301-- 3/29 prepU

A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. 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."

A client with an acute myocardial infarction is receiving nitroglycerin by continuous I.V. infusion. Which client statement indicates that this drug is producing its therapeutic effect?

"My chest pain is decreasing."

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?

"The pain occurred while I was mowing the lawn."

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.)

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

A patient asks the nurse how long he will have to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse?

3 minutes

In order 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?

60 minutes

A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?

Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.

Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication?

Angina pectoris

Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent?

Antiplatelets

A patient complains about chest pain and heavy breathing when exercising or when stressed. Which of the following is a priority nursing intervention for the patient diagnosed with coronary artery disease?

Assess chest pain and administer prescribed drugs and oxygen

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.

The nurse plays an important role in monitoring and managing potential complications in the patient who has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which of the following respiratory complications?

Atelectasis

A client is receiving nitroglycerin ointment (Nitro-Dur) 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?

Blood pressure 84/52 mm Hg

Which diagnostic is a marker for inflammation of vascular endothelium?

C-reactive protein (CRP)

Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin?

Clopidogrel (Plavix)

A client comes to the Emergency Department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client?

Coronary artery disease

What is a characteristic of atherosclerosis?

Fatty deposits in the lumen of arteries

A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti-coagulation therapy. Which of the following does the nurse identify as a major indication of concern?

Hematocrit of 30%

The nurse is discussing risk factors for developing CAD with a patient in the clinic. Which results would indicate that the patient is not at significant risk for the development of CAD?

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

An 83-year-old client is undergoing lipid profile studies in an effort to determine a proper nutritional balance for his CAD. In his lipid profile, his LDL is greater than his HDL. Depending on his other risk factors, when would you expect hyperlipidemia treatment to begin?

LDL between 100 - 130mg/dL

Which of the following techniques is used to surgically revascularize the myocardium?

Minimally invasive direct coronary bypass

A female patient is being seen in the ER complaining of fatigue and shoulder blade discomfort. She is also short of breath. Based on these symptoms, the nurse should suspect which of the following?

Myocardial infarction (MI)

The nurse knows to review laboratory tests for cardiac biomarkers for a patient suspected of suffering an MI. The nurse knows that all can be detected within hours of an injury. Which of the following is the earliest marker?

Myoglobin

Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome?

Pericardial friction rub

The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported.

Potassium level of 6 mEq/L

Which of the following medications is an antidote to heparin?

Protamine sulfate

Following cardiac surgery, the nurse assesses the patient for indicators of the common complication of hypovolemia. Choose the significant indicator.

Pulmonary artery wedge pressure (PAWP) of 6 mm Hg

The nurse is educating the patient about administering nitroglycerin prior to discharge from the hospital. What information should the nurse include in the instructions?

Take a nitroglycerin and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. If pain is not relieved, activate the emergency medical system.

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?

The client demonstrates ability to tolerate more activity without chest pain

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 at least a 70% occlusion of a major coronary artery

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks?

Troponin

Which of the following is a nonmodifiable risk factor for coronary artery disease (CAD)?

gender

A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse tells the client that, after taking the nitroglycerin, he may experience:

headache, hypotension, dizziness, and flushing

Which of the following is the analgesic of choice for acute MI?

morphine sulfate

A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the emergency department, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?

within 6 hours

Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure.

A serum BUN of 70 mg/dL

You are caring for a client with CAD. What is an appropriate nursing action when evaluating a client with coronary artery disease (CAD)?

Assess the characteristics of chest pain

The nursing instructor is talking about myocardial infarctions (MI) to her junior nursing class. What would the instructor tell the students is the most common cause of an MI?

Coronary thrombosis

The analgesic of choice for a hospitalized patient with an MI is morphine sulfate. An important nursing responsibility, prior to administering morphine, is to do which of the following?

Count the respiratory rate for bradypnea

Jack Donohue, a 62-year-old stock broker, attends his annual physical appointment and indicates physical changes since his last examination. He reports chest pain and palpitation during and after his morning jogs. Jack's family history reveals includes coronary artery disease. His lipid profile reveals his LDL level to be 122 mg/dl. Which of the following correctly states the Jack's condition?

High LDL level

The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.)

- Abrupt closure of the artery - Arterial dissection - Coronary artery vasospasm

A nurse reviews an ECG strip for a patient who is admitted with symptoms of an acute MI. The nurse recognizes the classic ECG changes that occur with an MI. Select all that apply.

- Abnormal Q-waves - T-wave hyperactivity and inversions - ST-segment elevations

A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which of the following risk factors will the nurse include? Choose all that apply.

- Family history of coronary heart disease - Age greater than 45 years for men - African-American descent - Elevated C-reactive protein

A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply.

- Hyperlipidemia - Obesity - Tobacco use

The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply.

- Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. - Renew the supply every 6 months. - Take the tablet in anticipation of any activity that can produce pain. - Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.

A nurse is teaching nitroglycerin to a client with hospitalized client with coronary artery disease who is being discharged. The nurse tells the client that nitroglycerin has which of the following actions? Choose all that apply.

- Reduces myocardial oxygen consumption - Dilates blood vessels - Decreases ischemia - Relieves pain

The nurse is reviewing the results of a total cholesterol level for a patient who has been taking simvastatin (Zocor). What results display the effectiveness of the medication?

160-190 mg/dL

After percutaneous transluminal coronary angioplasty (PTCA), the nurse suspects that a patient, who is on bed rest, may be experiencing the complication of bleeding. The nurse's initial action should be to do which of the following?

Apply manual pressure at the site of the insertion of the sheath

Which condition most commonly results in coronary artery disease (CAD)?

Atherosclerosis

Which medication should a nurse have on hand when removing a sheath after cardiac catheterization?

Atropine

A client kept his appointment to see a cardiologist for post-hospitalization follow up. The cardiologist examines him and inquires as to the medication's efficacy since his hospitalization. Effective medications are intended to produce arterial vasodilation. What type of medication, listed below, is not as an effective vasodilator as others?

Calcium-channel blockers

Which complication of cardiac surgery occurs when there is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles?

Cardiac tamponade

The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage?

Creatine kinase MB

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time?

Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction

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

A nurse records a client's history and discovers several risk factors for coronary artery disease (CAD). Which cardiac risk factors can the client control?

Diabetes, hypercholesterolemia, and hypertension

A patient is given a prescription for Lopressor, a beta-blocker, after being examined by his health care provider. Select the most important information the nurse should provide.

Don't suddenly stop taking the medication without calling your health care provider.

A client comes to the emergency department complaining of chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see?

Elevated ST segment

A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document?

Hypotension

Which of the following in an inconsistent manifestation of metabolic syndrome?

Hypotension

When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025), the nurse suspects:

Inadequate fluid volume

A patient, who is resting quietly in a step-down cardiac care unit, reports chest pain. The cardiac monitor indicates the presence of reversible ST-segment elevation. The nurse understands that the patient may be experiencing coronary artery vasospasm. This is a type of angina known as:

Variant

Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?

Inadequate tissue perfusion

A nurse is discussing pharmacologic therapy used in the treatment of coronary vascular disease with a nursing student. The nurse would be correct in identifying the use of a positive inotrope as having which of the following functions?

Increase in myocardial contractility

A patient has been recently placed on nitroglycerin. Which of the following should be included in the patient teaching plan?

Instruct the patient on side effects of flushing, throbbing headache, and tachycardia.

An 83-year-old client is undergoing lipid profile studies in an effort to determine a proper nutritional balance for his CAD. In his lipid profile, his LDL is greater than his HDL. Why is this a risk factor for this client?

LDL sticks to arteries

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize?

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

As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid.

Low-density lipoproteins (LDL)

A nurse completed a physical exam for an insurance company. The nurse noted a cluster of abnormalities that she knew was considered a major risk factor for coronary artery disease. Choose that condition.

Metabolic syndrome

Which of the following discharge instructions for self-care should the nurse provide to a patient who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?

Monitor the site for bleeding or hematoma.

The nurse is caring for a patient who is having chest pain associated with a myocardial infarction (MI). What medication should the nurse administer intravenously to reduce pain and anxiety?

Morphine sulfate

After undergoing cardiac surgery, a patient discovers a painless lump and complains to the nurse about the same. Which of the following is the most important nursing intervention for this patient?

Reassure the patient by informing him or her that the lump will disappear with time.

The nurse is part of a triage team that is assessing a patient to determine if his chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction is that the pain of angina is:

Relieved by rest and nitroglycerin

A 62-year-old client attends his annual physical appointment and indicates physical changes since his last examination. He reports chest pain and palpitations during and after his morning jogs. Family history reveals coronary artery disease. What would the nurse, recommend to minimize the client's cardiac risk?

Smoking cessation

A patient complains to the nurse about chest pain and palpitations during and after his morning jogs. The patient's family history reveals a history of coronary artery disease (CAD). What should the nurse recommend to minimize cardiac risk?

Smoking cessation

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur?

Worsening angina

During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect:

a drop in the client's heart rate

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. The specific type of MI the client had is most probably:

anterior

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an:

anticoagulant

A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of:

aspirin or clopidogrel (Plavix).

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 can result from:

coronary artery spasm

The nurse is caring for a client with a valvular disorder. The client is at risk for decreased cardiac output. What nursing intervention should a nurse perform for this client?

measure urine output

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except:

morphine IV

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?

potassium

A patient diagnosed with coronary artery disease is being placed on nitroglycerin. The nurse understands that the premise behind administration of nitrates in this patient population includes which of the following?

preload is reduced

A client with severe angina pectoris and electrocardiogram changes is seen by a physician in the emergency department. In terms of serum testing, it's most important for the physician to order cardiac:

troponin

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:

troponin level

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina?

unstable

Which of the following is also termed preinfarction angina?

unstable angina