Exam 2 Ch 27 Critical Care-Combined
The client with suspected mitral valve prolapse asks the nurse about tests that will be done to confirm the diagnosis. Which is the best response by the nurse?
"An echocardiogram along with clinical symptoms will assist in diagnosis."
The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation provided by the nurse?
"Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis."
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include?
"Client will verbalize the intention to stop smoking." A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina.
Your client is being prepared for echocardiography when they ask you why they need to have this test. What would be your best response? a) "Echocardiography is a way of determining the functioning of the left ventricle of your heart." b) "This test will find any congenital heart defects." c) "Echocardiography will tell your doctor if you have cancer of the heart." d) "This test can tell us a lot about your heart."
"Echocardiography is a way of determining the functioning of the left ventricle of your heart."
A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of developing the disorder. Which is the best response by the nurse?
"Exercise, keep your cholesterol in check, and manage your stress."
When the nurse is obtaining a health history on an elderly client who has had a previous myocardial infarction, the daughter states, "I have been giving my father ginkgo biloba every day, as he is beginning to have some memory loss." How does the nurse respond to the daughter's statement? a) "Did you ask your health care provider before giving him the herbal drug?" b) "This may interfere with other medications your father is taking." c) "Stop giving your father the herbal drug immediately." d) "How much of the herbal drug are you giving your father every day?"
"How much of the herbal drug are you giving your father every day?" Explanation: The nurse's response should be "How much of the herbal drug are you giving your father every day?" Using the nursing process, always assess the situation first.
The nurse has completed a teaching session on the self-administration of sublingual nitroglycerin. Which of the following patient statements indicates that the patient teaching has been effective
"I can take nitroglycerin prior to having sexual intercourse so I won't develop chest pain".
A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective? a) "I can still eat a ham-and-cheese sandwich with potato chips for lunch." b) "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." c) "I chose broiled chicken with a baked potato for dinner." d) "I'm glad I can still have chicken bouillon."
"I chose broiled chicken with a baked potato for dinner."
A 45-year-old male client with a confirmed DVT is being discharged from the ED. Which of the following client statements indicates that the client has received proper nursing instruction and understands how to manage his condition? a) "I should lie on my side with my knees bent when sleeping." b) "I need to do my leg exercises five times or more every hour." c) "I need to ice my leg every 2 hours for about 20 minutes." d) "I should try not to drink too much during the daytime."
"I need to do my leg exercises five times or more every hour."
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse?
"I should expect a low-grade fever and swelling at the site for the next week."
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse?
"I should expect a low-grade fever and swelling at the site for the next week." Fever and swelling at the site are signs of infection and should be reported to the physician. Showers should be taken until the insertion site is healed. Prolonged sitting can result in thrombosis formation. Bruising at the insertion site is common and may take from 1 to 3 weeks to resolve.
A client with aortic stenosis is scheduled for a balloon valvuloplasty. Which statement made by the client indicates a need for further teaching?
"I'll be able to lead a normal life after the procedure."
A client recovering from a myocardial infarction asks why he needs to take a stool softener. He says, "I had a heart attack; I don't have a problem with constipation." Which explanation should the nurse use to answer the client's question?
"If you strain to have a bowel movement, you can cause a drop in your heart rate that can be dangerous." Correct Explanation: When straining during defication, the client bears down, which momentarily may cause the heart to slow and cause fainting or syncope in the client.
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? a) "I should eliminate caffeine from my diet to lower my blood pressure." b) "If I include less fat in my diet, I'll lower my blood pressure." c) "A glass of red wine each day will lower my blood pressure." d) "Limiting my salt intake to 2 grams per day will improve my blood pressure."
"Limiting my salt intake to 2 grams per day will improve my blood pressure."
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? a) "My vision is blurred, so my blood pressure must be up." b) "I feel a tingling sensation around my mouth." c) "I have a bad headache." d) "My chest pain is decreasing."
"My chest pain is decreasing." Correct Explanation: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium. This action produces the drug's intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
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." Explanation: Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium. This action produces the drug's intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure
The nurse is caring for a client anticipating further testing related to cardiac blood flow. Which statement, made by the client, would lead the nurse to provide additional teaching? a) "I had an ECG already. It provided information on my heart rhythm. b) "I am able to have a nuclide study because I do not have any allergies." c) "The first test I am getting is an echocardiography. I am glad that it is not painful." d) "My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."
"My niece thought that I would be ordered a magnetic resonance imaging even though I have a pacemaker."
A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation? a) "Rehabilitation will help me function as well as I physically can." b) "When I finish the rehabilitation program I'll never have to worry about heart trouble again." c) "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor." d) "I won't be able to jog again even with rehabilitation."
"Rehabilitation will help me function as well as I physically can." Correct Explanation: The client demonstrates understanding of cardiac rehabilitation when he states that it helps the client reach his activity potential. Coronary artery disease, which typically causes an acute MI, is a chronic condition that isn't cured. Many clients who suffer an acute MI can eventually return to such activities as jogging, depending on the extent of cardiac damage. Cardiac rehabilitation involves physical activity as well as classroom education.
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?
"Removing the patch at night prevents drug tolerance while keeping the benefits."
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?
"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. Common adverse effects of nitroglycerine are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while you rest, there is less demand on the heart but not the primary reason for removing the patch.
A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) immediately following confirmed diagnosis of acute myocardial infarction. The client is overtly anxious and crying. Which response by the nurse is most appropriate?
"Tell me what concerns you most."
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? a) "The pain resolved after I ate a sandwich." b) "The pain got worse when I took a deep breath." c) "The pain occurred while I was mowing the lawn." d) "The pain lasted about 45 minutes."
"The pain occurred while I was mowing the lawn."
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." 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.
An anxious client who suffered an acute myocardial infarction is transferred from the coronary care unit to the telemetry unit. The client asks the charge nurse if he can have the same nurse care for him every day. How should the charge nurse respond? a) "Different nurses will be assigned to you each day to avoid your becoming dependent on one nurse." b) "We will try to assign you the same nurse as often as possible." c) "It's important for you to receive care from a variety of nurses so you can evaluate your care." d) "It's our policy to rotate client care assignments to ensure quality care for everyone."
"We will try to assign you the same nurse as often as possible." Correct Explanation: The charge nurse should try to accommodate the client's wishes by assigning him a familiar nurse whenever possible. Doing so should help decrease the client's anxiety. Preventing dependency shouldn't be a concern; allaying his anxiety should. The client shouldn't be concerned with evaluating the quality of care rendered by multiple nurses. Providing continuity of care helps ensure quality care.
The nurse is caring for patient experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase (Activase). Prior to administering this medication, which of the following questions is most important for the nurse to ask the patient
"What time did your chest pain start today?"
The central venous pressure (CVP) reading of 1 is low (2-6 mmHg) and indicates
reduced right ventricular preload, commonly caused by hypovolemia.
A man has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER?
10 minutes Explanation: The ECG provides information that assists in diagnosing acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the emergency department. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored.
The normal LDL range is
100 mg/dL
The goal of treatment is to decrease the LDL level below
100 mg/dL (less than 70 mg/dL for very high-risk patients).
A patient presents to the emergency room complaining of chest pain. The patient's orders include the following elements. Which order should the nurse complete first
12-lead ECG
Protein should make up approximately _____ of total calories.
15%
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? a) 210-240 mg/dL b) 250-275 mg/dL c) 160-190 mg/dL d) 280-300 mg/dL
160-190 mg/dL
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 Simvastatin (Zocor) is a statin Frequently given as initial therapy for significantly elevated cholesterol and low-density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL
Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal? a) 2 to 2.5 b) .5 to 1 c) 2.5 to 3 d) .25 to .75
2 to 2.5
Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal?
2 to 2.5 The amount of heparin administered is based on aPTT results, which should be obtained in follow-up to any alteration of dosage. The patient's aPTT value would have to be greater than .5 to 1 times normal to be considered therapeutic. An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic. The patient's aPTT value would have to be greater than .25 to .75 times normal to be considered therapeutic.
Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal?
2-2.5
What is the normal CVP level?
2-6
Which of the following factors would the nurse identify as a modifiable risk factor for the development of varicose veins?
Employed as over-the-road truck driver
A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range? a) 0.25 mg/mL b) 2.0 mg/mL c) 3.2 mg/mL d) 4.0 mg/mL
2.0 mg/mL
alteplase (Activase) are administered if the patient's chest pain lasts longer than
20 minutes, unrelieved by nitroglycerin, ST-segment elevation in the at least two leads that face the same area of the heart, less than 6 hours from onset of pain.
Dietary fiber should be ___to___ grams per day.
20-30
A client is receiving intravenous heparin to prevent blood clots. The order is for heparin 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL of D5W. At how many mL per hour will the nurse infuse this solution? Enter the correct number ONLY.
24 ml
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 (MI)
60 minutes
A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider. a) 2.6 b) 3.8 c) 3.4 d) 3.0
3.8
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
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 Nitroglycerin may be given by several routes: sublingual tablet or spray, oral capsule, topical agent, and intravenous (IV) administration. Sublingual nitroglycerin is generally placed under the tongue or in the cheek (buccal pouch) and ideally alleviates the pain of ischemia within 3 minutes.
The patient is expected to have a minimum urine output of
30 mL per hour.
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 (MI)?
60 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
According to the DASH diet, how many servings of vegetables should a person consume per day? a) 2 or fewer b) 2 or 3 c) 4 or 5 d) 7 or 8
4 or 5
The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following? a) 4 or 5 b) 7 or 8 c) 2 or 3 d) 2 or fewer
4 or 5
A client with suspected acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain?
4 to 6 hours Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is:
50 seconds or less. Heparin causes an elevation of the PTT and, thereby, increases the risk for bleeding. With a large cannulation such as a sheath used for angioplasty, the PTT should be 50 seconds or less before the sheath is removed. Removing the sheath before the PTT drops below 50 seconds can cause bleeding at the insertion site. The other PTT results are incorrect for determining when to remove the sheath.
Carbohydrates should make up ____% of total calories
50-60%
preload is reduced
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?
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 (MI)? a) 6 to 12 months b) 9 days c) 30 minutes d) 60 minutes
60 minutes Explanation: The 60-minute interval is known as "door-to-balloon time" for performance of PTCA on a diagnosed MI patient. The 30-minute interval is known as "door-to-needle time" for administration of thrombolytics post MI. The time frame of 9 days refers to the time for onset of vasculitis after administration of streptokinase for thrombolysis in an acute MI patient. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.
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. A. Don't suddenly stop taking the medication without calling your health care provider. B. Take the medication at the same time each day. C. If dizziness occurs, adjust the medication. D. Dress warmly. Blood circulation may be reduced in the extremities.
A All teaching points need to be covered, but the nurse needs to emphasize that Lopressor should not be suddenly stopped because some conditions can become worse.
potassium
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?
An 80-year-old male client who has been informed by his physician that he has arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is a: A. Expected part of the aging process B. High level of blood fat C. Vascular occlusive disease D. Condition in which the lumen of arteries fill with plaque
A Arteriosclerosis is loss of elasticity or hardening of the arteries that accompanies the aging process. While arteriosclerosis is a contributing factor to vascular occlusive disease, it is a term that refers to a loss of elasticity or hardening of the arteries that accompanies the aging process. Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Hyperlipidemia, or high levels of blood fat, triggers atherosclerotic changes.
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? A. Inability to speak. B. Adequate cough and gag reflex. C. Adequate vital capacity. D. Acceptable arterial blood gas (ABG) values.
A Before being extubated, the patient should have cough and gag reflexes and stable vital signs; be able to life the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable ABG levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
Which diagnostic is a marker for inflammation of vascular endothelium? A. C-reactive protein (CRP) B. LDL C. Triglyceride D. HDL
A C-reactive protein (CRP) is a marker for inflammation of vascular endothelium. LDL, HDL, and triglycerides are not marker of vascular endothelium inflammation. They are elements of fat metabolism.
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? A. Cardiac tamponade B. Fluid overload C. Hypertension D. Hypothermia
A Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high PAWP, CVP, and pulmonary artery diastolic pressure as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.
A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? A. Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction B. Disabled family coping related to knowledge deficit and a temporary change in family dynamics C. Anxiety related to an actual threat to health status, invasive procedures, and pain D. Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time
A For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.
When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality? A. Hyperkalemia B. Hypomagnesemia C. Hypercalcemia D. Hyponatremia
A 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 change in T-wave formation.
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? A. Heart B. Blood vessels C. Bronchi D. Uterus
A Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse? A. CVP reading: 1 mmHg B. Pain score: 5/10. C. Blood pressure: 110/68 mmHg D. Heart rate: 66 bpm
A The central venous pressure (CVP) reading of 1 is low (2-6 mmHg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.
A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime? A. Improve venous return B. Improve arterial flow C, Jncrease venous congestion D. Strengthen venous valves
A The major goal in management of venous insufficiency is to promote venous circulation. Arterial flow improvement is not the goal of treatment for this disorder. Venous valves that are incompetent cannot be strengthened. Venous congestion is a complication of venous insufficiency.
The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?
A The nurse should assess the characteristics of chest pain for a client with CAD. Assessing the client's mental and emotional status, skin, or for drug abuse will not assist the nurse in evaluating the client for CAD. The assessment should be aimed at evaluating for adequate blood flow to the heart.
A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation? A.Prothrombin time (PT) or international normalized ratio (INR) B. Urine output C. Vascular sites for bleeding D. Hourly IV infusion
A The nurse should monitor PT or INR when oral anticoagulation is prescribed. Vascular sites for bleeding, urine output, and hourly IV infusions are generally monitored in all clients.
low blood pressure
A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following?
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: A. Inadequate fluid volume B. Anuria C. Overhydration D. Normal glomerular filtration
A Urine output of less than 25 mL/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 25 mL or greater per hour and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric patient does not produce urine.
On a medical-surgical floor, a nurse is caring for a cluster of clients with diabetes mellitus. Which client should the nurse assess first? a) An 80-year-old client with a blood glucose level of 350 mg/dl b) A 55-year-old complaining of chest pressure c) A 20-year-old client with a blood glucose level of 70 mg/dl d) A 60-year-old client experiencing nausea and vomiting
A 55-year-old complaining of chest pressure Correct Explanation: The nurse should assess the client with chest pressure first because he might be experiencing a myocardial infarction. The blood glucose levels in 20-year-old client and 80-year-old client are abnormal, but not life threatening; therefore, these clients don't require immediate attention. After assessing the client with chest pressure, the nurse should assess the client experiencing nausea and vomiting.
What is myoglobin?
A biomarker that rises in 2 to 3 hours after heart damage during an MI
coronary artery disease
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 the nurse suspect in this client?
elevated ST segment
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?
anticoagulant
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:
an old MI
A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates
prothrombin time (PT) or international normalized ratio (INR)
A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation?
administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin
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?
removing the patch at night prevents drug tolerance while keeping the benefits
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?
24
A client is receiving intravenous heparin to prevent blood clots. The order is for heparin 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL of D5W. At how many mL per hour will the nurse infuse this solution? Enter the correct number ONLY.
blood pressure 84/52 mm Hg
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?
nitroglycerin SL
A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experieincing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician?
12 lead ECG
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first?
fatty deposits in the lumen of arteries
A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display?
assess chest pain and administer prescribed drugs and oxygen
A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease?
ankle-brachial index
A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD?
inotropic agents diuretics digoxin
A patient who had CABG is exhibiting signs of cardiac failure. What medications does the nurse anticipate administering for this patient? (Select all that apply.)
sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
A client was transferring a load of fire wood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which orders by the physician?
calcium-channel blocker
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug?
client will verbalize the intention to stop smoking
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include?
The nurse is caring for a five-client assignment on a cardiac unit. In caring for which client would the nurse be most correct to assess for an effusion? a) A client with chest pain b) A client with aortic stenosis c) A client with chest trauma d) A client with mitral valve prolapse
A client with chest trauma
troponin
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:
high LDL level
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a:
I should expect a low-grade fever and swelling at the site for the next week
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse?
The nurse is aware that age-related changes in the heart muscle put the elderly at risk for dyspnea, angina, and syncope. Which of the following is an age-related change in the cardiovascular system that affects the sympathetic nervous system? a) An increased contractility response to exercise b) A decreased response to beta-blockers c) Tachycardia d) Decreased time for the heart rate to return to baseline
A decreased response to beta-blockers
The nurse is assessing a patient who complains of feeling "light-headed." When obtaining orthostatic vital signs, what does the nurse determine is a significant finding? a) An increase of 5 mm Hg in diastolic pressure b) An unchanged systolic pressure c) An increase of 10 mm Hg blood pressure reading d) A heart rate of more than 20 bpm above the resting rate
A heart rate of more than 20 bpm above the resting rate
The nurse has been asked to explain the cause of angina pain to a patient's family. Choose the best statement. The pain is due to:
A lack of oxygen in the heart muscle that causes the death of cells. Impeded blood flow, due to blockage in a coronary artery, deprives the cardiac muscle cells of oxygen thus leading to a condition known as ischemia.
chest discomfort not relieved by rest or nitroglycerin
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)?
hypotension
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?
central venous pressure reading of 1
A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse?
decrease resting heart rate
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect?
hyperlipidemia tobacco use obesity
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
hematocrit of 30%
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?
altered level of consciousness
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse?
A patient has had a 12-lead -ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes this finding indicates which of the following
A past MI
the patient has at least a 70% occlusion of a major coronary artery
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)?
increased liver enzymes
A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect?
heart
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?
A 65-year-old male client with CAD has been prescribed a transdermal nitroglycerin patch. The nurse's instructions to the client would include which of the following? Select all that apply. A. Remove the transdermal patch at night and reapply in the morning. B. Store the patch in its original container when not in use. C. Cover the patch in plastic wrap after applying. D. Seek emergency treatment if flushing or nausea occurs
A, B Transdermal nitroglycerin systems are applied to the skin and slowly release nitroglycerin. Clients should be instructed to store the patch in its original container when not in use and keep tightly closed, remove the patch each night and reapply in the morning to prevent diminishing vasodilating effects, and expect possible side effects, such as headache, flushing, or nausea.
The nurse is assigned to care for a patient with heart failure. What classification of medication does the nurse anticipate administering that will improve symptoms as well as increase survival? a) Calcium channel blocker b) ACE inhibitor c) Diuretic d) Bile acid sequestrants
ACE inhibitor
The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse? a) Fatigue b) Dizziness c) An extra heart sound d) Syncope
An extra heart sound
The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for?
Abrupt closure of the artery Arterial dissection Coronary artery vasospasm
Which nursing diagnosis is most significant in planning the care for a client with Raynaud's disease?
Activity intolerance
Which nursing diagnosis is most significant in planning the care for a client with Raynaud's disease?
Acute Pain The hallmark symptom of Raynaud's Disease is pain related to the arterial insufficiency. Disturbed Sensory Perception associated with paresthesia can occur but is less significant than pain. Self-Care Deficit and Activity Intolerance can occur but less significant than Acute Pain.
Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority?
Acute pain Explanation: The nursing diagnosis of Acute pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. This makes Risk for imbalanced body temperature an incorrect answer. The client's blood pressure and heart rate don't suggest a nursing diagnosis of Decreased cardiac output. Anxiety could be an appropriate nursing diagnosis, but addressing Acute pain (the priority concern) may alleviate the client's anxiety.
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.
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? a) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. b) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. c) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. d) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs.
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
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. 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 physician before completing the initial assessment is premature.
Before administering digoxin to a client with valvular disease, the nurse assesses the apical heart rate as 62 beats/minute. The client's usual rate ranges between 66 to 72 beats/minute. Which is the best action for the nurse to take?
Administer the digoxin.
The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause decreased preload. The student correctly answers which of the following? a) Ambulation b) Application of antiembolytic stockings c) Administration of a vasodilating drug (as ordered by a physician) d) Maintaining the client's legs elevated
Administration of a vasodilating drug (as ordered by a physician)
myoglobin
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time?
A 48-year-old client with challenging menopausal symptoms is visiting the OB-GYN practice where you practice nursing. She has discussed treatment options with the physician and now has some questions that she would like to further discuss with you. The client includes in her questioning, "What are the potential risks of hormone replacement therapy?" Which of the following is the best answer? a) All options are correct. b) Breast cancer c) Stroke (CVA) d) Heart disease
All options are correct. Correct Explanation: In using hormonal replacement therapy, the risks of breast cancer and the seriousness of future myocardial infarction and stroke may outweigh the potential benefit of alleviating symptoms associated with menopause. The Women's Health Initiative study revealed an increase in breast cancer in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in blood clots and stroke in postmenopausal women taking HRT. The Women's Health Initiative study revealed an increase in heart disease in postmenopausal women taking HRT.
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse
Altered level of consciousness
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse?
Altered level of consciousness A patient receiving fibrinolytic therapy is at risk for complications associated with bleeding. Altered level of consciousness may indicate hypoxia and intracranial bleeding and the infusion should be discontinued immediately. Minimal bleeding requires manual pressure. Reperfusion dysrhythmias are an expected finding. A chest pain score of 2 is low, and indicates the patient's chest pain is subsiding, an expected outcome of this therapy.
The nursing instructor is discussing pulmonary arterial hypertension with the nursing students. What would the instructor describe as the pathophysiology of secondary pulmonary arterial hypertension? a) Bronchial thickening causes increased resistance and pressure in the pulmonary vascular bed. b) Chronic lung disease causes scaring in the bronchioles raising pressure in the pulmonary vascular bed. c) Left-sided heart failure causes increased resistance and pressure in the pulmonary vascular bed. d) Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed.
Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed
What ECG findings does the nurse observe in a patient who has had a myocardial infarction (MI)? (Select all that apply.)
An abnormal Q wave T-wave inversion ST-segment elevation The ECG changes that occur with an MI are seen in the leads that view the involved surface of the heart. The expected ECG changes are T-wave inversion, ST-segment elevation, and development of an abnormal Q wave (Fig. 27-5).
assess for factors that may be causing the client's delirium
An older adult is postoperative day one, following a coronary artery bypass graft (CABG).The client's family members express concern to the nurse that the client is uncharacteristically confused and does not know where he is. After reporting these change in status to the care provider, the nurse should:
Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication?
Angina pectoris Angina pectoris is a symptom of myocardial ischemia. Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumens. Atheromas are fibrous caps composed of smooth muscle cells that form over lipid deposits within arterial vessels. Ischemia is insufficient tissue oxygenation and may occur in any part of the body.
Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication? a) Angina pectoris b) Atherosclerosis c) Atheroma d) Ischemia
Angina pectoris Correct Explanation: Angina pectoris is a symptom of myocardial ischemia. Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumens. Atheromas are fibrous caps composed of smooth muscle cells that form over lipid deposits within arterial vessels. Ischemia is insufficient tissue oxygenation and may occur in any part of the body.
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
Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent?
Antiplatelets Explanation: Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as Plavix or aspirin. Nitrates, beta blockers, and calcium channel blockers would not be used for this purpose.
Following a percutaneous coronary intervention (PCI), a patient is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which of the following methods to induce hemostasis after sheath is contraindicated
Application of a sandbag to the area
Which of the following methods to induce hemostasis after sheath removal post percutaneous transluminal coronary angioplasty (PTCA) is the least effective?
Application of a sandbag to the area Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding. Application of a vascular closure device has been demonstrated to be very effective. Direct manual pressure to the sheath introduction site has been demonstrated to be effective and was the first method used to induce hemostasis post PTCA. Application of a pneumatic compression device post PTCA has been demonstrated to be effective.
Preventative measures utilized to prevent venous stasis include
Application of sequential pneumatic compression wraps or antiembolic stockings; discouraging leg crossing; avoiding elevating the knees on the bed; omitting pillows in the popliteal space; beginning passive exercises followed by active exercises to promote circulation and prevent venous stasis.
The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which of the following measures should the nurse complete to prevent deep venous thrombosis (DVT) and possible pulmonary embolism (PE) development
Apply antiembolism stockings, Avoid elevating the knees on the bed, Initiate passive exercises.
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 what?
Apply manual pressure at the site of the insertion of the sheath.
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. The immediate nursing action would be to apply pressure, which may stop the bleeding. If the bleeding does not stop, the health care provider needs to be notified.
The client states, "My doctor says that because I am now taking this water pill, I need to eat more foods that contain potassium. Can you give me some ideas about what foods would be good for this?" The nurse's appropriate response is which of the following? a) Cranberries, apples, popcorn b) Bok choy, cooked leeks, alfalfa sprouts c) Apricots, dried peas and beans, dates d) Asparagus, blueberries, green beans
Apricots, dried peas and beans, dates
A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response?
Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age
A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response?
Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.
Which condition most commonly results in coronary artery disease (CAD)?
Artherosclerosis
You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult?
Artherosclerosis
low-density lipoproteins (LDL)
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.
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 The nurse assesses the patient for chest pain and administers the prescribed drugs that dilate the coronary arteries. The nurse administers oxygen to improve the oxygen supply to the heart. Assessing the blood pressure or the physical history does not clearly indicate that the patient has CAD. The nurse does not administer aspirin without the physician's prescription.
Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following nursing assessments would be considered as primary for this client?
Assess peripheral pulses in affected extremity.
You are caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?
Assess the characteristics of chest pain
You are caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?
Assess the characteristics of chest pain. The nurse should assess the characteristics of chest pain for a client with CAD. Assessing the client's mental and emotional status, skin, or for drug abuse will not assist the nurse in evaluating the client for CAD. The assessment should be aimed at evaluating for adequate blood flow to the heart.
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 cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure.
When starting a client on oral or I.V. diltiazem (Cardizem), for which potential complication should the nurse monitor?
Atrioventricular block Explanation: 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.
Which condition most commonly results in coronary artery disease (CAD)?
Atherosclerosis Atherosclerosis (plaque formation), is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.
You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult?
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.
You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in th
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.
When starting a client on oral or I.V. diltiazem (Cardizem), for which potential complication should the nurse monitor?
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?
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.
Which medication should a nurse have on hand when removing a sheath after cardiac catheterization?
Atropine Explanation: Removing the sheath after cardiac catheterization may cause a vasovagal response, including bradycardia. The nurse should have atropine on hand to increase the client's heart rate if this occurs. Heparin thins the blood; clients should stop taking it before the sheath removal. Protamine sulfate is an antidote to heparin, but the nurse shouldn't administer it during sheath removal. Adenosine treats tachyarrhythmias.
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?
Avoid situations that contribute to ischemic episodes.
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?
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. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.
The nurse is working with a client who has just been diagnosed with an aneurysm. What advice should the nurse provide to this client?
Avoid straining during bowel movements and coughing.
The nurse is caring for a patient diagnosed with unstable angina receiving IV heparin. The patient is placed on bleeding precautions. Bleeding precautions include which of the following measures
Avoiding continuous BP monitoring
A patient presents to the emergency room with characteristics of atherosclerosis. What characteristics would the patient display? A. Blood clots in the arteries B. Fatty deposits in the lumen of arteries C. Cholesterol plugs in the lumen of veins D. Emboli in the veins
B Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Therefore, options B, C, and D are incorrect.
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? A. "The pain got worse when I took a deep breath." B. "The pain occurred while I was mowing the lawn." C. "The pain resolved after I ate a sandwich." D. "The pain lasted about 45 minutes."
B 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.
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? A. 210-240 mg/dL B. 160-190 mg/dL C. 280-300 mg/dL D. 250-275 mg/dL
B Simvastatin (Zocor) is a statin Frequently given as initial therapy for significantly elevated cholesterol and low-density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.
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? A. Report changes in the usual pattern of chest pain. B. Avoid situations that contribute to ischemic episodes. C. Take over-the-counter decongestants. D. Avoid fatty foods and exercise
B 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. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.
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? A. The client states that sublingual nitroglycerin usually relieves his chest pain. B. The client demonstrates ability to tolerate more activity without chest pain. C. The client exhibits a heart rate above 100 beats/minute. D. The client verbalizes the intention of making all necessary lifestyle changes except for stopping smoking.
B 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. The client should have a normal electrocardiogram with no arrhythmias and a regular heart rate of 60 to 100 beats/minute. Smoking is a cardiovascular risk factor that the client must be willing to eliminate. A client who responds favorably to therapy shouldn't have chest pain.
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? A. Not important to assess the patient or to notify the physician B. Assess chest pain and administer prescribed drugs and oxygen C. Assess the physical history of the patient D. Assess the blood pressure and administer aspirin
B The nurse assesses the patient for chest pain and administers the prescribed drugs that dilate the coronary arteries. The nurse administers oxygen to improve the oxygen supply to the heart. Assessing the blood pressure or the physical history does not clearly indicate that the patient has CAD. The nurse does not administer aspirin without the physician's prescription.
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery? A. Blood glucose level B. Inadequate tissue perfusion C. Mental alertness D. Activity intolerance
B The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.
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? A. Refrain from sexual activity for one month B. Monitor the site for bleeding or hematoma. C. Cleanse the site with disinfectants and dress the wound appropriately D. Normal activities of daily living can be resumed the first day post op
B The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or development of a hard mass indicative of hematoma. A nurse does not advise the patient to clean the site with disinfectants or refrain from sexual activity for one month.
A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? A. "Client performs relaxation exercises three times per day to reduce stress." B. "Client walks 4 miles in 1 hour every day." C. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol." D. "Client verbalizes an understanding of the need to seek emergency help if his heart rate increases markedly while at rest."
B 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. Therefore, this client requires appropriate exercise guidelines and precautions. Performing relaxation exercises; following a low-fat, low-cholesterol diet; and seeking emergency help if the heart rate increases markedly at rest indicate understanding of the cardiac rehabilitation program. For example, the client should reduce stress, which speeds the heart rate and thus increases myocardial oxygen demands. Reducing dietary fat and cholesterol intake helps lower risk of atherosclerosis. A sudden rise in the heart rate while at rest warrants emergency medical attention because it may signal a life-threatening arrhythmia and increase myocardial oxygen demands.
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? a) Hourly administration of a fluid bolus b) BP and pulse measurements every 15 to 30 minutes c) Insertion of a central venous catheter d) Intubation of the airway
BP and pulse measurements every 15 to 30 minutes
Aortic stenosis remains asymptomatic for several decades. However, once a client becomes symptomatic for aortic stenosis, life expectancy without further treatment is only 2 to 3 years. What is the treatment of choice for symptomatic aortic stenosis?
Balloon valvuloplasty Additional treatment eventually becomes critical because average survival is 2 to 3 years once symptoms develop. Balloon valvuloplasty is an invasive, nonsurgical procedure to enlarge a narrowed valve opening. Balloon angioplasty, cardiac catheterization, and cardiac graft procedure are not indicated treatments for aortic stenosis.
A physician in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. Physical findings include bilateral crackles, a third heart sound (S3), distended neck veins, elevated blood pressure, and pitting edema of the ankles. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? a) A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling b) Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours c) Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours d) A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling
Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? a) Dependent edema b) Jugular vein distention c) Right upper quadrant pain d) Bibasilar crackles
Bibasilar crackles
A nurse is caring for a patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications? a) Bleeding and wound dehiscence b) Evisceration c) Thrombosis and infection d) Bleeding and infection
Bleeding and infection
Clients taking vasodilator drugs can be a greater risk for postprandial hypotension. Which of the following is the best nursing explanation for this phenomenon?
Blood is being diverted to the gastrointestinal tract.
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 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. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately
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 Explanation: 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. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration.
On assessment, the nurse knows that a patient who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity would have heart failure classified as Stage: a) A b) C c) D d) B
C
A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. The nurse should tell the client that: A. his cholesterol is within the recommended guidelines and he doesn't need to lower it. B. he should take his statin medication and not worry about his cholesterol. C. she'll ask the dietitian to talk with him about modifying his diet. D. he should begin a running program, working up to 2 miles per day.
C A dietitian can help the client decrease the fat in his diet and make other beneficial dietary modifications. This client's total cholesterol isn't within the recommended guidelines; it should be less than 200 mg/dl. LDL should be less than 79 mg/dl, and HDL should be greater than 40 mg/dl. Although this client should take his statin medication, he should still be concerned about his cholesterol level and make other lifestyle changes, such as dietary changes, to help lower it. The client should increase his activity level, but he doesn't need to run 2 miles per day.
Aortic stenosis remains asymptomatic for several decades. However, once a client becomes symptomatic for aortic stenosis, life expectancy without further treatment is only 2 to 3 years. What is the treatment of choice for symptomatic aortic stenosis? A. Cardiac graft procedure B. Balloon angioplasty C. Balloon valvuloplasty D. Cardiac catheterization
C Additional treatment eventually becomes critical because average survival is 2 to 3 years once symptoms develop. Balloon valvuloplasty is an invasive, nonsurgical procedure to enlarge a narrowed valve opening. Balloon angioplasty, cardiac catheterization, and cardiac graft procedure are not indicated treatments for aortic stenosis.
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: A. skeletal muscle damage due to a recent fall. B. I.M. injection. C. Myocardial necrosis. D. Cerebral bleeding.
C An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
Which condition most commonly results in coronary artery disease (CAD)? A. Renal failure B. Diabetes mellitus C. Atherosclerosis D. Myocardial infarction
C Atherosclerosis (plaque formation), is the leading cause of CAD. Diabetes mellitus is a risk factor for CAD, but it isn't the most common cause. Myocardial infarction is a common result of CAD. Renal failure doesn't cause CAD, but the two conditions are related.
The nurse is reevaluating a patient 2 hours following a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which of the following assess A.Potassium level of 4.0 mE/qL B. Dried blood at the puncture site C. Urine output of 40 mL D. Heart rate of 100 bpm
C Complications that may occur following a PTCA include myocardial ischemia, bleeding and hematoma formation, retroperitoneal hematoma, arterial occlusion, pseudoaneurysm formation, arteriovenous fistula formation, and acute renal failure. The urine output of 40 mL over a 2-hour period may indicate acute renal failure. The patient is expected to have a minimum urine output of 30 mL per hour. Dried blood at the insertion site is a finding warranting no acute intervention. A serum potassium level of 4.0 mEq/L is within normal range. The heart rate of 100 bmp is within the normal range and indicates no acute distress.
During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect: A. the client's pupils to become dilated. B. a decrease in the client's gastric secretions. C. a drop in the client's heart rate. D. the client to experience bronchodilation
C During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it, in turn, may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate leading to syncope. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
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? A. Sodium nitroprusside B. Protamine sulfate C. Atropine D. Digoxin
C 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.
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? A. Hypothermia B. Decreased erythrocyte sedimentation rate (ESR) C. Pericardial friction rub D. Decreased white blood cell (WBC) count
C The syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.
A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload?
Cardiac tamponade Preload alterations occur when too little blood volume returns to the heart as a result of persistent bleeding and hypovolemia. Excessive postoperative bleeding can lead to decreased intravascular volume, hypotension, and low cardiac output. Bleeding problems are common after cardiac surgery because of the effects of cardiopulmonary bypass, trauma from the surgery, and anticoagulation.
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? A. "You do not need the effects of nitroglycerine while you sleep." B. "Nitroglycerine causes headaches, but removing the patch decreases the incidence." C."Removing the patch at night prevents drug tolerance while keeping the benefits." D. "Contact dermatitis and skin irritations are common when the patch remains on all day."
C 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. Common adverse effects of nitroglycerine are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while you rest, there is less demand on the heart but not the primary reason for removing the patch.
Which diagnostic is a marker for inflammation of vascular endothelium?
C-reactive protein (CRP) C-reactive protein (CRP) is a marker for inflammation of vascular endothelium. LDL, HDL, and triglycerides are not marker of vascular endothelium inflammation. They are elements of fat metabolism.
A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse
CVP reading: 1 mmHg
A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse?
CVP reading: 1 mmHg The central venous pressure (CVP) reading of 1 is low (2-6 mmHg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.
The nurse is aware that diltiazem (Cardizem) is categorized as which type of drug?
Calcium channel blockers
A 56-year-old male client with CAD kept his appointment to see a cardiologist for posthospitalization follow up. The client indicates that he thinks the diltiazem (Cardizem) has been making him nauseous. The nurse is aware that diltiazem (Cardizem) is categorized as which type of drug?
Calcium-channel blockers
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 Explanation: Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents.
The nurse accompanies a client to an exercise stress test. The client can achieve the "target heart rate," but the ECG leads show an ST-segment elevation. The nurse recognizes this as a "positive" stress test, and will begin to prepare the client for which of the following procedures? a) Telemetry monitoring b) Transesophageal echocardiogram c) Cardiac catheterization d) Pharmacologic stress test
Cardiac catheterization
The nurse is caring for a patient diagnosed with myocarditis. The nurse understands that which of the following is the hallmark of myocarditis? a) Cardiac muscle inflammation b) Shortness of breath c) Chest pain d) Pericardial friction rub
Cardiac muscle inflammation
LDH1 and LDH2 may be elevated in response to...
Cardiac or other organ damage during an MI.
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
A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine (Duramorph), oxygen, and aspirin. The physician diagnoses acute coronary syndrome. When the client arrives on the unit, his vital signs are stable and he has no complaints of pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order?
Carvedilol (Coreg) Explanation: A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.
Nursing instruction during postural drainage should include telling the patient to: a) Sit upright to promote ventilation. b) Lie supine to rest the lungs. c) Remain in each position for 30 to 45 minutes for best results. d) Change positions frequently and cough up secretions.
Change positions frequently and cough up secretions.
A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI
Chest discomfort not relieved by rest or nitroglycerin
A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI?
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 ACS (acute coronary syndrome) or MI, may also occur with angina and, alone, are not indicative of an MI.
The patient with which of the following characteristics is considered high risk for the development of infective endocarditis? a) Cyanotic congenital malformations b) Mitral valve prolapse with valvular regurgitation c) Hypertrophic cardiomyopathy d) Acquired valvular dysfunction
Cyanotic congenital malformations
The nurse is preparing to apply ECG electrodes to a male patient who requires continuous cardiac monitoring. Which of the following should the nurse complete to optimize skin adherence and conduction of the heart's electrical current? a) Once the electrodes are applied, change them every 72 hours. b) Clip the patient's chest hair prior to applying the electrodes. c) Clean the patient's chest with alcohol prior to application of the electrodes. d) Apply baby powder to the patient's chest prior to placing the electrodes.
Clip the patient's chest hair prior to applying the electrodes.
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Diltiazem (Cardizem) b) Amlodipine (Norvasc) c) Felodipine (Plendil) d) Clopidogrel (Plavix)
Clopidogrel (Plavix)
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin?
Clopidogrel (Plavix) Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin?
Clopidogrel (Plavix) Explanation: Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers
Which of the following is a term used to describe the splitting or separating of fused cardiac valve leaflets? a) Valvuloplasty b) Chordoplasty c) Annuloplasty d) Commissurotomy
Commissurotomy
The nurse identifies which of the following symptoms as a manifestation of right-sided heart failure (HF)? a) Reduction in cardiac output b) Accumulation of blood in the lungs c) Reduction in forward flow d) Congestion in the peripheral tissues
Congestion in the peripheral tissues
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? a) Dyspnea b) Uncontrolled restlessness c) Constant chest pain d) Fatigue lasting more than 1 month
Constant chest pain
An asymptomatic patient questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which of the following is the most appropriate nursing response? a) Avoid strenuous cardiovascular exercise. b) Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop. c) Continue the exercise routine but take ample rest after exercising. d) Avoid any type of exercise
Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop.
A nurse is caring for a client with a central venous pressure (CVP) of 4 mm Hg. Which nursing intervention is appropriate? a) Continue to monitor the client as ordered. b) Rezero the equipment and take another reading. c) Call the physician and obtain an order for a fluid bolus. d) Call the physician and obtain an order for a diuretic.
Continue to monitor the client as ordered.
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 The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
Exercise has which effect on clients with asthma, chronic bronchitis, and emphysema? a) It worsens respiratory function and is discouraged. b) It reduces the number of acute attacks. c) It improves respiratory muscle strength. d) It enhances cardiovascular fitness.
Correct response: It enhances cardiovascular fitness. Explanation: Exercise can improve cardiovascular fitness and it helps the client to better tolerate periods of hypoxia, perhaps reducing the risk of heart attack. Most exercise has little effect on respiratory muscle strength, and these clients can't tolerate the type of exercise necessary to do this. Exercise won't reduce the number of acute attacks. In some instances, exercise may be contraindicated. The client should check with his physician before starting any exercise program.
Question: The client is admitted to the telemetry unit due to chest pain. The client has polysubstance abuse, and the nurse assesses that the client is anxious and irritable and has moist skin. What should the nurse do in order of priority from first to last? All options must be used. Administer the prescribed dose of morphine. Take vital signs. Position electrodes on the chest. Obtain a history of which drugs the client has used recently.
Correct response: Position electrodes on the chest. Take vital signs. Administer the prescribed dose of morphine. Obtain a history of which drugs the client has used recently. Explanation: The nurse should first connect the client to the monitor by attaching the electrodes. Electrocardiography can be used to identify myocardial ischemia and infarction, rhythm and conduction disturbances, chamber enlargement, electrolyte imbalances, and the effects of drugs on the client's heart. The nurse next obtains vital signs to establish a baseline. Next, the nurse should administer the morphine; morphine is the drug of choice in relieving myocardial infarction (MI) pain; it may cause a transient decrease in blood pressure. When the client is stable, the nurse can obtain a history of the client's drug use.
The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? a) Calculate the palpated volume. b) Count the radial pulse for 20 to 25 seconds. c) Calculate the pauses between pulsations. d) Count the heart rate at the apex.
Count the heart rate at the apex.
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. The nurse should always check the respiratory rate prior to administering morphine sulfate. The drug should be withheld, and the health care provider notified, if the respiratory rate is below 16 breaths/minute.
myocardial necrosis
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:
The nurse is caring for a patient who was admitted to the telemetry unit with a diagnosis of rule/out acute MI. The patient's chest pain began 3 hours ago. Which of the following laboratory tests would be most helpful in confirming the diagnosis of a current MI
Creatinine kinase-myoglobin (CK-MB) level
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? A. Within 12 hours B. Within 24 to 48 hours C. Within 5 to 7 days D. Within 6 hours
D For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Physicians initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.
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? A. Sodium B. Magnesium C. Calcium D. Potassium
D Hyperkalemia (high potassium) can result in the following ECG changes: tall peaked T waves, wide QRS, and bradycardia. The nurse should be prepared to administer a diuretic or an ion-exchange resin (sodium polystyrene sulfonate [Kayexalate]); IV sodium bicarbonate, or IV insulin and glucose. Imbalances in the other electrolytes listed would not result in peaked T waves.
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? A. "I feel a tingling sensation around my mouth." B. "My vision is blurred, so my blood pressure must be up." C. "I have a bad headache." D. "My chest pain is decreasing."
D Nitroglycerin, a vasodilator, increases the arterial supply of oxygen-rich blood to the myocardium. This action produces the drug's intended effect: relief of chest pain. Headache is an adverse effect of nitroglycerin. The drug shouldn't cause a tingling sensation around the mouth and should lower, not raise, blood pressure.
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? A. Hyperactive bowel sounds B. Hypertension C. Urinary incontinence D. Hypotension
D 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.
A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: A. Increased C-reactive protein levels B. Decreased LDH levels C. Decreased myoglobin levels D. Elevated troponin levels
D Troponin is present only in myocardial tissue; therefore, it is the gold standard for determining heart damage in the early stages of an MI. LDH1 and LDH2 may be elevated in response to cardiac or other organ damage during an MI. Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage during an MI. C-reactive protein, erythrocyte sedimentation rate, and the WBC count increase on about the third day following MI because of the inflammatory response that the injured myocardial cells triggered. These levels would not be elevated during the MI event.
The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? A. Myoglobin B. Total CK C. CK-MB D. Troponin
D Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: A. Aspirin B. Statin C. Angiotensin-converting enzyme (ACE) inhibitor D. Morphine IV
D Upon patient discharge, there needs to be documentation that the patient was discharged on a statin, an ACE or angiotensin receptor blocking agent (ARB), and aspirin. Morphine IV is used for these patients to reduce pain and anxiety. The patient would not be discharged with IV morphine.
A nurse taking care of a patient recently admitted to the ICU observes the patient coughing up large amounts of pink, frothy sputum. Auscultation of the lungs reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this patient is developing which of the following problems? a) Tuberculosis b) Decompensated heart failure with pulmonary edema c) Bilateral pneumonia d) Acute exacerbation of chronic obstructive pulmonary disease
Decompensated heart failure with pulmonary edema
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 For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.
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 Explanation: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.
A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following
Decreases resting heart rate
A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following?
Decreases resting heart rate
A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following?
Decreases resting heart rate The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce the myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available.
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 Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).
The nurse is providing teaching to a post-valve replacement client. Which of the following activities would require prophylactic antibiotic use? Select all that apply.
Dental cleaning/care and colonoscopy are invasive procedures that can disturb the normal bacteria located in residence and place a valve replacement client at risk for infective endocarditis. Vision screening, echocardiogram, MRI, and chelation therapy are not invasive procedures and do not mobilize bacteria.
A cardiac patient with a magnesium lab result of 2.5 mEq/L would most likely evidence which of the following? a) Depressed myocardial contractility b) Ventricular arrhythmias c) Increased cardiac excitability. d) Atrial tachycardia
Depressed myocardial contractility
A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and his family to expect which common symptom that typically resolves spontaneously?
Depression For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves without medical intervention. However, the nurse should advise family members that symptoms of depression don't always resolve on their own. They should make sure they recognize worsening symptoms of depression and know when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure. Because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition following CABG surgery. This symptom warrants immediate physician notification.
A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and his family to expect which common symptom that typically resolves spontaneously?
Depression Explanation: For the first few weeks after CABG surgery, clients commonly experience depression, fatigue, incisional chest discomfort, dyspnea, and anorexia. Depression typically resolves without medical intervention. However, the nurse should advise family members that symptoms of depression don't always resolve on their own. They should make sure they recognize worsening symptoms of depression and know when to seek care. Ankle edema seldom follows CABG surgery and may indicate right-sided heart failure. Because this condition is a sign of cardiac dysfunction, the client should report ankle edema at once. Memory lapses reflect neurologic rather than cardiac dysfunction. Dizziness may result from decreased cardiac output, an abnormal condition following CABG surgery. This symptom warrants immediate physician notification.
A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur? a) Pansystolic, blowing, high-pitched b) Systolic, harsh, crescendo-decrescendo c) Diastolic, rumbling, low-pitched d) Diastolic, blowing, decrescendo
Diastolic, rumbling, low-pitched
The nurse is caring for a patient diagnosed with myocarditis. The nurse must be aware that patients with myocarditis are sensitive to which of the following medications? a) Lasix b) Digoxin c) Penicillin d) Corticosteroids
Digoxin
The nurse is caring for a geriatric client. The client is ordered Lanoxin (digoxin) tablets 0.125mg daily for a cardiac dysrhythmias. Which of the following assessment considerations is essential when caring for this age-group? a) Cardiac output b) Activity level c) Digoxin level d) Dyspnea
Digoxin level
An 87-year-old male client with a history of cardiomyopathy is admitted to the cardiac unit. The client experiences dyspnea on exertion, fatigue, leg swelling, and chest pain. The nurse is aware that this client has which type of cardiomyopathy? a) Peripartum cardiomyopathy b) Dilated cardiomyopathy c) Restrictive cardiomyopathy d) Hypertrophic cardiomyopathy
Dilated cardiomyopathy
The nurse caring for a client who is suspected of having cardiovascular disease has a stress test ordered. The client has a co-morbidity of multiple sclerosis, so the nurse knows the stress test will be drug-induced. What drug will be used to dilate the coronary arteries? a) Thallium b) Ativan c) Diazepam d) Dobutamine
Dobutamine
Which drug is most commonly used to treat cardiogenic shock? a) Dopamine (Intropin) b) Enalapril (Vasotec) c) Furosemide (Lasix) d) Metoprolol (Lopressor)
Dopamine
a drop in the client's heart rate
During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect:
A client is admitted to the hospital with aortic stenosis. Which of the following assessment findings would indicate the development of left ventricular failure? a) Dyspnea, distended jugular veins, orthopnea b) Distended jugular veins, pedal edema, nausea c) Orthopnea, nausea, pedal edema d) Dyspnea, orthopnea, pulmonary edema
Dyspnea, orthopnea, pulmonary edema
A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement? a) Stress test b) Tilt-table test c) Cardiac catheterization d) Echocardiography
Echocardiography
The client with a diagnosis of heart failure reports frequently awakening during the night with the need to urinate. The nurse offers which explanation? a) Fluid that is held in the lungs during the day becomes part of the circulation at night and the kidneys produce an increased amount of urine. b) The blood pressure is lower when the client is recumbent and this causes the kidneys to work harder; therefore, more urine is produced. c) When the client is in the recumbent position, more pressure is put on the bladder with the result of increased need to urinate. d) Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys.
Edema is collected in dependent extremities during the day; at night when the client lays down, it is reabsorbed into the circulation and excreted by the kidneys.
A 78-year-old client has been diagnosed with right-sided heart failure from her symptomology. Her cardiologist will confirm his suspicions through diagnostics. Which of the following diagnostics are used to reveal right ventricular enlargement? Select all that apply. a) Electrocardiogram b) Echocardiography c) Chest radiograph d) Pulmonary arteriography
Electrocardiogram Chest radiograph Echocardiography
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 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 Explanation: Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.
The nurse is caring for a patient newly diagnosed with coronary artery disease (CAD). While developing a teaching plan for the patient to address modifiable risk factors for CAD, the nurse will include which of the following
Elevated blood pressure, Obesity
A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows:
Elevated troponin levels
A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows:
Elevated troponin levels Troponin is present only in myocardial tissue; therefore, it is the gold standard for determining heart damage in the early stages of an MI. LDH1 and LDH2 may be elevated in response to cardiac or other organ damage during an MI. Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage during an MI. C-reactive protein, erythrocyte sedimentation rate, and the WBC count increase on about the third day following MI because of the inflammatory response that the injured myocardial cells triggered. These levels would not be elevated during the MI event.
A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: a) Elevated troponin levels b) Increased C-reactive protein levels c) Decreased myoglobin levels d) Decreased LDH levels
Elevated troponin levels Correct Explanation: Troponin is present only in myocardial tissue; therefore, it is the gold standard for determining heart damage in the early stages of an MI. LDH1 and LDH2 may be elevated in response to cardiac or other organ damage during an MI. Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage during an MI. C-reactive protein, erythrocyte sedimentation rate, and the WBC count increase on about the third day following MI because of the inflammatory response that the injured myocardial cells triggered. These levels would not be elevated during the MI event.
Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply. a) Elevated erythrocyte sedimentation rate (ESR) b) Decreased C-reactive protein c) Elevated white blood cell (WBC) count d) Elevated c-reactive protein e) Decreased sedimentation rate
Elevated white blood cell (WBC) count Elevated c-reactive protein •Elevated erythrocyte sedimentation rate (ESR)
Cholesterol should make up ______mg/day
Less than 200
The area of the heart that is located at the third IC space to the left of the sternum is the a) Erb's point. b) aortic area. c) pulmonic area. d) epigastric area.
Erb's point
You are caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client?
Examine the legs for color, capillary refill time, and tissue integrity.
Which signs and symptoms accompany a diagnosis of pericarditis? a) Low urine output secondary to left ventricular dysfunction b) Lethargy, anorexia, and heart failure c) Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) d) Pitting edema, chest discomfort, and nonspecific ST-segment elevation
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
What are the side effects of nitroglycerin?
Flushing, throbbing headache, and tachycardia.
Which symptom is most important in determining the diagnosis and nursing care for a client experiencing pulmonary hypertension?
Frothy sputum
A diastolic blood pressure of 90 mm Hg is classified as which of the following? a) Prehypertension b) Grade 1 hypertension c) Grade 2 hypertension d) Normal
Grade 1 hypertension
A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? a) Serratia marcescens b) Group A, beta-hemolytic streptococcus c) Staphylococcus aureus d) Pseudomonas aeruginosa
Group A, beta-hemolytic streptococcus
A patient with congestive heart failure is admitted to the hospital with complaints of shortness of breath. How should the nurse position the patient in order to decrease preload? a) Head of the bed elevated at 45 degrees and lower arms supported by pillows b) Prone with legs elevated on pillows c) Head of the bed elevated at 30 degrees and legs elevated on pillows d) Supine with arms elevated on pillows above the level of the heart
Head of the bed elevated at 45 degrees and lower arms supported by pillows
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? a) Blood vessels b) Heart c) Bronchi d) Uterus
Heart
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located?
Heart Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.
During assessment of a 63-year-old retired mechanic, the nurse notes and documents an S3 heart sound. The nurse knows that this sound is an abnormal sound suggestive of: a) Congenital heart disease. b) Heart failure. c) Coronary artery disease. d) Aortic stenosis.
Heart failure.
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% Hematocrit is a measurement of the proportion of blood volume that is occupied by red blood cells. A lowered hematocrit can imply internal bleeding.
2 to 2.5
Heparin therapy is usually considered therapeutic when the activated partial thromboplastin time (aPTT) is how many times higher than a normal value?
The nurse is reviewing the laboratory results for a patient diagnosed with coronary artery disease (CAD). The patient's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as which of the following
High
The lab values of a patient diagnosed with coronary artery disease (CAD) have just come back from the lab. His low-density lipoprotein (LDL) level is 112 mg/dL. This lab value is what?
High LDL
A 62-year-old male client who works as a stockbroker reports chest pain and palpitations during and after his morning jogs. The client's family history includes CAD. His lipid profile reveals his LDL level to be 122 mg/dL. The nurse is aware that this client has which of the following?
High LDL level
Often, women and elderly do not have the typical chest pain associated with a myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which can lead to misdiagnosis. Some older adults may experience little or no chest pain. Gender is not a contributing factor for fatal occurrence but rather a result of symptoms association.
High-density lipoprotein (HDL), 80 mg/dL A fasting lipid profile should demonstrate the following values (Alberti et al., 2009): LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients); total cholesterol less than 200 mg/dL; HDL cholesterol greater than 40 mg/dL for males and greater than 50 mg/dL for females; and triglycerides less than 150 mg/dL.
During auscultation of a patient, the nurse suspects a diagnosis of mitral valve regurgitation when hearing which of the following? a) Diastolic murmur at the left sternal border b) Low-pitched diastolic murmur at the apex c) Mitral click d) High-pitched blowing sound at the apex
High-pitched blowing sound at the apex
A nurse is caring for a patient post cardiac surgery. Upon assessment, the patient appears restless and is complaining of nausea and weakness. The patient's ECG reveals peaked T waves. The nurse reviews the patient's serum electrolytes anticipating which of the following abnormalities
Hyperkalemia
When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality?
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 change in T-wave formation
A nurse is caring for a patient post cardiac surgery. Upon assessment, the patient appears restless and is complaining of nausea and weakness. The patient's ECG reveals peaked T waves. The nurse reviews the patient's serum electrolytes anticipating which of the following abnormalities?
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 change in T-wave formation.
When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which of the following electrolyte imbalances?
Hypermagnesemia Explanation: Untreated hypomagnesemia may result in coma, apnea, and cardiac arrest. Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV block, flat or inverted T waves). Signs of hyperkalemia include: mental confusion, restlessness, nausea, weakness, paresthesias of extremities, dysrhythmias (tall, peaked T waves; increased amplitude, widening QRS complex; prolonged QT interval). Signs and symptoms of hypomagnesemia include: paresthesias, carpopedal spasm, muscle cramps, tetany, irritability, tremors, hyperexcitability, hyperreflexia, cardiac dysrhythmias (prolonged PR and QT intervals, broad flat T waves), disorientation, depression, and hypotension
Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome?
Hypertension
A nurse is discussing cardiac hemodynamics with a nursing student and explains the concept of afterload. The student asks what medical conditions might cause increased afterload. The nurse correctly answers which of the following? a) Diabetes mellitus and aortic valve stenosis b) Hypertension and mitral valve stenosis c) Diabetes mellitus and mitral vave stenosis d) Hypertension and aortic valve stenosis
Hypertension and aortic valve stenosis
Which of the following is inconsistent as a condition related to metabolic syndrome?
Hypotension
Which of the following is inconsistent as a condition related to metabolic syndrome? a) Dyslipidemia b) Hypotension c) Insulin resistance d) Abdominal obesity
Hypotension
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 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 of the following in an inconsistent manifestation of metabolic syndrome?
Hypotension Explanation: Metabolic syndrome consists of insulin resistance, dyslipidemia, hypertension, and chronic inflammation.
A patient admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which of the following medications will the nurse administer to relieve the patient's anxiety and decrease cardiac workload
IV morphine
What is the analgesic of choice for an acute MI?
IV morphine
20. An adult woman is admitted to the CCU with a myocardial infarction. The morning after admission, she tells the nurse she must go home tonight to care for the children when her husband goes to work. What nursing diagnosis best describes this problem? a. Anxiety related to physical limitations b. Alteration in cardiac output c. Knowledge deficit related to disease process d. Impaired home maintenance
Impaired Home Maintenance
Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply. a) Decreasing renal absorption of sodium. b) Modifying the rate of myocardial contraction. c) Increasing the force of cardiac output to overcome peripheral resistance. d) Impairing the synthesis of norepinephrine.
Impairing the synthesis of norepinephrine. Modifying the rate of myocardial contraction. Decreasing renal absorption of sodium.
A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime?
Improve venous return
A patient diagnosed with a myocardial infarction (MI) has begun an active rehabilitation program. The nurse recognizes an overall goal of rehabilitation for a patient who has had an MI includes which of the following
Improvement of the quality of life
to decrease workload of the heart
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?
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)?
Inability to speak. Before being extubated, the patient should have cough and gag reflexes and stable vital signs; be able to life the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable ABG levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)?
Inability to speak. Explanation: Before being extubated, the patient should have cough and gag reflexes and stable vital signs; be able to life the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable ABG levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.
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
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
When the nurse notes that the post cardiac surgery patient demonstrates low urine output (less than 25 mL per hour) with high specific gravity (greater than 1.025), the nurse suspects which of the following conditions?
Inadequate fluid volume Urine output of less than 25 mL per hour may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 25 mLor greater per hour and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric patient does not produce urine.
Cardiogenic shock is pump failure that primarily occurs because of which of the following? a) Coronary artery stenosis b) Myocardial ischemia c) Right atrial flutter d) Inadequate tissue perfusion
Inadequate tissue perfusion
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?
Inadequate tissue perfusion The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin.
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?
Inadequate tissue perfusion Explanation: The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.
Aging is positively correlated to the incidence of hypertension. This is due to three of the following four structural or functional changes. Which choice is not considered a cause? a) Atherosclerosis b) Decreased elasticity of the major blood vessels c) Increased arterial resistance to left ventricular ejection d) Increased ability to exert diastolic pressure
Increased ability to exert diastolic pressure
A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect?
Increased liver enzymes Myopathy and increased liver enzymes are significant side effects of the statins, HMG-CoA reductase inhibitors that are used to affect lipoprotein metabolism.
Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? a) Activity Intolerance b) Risk for Decreased Cardiac Output c) Impaired Gas Exchange d) Ineffective Tissue Perfusion
Ineffective Tissue Perfusion
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. Explanation: The patient should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The patient should renew the nitroglycerin supply every 6 months. If the pain is severe, the patient can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.
Which of the following is the analgesic of choice for acute MI?
Morphine sulfate
What can a low hematocrit level indicate?
Internal bleeding
The nurse is caring for a patient prescribed warfarin (Coumadin) orally. The nurse reviews the patient's prothrombin time (PT) level to evaluate the effectiveness of the medication. The nurse should also evaluate which of the following laboratory values? a) International normalized ratio (INR) b) Sodium c) Complete blood count (CBC) d) Partial thromboplastic time (PTT)
International normalized ratio (INR)
What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock? a) Cardiac pacemaker b) Defibrillator c) Intra-aortic balloon pump d) Hypothermia-hyperthermia machine
Intra-aortic balloon pump
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 viselike and radiates to the shoulders and arms. It is sudden in onset and prolonged in duration Chest pain that occurs suddenly, continues despite rest and medication, is substernal, and is sometimes viselike and radiating to the shoulders and arms is associated with an MI. Angina pectoris pain is generally relieved by rest and nitroglycerin.
A patient informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hypertension." What can the nurse educate the client about regarding this statement? a) The patient should use other methods of flavoring foods. b) It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. c) The patient can speak to the physician about increasing the dosage of medication instead of reducing the added salt. d) If dietary sodium isn't restricted, the patient will be unable to control the blood pressure and will be at risk for stroke.
It takes 2 to 3 months for the taste buds to adapt to changes in salt intake.
A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume? a) Supine b) Leaning forward while sitting c) Semi-Fowler's d) Prone
Leaning forward while sitting
The nurse is assessing the murmur on a client with mitral stenosis. Which is the best position for the client to take for this evaluation?
Left lateral
For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations? a) Edema b) Dyspnea c) Angina d) Left ventricular dysfunction
Left ventricular dysfunction
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. 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.
You are caring for a client with a valvular disorder. What nutritional intervention would be appropriate for a client with a valvular disorder?
Limit sodium intake
The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer? a) Cardizem b) Rythmol c) Lopressor d) Cordarone
Lopressor
A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following?
Low blood pressure The patient receiving anticoagulation therapy should be monitored for signs and symptoms of external and internal bleeding, such as low blood pressure, increased heart rate, and decreased serum hemoglobin and hematocrit.
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 lipo-proteins (LDL)
A client, who is resting in bed, presents with symptoms of poikilothermy, bilateral lower extremity edema, and pallor. Which is the best nursing measure to initiate? a) Apply cool compresses. b) Smoking cessation class. c) Elevate the legs. d) Lower the legs.
Lower the legs.
The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? a) Lowering and controlling the blood pressure without adverse effects and without undue cost b) Instructing the patient to enter a weight loss program and begin an exercise regimen c) Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence d) Making sure that the patient adheres to the therapeutic medication regimen
Lowering and controlling the blood pressure without adverse effects and without undue cost
An elevation in ST segment in two contiguous leads is a key diagnostic indicator for
MI (i.e. ST elevation myocardial infarction, STEMI). T
The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension? a) Reduce smoking to no more than four cigarettes per day b) Limit aerobic physical activity to 15 minutes, three times per week c) Stop alcohol intake d) Maintain adequate dietary intake of potassium
Maintain adequate dietary intake of potassium
Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? a) Maintain the patient on bed rest b) Administer a prescribed antipyretic c) Administer supplemental oxygen d) Elevate the patient's head
Maintain the patient on bed rest
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.
When preparing a patient for a cardiac catheterization, the patient states that she has allergies to seafood. Which of the following medications may give to her prior to the procedure? a) Furosemide (Lasix) b) Phenytoin (Dilantin) c) Lorazepam (Ativan) d) Methylprednisolone (Solu-Medrol)
Methylprednisolone (Solu-Medrol)
Which of the following techniques is used to surgically revascularize the myocardium?
Minimally invasive direct coronary bypass Explanation: There are several techniques 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 patient is experiencing acute pain in the leg, peripheral bypass is performed. Gastric bypass is a surgical procedure that alters the process of digestion.
The nurse is caring for a male patient who is being evaluated for lipid-lowering medication. The patient's laboratory results reveal the following: Total cholesterol: 230 mg/dL, LDL: 120 mg/dL, and a triglyceride level of 310 mg/dL. Which of the following classes of medications would be most appropriate for the patient based on his laboratory findings
Nicotinic acids
A nursing student is preparing home care instructions for a patient with infective endocarditis. The student would make sure to include which of the following? Choose all that apply. a) Record urine output and report anything less than 240 mL/day to your physician. b) Monitor intravenous catheter sites for signs of infection. c) Inform all health care providers of history of endocarditis. d) Encourage oral hygiene at least twice daily with a soft toothbrush.
Monitor intravenous catheter sites for signs of infection. Encourage oral hygiene at least twice daily with a soft toothbrush. Inform all health care providers of history of endocarditis.
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 provides certain discharge instructions for self-care, such as monitoring the site for bleeding or development of a hard mass indicative of hematoma. A nurse does not advise the patient to clean the site with disinfectants or refrain from sexual activity for one month.
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except:
Morphine IV Upon patient discharge, there needs to be documentation that the patient was discharged on a statin, an ACE or angiotensin receptor blocking agent (ARB), and aspirin. Morphine IV is used for these patients to reduce pain and anxiety. The patient would not be discharged with IV morphine.
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
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?
Morphine sulfate (Morphine)
A client is being evaluated for mitral stenosis versus mitral insufficiency. Which of the following symptoms would the nurse find in either condition?
Murmur
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? a) Deep vein thrombosis (DVT) b) Myocardial infarction (MI) c) Stroke d) Intracerebral hemorrhage
Myocardial infarction (MI) Correct Explanation: Women often present with symptoms different from those seen in men, therefore a high level of suspicion is associated with vague complaints such as fatigue, shoulder blade discomfort, and/or shortness of breath. The clinical manifestations noted are not consistent with DVT, stroke, or intracerebral hemorrhage.
Troponin is present only on..
Myocardial tissue
The nurse is caring for a male patient who is being evaluated for lipid-lowering medication. The patient's laboratory results reveal the following: Total cholesterol: 230 mg/dL, LDL: 120 mg/dL, and a triglyceride level of 310 mg/dL. Which of the following classes of medications would be most appropriate for the patient based on his laboratory findings?
Nicotinic acids The most appropriate class of medications based on the patient's laboratory findings would be nicotinic acids. This class of medications is prescribed for patients with: minimally elevated cholesterol and LDL levels or as an adjunct to a statin when the lipid goal has not been has not been achieved and triglyceride (TG) levels are elevated.
A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well." The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders
Nitroglycerin SL
A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders?
Nitroglycerin SL Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the patient's chest pain.
A patient with infective endocarditis (IE) and a fever is admitted to the intensive care unit (ICU). Which of these physician orders should the nurse implement first? a) Order blood cultures drawn from two sites. b) Administer ceftriaxone (Rocephin) 1 g IVPB q 12 hours. c) Obtain a transesophageal echocardiogram. d) Give acetaminophen (Tylenol) pro re nata (PRN) for fever higher than 100.3 degrees.
Order blood cultures drawn from two sites.
The patient with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate
PCI Superior outcomes have been reported with the use of PCI compared to thrombolytics.
The test used to monitor Coumadin is a. CBC b. PTT c. PT
PT
A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation?
PT or INR
What is variant angina described as?
Pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm
A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction?
Pallor
A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction?
Pallor Pallor is the initial symptom in Raynaud's followed by cyanosis and aching pain. Gangrene can occur with persistent attacks and interference of blood flow. Clubbing of the fingers is a symptom associated with chronic oxygen deprivation to the distal phalanges.
worsening angina
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?
The nurse recognizes that the treatment for a non-ST elevation myocardial infarction (NSTEMI) differs from that of a patient with a STEMI, in that a STEMI is more frequently treated with which of the following
Percutaneous coronary intervention (PCI)
The client teaching instructions for a 57-year-old male client with thrombophlebitis who is being discharged should include which of the following? Select all that apply. a) Ambulate as tolerated. b) Perform leg exercises each hour. c) Take anticoagulant therapy when symptoms occur. d) Avoid sitting for too long. e) Avoid elevating affected extremity.
Perform leg exercises each hour. Ambulate as tolerated. Avoid sitting for too long.
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 syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.
A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together? a) Potassium level b) Sodium level c) Magnesium level d) Calcium level
Potassium Level
A client is recovering from an acute myocardial infarction (MI). During the first week of the client's recovery, the nurse should stay alert for which abnormal heart sound? a) Pericardial friction rub b) Graham Steell's murmur c) Ejection click d) Opening snap
Pericardial friction rub Correct Explanation: A pericardial friction rub, which sounds like squeaky leather, may occur during the first week following an MI. Resulting from inflammation of the pericardial sac, this abnormal heart sound arises as the roughened parietal and visceral layers of the pericardium rub against each other. Certain stenosed valves may cause a brief, high-pitched opening snap heard early in diastole. Graham Steell's murmur is a high-pitched, blowing murmur with a decrescendo pattern; heard during diastole, it indicates pulmonary insufficiency, such as from pulmonary hypertension or a congenital pulmonary valve defect. An ejection click, associated with mitral valve prolapse or a rigid, calcified aortic valve, causes a high-pitched sound during systole.
serum BUN of 70 mg/dL
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.
pericardial friction rub
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?
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 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 Hyperkalemia (high potassium) can result in the following ECG changes: tall peaked T waves, wide QRS, and bradycardia. The nurse should be prepared to administer a diuretic or an ion-exchange resin (sodium polystyrene sulfonate [Kayexalate]); IV sodium bicarbonate, or IV insulin and glucose. Imbalances in the other electrolytes listed would not result in peaked T waves.
A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? a) Sodium level of 152 mEq/L b) Magnesium level of 2.5 mg/dl c) Potassium level of 2.8 mEq/L d) Calcium level of 7.5 mg/dl
Potassium level of 2.8 mEq/L
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
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. Explanation: Nitroglycerin dilates primarily the veins, and in higher dosages, also the arteries. Dilation of the veins causes venous pooling of the blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload ) is reduced. Nitroglycerine is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain
Which medication is an antidote to heparin?
Protamine Sulfate
The nurse is caring for a patient following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which of the following medications to neutralize the unfractionated heparin the patient received
Protamine sulfate
The nurse is caring for a patient following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which of the following medications to neutralize the unfractionated heparin the patient received?
Protamine sulfate
A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation?
Prothrombin time (PT) or international normalized ratio (INR)
A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation?
Prothrombin time (PT) or international normalized ratio (INR) The nurse should monitor PT or INR when oral anticoagulation is prescribed. Vascular sites for bleeding, urine output, and hourly IV infusions are generally monitored in all clients.
A mechanical prosthetic heart valve client is admitted with leukopenia and abdominal pain. Which diagnostic lab data would the nurse access first?
Prothrombin time and international normalized ratio (PT/INR)
A client with mitral stenosis develops a productive cough with pink, frothy sputum. The best interpretation made by the nurse would be to further evaluate for which complication?
Pulmonary edema
A client is being evaluated for coronary artery disease (CAD) and is scheduled for an electron beam computed tomography. The nurse understands that the primary advantage of this radiologic test is which of the following?
Quantifies calcified plaque The primary advantage of EBCT is to detect and quantify calcified plaque in the coronary arteries even before symptoms arise. EBCT is noninvasive and provides clearer images with less exposure to radiation than a CT scan but not the primary reason for use.
A physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the previous 6 months. Which action should the nurse take? a) Inform the client that he should discuss his MI with the physician. b) Question the physician about the order. c) Discontinue the medication. d) Administer the medication as ordered.
Question the physician about the order. Correct Explanation: Cardiovascular toxicity is a problem with tricyclic antidepressants, and the nurse should question the use of these drugs in a client with cardiac disease. Administering the medication would be an act of negligence. A nurse can't discontinue a medication without a physician's order. It's the nurse's responsibility, not the client's, to discuss questions of care with the physician.
A client with aortic regurgitation is experiencing dyspnea and chest pain with activity. The nurse knows that the cause of the symptoms can be best determined by which diagnostic test?
Radionuclide scan
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
Which activity would be appropriate to delegate to unlicensed assistive personnel (UAP) for a client diagnosed with a myocardial infarction who is stable? a) Help the client identify risk factors for CAD. b) Evaluate the lung sounds. c) Provide teaching on a 2-g sodium diet. d) Record the intake and output.
Record the intake and output. Correct Explanation: UAP are able to measure and record intake and output. The nurse is responsible for client teaching, physical assessments, and evaluating the information collected on the client.
Part of the continued management of a patient with infective endocarditis is assessment for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? a) Splinter hemorrhages seen under the fingernails b) Patterns of petechiae on the chest c) Erythematosus modules on the pads of the fingers d) Red or purple macules found on the palms of the hands
Red or purple macules found on the palms of the hands
A client has chest pain rated at 8 on a 10-point visual analog scale. The 12-lead electrocardiogram reveals ST elevation in the inferior leads and troponin levels are elevated. What should the nurse do first? a) Provide client education on medications and diet. b) Limit visitation by family and friends. c) Reduce pain and myocardial oxygen demand. d) Monitor daily weights and urine output.
Reduce pain and myocardial oxygen demand. Correct Explanation: Nursing management for a client with a myocardial infarction should focus on pain management and decreasing myocardial oxygen demand. Fluid status should be closely monitored. Client education should begin once the client is stable and amenable to teaching. Visitation should be based on client comfort and maintaining a calm environment.
Decreased pulse pressure reflects which of the following? a) Tachycardia b) Reduced distensibility of the arteries c) Elevated stroke volume d) Reduced stroke volume
Reduced distensibility of the arteries
A central venous pressure (CVP) reading of 1 indicates what?
Reduced right ventricular preload, commonly caused by hypovolemia.
A patient is admitted to the emergency room with a blood pressure reading of 200/130 mm Hg. This is a hypertensive emergency situation than can lead to organ damage if not managed immediately. The nurse understands that which of the following are therapeutic goals? Select all that apply. a) Reduction to a target goal pressure over a period of days. b) Reduction of the mean blood pressure by 25% within the first hour. c) An immediate lowering of the blood pressure to a normotensive level within the first 30 minutes. d) Achievement of a goal pressure of about 160/100 within 2 to 6 hours.
Reduction of the mean blood pressure by 25% within the first hour. Achievement of a goal pressure of about 160/100 within 2 to 6 hours. Reduction to a target goal pressure over a period of days.
The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock? a) Restlessness and confusion b) Increased urinary output c) High blood pressure d) Hyperactive bowel sounds
Restlessness and confusion
What disease process is mitral regurgitation associated with?
Rheumatic carditis
Which historical fact is of greatest value to a nurse who is interviewing a client being admitted for possible mitral regurgitation?
Rheumatic fever
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? a) Risk for infection b) Chronic pain c) Impaired memory d) Impaired gas exchange
Risk for infection
The nurse is caring for a patient presenting to the emergency department (ED) complaining of chest pain. Which of the following electrocardiographic (ECG) findings would be most concerning to the nurse
ST elevations
The nurse is caring for a patient presenting to the emergency department (ED) complaining of chest pain. Which of the following electrocardiographic (ECG) findings would be most concerning to the nurse? a) ST elevations b) Sinus tachycardia c) Isolated premature ventricular contractions (PVCs) d) Frequent premature atrial contractions (PACs)
ST elevations Correct Explanation: The first signs of an acute MI are usually seen in the T wave and ST segment. The T wave becomes inverted; the ST segment elevates (usually flat). An elevation in ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e. ST elevation myocardial infarction, STEMI). This patient requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.
morphine sulfate (morphine)
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?
A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. His cholesterol profile is as follows: total cholesterol 265 mg/dl, low-density lipoprotein (LDL) 139 mg/dl, and high-density lipoprotein (HDL) 32 mg/dl. The client asks the nurse how to lower his cholesterol. The nurse should tell the client that:
She'll ask the dietitian to talk with him about modifying his diet.
The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium? a) Furosemide (Lasix) b) Spironolactone (Aldactone) c) Chlorthalidone (Hygroton) d) Chlorothiazide (Diuril)
Spironolactone (Aldactone)
The nurse is instructing a new graduate nurse. Together, they are caring for a client with infective endocarditis. What is a sign of infective endocarditis? a) Homan's sign b) Splinter hemorrhage c) Precordial pain d) Heart murmur
Splinter hemorrhage
A 65-year-old male client with CAD has been prescribed a transdermal nitroglycerin patch. The nurse's instructions to the client would include which of the following? Select all that apply.
Store the patch in its original container when not in use. Remove the transdermal patch at night and reapply in the morning. Transdermal nitroglycerin systems are applied to the skin and slowly release nitroglycerin. Clients should be instructed to store the patch in its original container when not in use and keep tightly closed, remove the patch each night and reapply in the morning to prevent diminishing vasodilating effects, and expect possible side effects, such as headache, flushing, or nausea
A client was transferring a load of fire wood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which orders by the physician?
Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry The nurse should anticipate an order for sublingual nitroglycerin, tPA, and telemetry. (The client's chest pain began 4 hours before diagnosis.) The preferred choice is tPA, which is more specific for cardiac tissue than streptokinase. Stress testing shouldn't be performed during an MI. The client doesn't exhibit symptoms that indicate the use of lidocaine.
The nurse is caring for a client who is status postoperative from a vein stripping. What would the nurse monitor for?
Swelling in the operative leg
A client with aortic valve regurgitation is asking about his disease process. What would you, as the nurse, tell the client is the first sign of aortic valve regurgitation?
Tachycardia
The nurse is caring for a client with a valvular disorder of the heart. What intervention should the nurse perform before administering the prescribed beta-blockers to clients with valvular disorders of the heart?
Take the client's apical pulse.
Which of the following teaching interventions should the nurse include in the plan of care for a patient with valvular heart disease who is experiencing pulmonary congestion? a) Teaching patients to rest and sleep in a chair or sit in bed with head elevated b) Teaching patients to report a weight gain of 3 pounds in 1 week c) Teaching patients to take nitroglycerin if shortness of breath develops d) Teaching patients to drink at least 2 L of fluid daily and monitor urine output
Teaching patients to rest and sleep in a chair or sit in bed with head elevated
atropine
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?
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. Explanation: 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. The client should have a normal electrocardiogram with no arrhythmias and a regular heart rate of 60 to 100 beats/minute. Smoking is a cardiovascular risk factor that the client must be willing to eliminate. A client who responds favorably to therapy shouldn't have chest pain
troponin
The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks?
a lack of oxygen in the heart muscle that causes the death of cells
The nurse has been asked to explain the cause of angina pain to a patient's family. Choose the best statement. The pain is due to:
The client is admitted for a scheduled cardiac catheterization. On the morning of the procedure, while assessing the client's morning laboratory values, the nurse notes a blood urea nitrogen (BUN) of 34 mg/dL and a creatinine of 4.2 mg/dL. The nurse makes it a priority to notify the physician for which of the following reasons? a) These values show a risk for dysrhythmias. b) The client is at risk for renal failure due to the contrast agent that will be given during the procedure. c) The client is over-hydrated, which puts him at risk for heart failure during the procedure. d) The client is at risk for bleeding.
The client is at risk for renal failure due to the contrast agent that will be given during the procedure.
A nurse is assigned with an ancillary staff member to care for a group of cardiac clients. Which client should the nurse address first? a) The client admitted with unstable angina pectoris who wants to be discharged. b) The client who suffered an acute myocardial infarction (MI) who is complaining of constipation. c) The client who has his call light on. d) The client who had a pacemaker inserted yesterday and who is complaining of incisional pain.
The client who suffered an acute myocardial infarction (MI) who is complaining of constipation. Explanation: The client who suffered an acute MI who is complaining of constipation should be addressed first. If the client strains at stool after an MI, the vagal response may be stimulated, causing bradycardia thereby provoking arrhythmias. After addressing the MI client with constipation, the nurse should promptly address the pain-relief needs of the client who had a pacemaker inserted the previous day. The nurse should delegate answering the call light to the ancillary personnel. She may also delegate some of the discharge preparation, such as packing the client's belongings.
high
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is
decreases the sinoatrial node automaticity
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?
protamine sulfate
The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received?
ST elevation
The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse?
nicotinic acid
The nurse is caring for a client who is being evaluated for lipid-lowering medication. The client's laboratory results reveal the following: total cholesterol 230 mg/dL, LDL 120 mg/dL, triglyceride level 310 mg/dL. Which class of medications would be most appropriate for the client based on these laboratory findings?
avoid situations that contribute to ischemic episodes
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?
atherosclerosis
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?
high
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
vague symptoms
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause?
percutaneous coronary intervention (PCI)
The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with
Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene?
The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. Sometimes clients are concerned about resuming sexual activity but are afraid to ask. Making inappropriate sexual comments provides a forum for asking questions. It isn't necessary to report the incident to the nursing supervisor immediately without investigating the situation further. The client's call light must be answered in a timely fashion. More information is needed before assuming that the client is asking for extra attention.
potassium level of 6 mEq/L
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.
enhance myocardial oxygenation
The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to:
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)? a) The patient has had angina longer than 3 years. b) The patient has at least a 70% occlusion of a major coronary artery. c) The patient has an ejection fraction of 65%. d) The patient has compromised left ventricular function.
The patient has at least a 70% occlusion of a major coronary artery.
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. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).
A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant? a) The patient has jugular vein distention and 3+ pedal oedema. b) The patient reports chest pain after eating a large meal. c) The patient's has an enlarged liver and oedematous abdomen. d) The patient reports shortness of breath when walking.
The patient reports shortness of breath when walking.
What is the hematocrit a measure of?
The proportion of blood volume that is occupied by red blood cell
60 minutes
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)?
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?
To decrease workload of the heart
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?
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. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and Bvitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.
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
What is the most accurate serum determinant of an MI?
Troponin
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 Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
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 Explanation: Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.
The nurse is awaiting results of cardiac biomarkers for a patient with severe chest pain. The nurse would identify which cardiac biomarker as remaining elevated the longest when myocardial damage has occurred? a) Myoglobin b) Brain natriuretic peptide (BNP) c) Troponin T and I d) CK-MB
Troponin T and I
The nurse is reevaluating a patient 2 hours following a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which of the following assessment findings may indicate the patient is experiencing a complication of the procedure
Urine output of 40 mL
When a patient who has been 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
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
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 Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
Which of the following is also termed preinfarction angina?
Unstable Angina Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs on exertion and it relieved by rest. Variant angina is exhibited by pain at rest with reversible ST-segment elevation. In silent angina, there is evidence of ischemia, but the patient reports no symptoms.
A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour? a) Up to 25% b) 45% c) 40% d) 35%
Up to 25%
morphine IV
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except:
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause?
Vague symptoms
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause?
Vague symptoms Often, women and elderly do not have the typical chest pain associated with a myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which can lead to misdiagnosis. Some older adults may experience little or no chest pain. Gender is not a contributing factor for fatal occurrence but rather a result of symptoms association.
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? a) Chest pain is typical b) Vague symptoms c) Gender bias d) Decreased sensation to pain
Vague symptoms Correct Explanation: Often, women and elderly do not have the typical chest pain associated with a myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which can lead to misdiagnosis. Some older adults may experience little or no chest pain. Gender is not a contributing factor for fatal occurrence but rather a result of symptoms association.
A patient taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the patient no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the physician ordering? a) Valsartan (Diovan) b) Isosorbide dinitrate (Dilatrate) c) Furosemide (Lasix) d) Metoprolol (Lopressor)
Valsartan (Diovan)
The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? a) Metolazone (Zaroxolyn) b) Valsartan (Diovan) c) Digoxin (Lanoxin) d) Carvedilol (Coreg)
Valsartan (Diovan)
A 23-year-old female client has been diagnosed with Raynaud's disease. The nurse teaches the client which of the following self-care strategies to minimize risks associated with this disease? Select all that apply.
Wear gloves to protect hands from injury when performing tasks. Do not smoke or stop smoking. Avoid over-the-counter decongestants and cold remedies The nurse instructs clients with Raynaud's disease to quit smoking, avoid over-the-counter decongestants, cold remedies, and drugs for symptomatic relief of hay fever because of their vasoconstrictive qualities, protect hands and feet from injury, and wear warm socks and mittens when going outdoors in the cold weather
A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? a) Assessing the client's vital signs every 4 hours b) Checking the client's lungs for crackles during every shift c) Weighing the client daily at the same time each day d) Measuring and recording fluid intake and output
Weighing the client daily at the same time each day
A client in the cardiac unit is undergoing procedures to determine the extent of his left-sided heart failure. As his nurse, what adventitious lung sounds would you expect to hear during your auscultation of his lungs to support his diagnosis? Select all that apply. a) Wet lung sounds b) Stridor c) Labor d) Wheezes
Wet lung sounds Wheezes
fatty deposits in the lumen of arteries
What is a characteristic of atherosclerosis?
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?
Withhold anticoagulant therapy
When assessing a patient with left-sided heart failure, what would be noted on auscultation of lungs? a) Wheezes with wet lung sounds b) Labor c) Stridor d) High-pitched sound
Wheezes with wet lung sounds
unstable
When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina?
the pain occurred while I was mowing the lawn
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?
see if rest relieves the chest pain before using the nitroglycerin
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions?
inadequate fluid volume
When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition?
hyperkalemia
When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality?
insulin resistance
Which are consistent with manifestations of metabolic syndrome?
abdomen bruit
Which assessment finding by the nurse is the most significant finding suggestive of aortic aneurysm?
cardiac tamponade
Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles?
atherosclerosis
Which condition most commonly results in coronary artery disease (CAD)?
inadequate tissue perfusion
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery?
clopidogrel
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin?
withhold anticoagulant therapy
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?
hypotension
Which of the following is inconsistent as a condition related to metabolic syndrome?
inability to speak
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)?
morphine
Which s the analgesic of choice for acute myocardial infarction (MI)?
unstable angina
Which term refers to preinfarction angina?
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?
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 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
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 For the best chance of salvaging the client's myocardium, a thrombolytic agent must be administered within 6 hours after onset of chest pain or other signs or symptoms of MI. Sudden death is most likely to occur within the first 24 hours after an MI. Physicians initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days
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 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 thrombocytopenia.
Which is a priority for exercising for a client who has just had a myocardial infarction? a) low-back training program b) strength training program c) risk modification education d) jogging exercise program
You selected: risk modification education Correct Explanation: Cardiac rehabilitation includes client and family education and individualized activity counseling. Generally, the educational programs focus on presenting all of the risk factors associated with coronary artery disease. Low-back training is associated with a back injury recovery program. A strength training or jogging exercise program is not appropriate immediately after a cardiac event.
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. During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it, in turn, may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate leading to syncope. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
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. Explanation: During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it, in turn, may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate leading to syncope. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.
An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician orders a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine whether the client has other major risk factors for CAD, the nurse should assess for:
a history of diabetes mellitus. Explanation: Diabetes mellitus, smoking, and hypertension are other major risk factors for CAD. Elevated HDL levels aren't a risk factor for CAD; in fact, increased HDL levels seem to protect against CAD. Ischemic heart disease is another term for CAD, not a risk factor. Alcoholism hasn't been identified as a major risk factor for CAD
A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? a) Low blood pressure b) High blood pressure c) Decreased heart rate d) Elevated hematocrit
a) Low blood pressure
When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? a. "See if rest relieves the chest pain before using the nitroglycerin." b. "Call 911 if you develop a headache following nitroglycerin use." c. "Place the nitroglycerin tablet between cheek and gum." d. "Only take one nitroglycerin tablet for each episode of angina."
a. "See if rest relieves the chest pain before using the nitroglycerin."
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? a. 12-lead ECG b. 2 L oxygen via nasal cannula c. Troponin level d. Aspirin 325 mg orally
a. 12-lead ECG
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? a. 160-190mg/dL b. 210-240mg/dL c. 250-275mg/dL d. 280-300mg/dL
a. 160-190mg/dL
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? a. 3 mins b. 15 mins c. 30 mins d. 60 mins
a. 3 mins
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? a. 3 minutes b. 15 minutes c. 30 minutes d. 60 mintues
a. 3 minutes
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a. 50 seconds or less b. 75 seconds or less c. 100 seconds or less d. 125 seconds or less
a. 50 seconds or less
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a. 50 seconds or less. b. 75 seconds or less. c. 100 seconds or less. d. 125 seconds or less.
a. 50 seconds or less.
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.) a. Abrupt closure of the artery b. Arterial dissection c. Coronary artery vasospasm d. Aortic dissection e. Nerve root pressure
a. Abrupt closure of the artery b. Arterial dissection c. Coronary artery vasospasm
Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? a. Application of a vascular closure device such as Angio-Seal or VasoSeal b. Direct manual pressure c. Application of a pneumatic compression device (e.g., FemoStop) d. Application of a sandbag to the area
a. Application of a vascular closure device such as Angio-Seal or VasoSeal
Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? a. Cardiac tamponade b. Fluid overload c. Hypertension d. Hypothermia
a. Cardiac tamponade
A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? a. Decreases resting heart rate b. Decreases cholesterol level c. Increases cardiac output d. Decreases platelet aggregation
a. Decreases resting heart rate
A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? a. IV morphine b. IV nitroglycerin c. Atenolol d. Amlodipine
a. IV morphine
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? a. Inability to speak. b. Adequate cough and gag reflex. c. Adequate vital capacity. d. Acceptable arterial blood gas (ABG) values.
a. Inability to speak.
Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? a. Inadequate tissue perfusion b. Mental alertness c. Blood glucose concentration d. Activity intolerance
a. Inadequate tissue perfusion
A patient has been recently placed on nitroglycerin. Which of the following should be included in the patient teaching plan? a. Instruct the patient on side effects of flushing, throbbing headache, and tachycardia. b. Instruct the patient to renew the nitroglycerin supply every 3 months. c. Instruct the patient not to crush the tablet. d. Instruct the patient to place nitroglycerin tablets in a plastic pill box.
a. Instruct the patient on side effects of flushing, throbbing headache, and tachycardia.
Which is the analgesic of choice for acute myocardial infarction (MI)? a. Morphine b. Aspirin c. Meperidine d. Ibuprofen
a. Morphine
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. a. Reduces myocardial oxygen consumption b. Decreases the urge to use tobacco c. Dilates blood vessels d. Decreases ischemia e. Relieves pain
a. Reduces myocardial oxygen consumption c. Dilates blood vessels d. Decreases ischemia e. Relieves pain
The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? a. ST elevation b. Isolated premature ventricular contractions (PVCs) c. Sinus tachycardia d. Frequent premature atrial contractions (PACs)
a. ST elevation
The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm? a. Severe back pain b. Hematemesis c. Rectal bleeding d. Hypertensive crisis
a. Severe back pain
Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene? a. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. b. The nurse should report the incident to her supervisor immediately. c. The nurse should instruct the nursing assistants to avoid answering his call light. d. The nurse should explain that the client most likely wants extra attention.
a. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask.
An obese white male client, age 49, is diagnosed with hypercholesterolemia. The physician orders a low-fat, low-cholesterol, low-calorie diet to reduce blood lipid levels and promote weight loss. This diet is crucial to the client's well-being because his race, sex, and age increase his risk for coronary artery disease (CAD). To determine whether the client has other major risk factors for CAD, the nurse should assess for: a. a history of diabetes mellitus b. elevated high-density lipoprotein (HDL) levels c. a history of ischemic heart disease d. alcoholism
a. a history of diabetes mellitus
the nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. The nurse immediately asks another nurse to contact the HCP and prepares to implement which priority interventions? Select All That Apply a. administering oxygen b. inserting a foley catheter c. administering furosemide (lasix) d. administering morphine sulfate intravenously e. transporting the client to a coronary care unit. f. placing the client in a low Fowler's side-lying position
a. administering oxygen b. inserting a foley catheter c. administering furosemide (lasix) d. administering morphine sulfate intravenously
A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD? a. ankle-brachial index b. exercise electrocardiography c. electron beam computed tomography d. photoplethysmography
a. ankle-brachial index
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: a. anterior. b. posterior. c. lateral. d. inferior.
a. anterior.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? a. calcium-channel blocker b. beta-adrenergic blocker c. nitrate d. diuretic
a. calcium-channel blocker
a patient has had cardiac surgery and is being monitored in the ICU. what complication should the nurse monitor for that is associated with an alteration in preload? a. cardiac tamponade b. elevated central venous pressure c. hypertension d. hypothermia
a. cardiac tamponade
A client who has been diagnosed with Prinzmetal's angina will present with which symptom? a. chest pain that occurs at rest and usually in the middle of the night b. radiating chest pain that lasts 15 minutes or less c. prolonged chest pain that accompanies exercise d. chest pain of increased frequency, severity, and duration
a. chest pain that occurs at rest and usually in the middle of the night
What is a modifiable risk factor for the development of atherosclerosis? a. consumption of a high-fat diet b. prior infection with Chlamydia pneumoniae c. gender d. history of rheumatic fever
a. consumption of a high-fat diet
the nurse is administering a CCB to a patient who has symptomatic sinus tachycardia at a rate of 132bpm. what is the anticipated action of the drug for this patient? a. decreases the SA node automaticity b. increases the AV node conduction c. increases the heart rate d. creates a positive inotropic effect
a. decreases the SA node automaticity
a patient who had a CABG is exhibiting signs of cardiac failure. what medications does this nurse anticipate administering for this patient? (SAA) a. diuretics b. digoxin c. inotropic agents d. dialysis e. nitroprusside
a. diuretics b. digoxin c. inotropic agents
The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with a. percutaneous coronary intervention (PCI) b. IV heparin c. IV nitroglycerin d. thrombolytics
a. percutaneous coronary intervention (PCI)
A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? a. smoking cessation b. a protein-rich diet c. exercise avoidance d. antioxidant supplements
a. smoking cessation
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? a.) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. b.) Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. c.) Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. d.) Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team.
a.) Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
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? a.) Assess the client's level of pain and administer prescribed analgesics. b.) Ensure that the client's family is kept informed of his status. c.) Prepare the client for pulmonary artery catheterization. d.) Assess the client's level of anxiety and provide emotional support.
a.) Assess the client's level of pain and administer prescribed analgesics.
Which condition most commonly results in coronary artery disease (CAD)? a.) Atherosclerosis b.) Renal failure c.) Diabetes mellitus d.) Myocardial infarction
a.) Atherosclerosis
The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock? a) High blood pressure b) Restlessness and confusion c) Increased urinary output d) Hyperactive bowel sounds
restlessness and confusion
A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI? a.) Chest discomfort not relieved by rest or nitroglycerin b.) Cool, clammy, diaphoretic, and pale appearance c.) Intermittent nausea and emesis for 3 days d.) Anxiousness, restlessness, and lightheadedness
a.) Chest discomfort not relieved by rest or nitroglycerin
A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following? a.) Decreases resting heart rate b.) Increases cardiac output c.) Decreases platelet aggregation d.) Decreases cholesterol level
a.) Decreases resting heart rate
Which of the following is inconsistent as a condition related to metabolic syndrome? a.) Hypotension b.) Dyslipidemia c.) Insulin resistance d.) Abdominal obesity
a.) Hypotension
An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? a.) Leads V3 and V4 b.) Leads I, aVL, V5, and V6 c.) Leads II, III, and aVF d.) Leads V1 and V2
a.) Leads V3 and V4
Which of the following is the analgesic of choice for acute MI? a.) Morphine sulfate b.) Motrin c.) Aspirin d.) Demerol
a.) Morphine sulfate
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? a.) Potassium b.) Calcium c.) Magnesium d.) Sodium
a.) Potassium
The nurse is caring for a patient following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which of the following medications to neutralize the unfractionated heparin the patient received? a.) Protamine sulfate b.) Aspirin c.) Alteplase (t-PA) d.) Clopidogrel (Plavix)
a.) Protamine sulfate
Following cardiac surgery, the nurse assesses the patient for indicators of the common complication of hypovolemia. Choose the significant indicator. a.) Pulmonary artery wedge pressure (PAWP) of 6 mm Hg b.) Central venous pressure (CVP) reading of 8 mm Hg c.) Heart rate of 60 bpm d.) Blood pressure reading of 130/95 mm Hg
a.) Pulmonary artery wedge pressure (PAWP) of 6 mm Hg
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? a.) Vague symptoms b.) Decreased sensation to pain c.) Chest pain is typical d.) Gender bias
a.) Vague symptoms
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? a.) Withhold anticoagulant therapy. b.) Inform client of diagnostic tests. c.) Remove hair from skin insertion sites. d.) Assess distal pulses.
a.) Withhold anticoagulant therapy.
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: a.) anticoagulant. b.) antibiotic. c.) antihypertensive. d.) anticonvulsant.
a.) anticoagulant
Chest pain or discomfort not relieved by rest or nitroglycerin is associated with
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 patient for
acute MI.
IV morphine is the analgesic of choice for treatment of an
acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart.
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20mL/h for 2 hours. The client received a single bolus of 500mL of IV fluid. Urine output for the subsequent hour was 25mL. Daily laboratory results indicate the blood urea nitrogen level is 45mg/dL and serum creatinine leel is 2.2mg/dL/ On the basis of these findings, the nurse would anticipate the client is at risk for which problem? a. hypovolemia b. acute kidney injury c. glomerulonephritis d. urinary tract infection
acute kidney injury
The urine output of 40 mL over a 2-hour period may indicate
acute renal failure.
When assessing a client with left-sided heart failure, the nurse expects to note: a) pitting edema of the legs. b) air hunger. c) ascites. d) jugular vein distention.
air hunger
Following a coronary artery bypass graft, a client begins having chest "fullness" and anxiety. The nurse suspects cardiac tamponade and prints a lead II electrocardiogram (ECG) strip for interpretation. In looking at the strip, the change in the QRS complex that would most support her suspicion is: a) amplitude increase. b) amplitude decrease. c) narrowing complex. d) widening complex.
amplitude decrease
A patient presents to the emergency room complaining of chest pain the priority is to determine if the patient is suffering
an acute MI and implement appropriate interventions as quickly as possible.
An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates
an old, not acute, MI.
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: a) lateral. b) posterior. c) inferior. d) anterior.
anterior
Clopidogrel (Plavix) is an
antiplatelet medication that is given to reduce the risk of thrombus formation post coronary stent placement.
9. A 53-year-old is showing symptoms of dyspnea on exertion, angina, and exertional syncope (light-headedness with activity). Which of the following do these manifestations indicate? a. Aortic stenosis b. Mitral regurgitation c. Aortic regurgitation d. Mitral valve prolapse
aortic stenosis
The patient receiving heparin is placed on bleeding precautions, which can include
applying pressure to the site of any needle punctures for a longer time than usual, avoiding intramuscular injections, avoiding tissue injury and bruising from trauma or constrictive devices (e.g. continuous use of an automatic BP cuff).
The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status? a) Listening to breath sounds b) Pulse oximetry c) End-tidal CO2 d) Arterial blood gases
arterial blood gases
The antiplatelet effect of
aspirin does not reverse the effects of heparin.
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). fter PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Physicians order heparin for anticoagulation during this procedure; some physicians discharge clients with a prescription for long-term warfarin (Coumadin) or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The physician may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.
Hypercalcemia would likely be demonstrated by
asystole.
An immediate objective of rehabilitation of the MI patient is to limit the effects and progression of
atherosclerosis.
Which of the following terms is used to describe the ability of the heart to initiate an electrical impulse? a) Excitability b) Contractility c) Automaticity d) Conductivity
automaticity
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a) Angiotensin-converting enzyme (ACE) inhibitor b) Morphine IV c) Aspirin d) Statin
b) Morphine IV
The nurse recognizes that the treatment for a non-ST elevation myocardial infarction (NSTEMI) differs from that of a patient with a STEMI, in that a STEMI is more frequently treated with which of the following? a) Thrombolytics b) Percutaneous coronary intervention (PCI) c) IV nitroglycerin d) IV heparin
b) Percutaneous coronary intervention (PCI)
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? a) Hypothermia b) Pericardial friction rub c) Decreased white blood cell (WBC) count d) Decreased erythrocyte sedimentation rate (ESR)
b) Pericardial friction rub
A client, who has undergone a percutaneous transluminal coronary angioplasty (PTCA), has received discharge instructions. Which statement by the client would indicate the need for further teaching by the nurse? a. "I should avoid taking a tub bath until my catheter site heals." b. "I should expect a low-grade fever and swelling at the site for the next week." c. "I should avoid prolonged sitting." d. "I should expect bruising at the catheter site for up to 3 weeks."
b. "I should expect a low-grade fever and swelling at the site for the next week."
When starting a client on oral or I.V. diltiazem (Cardizem), for which potential complication should the nurse monitor? a. flushing b. AV block c. renal failure d. hypertension
b. AV block
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? a. Minimal oozing of blood from the IV site b. Altered level of consciousness c. Presence of reperfusion dysrhythmias d. Chest pain 2 of 10 (on a 1-to-10 pain scale)
b. Altered level of consciousness
A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response? a. Atherosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. b. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. c. Arteriosclerosis is a formation of clots in the inner lining of the arteries. d. Atherosclerosis is a formation of clots in the inner lining of the arteries.
b. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age.
A patient has returned to the nursing unit after having a percutaneous coronary intervention (PCI) in the hospital's cardiac catheterization laboratory. The nurse who is providing care for this patient should prioritize what assessment? a. Assessing the patient's capillary refill time and peripheral pulses b. Assessing the patient for signs and symptoms of hemorrhage c. Assessing the patient for signs and symptoms of acute renal failure d. Assessing the patient for signs and symptoms of infection
b. Assessing the patient for signs and symptoms of hemorrhage
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.) a. It is relieved by rest and inactivity. b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms. e. It subsides after taking nitroglycerin.
b. It is substernal in location. c. It is sudden in onset and prolonged in duration. d. It is viselike and radiates to the shoulders and arms.
A 45-year-old adult male patient is admitted to emergency after he developed unrelieved chest pain that was present for approximately 20 minutes before he presented to the emergency department. The patient has been subsequently diagnosed with a myocardial infarction (MI). To minimize cardiac damage, what health care provider's order will the nurse expect to see for this patient? a. Thrombolytics, oxygen administration, and bed rest b. Morphine sulfate, oxygen administration, and bed rest c. Oxygen administration, anticoagulants, and bed rest d. Bed rest, albuterol nebulizer treatments, and oxygen administration
b. Morphine sulfate, oxygen administration, and bed rest
After 2-hour onset of acute chest pain, the client is brought to the emergency department for evaluation. Elevation of which diagnostic findings would the nurse identify as suggestive of an acute myocardial infarction at this time? a. Troponin I b. Myoglobin c. WBC (white blood cell) count d. C-reactive protein
b. Myoglobin
what ECG findings does the nurse observe in a patient who has had an MI? (SAA) a. an absent P wave b. an abnormal Q wave c. T wave insertion d. ST segment elevation e. prolonged PR interval
b. an abnormal Q wave c. T wave insertion d. ST segment elevation
the nurse administers propranolol hydrochloride to a patient with a heart rate of 64bpm. an hour later, the nurse observes the heart rate to be 36bpm. what medication should the nurse prepare to administer that is an antidote for the propranolol? a. digoxin b. atropine c. protamine sulfate d. sodium nitroprisside
b. atropine
the nurse is reviewing the lab results for a patient having a suspected MI. what cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? a. alkaline phosphatase b. creatine kinase (CK-MB) c. myoglobin d. troponin
b. creatine kinase (CK-MB)
The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is a. low b. high c. normal d. extremely high
b. high
the nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and an MI. how should the nurse describe the pain experienced during a MI? a. it is relieved by rest and inactivity b. it is substernal in location c. it is sudden in onset and prolonged in duration d. it is viselike and radiates to the shoulders and arms e. it subsides after taking nitro
b. it is substernal in location c. it is sudden in onset and prolonged in duration d. it is viselike and radiates to the shoulders and arms
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: a. amantadine (Symmetrel). b. nitroglycerin (Nitrostat). c. digoxin (Lanoxin). d. diphenhydramine (Benadryl).
b. nitroglycerin (Nitrostat).
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a.) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol." b.) "Client will verbalize the intention to stop smoking." c.) "Client will verbalize the intention to avoid exercise." d.) "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours."
b.) "Client will verbalize the intention to stop smoking."
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? a.) "The pain resolved after I ate a sandwich." b.) "The pain occurred while I was mowing the lawn." c.) "The pain lasted about 45 minutes." d.) "The pain got worse when I took a deep breath."
b.) "The pain occurred while I was mowing the lawn."
Following a percutaneous transluminal coronary angioplasty, a client is monitored in the postprocedure unit. The client's heparin infusion was stopped 2 hours earlier. There is no evidence of bleeding or hematoma at the insertion site, and the pressure device is removed. The nurse should plan to remove the femoral sheath when the partial thromboplastin time (PTT) is: a.) 100 seconds or less. b.) 50 seconds or less. c.) 75 seconds or less. d.) 125 seconds or less.
b.) 50 seconds or less.
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 (MI)? a.) 9 days b.) 60 minutes c.) 6 to 12 months d.) 30 minutes
b.) 60 minutes
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse? a.) Minimal oozing of blood from the IV site b.) Altered level of consciousness c.) Chest pain: 2 of 10 (1-to-10 pain scale) d.) Presence of reperfusion dysrhythmias
b.) Altered level of consciousness
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? a.) Avoid fatty foods and exercise. b.) Avoid situations that contribute to ischemic episodes. c.) Take over-the-counter decongestants. d.) Report changes in the usual pattern of chest pain.
b.) Avoid situations that contribute to ischemic episodes.
A patient has had cardiac surgery and is being monitored in the intensive care unit (ICU). What complication should the nurse monitor for that is associated with an alteration in preload? a.) Hypothermia b.) Cardiac tamponade c.) Elevated central venous pressure d.) Hypertension
b.) Cardiac tamponade
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. a.) Dress warmly. Blood circulation may be reduced in the extremities. b.) Don't suddenly stop taking the medication without calling your health care provider. c.) If dizziness occurs, adjust the medication. d.) Take the medication at the same time each day.
b.) 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? a.) Absent Q wave b.) Elevated ST segment c.) Prolonged PR interval d.) Widened QRS complex
b.) Elevated ST segment
The nurse is caring for a patient newly diagnosed with coronary artery disease (CAD). While developing a teaching plan for the patient to address modifiable risk factors for CAD, the nurse will include which of the following? Select all that apply. a.) Alcohol use b.) Elevated blood pressure c.) Drug use d.) Decreased LDL level e.) Obesity
b.) Elevated blood pressure e.) Obesity
A female client returns for a follow-up visit to the cardiologist 4 days after a trip to the ED for sudden shortness of breath and abdominal pain. The nurse realizes the client had a myocardial infarction because the results from the blood work drawn in the hospital shows: a.) Decreased myoglobin levels b.) Elevated troponin levels c.) Decreased LDH levels d.) Increased C-reactive protein levels
b.) Elevated troponin levels
A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? a.) Blood vessels b.) Heart c.) Bronchi d.) Uterus
b.) Heart
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? a.) Hemoglobin of 16 g/dL b.) Hematocrit of 30% c.) Heart rate of 87 bpm d.) Blood pressure of 129/72 mm Hg
b.) Hematocrit of 30%
A 62-year-old male client who works as a stockbroker reports chest pain and palpitations during and after his morning jogs. The client's family history includes CAD. His lipid profile reveals his LDL level to be 122 mg/dL. The nurse is aware that this client has which of the following? a.) Normal LDL level b.) High LDL level c.) Fasting LDL level d.) Low LDL level
b.) High LDL level
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? a.) Hypertension b.) Hypotension c.) Urinary incontinence d.) Hyperactive bowel sounds
b.) Hypotension
A client with venous insufficiency is instructed to exercise, apply elastic stockings, and elevate the extremities. Which is the primary benefit for this nursing management regime? a.) Improve arterial flow b.) Improve venous return c.) Strengthen venous valves d.) Increase venous congestion
b.) Improve venous return
A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? a.) Gastrointestinal distress b.) Increased liver enzymes c.) Hyperglycemia d.) Hyperuricemia
b.) Increased liver enzymes
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? a.) Hypothermia b.) Pericardial friction rub c.) Decreased erythrocyte sedimentation rate (ESR) d.) Decreased white blood cell (WBC) count
b.) 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. a.) Bilateral rales and rhonchi b.) Potassium level of 6 mEq/L c.) Serum glucose of 124 mg/dL d.) Weight gain of 6 ounces
b.) Potassium level of 6 mEq/L
A nurse is assigned to care for a recently admitted patient who has been diagnosed with refractory angina. Before meeting the patient, the nurse expects her to exhibit the following symptoms: a.) Predictable and consistent pain that occurs on exertion and is relieved by rest b.) Severe, incapacitating chest pain c.) Pain that may occur at rest, but the threshold for pain is lower than expected d.) Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina
b.) Severe, incapacitating chest pain
During his annual physical exam, a 62-year-old male client reports experiencing chest pain and palpitations during and after his morning jogs. Family history reveals coronary artery disease. The nurse should instruct the client in the following to reduce the client's cardiac risk? a.) Exercise avoidance b.) Smoking cessation c.) Antioxidant supplements d.) Protein-rich diet
b.) Smoking cessation
The nurse is providing education about angina pectoris to a hospitalized client who is about to be discharged. The nurse includes which of the following information about managing this condition? Choose all that apply. a.) Follow a diet high in saturated fats. b.) Stop smoking. c.) Carry nitroglycerin at all times. d.) Avoid all physical activity. e.) Balance rest with activity.
b.) Stop smoking. c.) Carry nitroglycerin at all times. e.) Balance rest with activity.
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)? a.) The patient has compromised left ventricular function. b.) The patient has at least a 70% occlusion of a major coronary artery. c.) The patient has an ejection fraction of 65%. d.) The patient has had angina longer than 3 years.
b.) The patient has at least a 70% occlusion of a major coronary artery.
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. a.) Race b.) Tobacco use c.) Hyperlipidemia d.) Obesity e.) Gender
b.) Tobacco use c.) Hyperlipidemia d.) Obesity
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? a.) Intractable b.) Unstable c.) Variant d.) Refractory
b.) Unstable
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of: a.) skeletal muscle damage due to a recent fall. b.) myocardial necrosis. c.) cerebral bleeding. d.) I.M. injection.
b.) myocardial necrosis.
The nurse is caring for a client with an elevated blood pressure and no previous history of hypertension. At 0900, the blood pressure was 158/90 mm Hg. At 0930, the blood pressure is 142/82 mm Hg. The nurse is most correct when relating the fall in blood pressure to which structure? a) Chemoreceptors b) Sympathetic nerve fibers c) Baroreceptors d) Vagus nerve
baroreceptors
A patient receiving fibrinolytic therapy is at risk for complications associated with
bleeding.
Which of the following complications would the nurse assess for in a patient that just receivied a PTCA? a. bleeding, embolus, and dissection b. infection, bleeding and insufficient airway clearance c. raynaud's phenomen, bleeding and thrombi d. hypotension, CVA, nocturia
infection, bleeding and insufficient airway clearance
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? a) Internal bleeding b) Thrombocytopenia c) Worsening angina d) Formation of blood clots
c) Worsening angina
A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? a. "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." b. "Client will verbalize the intention to avoid exercise." c. "Client will verbalize the intention to stop smoking." d. "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."
c. "Client will verbalize the intention to stop smoking."
Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal? a. .25 to .75 b. .75 to 1.5 c. 2.0 to 2.5 d. 2.5 to 3.0
c. 2.0 to 2.5
Which assessment finding by the nurse is the most significant finding suggestive of aortic aneurysm? a. High blood pressure b. Severe back pain c. Abdomen bruit d. Nausea and vomiting
c. Abdomen bruit
You are caring for a client with CAD. What is an appropriate nursing action when evaluating a client with coronary artery disease (CAD)? a. Assess the client's mental and emotional status. b. Assess the skin of the client. c. Assess the characteristics of chest pain. d. Assess for any kind of drug abuse.
c. Assess the characteristics of chest pain.
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? a. Coronary thrombosis b. Arteriosclerosis c. Atherosclerosis d. Raynaud's disease
c. Atherosclerosis
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? a. Amlodipine b. Diltiazem c. Clopidogrel d. Felodipine
c. Clopidogrel
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? a. cholesterol, 280mg/dL b. LDL, 160mg/dL c. HDL, 80mg/dL d. a ratio of LDL to HDL, 4.5 to 1.0
c. HDL, 80mg/dL
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? a. Cholesterol, 280 mg/dL b. Low density lipoprotein (LDL), 160 mg/dL c. High-density lipoprotein (HDL), 80 mg/dL d. A ratio of LDL to HDL, 4.5 to 1.0
c. High-density lipoprotein (HDL), 80 mg/dL
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? a. Ca b. Mg c. K d. Na
c. K
Which technique is used to surgically revascularize the myocardium? a. Balloon bypass b. Peripheral bypass c. Minimally invasive direct coronary bypass d. Gastric bypass
c. Minimally invasive direct coronary bypass
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? a. Isosorbide mononitrate (Isordil) b. Meperidine hydrochloride (Demerol) c. Morphine sulfate (Morphine) d. Nitroglycerin transdermal patch
c. Morphine sulfate (Morphine)
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? a. Creatinine kinase-myocardial band (CK-MB) b. Total creatinine kinase (CK) c. Myoglobin d. Troponin I and T
c. Myoglobin
A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction? a. Cyanosis b. Gangrene c. Pallor d. Clubbing of the fingers
c. Pallor
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: a. Described as crushing and substernal b. Associated with nausea and vomiting c. Relieved by rest and nitroglycerin d. Accompanied by diaphoresis and dyspnea
c. Relieved by rest and nitroglycerin
A nurse is assigned to care for a recently admitted patient who has been diagnosed with refractory angina. Before meeting the patient, the nurse expects her to exhibit the following symptoms: a. Predictable and consistent pain that occurs on exertion and is relieved by rest b. Pain that may occur at rest, but the threshold for pain is lower than expected c. Severe, incapacitating chest pain d. Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina
c. Severe, incapacitating chest pain
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: a. activities that increase myocardial oxygen demand. b. an unpredictable amount of activity. c. coronary artery spasm. d. the same type of activity that caused previous angina episodes.
c. coronary artery spasm.
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: a. nausea, vomiting, depression, fatigue, and impotence. b. sedation, nausea, vomiting, constipation, and respiratory depression. c. headache, hypotension, dizziness, and flushing. d. flushing, dizziness, headache, and pedal edema.
c. headache, hypotension, dizziness, and flushing.
the nurse is caring for a patient who is having chest pain associated with an MI. what medication should the nurse administer IV to reduce pain and anxiety? a. meterpidine hydrochloride b. hydromorphone hydrochloride c. morphine sulfate d. codeine sulphate
c. morphine sulfate
A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? a. recent consumption of a meal b. shellfish allergy c. prior intracranial hemorrhage d. use of heparin
c. prior intracranial hemorrhage
the nurse is educating the patient about administering nitro prior to discharge. what info should the nurse include in the instructions? a. take a nitro and if the pain is not relieved, drive to the nearest ED b. take 2 nitros and if the pain is not relieved, go to the nearest ED c. take a nitro and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. if the pain is not relieved, activate the emergency medical system d. take 2 nitros every 10 minutes until a total of 6 pills are taken. if pain is not relieved, activate the emergency medical system
c. take a nitro and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. if the pain is not relieved, activate the emergency medical system
his patient requires immediate
invasive therapy or fibrinolytic medications.
a patient with CAD is having a cardiac catheterization. what indicator is present for the patient to have a percutaneous transluminal coronary angioplasty (PTCA)? a. the patient has compromised left ventricular function b. the patient has had angina longer than 3 years c. the patient has at least a 70% occlusion of a major artery d. the patient has an ejection fraction of 65%
c. the patient has at least a 70% occlusion of a major artery
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? a.) "A burning sensation after administration indicates that the nitroglycerin tablets are potent." b.) "Replace leftover sublingual nitroglycerin tablets every 9 months to make sure your pills are fresh." c.) "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." d.) "You may take a sublingual nitroglycerin tablet every 30 minutes, if needed. You may take as many as four doses."
c.) "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? a.) "My vision is blurred, so my blood pressure must be up." b.) "I feel a tingling sensation around my mouth." c.) "My chest pain is decreasing." d.) "I have a bad headache."
c.) "My chest pain is decreasing."
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? a.) Decrease anticoagulant or antiplatelet therapy. b.) Notify the health care provider. c.) Apply manual pressure at the site of the insertion of the sheath. d.) Review the results of the latest blood cell count, especially the hemoglobin and hematocrit.
c.) Apply manual pressure at the site of the insertion of the sheath.
You are caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD? a.) Assess for any kind of drug abuse. b.) Assess the client's mental and emotional status. c.) Assess the characteristics of chest pain. d.) Assess the skin of the client.
c.) Assess the characteristics of chest pain.
You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a.) Raynaud's disease b.) Arteriosclerosis c.) Atherosclerosis d.) Coronary thrombosis
c.) Atherosclerosis
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? a.) Protamine sulfate b.) Digoxin c.) Atropine d.) Sodium nitroprusside
c.) Atropine
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? a.) Measure the blood pressure for hypertension. b.) Check the radial pulse for arrhythmias. c.) Count the respiratory rate for bradypnea. d.) Measure urinary output for dehydration.
c.) Count the respiratory rate for bradypnea.
A client is recovering from coronary artery bypass graft (CABG) surgery. The nurse knows that for several weeks after this procedure, the client is at risk for certain conditions. During discharge preparation, the nurse should advise the client and his family to expect which common symptom that typically resolves spontaneously? a.) Dizziness b.) Memory lapses c.) Depression d.) Ankle edema
c.) Depression
A patient presents to the emergency room with characteristics of atherosclerosis. What characteristics would the patient display? a.) Cholesterol plugs in the lumen of veins b.) Blood clots in the arteries c.) Fatty deposits in the lumen of arteries d.) Emboli in the veins
c.) Fatty deposits in the lumen of arteries
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? a.) A ratio of LDL to HDL, 4.5 to 1.0 b.) Cholesterol, 280 mg/dL c.) High-density lipoprotein (HDL), 80 mg/dL d.) Low density lipoprotein (LDL), 160 mg/dL
c.) High-density lipoprotein (HDL), 80 mg/dL
A patient diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapies. Which of the following statements reflect a goal of rehabilitation for the patient with an MI? a.) Limitation of the effects and progression of atherosclerosis b.) Ability to return the patient to work and a preillness functional capacity c.) Improvement the quality of life d.) Prevention of another cardiac event
c.) Improvement the quality of life
Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? a.) Adequate vital capacity. b.) Acceptable arterial blood gas (ABG) values. c.) Inability to speak. d.) Adequate cough and gag reflex.
c.) Inability to speak.
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: a.) Anuria b.) Overhydration c.) Inadequate fluid volume d.) Normal glomerular filtration
c.) Inadequate fluid volume
A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? a.) Restrict alcohol intake to two drinks per day. b.) Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. c.) Lie down or sit in a chair for 5 to 10 minutes after taking the drug. d.) Store the drug in a cool, well-lit place.
c.) Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? a.) Decreased heart rate b.) High blood pressure c.) Low blood pressure d.) Elevated hematocrit
c.) Low blood pressure
The nurse is caring for a patient presenting to the emergency department (ED) complaining of chest pain. Which of the following electrocardiographic (ECG) findings would be most concerning to the nurse? a.) Sinus tachycardia b.) Frequent premature atrial contractions (PACs) c.) ST elevations d.) Isolated premature ventricular contractions (PVCs)
c.) ST elevations
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? a.) To decrease homocysteine levels b.) To dilate coronary arteries c.) To decrease workload of the heart d.) To prevent angiotensin II conversion
c.) To decrease workload of the heart
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? a.) Within 5 to 7 days b.) Within 24 to 48 hours c.) Within 6 hours d.) Within 12 hours
c.) Within 6 hours
The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to: a.) administer sublingual nitroglycerin. b.) educate the client about his symptoms. c.) enhance myocardial oxygenation. d.) decrease anxiety.
c.) enhance myocardial oxygenation.
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: a.) lactate dehydrogenase. b.) myoglobin. c.) troponin. d.) creatine kinase.
c.) troponin.
A 56-year-old male client with CAD kept his appointment to see a cardiologist for posthospitalization follow up. The client indicates that he thinks the diltiazem (Cardizem) has been making him nauseous. The nurse is aware that diltiazem (Cardizem) is categorized as which type of drug? a) Nitrates b) Diuretics c) Calcium-channel blockers d) Beta-adrenergic blockers
calcium channel blockers
A patient with pulmonary hypertension has a positive vasoreactivity test. What medication does the nurse anticipate administering to this patient? a) Angiotensin converting enzyme inhibitor b) Angiotensin receptor blockers c) Calcium channel blockers d) Beta blockers
calcium channel blockers
A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? a) Attach a pulse oximeter probe and obtain values. b) Call for a chest x-ray. c) Observe for mist in the endotracheal tube. d) Listen for breath sounds over the epigastrium.
call chest for x ray
Troponin I and T are specific for
cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury.
A client is admitted to the ED with chest pain that is consistent with myocardial infarction based on elevated troponin levels. Heart sounds are normal and vital signs are noted on the client's chart. The nurse should alert the healthcare provider because theres changes are most with which complication? P: 92, 96, 104, 118 R: 24, 26, 28, 32 BP: 140/88 128/82, 104/68, 88/58 a) cardiogeneic shock b) cardiac tamponade c) pulmonary embolism d) dissescting thoracic aortic aneurysm
cardiogenic shock
a client is wearing a continous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse? a. call a code. b. call a health care provider c. check the client's status and lead placement. d. press the recorder button on the electrocardiogram console.
check the client's status and lead placement.
IV nitroglycerin is given to alleviate
chest pain.
Replacement fluids such as
colloids, packed red blood cells, or crystalloid solutions may be prescribed.
Digoxin is used to treat a. rheumatic heart b. angina c. myocardial infarcation d. congestive heart failure
congestive heart failure
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? a) Uncontrolled restlessness b) Constant chest pain c) Fatigue lasting more than 1 month d) Dyspnea
constant chest pain
When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Oral b) Continuous IV infusion c) Sublingual d) Intramuscular
continous IV fusion
The nurse is reevaluating a patient 2 hours following a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which of the following assessment findings may indicate the patient is experiencing a complication of the procedure? a.) Potassium level of 4.0 mE/qL b.) Heart rate of 100 bpm c.) Dried blood at the puncture site d.) Urine output of 40 mL
d.) Urine output of 40 mL
Hypertension, obesity, hyperlipidemia, tobacco use, diabetes mellitus, metabolic syndrome, and physical inactivity are modifiable risk factor for
coronary artery disease CAD.
Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by
coronary artery vasospasm.
The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit? a) Count the heart rate at the apex. b) Count the radial pulse for 20 to 25 seconds. c) Calculate the pauses between pulsations. d) Calculate the palpated volume.
count the heart rate at the apex
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds? a. stridor b. crackles c. scattered rhonchi d. diminished breath sounds
crackles
Unstable angina is also called
crescendo or preinfarction angina and indicates the need for a change in treatment.
A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection? a) Calan b) Procardia c) Cyclosporine d) Vancocin
cyclosporine
This classification of medication, beta-adrenergic blocking agents also reduces the incidence of
recurrent angina, infarction, and cardiac mortality. Generally the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm.
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? a) Blood pressure of 129/72 mm Hg b) Heart rate of 87 bpm c) Hemoglobin of 16 g/dL d) Hematocrit of 30%
d) Hematocrit of 30%
Which of the following is inconsistent as a condition related to metabolic syndrome? a) Insulin resistance b) Dyslipidemia c) Abdominal obesity d) Hypotension
d) Hypotension
Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority? a. Risk for imbalanced body temperature b. Decreased cardiac output c. Anxiety d. Acute pain
d. Acute pain
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? a. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. b. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician. c. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. d. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
d. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
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? a. Blood pressure of 129/72 mm Hg b. Heart rate of 87 bpm c. Hemoglobin of 16 g/dL d. Hematocrit of 30%
d. Hematocrit of 30%
In arteriosclerosis, commonly referred to as hardening of the arteries, the rigid arterial vessels fail to stretch. This has the potential for what? a. Decreasing the flow of unoxygenated blood through the body b. Slowing the flow of blood throughout the body c. Increasing the flow of blood throughout the body d. Sending a reduced volume of oxygenated blood to the major organs of the body
d. Sending a reduced volume of oxygenated blood to the major organs of the body
A client was transferring a load of fire wood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which orders by the physician? a. Streptokinase, aspirin, and morphine administration b. Morphine administration, stress testing, and admission to the cardiac care unit c. Serial liver enzyme testing, telemetry, and a lidocaine infusion d. Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
d. Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? a. Inform client of diagnostic tests. b. Remove hair from skin insertion sites. c. Assess distal pulses. d. Withhold anticoagulant therapy.
d. Withhold anticoagulant therapy.
During the insertion of a rigid scope for bronchoscopy, a client experiences a vasovagal response. The nurse should expect: a. the client's pupils to become dilated. b. the client to experience bronchodilation. c. a decrease in the client's gastric secretions. d. a drop in the client's heart rate.
d. a drop in the client's heart rate.
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: a. silent b. stable c. intractable d. variant
d. variant
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: a.) Intractable b.) Silent c.) Stable d.) Variant
d.) Variant
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? a.) Thrombocytopenia b.) Formation of blood clots c.) Internal bleeding d.) Worsening angina
d.) Worsening angina
The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation provided by the nurse? a.) "Arteriosclerosis is when the vessels become dilated and weakened,whereas atherosclerosis is the deposit of fatty substances in the vessel lining." b.) "Atherosclerosis and arteriosclerosis are disorders in which the lining of the vessels become narrowed due to plaque formation." c.) "Arteriosclerosis and atherosclerosis are the same disorder. The terms are interchangeable." d.) "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis."
d.) "Arteriosclerosis is a condition that produces structural changes in the arteries, and atherosclerosis is a specific type of arteriosclerosis."
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? a.) 210-240 mg/dL b.) 280-300 mg/dL c.) 250-275 mg/dL d.) 160-190 mg/dL
d.) 160-190 mg/dL
Shortly after being admitted to the coronary care unit with an acute myocardial infarction (MI), a client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6° F (37.6° C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. Which nursing diagnosis takes highest priority? a.) Anxiety b) .Risk for imbalanced body temperature c.) Decreased cardiac output d.) Acute pain
d.) Acute pain
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? a.) Assess the physical history of the patient b.) Not important to assess the patient or to notify the physician c.) Assess the blood pressure and administer aspirin d.) Assess chest pain and administer prescribed drugs and oxygen
d.) Assess chest pain and administer prescribed drugs and oxygen
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? a.) Temperature of 100.2° F (37.9° C) b.) Respiration 26 breaths/minute c.) Pulse rate of 84 beats/minute d.) Blood pressure 84/52 mm Hg
d.) Blood pressure 84/52 mm Hg
A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse? a.) Pain score: 5/10. b.) Heart rate: 66 bpm c.) Blood pressure: 110/68 mmHg d.) CVP reading: 1 mmHg
d.) CVP reading: 1 mmHg
A 56-year-old male client with CAD kept his appointment to see a cardiologist for posthospitalization follow up. The client indicates that he thinks the diltiazem (Cardizem) has been making him nauseous. The nurse is aware that diltiazem (Cardizem) is categorized as which type of drug? a.) Nitrates b.) Diuretics c.) Beta-adrenergic blockers d.) Calcium-channel blockers
d.) Calcium-channel blockers
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? a.) Raynaud's disease b.) Venous occlusive disease c.) Cardiogenic shock d.) Coronary artery disease
d.) Coronary artery disease
An 80-year-old male client who has been informed by his physician that he has arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is a: a.) Vascular occlusive disease b.) High level of blood fat c.) Condition in which the lumen of arteries fill with plaque d.) Expected part of the aging process
d.) Expected part of the aging process
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a.) Statin b.) Aspirin c.) Angiotensin-converting enzyme (ACE) inhibitor d.) Morphine IV
d.) Morphine IV
A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a.) Ativan 1 mg orally b.) Serum electrolytes c.) Chest x-ray d.) Nitroglycerin SL
d.) Nitroglycerin SL
The nurse recognizes that the treatment for a non-ST elevation myocardial infarction (NSTEMI) differs from that of a patient with a STEMI, in that a STEMI is more frequently treated with which of the following? a.) IV heparin b.) Thrombolytics c.) IV nitroglycerin d.) Percutaneous coronary intervention (PCI)
d.) Percutaneous coronary intervention (PCI)
A client has had oral anticoagulation ordered. What should you monitor for when your client is taking oral anticoagulation? a.) Hourly IV infusion b.) Vascular sites for bleeding c.) Urine output d.) Prothrombin time (PT) or international normalized ratio (INR)
d.) Prothrombin time (PT) or international normalized ratio (INR)
A client is being evaluated for coronary artery disease (CAD) and is scheduled for an electron beam computed tomography. The nurse understands that the primary advantage of this radiologic test is which of the following? a.) Clear images b.) Less exposure to radiation c.) Less invasive procedure d.) Quantifies calcified plaque
d.) Quantifies calcified plaque
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: a.) Described as crushing and substernal b.) Accompanied by diaphoresis and dyspnea c.) Associated with nausea and vomiting d.) Relieved by rest and nitroglycerin
d.) Relieved by rest and nitroglycerin
The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a.) Myoglobin b.) CK-MB c.) Total CK d.) Troponin
d.) Troponin
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: a.) penicillin V or erythromycin (E-Mycin). b.) pentoxifylline (Trental) or acetaminophen (Tylenol). c.) aspirin or acetaminophen (Tylenol). d.) aspirin or clopidogrel (Plavix).
d.) 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: a.) an unpredictable amount of activity. b.) activities that increase myocardial oxygen demand. c.) the same type of activity that caused previous angina episodes. d.) coronary artery spasm.
d.) coronary artery spasm.
Hypovolemia is the most common cause of
decreased cardiac output after cardiac surgery.
The nurse is caring for a client who has been receiving IV dieurectics suspects the client is experiencing a fluid volume deficit. Which assessment finding would the nurse note in a client with this condition? a. lung congestion b. decreased heamtocrit c. increase blood pressure d. decreased central venous pressure
decreased central venous pressure
The client has been managing angina episodes with nitroglycerin. Which finding indicates that the therapeutic effect of the drug has been achieved? a) increased blood pressure b) decreased chest pain c) decreased blood pressure d) decreased heart rate
decreased chest pain Correct Explanation: Nitroglycerin acts to decrease myocardial oxygen consumption. Vasodilation makes it easier for the heart to eject blood, resulting in decreased oxygen needs. Decreased oxygen demand reduces pain caused by heart muscle not receiving sufficient oxygen. While blood pressure may decrease ever so slightly due to the vasodilation effects of nitroglycerine, it is only secondary and not related to the angina the client is experiencing. Increased blood pressure would mean the heart would work harder, increasing oxygen demand and thus angina. Decreased heart rate is not an effect of nitroglycerine.
For both outpatients and inpatients scheduled for diagnostic procedures of the cardiovascular system, the nurse performs a thorough initial assessment to establish accurate baseline data. Which of the following data is necessary to collect if the patient is experiencing chest pain? a) Description of the pain b) Sound of the apical pulses c) Pulse rate in upper extremities d) Blood pressure in the left arm
description of the pain
A thrombolytic works by a. thinning blood b. increasing clottng c. destroying platelets d. destroying thrombus
destroying thrombus
The nurse is caring for a patient diagnosed with myocarditis. The nurse must be aware that patients with myocarditis are sensitive to which of the following medications? a) Penicillin b) Digoxin c) Corticosteroids d) Lasix
digoxin
Patient with myocarditis are sensitive to which of the following medications? a) Lasix b) Penicillin c) Digoxin d) Corticosteroids
digozxin
You are doing the final checklist before sending home a 63-year-old female who has been newly diagnosed with hypertension. She is going to be starting her first antihypertensive medicine. What is one of the main things you should tell her and her husband to watch for? a) Blurred vision b) Dizziness c) Persistent cough d) Tremor
dizziness
A client whose condition remains stable after a myocardial infarction gradually increases activity. To determine whether the activity is appropriate for the client the nurse should assess the client for: a) cyanosis. b) edema. c) dyspnea. d) weight loss.
dyspnea. Correct Explanation: Physical activity is gradually increased after a myocardial infarction while the client is still hospitalized and through a period of rehabilitation. The client is progressing too rapidly if activity significantly changes respirations, causing dyspnea, chest pain, a rapid heartbeat, or fatigue. When any of these symptoms appears, the client should reduce activity and progress more slowly. Edema suggests a circulatory problem that must be addressed but does not necessarily indicate overexertion. Cyanosis indicates reduced oxygen-carrying capacity of red blood cells and indicates a severe pathology. It is not appropriate to use cyanosis as an indicator for overexertion. Weight loss indicates several factors but not overexertion.
Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion of lidocaine. To monitor the effectiveness of the intervention, the nurse should focus primarily on the client's: a) creatine kinase (CK) and troponin levels. b) electrocardiogram (ECG). c) urine output. d) blood pressure and heart rate.
electrocardiogram (ECG).
Within the heart, several structures and several layers all play a part in protecting the heart muscle and maintaining cardiac function. The inner layer of the heart is composed of a thin, smooth layer of cells, the folds of which form heart valves. What is the name of this layer of cardiac tissue? a) Myocardium b) Endocardium c) Pericardium d) Epicardium
endocardium
You are monitoring the results of laboratory tests performed on a client admitted to the cardiac ICU with a diagnosis of myocardial infarction. Which test would you expect to show elevated levels? a) Enzymes b) WBC c) Platelets d) RBC
enzymes
A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have? a) Essential (primary) b) Pathologic c) Secondary d) Malignant
essential (primary)
Overall, cardiac rehabilitation is a complete program dedicated to
extending and improving quality of life.
The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse? a) Fatigue b) Syncope c) Dizziness d) Extra heart sound
extra heart sound
Which of the following symptoms should the nurse expect to find as an early symptom of chronic heart failure? a) Pedal edema b) Irregular pulse c) Fatigue d) Nocturia
fatigue
Side effects of nitroglycerin includes
flushing, throbbing headache, hypotension, and tachycardia.
It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because a) gradual changes in position help reduce the heart's work to resupply oxygen to the brain. b) gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. c) gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain. d) gradual changes in position help reduce the blood pressure to resupply oxygen to the brain.
gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.
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. Explanation: Headache, hypotension, dizziness, and flushing are classic adverse effects of nitroglycerin, a vasodilator. Vasodilators, beta-adrenergic blockers, and calcium channel blockers are three major classes of drugs used to treat angina pectoris. Nausea, vomiting, depression, fatigue, and impotence are adverse effects of propranolol, a beta-adrenergic blocker. Sedation, nausea, vomiting, constipation, and respiratory depression are common adverse effects of morphine, an opioid analgesic that relieves pain associated with acute myocardial infarction. Flushing, dizziness, headache, and pedal edema are common adverse effects of nifedipine, a calcium channel blocker.
6. What recurring condition most commonly occurs with cardiomyopathy? a. Heart failure b. Diabetes Mellitus c. Myocardial infarction d. Pericardial effusion
heart failure
During assessment of a 63-year-old retired mechanic, the nurse notes and documents an S3 heart sound. The nurse knows that this sound is an abnormal sound suggestive of: a) Heart failure. b) Congenital heart disease. c) Aortic stenosis. d) Coronary artery disease.
heart failure
The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) a) Heart rate b) Character of apical and peripheral pulses c) Heart rhythm d) Lung sounds e) Respiratory rate
heart rate character of apical and peripheral pulses heart rhythm
Nitroglycerin is volatile and is inactivated by
heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency.
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? a) Heart rate of 87 bpm b) Blood pressure of 129/72 mm Hg c) Hemoglobin of 16 g/dL d) Hematocrit of 30%
hematocrit of 30%
The nurse is a client with heart failure who is receiving high dose diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, diminished deep tendon reflexes. The nurse suspects hypoantremia. What aditional signs would the nurse expect to notice in a client with hyponatremia? a. muscle twitches b. decreased urinary output c. hyperactive bowel sounds d. increases specific gravity in urine
hyperactive bowel sounds
Which of the following would be inconsistent as a component of metabolic syndrome? a) Hypertension b) Abdominal obesity c) Hypotension d) Elevated triglyceride levels
hypotension
Hypomagnesemia would likely be demonstrated by
hypotension, lethargy, and vasodilation.
Altered level of consciousness may indicate
hypoxia and intracranial bleeding and the infusion should be discontinued immediately.
Mr T. is a 68 yo male who is admitted to the ICU after his first CABG surgery. His nurse has identified the following nursing diagnoses for him. Which would be the priority? a. infeffective temperature regulation b. impaired gas exchange c. risk for fluid volume imbalance d. decreaed cardiac output
impaired gas exchange
Application of a vascular closure device (Angioseal, VasoSeal), direct manual pressure to the sheath introduction site, and application of a mechanical compression device (C-shaped clamp) are all appropriate methods used to
induce hemostasis following peripheral sheath removal.
Within the physiology of the heart, each chamber has a particular role in maintaining cellular oxygenation. Which chamber of the heart is responsible for receiving oxygenated blood from the lungs? a) Left ventricle b) Left atrium c) Right ventricle d) Right atrium
left atrium
A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? a) High blood pressure b) Low blood pressure c) Elevated hematocrit d) Decreased heart rate
low blood pressure
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. a) Triglycerides b) High-density lipoproteins (HDL) c) Low-density lipoproteins (LDL) d) Total cholesterol
low-density lipoproteins (LDL)
Hyperkalemia is indicated by
mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves).
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is schedukled for cardiac catherization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure. a) regular insulin b) glipizide (glucotrol) c) repaglinide (prandin) d) metformin (glucophage)
metformin (glucophage)
Nicotinic acids is prescribed for patients with
minimally elevated cholesterol and LDL levels or as an adjunct to a statin when the lipid goal has not been has not been achieved and triglyceride (TG) levels are elevated.
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a) Aspirin b) Morphine IV c) Statin d) Angiotensin-converting enzyme (ACE) inhibitor
morphine IV
Complications that may occur following a PTCA include
myocardial ischemia, bleeding and hematoma formation, retroperitoneal hematoma, arterial occlusion, pseudoaneurysm formation, arteriovenous fistula formation, and acute renal failure.
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:
myocardial necrosis. An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
Creatine kinase-MB isoenzyme (CK-MB) can increase as a result of:
myocardial necrosis. Explanation: An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injury, such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
A serum potassium level of 4.0 mEq/L is within
normal range.
The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure is 0.0 second. Overall heart rate is 64bpm. What correct interpretation based on these characteristics? a. sinus bradycardia b. sick sinus syndrome c. normal sinus rhythm d. first degree heart block
normal sinus rhythm
An increase in myoglobin is
not very specific in indicating an acute cardiac event; however, negative results are an excellent parameter for ruling out an acute MI.
Elevated CK-MB assessment by mass assay is an indicator
of acute MI; the levels begin to increase within a few hours and peak within 24 hours of an MI. If the area is reperfused (due to thrombotic therapy or PCI), it peaks earlier.
The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to
reduce the myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise.
The nurse is developing a discharge plan for a client who has had a myocardial infarction. Planning for discharge for this client should begin: a) four weeks after the onset of illness. b) on discharge from the hospital. c) on admission to the hospital. d) on discharge from the cardiac care unit.
on admission to the hospital. Correct Explanation: A basic principle of rehabilitation, including cardiac rehabilitation, is that rehabilitation begins on hospital admission. Early rehabilitation is essential to promote maximum functional ability as the client recovers from an illness. Delaying rehabilitation activities is associated with poorer client outcomes.
The nurse is providing discharge instructions to a client with unstable angina. The client is ordered Nitrostat 1/150 every 5 minutes as needed for angina. Which side effect, emphasized by the nurse, is common especially with the increased dosage? a) Dry mouth b) Orthostatic hypotension c) Nausea d) Rash
orthostatic hypotension
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 angina-producing activity, such as exercise, stair-climbing, or sexual intercourse), it is best taken before pain develops.
When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. angina b. hemoptysis. c. hypertension d. paroxysmal nocturnal dyspnea (PND).
paroxysmal nocturnal dyspnea (PND).
A test used to monitor heparin is a. complete blood count b. platelets c. partial thromboplastin time (PTT) d. prothrombin time (PT)
partial thromboplastin time (PTT)
The 60-minute interval is known as "door-to-balloon time" for performance of
percutaneous transluminal coronary angioplasty PTCA on a diagnosed MI patient.
A client is in sinus bradycardia, with a HR of 45, complains of dizziness and has a bP of 82/60 mm Hg. Which prescription should the nurse anticipate will be prescribed? a. defillibrate the client b. administer digoxin (lanoxin) c. continue to monitor the client d. prepare for transcutaneous pacing
prepare for transcutaneous pacing
An immediate objective of rehabilitation of the MI patient is to
prevent another cardiac event.
An anticoagulant works by a. thinning blood b. destroying platelets c. dissolving thrombus d. preventing thrombus
preventing thrombus
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for: a) dry mucous membranes. b) pulmonary crackles. c) high urine output. d) hypertension.
pulmonary crackles
Which valve lies between the right ventricle and the pulmonary artery? a) Mitral b) Tricuspid c) Chordae tendineae d) Pulmonic
pulmonic
Before discharge from the hospital after a myocardial infarction, a client is taught to exercise by gradually increasing the distance walked. Which vital sign should the nurse teach the client to monitor to determine whether to increase or decrease the exercise level? a) respiratory rate b) blood pressure c) pulse rate d) body temperature
pulse rate Correct Explanation: The client who is on a progressive exercise program at home after a myocardial infarction should be taught to monitor the pulse rate. The pulse rate can be expected to increase with exercise, but exercise should not be increased if the pulse rate increases more than about 25 bpm from baseline or exceeds 100 to 125 bpm. The client should also be taught to discontinue exercise if chest pain occurs.
A nurse reviewing a patient's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and has an increase in overall size and mass, especially along the septum. The ventricular walls are thickened reducing the size of the ventricular cavities. Several areas of the myocardium have evidence of scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy? a) Arrhythmogenic right ventricular cardiomyopathy b) Hypertrophic c) Dilated d) Restrictive
restrictive
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? a) Impaired memory b) Chronic pain c) Risk for infection d) Impaired gas exchange
risk for infection
Nitroglycerin is very unstable; it should be carried
securely in its original container (e.g., capped dark glass bottle); tablets should never be removed and stored in metal or plastic pillboxes.
A nurse is caring for a client with acute mitral regurgitation related to an acute myocardial infarction. The nurse knows to monitor the client carefully for symptoms of which initial complication or result? a) Infarcted bowel b) Severe heart failure c) Cerebral vascular accident (CVA) d) Kidney failure
severe heart failure
Intractable or refractory angina produces
severe, incapacitating chest pain that does not respond to conventional treatment.
The time frame of 9 days refers to the time for onset of vasculitis after administration of
streptokinase for thrombolysis in an acute MI patient.
The first signs of an acute MI are usually seen in
the T wave and ST segment. The T wave becomes inverted; the ST segment elevates (usually flat).
The nurse is caring for a patient with a diagnosis of pericarditis. Where does the nurse understand the inflammation is located? a) The heart's muscle fibers b) The inner lining of the heart and valves c) The thin fibrous sac encasing the heart d) The exterior layer of the heart
the thin fibrous sac encasing the heart
The nurse understands that an overall goal of hypertension management includes which of the following? a) There is no complaint of postural hypotension. b) There are no complaints of sexual dysfunction. c) There is no indication of target organ damage. d) The patient maintains a normal blood pressure reading.
there is no indication of target organ damage
A couple have presented to the healthcare provider for a follow up visit following the husbands myocardial infarction (MI) one week ago. The nurse knows that education on resuming intimate sexual contact should be discussed. Which of the following is correct regarding the timeline for returning to sexual intercourse? a) one month if no symptoms of chest pain b) three months if no symptoms of chest pain c) three weeks if no symptoms of chest pain d) one week if no symptoms of chest pain
three months if no symptoms of chest pain Explanation: Activities of daily living, including sexual activity, should be resumed gradually, and stressors such as overexertion, alcohol consumption, and emotional upheavals should be avoided. After an uncomplicated MI, sexual activity may begin at about the third week of recovery, beginning with masturbation to partial erection in the male. Generally, this activity is gradually increased until 3 months after the MI, when sexual intercourse may be resumed. Any chest pain that occurs should be discussed with the healthcare provider prior to resuming sexual intercourse.
The client is instructed to take Nitroglycerin
three tablets 5 minutes apart and if the chest pain is not relieved emergency medical services should be contacted.
Alteplase is a
thrombolytic agent.
The 30-minute interval is known as "door-to-needle time" for administration of
thrombolytics post MI.
The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a) Total CK b) Troponin c) Myoglobin d) CK-MB
troponin
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. This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase and myoglobin tests can show evidence of muscle injury, but they're less specific indicators of myocardial damage than troponin.
Protamine sulfate is known as the antagonist for
unfractionated heparin (it neutralizes heparin).
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? a) Intractable b) Variant c) Unstable d) Refractory
unstable
Which of the following is also termed preinfarction angina? a) Stable angina b) Variant angina c) Unstable angina d) Silent ischemia
unstable angina
A cliet with myocardial infarction is developing cardiogenic shock. Because of thee risk of myocardial ischemia, what condition should the nurse carefully assess for? a. bradycardia b. ventricular dysryhtmias c. rising diastolic blood pressure d. falling central venous pressure
ventricular dysryhtmias
The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery? a) Furosemide b) Aspirin c) Digoxin d) Warfarin
warfarin
Hyponatremia would likely be indicated by
weakness, fatigue, and confusion without change in T-wave formation.
An immediate objective of rehabilitation of the MI patient is to return the patient to
work and a preillness lifestyle.
A 62-year-old female who is 2 weeks CABG returns to her cardiologist due to new symptoms, including heaviness in her chest and pain between her breasts. She reports that leaning forward decreases the pain. The cardiologist admits her to the hospital to rule out pericarditis. Which of the following is a contributing cause to pericarditis? Select all that apply. a) Myocarditis b) Tuberculosis c) Cardiac surgery d) Chest trauma e) Pneumonia
• Cardiac surgery • Tuberculosis • Myocarditis • Chest trauma Explanation: Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or MI (heart attack) or develops after cardiac surgery.
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 Explanation: 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.
A client has been in the critical care unit for 3 days following a severe myocardial infarction. Although he is medically stable, he has begun to have fluctuating episodes of consciousness, illogical thinking, and anxiety. He is picking at the air to "catch these baby angels flying around my head." While waiting for medical and psychiatric consults, which needs have the highest priority? Select all that apply. a) calling the client's family to report his onset of dementia b) decreasing as much "foreign" stimuli as possible c) avoiding challenging the client's perceptions about "baby angels" d) gently presenting reality as needed e) orienting the client about his medical condition
• decreasing as much "foreign" stimuli as possible • avoiding challenging the client's perceptions about "baby angels" • gently presenting reality as needed Explanation: The abnormal stimuli of the critical care unit can aggravate the symptoms of delirium. Arguing with hallucinations is inappropriate. When a client has illogical thinking, gently presenting reality is appropriate, but orienting the client to his condition is unlikely to be helpful. Dementia is not the likely cause of the client's symptoms. The client is experiencing delirium, not dementia.
The client was admitted to the hospital following a myocardial infarction. Two days later, the client exhibits a blood pressure of 90/58, pulse rate of 132 beats/min, respirations of 32 breaths/min, temperature of 101.8°F, and skin warm and flushed. Appropriate interventions include (Select all that apply) a) obtaining a urine specimen for culture b) administering pantoprazole (Protonix) IV daily c) instituting vital signs every 4 hours d) maintaining the IV site inserted on admission e) monitoring urine output every hour
• obtaining a urine specimen for culture • administering pantoprazole (Protonix) IV daily • monitoring urine output every hour Explanation: The client is exhibiting signs of septic shock. It is important to identify the source of infection, such as obtaining a urine specimen for culture. Medication, such as pantoprazole, would be administered to prevent stress ulcers. The nurse would monitor urinary output every hour to evaluate effectiveness of therapy. IV sites would be changed and catheter tips cultured as this could be the source of infection. The client's condition warrants vital signs being assessed more frequently than every 4 hours.
