets every 6 months, not every 9 months, and store them in a tightly closed container in a cool, dark place.

The nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? 1. "I can take nitroglycerin before sex so I won't develop chest pain". 2. "After taking two tablets with no relief, I should call EMS." 3. "I can put the nitroglycerin tablets in my daily pill dispenser with my other medications". 4. "Side effects of nitroglycerin include flushing, throbbing headache, and hypertension".

1. "I can take nitroglycerin before sex so I won't develop chest pain". Nitroglycerin can be taken in anticipation of any activity that may produce pain. Because nitroglycerin increases tolerance for exercise and stress when taken prophylactically (i.e., before an angina-producing activity such as exercise, stair-climbing, or sexual intercourse), it is best taken before pain develops.

A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response? 1. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. 2. Atherosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. 3. Arteriosclerosis is a formation of clots in the inner lining of the arteries. 4. Atherosclerosis is a formation of clots in the inner lining of the arteries.

1. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.

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

1. C-reactive protein (CRP) CRP is a marker for inflammation of the vascular endothelium. LDL, HDL, and triglycerides are not markers of vascular endothelial inflammation. They are elements of fat metabolism.

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

1. Chest discomfort not relieved by rest or nitroglycerin Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with acute coronary syndrome or MI, may also occur with angina and, alone, are not indicative of an MI.

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

1. Hypotension A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.

vA new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? 1. Hypotension 2. Urinary incontinence 3. Hyperactive bowel sounds 4. Hypertension

1. Hypotension The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.

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

1. 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.

After undergoing cardiac surgery, a client discovers a painless lump and reports this to the nurse. What is the most important nursing intervention for this client? 1. Reassure the client by informing him or her that the lump will disappear with time. 2. Inform the client that the lump will be removed by the surgeon. 3. Reassure the client by informing him or her that the lump will disappear after a course of drug therapy. 4. Reassure the client and direct the client to the health care provider.

1. Reassure the client by informing him or her that the lump will disappear with time. The nurse will reassure the client by informing him or her that the lump will disappear with time and will not require surgery, drug therapy, or a visit to the health care provider.

A nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. 1. Reduces myocardial oxygen consumption 2. Decreases the urge to use tobacco 3. Dilates blood vessels 4. Decreases ischemia 5. Relieves pain

1. Reduces myocardial oxygen consumption 3. Dilates blood vessels 4. Decreases ischemia 5. Relieves pain Nitroglycerin dilates blood vessels and reduces the amount of blood returning to the heart, which reduces the workload of the heart and myocardial oxygen consumption. As the dilated vessels allow more blood supply to the heart, ischemia and pain are reduced. Nitroglycerin does not affect the urge to use tobacco.

The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? 1. The abrupt stop can cause a myocardial infarction. 2. The abrupt stop can lead to formation of blood clots. 3. The abrupt stop will precipitate internal bleeding. 4. The abrupt stop can trigger a migraine headache.

1. The abrupt stop can cause a myocardial infarction. 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? 1. The client demonstrates ability to tolerate more activity without chest pain. 2. The client exhibits a heart rate above 100 beats/minute. 3. The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking. 4. The client states that sublingual nitroglycerin usually relieves his chest pain.

1. 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.

A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? 1. calcium-channel blocker 2. beta-adrenergic blocker 3. nitrate 4. diuretic

1. calcium-channel blocker

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

1. chest pain that occurs at rest and usually in the middle of the night A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8:00 AM, is sporadic over 3-6 months, and diminishes over time.

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

1. high. A level of 115 mg/dL is considered to be high. The goal of treatment is to decrease the LDL level below 100 mg/dL (less than 70 mg/dL for very high-risk clients).

The nurse is assessing a client with suspected postpericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? 1. pericardial friction rub 2. hypothermia 3. decreased white blood cell (WBC) count 4. decreased erythrocyte sedimentation rate (ESR)

1. pericardial friction rub Postpericardiotomy syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia.

To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? 1. 30 minutes 2. 60 minutes 3. 9 days 4. 6 to 12 months

2. 60 minutes The 60-minute interval is known as "door-to-balloon time" in which a PTCA can be performed on a client with a diagnosed MI. The 30-minute interval is known as "door-to-needle time" for the administration of thrombolytics after MI. The time frame of 9 days refers to the time until the onset of vasculitis after administration of streptokinase for thrombolysis in a client with an acute MI. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same client for acute MI.

When starting a client on oral or I.V. diltiazem, for which potential complication should the nurse monitor? 1. Flushing 2. Atrioventricular block 3. Renal failure 4. Hypertension

2. Atrioventricular block The chief complications of diltiazem are hypotension, atrioventricular blocks, heart failure, and elevated liver enzyme levels. Other reported reactions include flushing, nocturia, and polyuria, but not renal failure. Although flushing may occur, it's an adverse reaction, not a potential complication.

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

2. Atropine Sheath removal and the application of pressure on the vessel insertion site may cause the heart rate to slow and the blood pressure to decrease (vasovagal response). A dose of IV atropine is usually given to treat this response.

The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? 1. Report changes in the usual pattern of chest pain. 2. Avoid situations that contribute to ischemic episodes. 3. Avoid fatty foods and exercise. 4. Take over-the-counter decongestants.

2. Avoid situations that contribute to ischemic episodes. Teaching for clients with Raynaud's disease and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes.

When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality? 1. Hypercalcemia 2. Hyperkalemia 3. Hypomagnesemia 4. Hyponatremia

2. Hyperkalemia Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion, without a change in T wave formation.

A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication? 1. Amantadine 2. Nitroglycerin 3. Digoxin 4. Diphenhydramine

2. Nitroglycerin A cholinergic blocking agent may cause dry mouth and delay the sublingual absorption of nitroglycerin. The nurse should offer the client sips of water before administering nitroglycerin.

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? 1. To dilate coronary arteries 2. To decrease workload of the heart 3. To decrease homocysteine levels 4. To prevent angiotensin II conversion

2. To decrease workload of the heart Beta-adrenergic blockers are used in the treatment of CAD to decrease the myocardial oxygen by reducing heart rate and workload of the heart.

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

2. Unstable angina Preinfarction angina is also known as unstable angina.

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? 1. hyperuricemia 2. increased liver enzymes 3. hyperglycemia 4. severe muscle pain

2. increased liver enzymes Myopathy and increased liver enzymes are significant side effects of the statin Lipitor.

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? 1. "Nitroglycerine causes headaches, but removing the patch decreases the incidence." 2. "You do not need the effects of nitroglycerine while you sleep." 3. "Removing the patch at night prevents drug tolerance while keeping the benefits." 4. "Contact dermatitis and skin irritations are common when the patch remains on all day."

3. "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.

Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal? 1. .25 to .75 2. .75 to 1.5 3. 2.0 to 2.5 4. 2.5 to 3.0

3. 2.0 to 2.5 The amount of heparin administered is based on aPTT results, which should be obtained during the follow-up to any alteration of dosage

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

3. Atherosclerosis Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. The disease correlates with the aging process. The other choices may occur at any age.

A 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? 1. Pulse rate of 84 beats/minute 2. Respiration 26 breaths/minute 3. Blood pressure 84/52 mm Hg 4. Temperature of 100.2° F (37.9° C)

3. 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.

A client is admitted for treatment of Prinzmetal's 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? 1. Activities that increase myocardial oxygen demand. 2. An unpredictable amount of activity. 3. Coronary artery spasm. 4. The same type of activity that caused previous angina episodes.

3. Coronary artery spasm. Prinzmetal's angina results from coronary artery spasm.

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

3. Lie down or sit in a chair for 5 to 10 minutes after taking the drug. 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.

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

3. Minimally invasive direct coronary bypass Several techniques are used to surgically revascularize the myocardium; one of them is minimally invasive direct coronary bypass. Balloon bypass is not used to revascularize the myocardium. If the client is experiencing acute pain in the leg, peripheral bypass is performed. Gastric bypass is a surgical procedure that alters the process of digestion.

Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? 1. Isosorbide mononitrate (Isordil) 2. Meperidine hydrochloride (Demerol) 3. Morphine sulfate (Morphine) 4. Nitroglycerin transdermal patch

3. Morphine sulfate (Morphine) Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.

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? 1. Described as crushing and substernal 2. Associated with nausea and vomiting 3. Relieved by rest and nitroglycerin 4. Accompanied by diaphoresis and dyspnea

3. Relieved by rest and nitroglycerin One characteristic that can differentiate the pain of angina from a 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 caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? 1. an hourly urine output of 50 to 70 mL 2. a urine specific gravity reading of 1.021 3. a serum BUN of 70 mg/dL 4. a serum creatinine of 1.0 mg/dL

3. 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 nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? 1. weight gain of 6 ounces 2. serum glucose of 124 mg/dL 3. potassium level of 6 mEq/L 4. bilateral rales and rhonchi

3. potassium level of 6 mEq/L Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain is not significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed.

A client comes to the health care provider's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction? 1. "Client performs relaxation exercises three times per day to reduce stress." 2. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol." 3. "Client verbalizes an understanding of the need to seek emergency help if heart rate increases markedly while at rest." 4. "Client walks 4 miles in 1 hour every day."

4. "Client walks 4 miles in 1 hour every day." Four weeks after an MI, a client's walking program should aim for a goal of 2 miles in less than 1 hour. Walking 4 miles in 1 hour is excessive and may induce another MI by increasing the heart's oxygen demands.

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

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

4. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Cardiac chest pain is caused by myocardial ischemia. Therefore the nurse should administer supplemental oxygen to increase the myocardial oxygen supply, attach a cardiac monitor to help detect life-threatening arrhythmias, and take vital signs to ensure that the client isn't hypotensive before giving sublingual nitroglycerin for chest pain. Registration information may be delayed until the client is stabilized. Alerting the cardiac catheterization team or the health care provider before completing the initial assessment is premature.

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

4. Withhold anticoagulant therapy. The nurse knows to withhold the anticoagulant therapy to decrease chance of hemorrhage during the procedure. The nurse does inform the client of diagnostic test, will assess pulses, and prep the skin prior to the angioplasty, but this is not the most important action to be taken.

A nurse is monitoring the vital signs and blood results of a client who is receiving anticoagulation therapy. What does nurse identify as a major indication of concern? 1. blood pressure of 129/72 mm Hg 2. heart rate of 87 bpm 3. hemoglobin of 16 g/dL 4. hematocrit of 30%

4. 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.