Chapter 23: Management of Patients with Coronary Vascular Disorders
In preparation for cardiac surgery, a client was taught about measures to prevent venous thromboembolism. What statement indicates that the client clearly understood this education?
"I'll make sure that I don't cross my legs when I'm resting in bed."
When assessing a client diagnosed with angina pectoris, it is most important for the nurse to gather what information?
.The client's symptoms and the activities that precipitate attacks
The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments?
Balancing myocardial oxygen supply with demand
A client who is postoperative day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurse's most appropriate action?
Contact the client's health care provider and continue to assess fluid balance and renal function.
A client presents to the clinic reporting intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client that angina is most often attributable to what cause?
Coronary arteriosclerosis
A nurse educator is conducting an inservice for nursing students about how tobacco use impacts coronary artery disease (CAD)? What are the primary ways that tobacco use impacts CAD? Select all that apply.
Decreases the supply of oxygen to the myocardium Increases platelet adhesion Raises the heart rate and blood pressure Increases the blood carbon monoxide level
The nurse is caring for a client who has undergone percutaneous transluminal coronary angioplasty (PTCA). What is the major indicator of success for this procedure?
Increase in the size of the artery's lumen
An ED nurse is assessing a 71-year-old female client for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female clients? Select all that apply.
Indigestion Nausea
The nurse is caring for an adult client who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina?
Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)
A client with type 2 diabetes and hypertension (HTN) has a routine follow-up appointment after a cardiac stent placement. On assessment the nurse notes the client weighs 250 lb/113.4 kg with a waist circumference of 40 inches/101.6 cm, blood pressure is 162/84 mm Hg, and fasting blood glucose is 220 mg/dl. Based on these findings, which syndrome should the nurse most suspect?
Metabolic syndrome
The ED nurse is caring for a client with a suspected MI. What drug should the nurse anticipate administering to this client?
Morphine
A client with hypertension is ambulating in the hospital hallway and reports chest pain. In which order would the nurse assess and treat this client?
The client is instructed to stop all activity. The nurse assesses the client's angina. The first set of vital signs are done. A 12-lead electrocardiogram (ECG) is performed. The client receives the first dose of nitroglycerin. The client is transferred to a higher acuity unit.
Family members bring a client to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data?
The symptoms indicate an acute coronary episode and should be treated as such.
A client with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the client about what potential adverse effects?
Throbbing headache or dizziness
A nurse is assigned four clients with diagnoses that rule out myocardial infarction (MI) due to chest pain. Which client's test results best demonstrate the specific diagnosis of unstable angina (USA)?
A 72-year-old client with an increase in myoglobin, no elevation in the ST segment, and no elevation in troponins.
The nurse providing care for a client post PTCA knows to monitor the client closely. For what complications should the nurse monitor the client? Select all that apply.
Abrupt closure of the coronary artery Bleeding at the insertion site Retroperitoneal bleeding Arterial occlusion
The nurse is creating a plan of care for a client with acute coronary syndrome. What nursing action should be included in the client's care plan?
Administer supplementary oxygen, as needed.
A client presents to the ED reporting severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU?
Begin ECG monitoring.
The nurse is caring for a client who is believed to have just experienced an MI. The nurse notes changes in the ECG of the client. What change on an ECG most strongly suggests to the nurse that ischemia is occurring?
T-wave inversion
The public health nurse is participating in a health fair and interviews a client with a history of hypertension, who is currently smoking one pack of cigarettes per day. The client denies any of the most common manifestations of CAD. The nurse should expect the focuses of CAD treatment to be:
diet therapy and smoking cessation.
A client with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The client is admitted to the cardiac critical care unit after the PTCA. The complications for which the nurse should monitor the client include which of the following?
Bleeding at insertion site
The OR nurse is explaining to a client that cardiac surgery requires the absence of blood from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues. What technique for achieving these simultaneous goals should the nurse describe?
Cardiopulmonary bypass
The nurse is caring for a client who will have coronary artery revascularization. When explaining the pre- and postoperative regimens, the nurse should address which subject?
Intubation and mechanical ventilation
The triage nurse in the ED assesses an adult client who presents with reports of midsternal chest pain that has lasted for the last 5 hours. If the client's symptoms are due to an MI, what will have happened to the myocardium?
It may have developed an increased area of infarction during the time without treatment.
The nurse is working with a client who had an MI and is now active in rehabilitation. The nurse should teach this client to cease activity if which of the following occurs?
The client experiences chest pain, palpitations, or dyspnea.
A nurse has taken on the care of a client who had a coronary artery stent placed yesterday. When reviewing the client's daily medication administration record, the nurse should anticipate administering what drug?
Clopidogrel
The nurse is caring for a client who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what?
Lipids and fibrous tissue
The nurse is providing care for a client with high cholesterol and triglyceride values. In teaching the client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following?
Low LDL values and high HDL values
An adult client is admitted to the ED with chest pain. The client states that there was unrelieved chest pain for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions?
Morphine sulphate, oxygen, and bed rest
The hospital nurse is caring for a client who reports that an angina attack is beginning. Which action is the nurse's most appropriate initial action?
Place the client on bed rest in a semi-Fowler position.
A nurse is working with a client who has been scheduled for a percutaneous coronary intervention (PCI) later in the week. What anticipatory guidance should the nurse provide to the client?
A sheath will be placed over the insertion site after the procedure is finished.
The nurse is writing a care plan for a client who has been diagnosed with angina pectoris. The client describes herself as being "distressed" and "shocked" by the new diagnosis. What nursing diagnosis is most clearly suggested by the client's statement?
Anxiety related to cardiac symptoms
A client in the cardiac step-down unit has begun bleeding from the percutaneous coronary intervention (PCI) access site in the femoral region. What is the nurse's most appropriate action?
Call for help and apply pressure to the access site.
The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. Which risk factors should the nurse list that can be controlled or modified?
Cholesterol levels, hypertension, and smoking
A client is recovering in the hospital from cardiac surgery. The nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. What intervention best addresses this risk?
Client's consistent performance of deep-breathing and coughing exercises
The nurse working on the coronary care unit is caring for a client with ACS. How can the nurse best meet the client's psychosocial needs?
Directly address the client's anxieties and fears.
The nurse is assessing a client with acute coronary syndrome (ACS). The nurse includes a careful history in the assessment, especially with regard to signs and symptoms. What signs and symptoms are suggestive of ACS? Select all that apply.
Dyspnea Unusual fatigue Syncope
The nurse has just admitted a client for cardiac surgery. The client tearfully describes feeling afraid of dying while undergoing the surgery. What is the nurse's best response?
Explore the factors underlying the client's anxiety.
An OR nurse is preparing to assist with a coronary artery bypass graft (CABG). The OR nurse knows that what vessel is most commonly used as source for a CABG?
Greater saphenous vein
A client with cardiovascular disease is being treated with amlodipine, which is intended to cause what therapeutic effect?
Reducing the heart's workload by decreasing heart rate and myocardial contraction
