cardiac 3/3/3
When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Give the scheduled aspirin and lipid-lowering medication..
Administration of oral medications is within the scope of practice for LPNs/LVNs.
When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice? d) Canned chicken noodle soup
Canned soups are very high in sodium content.
The nurse is providing care to a patient with chronic stable angina that is scheduled for a cardiac catheterization. What finding associated with myocardial ischemia could be obtained by this diagnostic procedure?
Cardiac catheterization is an invasive diagnostic procedure to find out the location and severity of blockages in the coronary circulation. ST segment depression is an important diagnostic finding for the presence of myocardial ischemia, which is obtained by electrocardiography (ECG). Cardiac enlargement is a sign of heart failure that can be seen on an x-ray. Echocardiography is used to detect the presence of abnormal wall motion due to myocardial ischemia.
Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the pain is caused by an acute myocardial infarction (AMI)? b. The pain has lasted longer than 30 minutes.
Chest pain that lasts for 20 minutes or more is characteristic of AMI.
Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? d. The patient states that the pain "goes away" with one sublingual nitroglycerin tablet.
Chronic stable angina is typically relieved by rest or nitroglycerin administration.
Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider? a. No change in the patient's chest pain
Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention (PCI) may be needed.
A male patient who has coronary artery disease (CAD) has serum lipid values of LDL cholesterol 98 mg/dL and HDL cholesterol 47 mg/dL. What should the nurse include in the patient teaching? d) The lipid levels are normal.
For men, the recommended LDL is less than 100 mg/dL, and the recommended level for HDL is greater than 40mg/dL.
The nurse has been teaching a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates an adequate understanding?
Health-promoting behaviors for those at risk for CAD include: improving physical activity such as brisk walking (three to four miles/hour for at least 30 minutes five or more times a week); reducing total fat and saturated fat intake; stopping all tobacco use, and altering patterns that are conducive to stress.
Which statement by an 84-year-old patient with coronary artery disease (CAD) indicates understanding of discharge teaching about physical activity?
Older adults have to use longer rest periods between exercise sessions because of decreased endurance and ability to tolerate stress. The older adults have decreased sweating and therefore shouldn't exercise in extremes of temperature outside. The older adults have to perform low level activity exercise for longer periods of time. The elderly adults have to change their lifestyle to accommodate a physical activity program, even though they are more prone to make such changes during hospitalization or when experiencing symptoms of CAD.
The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if the b. blood pressure is 90/54 mm Hg.
Patients taking β-adrenergic blockers should be monitored for hypotension and bradycardia.
When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administrating? a) Oxygen, nitroglycerin, aspirin, and morphine
The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine.
The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact? c) Inspect the patient's right side and back.
The best method to determine that the right femoral artery is intact after inspection of the insertion site is to logroll the patient to inspect the right side and back for retroperitoneal bleeding.
. A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is most appropriate when giving the medication? d. Give the patient's other medications 2 hours after the colesevelam.
The bile acid sequestrants interfere with the absorption of many other drugs, and giving other medications at the same time should be avoided.
A patient is recovering from a myocardial infarction (MI) and develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? c. Auscultate for a pericardial friction rub.
The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI.
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? b) "I can take up to five tablets every 3 minutes for relief of my chest pain."
The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina.
A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test should the nurse monitor to help determine whether the patient has had an AMI? d. Cardiac-specific troponin
Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI) and are highly specific indicators for MI
The nurse is caring for a patient who is 2 days post-MI. The patient reports that she is experiencing chest pain. She states, "It hurts when I take a deep breath." Which action would be a priority?
b. Obtain vital signs and auscultate for a pericardial friction rub.
The most common finding in individuals at risk for sudden cardiac death is:
c. left ventricular dysfunction
A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 and heart rate is 123. Based on this information, which nursing diagnosis is a priority for the patient? c. Stress overload related to acute change in health
All the nursing diagnoses may be appropriate for this patient, but the hypotension and tachycardia indicate decreased cardiac output and shock from the damaged myocardium
Which statement made by a patient with coronary artery disease after the nurse has completed teaching about therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? d. "I will miss being able to eat peanut butter sandwiches."
Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should come from monosaturated fats such as are found in nuts, olive oil, and canola oil.
The nurse is providing teaching to a patient recovering from an MI. How should resumption of sexual activity be discussed?r b) Discussed along with other physical activities
Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching.
The nurse, reviewing a patient's laboratory results, recognizes what result as most indicative of myocardial infarction?
Biochemical markers such as creatine phosphokinase (CPK), CPK-MB, and troponin are released specifically by myocardial cells when injured and are detectable in the blood. Myoglobin, although one of the first markers to increase after a myocardial infarction (MI), does not have as high of a cardiac specificity as others. C-reactive protein is increased after an MI as a result of the inflammation caused by tissue damage; however it is also not as highly specific to cardiac tissue. An increased white blood cell count may be present after an MI but is due to a generalized inflammatory response.
Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver (select all that apply)? b) Ezetimibe (Zetia) d) Atorvastatin (Lipitor)
Ezetimibe (Zetia) should not be used by patients with liver impairment. Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage and myopathy.
After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective?b. "It is important not to suddenly stop taking the carvedilol."
Patients who have been taking β-adrenergic blockers can develop intense and frequent angina if the medication is suddenly discontinued.
Which individuals would the nurse identify as having the highest risk for CAD? a) A 45-year-old depressed male with a high-stress job
The 45-year-old depressed male with a high-stress job is at the highest risk for CAD.
A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make? a. "What do you think caused your chest pain?"
When the patient is experiencing denial, the nurse should assist the patient in testing reality until the patient has progressed beyond this step of the emotional adjustment to MI.
A hospitalized patient with a history of chronic stable angina tells the nurse that she is having chest pain. The nurse bases his actions on the knowledge that ischemia: b. will be relieved by rest, nitroglycerin, or both
b. will be relieved by rest, nitroglycerin, or both
A patient is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in the teaching plan?
c. Begin an exercise program that aims for at least five 30-minute sessions per week
When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? b. Attach the cardiac monitor.
Because dysrhythmias are the most common complication of myocardial infarction (MI), the first action should be to place the patient on a cardiac monitor
When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the. d. elevation of the patient's low-density lipoprotein (LDL) level.
Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient's LDL level.
To improve the physical activity level for a mildly obese 71-year-old patient, which action should the nurse plan to take? b. Determine what kind of physical activities the patient usually enjoys.
Because patients are more likely to continue physical activities that they already enjoy, the nurse will plan to ask the patient about preferred activities.
Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for d. the ability to do daily activities without chest pain.
Because the medication is ordered to improve the patient's angina, effectiveness is indicated if the patient is able to accomplish daily activities without chest pain.
When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice?
Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content. Baked flounder, angel food cake, and baked potato with margarine are all low-sodium and low-fat and would be appropriate for this diet.
The nurse is examining the ECG of a patient who has just been admitted with a suspected myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary occlusion?
The presence of a pathologic Q wave, as often accompanies ST segment elevation myocardial infarction (STEMI), is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.
20. When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient that b. additional diagnostic testing will be required.
Diagnostic testing (e.g., stress test, Holter monitor, electrophysiologic studies, cardiac catheterization) is used to determine the possible cause of the SCD and treatment options. SCD is likely to recur.
For which problem is percutaneous coronary intervention (PCI) most clearly indicated? d) Acute myocardial infarction
PCI is indicated to restore coronary perfusion in cases of myocardial infarction.
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication?
Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first three days following CABG surgery. Although dehydration, paralytic ileus, and acute respiratory distress syndrome could occur, they are not common complications.
Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patient's response to the activity, which assessment data would indicate that the exercise level should be decreased? c. Heart rate increases from 66 to 92 beats/minute.
A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest.
A patient experienced sudden cardiac death (SCD) and survived. What should the nurse expect to be used as preventive treatment for the patient? d) Implantable cardioverter-defibrillator (ICD)
An ICD is the most common approach to preventing recurrence of SCD.
The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI) (select all that apply)? b) Ashen skin c) Diaphoresis d) Nausea and vomiting e) S3 or S4 heart sounds
During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.
The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Teaching for this patient would include a. when cardiac rehabilitation will begin.
Early after an AMI, the patient will want to know when resumption of usual activities can be expected.
A nurse is assessing a 53-year-old obese female patient who has been postmenopausal for three years. The nurse suspects that the patient may have coronary artery disease and asks the patient to test her lipid profile. What abnormality in the lipid profile would the nurse expect to find?
Following menopause, there is a significant increase in the low-density lipoprotein levels and a consequent reduction in the high-density lipoprotein levels. This occurs due to hormonal changes in the body. This makes postmenopausal women more susceptible to developing coronary artery disease. Obese postmenopausal women may have increased levels of both high-density lipoproteins and low-density lipoproteins (HDLs and LDLs). As the patient is obese, the low-density lipoproteins (LDL) levels would be high and as she is postmenopausal, there is a marked reduction in high-density lipoprotein levels (HDLs). Before menopause, high estrogen levels cause an increase in high-density lipoproteins and lowering of low-density lipoprotein levels.
Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin? c. Heparin prevents the development of new clots in the coronary arteries.
Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis.
A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression? d) Keep Hgb A1C less than 7%.
If the Hgb A1C is kept below 7%, this means that the patient has had good control of her blood glucose over the past 3 months.
The patient is being dismissed from the hospital after ACS and will be attending rehabilitation. What information does the patient need to be taught about the early recovery phase of rehabilitation? d) Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring.
In the early recovery phase after the patient is dismissed from the hospital, the activity level is gradually increased under supervision and with ECG monitoring.
A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? d. Reinforcement of teaching about the purpose of prescribed medications
LPN/LVN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient response to exercise after a NSTEMI requires more education and should be done by the RN.
Which nursing intervention will be most effective when assisting the patient with coronary artery disease (CAD) to make appropriate dietary changes? c. Help the patient modify favorite high-fat recipes by using monosaturated oils when possible.
Lifestyle changes are more likely to be successful when consideration is given to the patient's values and preferences.
Which statement by a patient diagnosed with stable angina indicates understanding of the disease process?
Mismatch between oxygen demand of cardiac muscles and supply of oxygen leads to myocardial ischemia that is represented by pain. Decreased oxygenation level of blood indicates respiratory problems. Myocardial ischemia is completely reversible. The patient will start to experience symptoms of ischemia when the coronary artery is blocked by 75% or more.
Which patient would the nurse identify being at higher risk for developing coronary artery disease (CAD)?
Multiple risk factors increase the risk of CAD, and this patient has three risk factors: age over 55, African-American ethnic background, and cholesterol level greater than 240 mg/dL. Middle-aged nonsmoking African-American male has only two risk factors: middle age and male gender: Caucasian middle-age males are more prone to develop CAD. The Hispanic patient has only two risk factors for CAD: male gender and smoking. Middle-aged white male has two risk factors only (age and gender) because systolic blood pressure is less than 160 mm Hg.
A patient who has recently started taking pravastatin (Pravachol) and niacin (Nicobid) reports the following symptoms to the nurse. Which is most important to communicate to the health care provider? a. Generalized muscle aches and pains
Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute kidney injury and death in some patients who have taken the statin medications.
A nurse is advising a 24-year-old obese female about smoking cessation, since smoking can lead to coronary artery disease. Why does the nurse discourage cigarette smoking? Select all that apply.
Nicotine present in tobacco smoke stimulates the release of catecholamines. Catecholamines have a stimulatory effect on the sympathetic nervous system that causes an increase in heart rate and blood pressure. Carbon monoxide present in tobacco smoke has a greater affinity to hemoglobin than oxygen. Therefore carbon monoxide reduces the oxygen carrying capacity of blood. Tobacco smoke is known to increase the level of low-density lipoproteins and subsequently decrease in high-density lipoproteins. All these factors can lead to atherosclerosis. Tobacco smoke is known to decrease estrogen levels in premenopausal women thereby increasing their susceptibility to get coronary artery disease.
A patient with chronic stable angina has received a prescription for nitroglycerin (Nitrolingual). The nurse tells the patient that orthostatic hypotension is an important side effect of this drug. To prevent complications associated with the side effect, what should the nurse include in the patient's teaching?
Nitrates cause vasodilatation, which in turn causes peripheral pooling of blood. On changing position suddenly (from recumbent to erect posture), there is a sudden drop of blood pressure, which is known as orthostatic hypotension. This decreases the blood supply to the brain, which may lead to dizziness and falling. Headaches and flushing are not associated with orthostatic hypotension. If there is no tingling sensation on administering the drug, then the medication may be expired or ineffective.
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication? c) Atrial dysrhythmias
Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery.
Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will b. decrease spasm of the coronary arteries.
Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., diltiazem, amlodipine [Norvasc
After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? d. Tachypnea and crackles in lungs
Pulmonary congestion and tachypnea suggest that the patient may be developing heart failure, a complication of myocardial infarction (MI).
A nurse has identified a group of people who are at risk for developing coronary artery disease. To prevent atherosclerosis, the nurse advises a reduction in salt consumption. How does salt consumption increase the risk of developing atherosclerosis?
Salt contains sodium, which causes water retention in the body and thus hypertension. The shearing stress due to elevated blood pressure causes endothelial injury. This makes the blood vessels more susceptible to develop atherosclerosis. Hormonal changes, hyperlipidemia, and high homocysteine levels also contribute to atherosclerosis but are not caused by increased salt intake. Changes in the hormonal levels like a decrease in estrogen levels can increase the risk of atherosclerosis. Hyperlipidemia is a major predisposing factor for the development of atherosclerosis. Homocysteine contributes to atherosclerosis by damaging the inner lining of blood vessels, promoting plaque buildup, and altering the clotting mechanism to make clots more likely to occur.
A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about when sexual intercourse can be resumed. Which response by the nurse is best? b. "Sexual activity uses about as much energy as climbing two flights of stairs."
Sexual activity places about as much physical stress on the cardiovascular system as most moderate-energy activities such as climbing two flights of stairs.
The nurse assesses a patient with diabetes who reports shortness of breath, neck pain, and hypoglycemic symptoms. The patient's blood pressure is 130/86 mm Hg, heart rate is 102 beats/min, respiratory rate is 24 breaths/min, and the fingerstick blood glucose is 136 mg/dL. The nurse recognizes that the patient may be experiencing:
Signs and symptoms of a myocardial infarction (MI) include shortness of breath, neck pain, and cool, clammy skin. Although cool, clammy skin may resemble a hypoglycemic reaction, when found along with shortness of breath and neck pain it is very specific for an MI. The patient is not experiencing a complication of diabetes (ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome). The blood glucose is close to normal, and further diagnostics would be required to determine a diabetic complication. Only cool, clammy skin is indicative of hypoglycemia
During the administration of the thrombolytic agent to a patient with an acute myocardial infarction (AMI), the nurse should stop the drug infusion if the patient experiences c. a decrease in level of consciousness.
The change in level of consciousness indicates that the patient may be experiencing intracranial bleeding, a possible complication of thrombolytic therapy.
Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider? b. Pallor and weakness of the right hand
The changes in the right hand indicate compromised blood flow, which requires immediate evaluation and actions such as prescribed calcium channel blockers or surgery.
The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? c. Bilateral crackles are auscultated in the mid-lower lobes.
The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI).
After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? c. "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart."
The emergency medical services (EMS) system should be activated when chest pain or other symptoms are not completely relieved after 3 sublingual nitroglycerin tablets taken 5 minutes apart. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse).
When titrating IV nitroglycerin (Tridil) for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? b. Ask about chest pain.
The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand.
Which patient at the cardiovascular clinic requires the most immediate action by the nurse? b. Patient with stable angina whose chest pain has recently increased in frequency
The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum.
The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic group would the nurse select as the highest priority for this intervention? a) White male
The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men.
The patient recently diagnosed with coronary artery disease (CAD) asks the nurse: "What caused my problem?" Which response by the nurse is the most appropriate?
The major cause of CAD is an atherosclerosis that is manifested by fatty deposits on the walls of coronary arteries. Decrease in pumping action of the heart will result in congestive heart failure (CHF). Low oxygen saturation of the blood is a result of respiratory problems. Hypertension, not orthostatic hypotension, will predispose a patient to development of CAD.
A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate? d) Cardiac dysrhythmias
The most common complication after MI is dysrhythmias, which are present in 80% of patients
During the 48 hours after a myocardial infarction, a nurse should assign the highest priority to monitoring the patient for:
The nurse must be most alert for dysrhythmias, which may signal another MI or impending complications. The nurse should also be alert for increased anxiety, which may cause pain and lead to a secondary infarction. Anxiety and fear are highly likely but secondary in importance to monitoring the patient for dysrhythmias. Metabolic acidosis and reactions to new medications are not likely but should still be included as part of overall assessment of the patient.
A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Sildenafil (Viagra)
The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of severe hypotension caused by vasodilation.
The patient comes to the ED with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerotic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis B) Acute coronary syndrome (ACS)
The pain with ACS is severe, prolonged, and not easy to relieve.
After reviewing information shown in the accompanying figure from the medical records of a 43-year-old, which risk factor modification for coronary artery disease should the nurse include in patient teaching? c. Dietary changes to improve lipid levels
The patient has an elevated low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol, which will increase the risk of coronary artery disease.
In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? c. "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."
The patient should sit down before taking the nitroglycerin to decrease cardiac workload and prevent orthostatic hypotension.
When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse? d. Chest pain level 7 on a 0 to 10 point scale
The patient's chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse.
The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion? b) Pathologic Q wave
The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion.
A patient who has chest pain is admitted to the emergency department (ED) and all of the following are ordered. Which one should the nurse arrange to be completed first? c. Electrocardiogram (ECG)
The priority for the patient is to determine whether an acute myocardial infarction (AMI) is occurring so that reperfusion therapy can begin as quickly as possible.
A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten). The nurse should teach the patient that the primary purpose of captopril is to c. prevent changes in heart muscle.
The purpose for angiotensin-converting enzyme (ACE) inhibitors in patients with chronic stable angina who are at high risk for a cardiac event is to decrease ventricular remodeling.
The nurse is performing medication teaching to a patient who has been prescribed sublingual (SL) nitroglycerin (NTG) tablets. Which statement by the patient indicates a need for further education?
The recommended dose for the patient for whom NTG has been prescribed is one tablet taken SL or one metered spray for symptoms of angina. If symptoms are unchanged or worse after five minutes, the patient should contact the emergency medical services (EMS) system before taking additional NTG. Tell the patient to place an NTG tablet under the tongue and allow it to dissolve. NTG should cause a tingling sensation when administered; otherwise it may be outdated. Warn the patient that a headache, dizziness, or flushing may occur. Caution the patient to change positions slowly after NTG use because orthostatic hypotension may occur.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? d. 59-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)
This patient is at risk for bleeding from the arterial access site for the PCI, so the nurse should assess the patient's blood pressure, pulse, and the access site immediately. \
A patient with ST-segment elevation in three contiguous electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? c. "What time did your chest pain begin?"
Thrombolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI), so the time at which the chest pain started is a major determinant of the appropriateness of this treatment.
A nurse is caring for a patient with chest pain that began 10 days ago. Which serum cardiac marker should the nurse review to determine if a myocardial infarction occurred 10 days ago?
Troponin is a serum cardiac marker that is detectable in the blood up to two weeks after myocardial injury and is used to diagnose a myocardial infarction. Troponin has two subtypes: cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI). Serum levels of cTnT and cTnI begin to increase 4 to 6 hours after the onset of myocardial injury, peak at 10 to 24 hours, and return to normal over 10 to 14 days. Myoglobin is a protein found in skeletal and cardiac muscle. It is a sensitive indicator of early myocardial injury but is not specific for cardiac muscle; therefore, it is not used to diagnose a myocardial infarction. Myoglobin peaks and returns to normal in 3 to 15 hours. Homocysteine is a protein amino acid. High levels of homocysteine may indicate an increased risk for coronary artery disease. It is not used to diagnose myocardial infarction. Creatine kinase is a serum cardiac marker for myocardial injury but lacks specificity for myocardial damage. Serum levels peak at about 18 hours and return to normal within 24 to 36 hours.
When providing nutritional counseling for patients at risk for CAD, which foods would the nurse encourage patients to include in their diet (select all that apply)? a) Tofu b) Walnuts c) Tuna fish
Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly.
In caring for the patient with angina, the patient states, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, but the pain is gone now." What further assessment data should the nurse obtain from the patient?
Using PQRST, the assessment data not volunteered by the patient is the radiation (R) of pain, the area in which the patient felt the pain and if it radiated. The precipitating event (P) was going to the bathroom and having a bowel movement. The quality of the pain (Q) was "like before I was admitted," although a more specific description may be helpful. Severity of the pain (S) was the "worst chest pain ever," although an actual number may be needed. Timing (T) is supplied by the patient describing when the pain occurred and that the patient had had this pain previously.
In caring for the patient with angina, the patient said, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, but the pain is gone now." What further assessment data should the nurse obtain from the patient? c) "In what areas did you feel this pain?"
Using PQRST, the assessment data not volunteered by the patient is the radiation of pain, the area the patient felt the pain, and if it radiated.
When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says which of the following? b. "I will have small incisions in my leg where they will remove the vein."
When the internal mammary artery is used there is no need to have a saphenous vein removed from the leg.
