Med-Surg Ch 20: Care of Patients With Coronary Artery Disease and Cardiac Surgery

After the change-of-shift report, whiich of the following assigned patients should you attend to first? The patient with A. stable vital signs who returned 40 minutes ago after a PCTA B. an MI complaining of a headache who was transferred from the CCU earlier C. stable angina whose chest pain was relieved by two nitroglycerin tablets 2 hours ago D. unstable angina who is having chest pain, shortness of breath, nausea, and anxiety

unstable angina who is having chest pain, shortness of breath, nausea, and anxiety *The patient with unstable angina and chest pain is at risk of MI and should be monitored closely and treated to increase cardiac perfusion. This patient has the highest priority. (1) This patient is stable and will be monitored for continued stable vital signs and evidence of bleeding from the catheter insertion site as well as for chest pain indicating reclosing of the artery. (2) The patient who has had an MI and who now has a headache is not a priority. The headache may well be from nitrates being administered. The patient should receive analgesia for the headache, but it is not a high priority. (3) The patient with stable angina does not have a current complaint and is not a high priority.

The drug alteplase (t-PA) is given to the patient with a myocardial infarction (MI). Which statements accurately describes the purpose of this medication? A. "Alteplase (t-PA) dissolves the obstruction in the coronary artery." B. "Alteplase (t-PA) dilates vessels to relieve pain." C. "Alteplase (t-PA) strengthens cardiac contraction." D. "Alteplase (t-PA) increases cardian output."

"Alteplase (t-PA) dissolves the obstruction in the coronary artery." *Alteplase (t-PA) is a thrombolytic drug that will dissolve the clot if given withing 12 h of the MI.

The patient being evaluated for a heart transplant asks the nurse what the survival rate is. Which response is best for the nurse to make? A. "I'm not really sure. It is better if you ask your surgeon." B. "Every patient has different circumstances, but the average 3-year survival rate is 75%." C. "The survival rate is excellent. Almost all patients with a heart transplant live past 10 years." D. "There are not anty really good statistics for me to give you an accurate estimate."

"Every patient has different circumstances, but the average 3-year survival rate is 75%." *The average 1-year survival rate of about 85% to 90%, a 3 year survival rate of about 75%, and a 5 year survival rate of 60%. A significant number of heart transplant patients survive beyond 10 years

A patient is diagnosed with having attacks of angina pectoris. As part of the discharge instructions, the patient is instructed onthe appropriate storage and use of sublingual nitroglycerin. Which of the following patient statements indicates a need for further instructions? A. "The tablets should be kept in a cool, dark place." B. "I need to lie down after I take the medication." C. "I can take the tablet every 15 minutes for angina pains." D. "The expiration date on the bottle is important."

"I can take the tablet every 15 minutes for angina pains." *When pain is not relieved by the first nitroglycerin tablet within 5 minutes, the patient is to take another; a third tablet may be taken 5 minutes after the second tablet for unrelieved pain. If pain continues, the patient should contact the health care provider and go to the hospital. (1, 2, 4) All of the other options are correct.

The nurse is caring for a post-myocardial infarction (MI) patient who has been started on daily simvastatin (Zocor) and a low-fat diet. Which statement best indicates that the nurse's teaching has bee successful? A. "I will need to have blood work every month while taking Zocor." B. "I should take my Zocor with grapefruit juice to help absorption." C. "I should call my doctor if I experience uexplained muscle pain." D. "I should take Zocor an hour before my biggest meal of the day."

"I should call my doctor if I experience uexplained muscle pain." *Statins can injure muscle tissue and are toxic to the liver in some patient. Patients should report any unexplained muscle tenderness or pain persisting for more than a few days. Laboratory tests for liver enzymes are recommended at the start of therapy and only when clinically indicated. Grapefruit juice interferes with drug metabolis and should be avoided to prevent increased risk of toxicity. Zocor can be taken without regarf d to meals

A patient with angina has been given instructions concerning his care. Which of these statements, if made by the patient, indicates a need for further instruction? A. "If my mouth is dry, and I need a nitroglycerin, I should sip water first." B. "I'll try not to go out-of-doors when the weather is extremely chilly." C. "I should swallow 3 nitroglycerines, 5 minutes apart if I have chest pain." D. "I'm planning to take a nitroglycerin pill before I do activities that have caused me to have chest pain in the past."

"I should swallow 3 nitroglycerines, 5 minutes apart if I have chest pain." *Nitroglycerin tablets should be taken sublingually, not swallowed. Wetting the mouth prior to taking a nitroglycerin, avoiding extreme temperatures, and easy access to nitroglycerin are all appropriate statements.

Which statement by the patient indicates a need for additional teaching about taking his nitroglycerin? A. "I should try to sit or lie down before I take a tablet." B. "If I get a headache, I should not take any more." C. "I can take up to three tablets before I call my health care provider." D. "The tablets should be stored in a dark bottle."

"If I get a headache, I should not take any more."

The nurse performs patient teaching about minimally invasive direct coronary artery bypass (MIDCAB). Which statement indicates that the patient needs further instruction? A. "It frightens me to think that my heart will be stoped for a long time during surgery." B. "This surgery bypasses my artery that is blocked, and replaces it with sections of a vein or artery taken from another part of my body." C. "This surgery will hopefully control my angina since nothing else we have tried has worked." D. "I may come out of surgery with vessels removed from my legs."

"It frightens me to think that my heart will be stoped for a long time during surgery." *The MIDCAB procedure is less invasive that the traditional coronary artery bypass graft (CABG) procedure and does not require the patient be placed on the heart-lung machine due to stopping the heart for an extended period. Both procedures are used to treat angina that has not responded to more conservative treatment and utilize either the mammary artery or sections of the saphenous vein for the graft

A patient asks you, "What causes angina perctoris?" An accurate response would be A. "It is caused by the decreased blood flow to the coronary arteries resulting from shunting of the blood." B. "It is caused by the decreased blood flow to the myocardium resulting from partial obstruction of the coronary arteries." C. "It is caused by poor oxygenation of the coronary arteries resulting from poor gas exchange across the alveolar basement membrane." D. "It is caused by the inflammation of the sternal cartilage."

"It is caused by the decreased blood flow to the myocardium resulting from partial obstruction of the coronary arteries." *Angina is caused by decreased blood flow through a coronary artery; the area of the heart supplied by the affected artery receives insufficient blood to function properly. (1) Blood is not shunted anywhere. (3) Angina is not related to poor oxygenation due to a problem in the lungs. (4) The pain of angina is not caused by inflammation of the cartilage at the sternum.

The nurse is educating a patient on a low-fat, low-cholesterol diet after a myocardial infarction (MI). Which food choice should the nurse recommend? A. "Avoid eating frozen foods." B. "Replace a serving of red meat with a serving of fish." C. "Use nondairy creamer in your decaffeinated coffee." D. "Drink a serving of grapefruit juice each day."

"Replace a serving of red meat with a serving of fish." *Fish have a high content of omega-3 fatty acids, which are helpful in reducing cholesterol. Not all frozen foods are unhealthy. Frozen vegetables with no sodium added are a good choice for a low-fat, low-cholesterol diet. Nondairy creamer is high in trans fat and saturated fat. Grapefruit juce often interferes with metabolis of a variety of medications

The nurse is caring for a post-myocardial infarction (MI) patient. The patient questions the reason for a stool softener and denies constipation. Which statement indicates that the patient accurately understands the nurse's teaching? A. "Stool softeners help me to keep from straining during bowel movements, which can lower my heart rate." B. "Stool softeners help me to get rid of extra wastes that can harm my heart." C. "Stool softeners help reduce swelling that can increase work on my heart." D. "Stool softeners help to reduce discomfort from gas pains."

"Stool softeners help me to keep from straining during bowel movements, which can lower my heart rate." *Bearing down or straining at stool can stimulate the vagal nerve and induce bradycardia

The 60 year old female in the post-coronary care unit confides to the nurse, "My life is over. I'll never be able to care for my family, take a vacation, or work in my garden." Which response is most supportive? A. "You are doing great! You can do all of those things in a few weeks." B. You may have to give up some things, but there are other activities you might enjoy." C. "You are feeling a little blue today. Would you like medication to help you anxiety?" D. "You sound a little down. Tell me what you think is going to keep you from those activities; we might be able to address the problems."

"You sound a little down. Tell me what you think is going to keep you from those activities; we might be able to address the problems." *Helping patients identify and face depression is helpful in dispelling it, and talking about her concerns will open up conversation and address the concerns in a problem-solving approach.

A patient says to the LPN/LVN, "I guess now after my heart attack, I won't be able to have sex anymore." Which of these responses by the nurse is most appropriate? A. "You will have to wait at least 6 months, but then you will be able to have normal sex." B. "What makes you think you will not be able to have sex again?" C. "There are other ways besides sex to demonstrate your affection." D. "You will be able to resume sexual relationships but you may have to make some slight changes."

"You will be able to resume sexual relationships but you may have to make some slight changes." *For the majority of patients, sexual intercourse may be resumed with consideration given to decreasing oxygen demands. For a while after an MI, the patient may need to take a more passive role during intercourse. Other considerations include planning sexual activity for times when the patient is well-rested and to avoid an environment that is too hot or too cold during intercourse. It is not appropriate to question the patient abruptly, to advise the patient to express affection in another way, or to advise the patient to wait at least 6 months to resume having sexual relations.

The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed. Which response by the nurse is most accurate? A. "We will only roll you to the same side as the catheter insertion site." B. "You will lay flat for several hours, and we will place a sandbag over the dressing in the groin." C. "You will most likely be able to ambulate within a few hours if your doctor uses an arterial closure device at the catheter insertion site." D. "We will encourage you to flex and extend your legs when you return from the procedure to prevent a clot from forming at the insertion site."

"You will most likely be able to ambulate within a few hours if your doctor uses an arterial closure device at the catheter insertion site." *Most physicians use an arterial closure device at the puncture site, which enable the patient to be ambulatory withing 2 h after the cardia catherization procedure. The patient may be turned to either side. Sandbags were used in the past to prevent bleeding from the puncture site and the patient had to lay flat for several hours. Flexing and extending the legs immediately after the procedure would likely cause bleeding from the site

The nurse clarifies that the MONA protocol for drug administration in the emergent stage of a myocardial infarction (MI) involves the use of which therapies? (select all that apply) A. Aspirin B. Morphine C. Nitrates D. Antibiotics E. Oxygen

1. Aspirin 2. Morphine 3. Nitrates 4. Oxygen *Antibiotics are not part of the MONA protocol

Postoperative nursing care of a patient who has undergone CABG includes which priority intervention(s)? (select all that apply) A. Assessing cardiac rate and rhythm B. Encouraging use of an incentive spirometer C. Monitoring liver enzymes D. Assessing bowel sounds E. Managing pain

1. Assessing cardiac rate and rhythm 2. Encouraging use of an incentive spirometer 3. Managing pain *In the immediate postoperative period, monitoring heart status is a priority. Encouraging deep breathing using the incentive spirometer can help prevent pulmonary complications. Pain control is very important after open heart surgery. (3) Liver enzyme monitoring is not a priority at this time. (4) Bowel sounds may be absent in the immediate postoperative period after such extensive anesthesia and surgery; they should be assessed once a shift.

Immediately following a patient's cardiac catheterization, what are the highest priority interventions when the patient returns to his room? (Select all that apply.) A. Assessing the pulses distal to the catheterization site B. Administering oxygen via mask C. Taking the patient's vital signs D. Allowing the patient to rest E. Monitoring the electrocardiogram (ECG)

1. Assessing the pulses distal to the catheterization site 2. Taking the patient's vital signs *Nursing priority should be given to checking the pulses distal to the catheter insertion site, monitoring vital signs, and assessing the catheterization site for signs of bleeding. Patients do not generally require supplemental oxygen post-catheterization. Rest and monitoring the ECG are not the highest priorities when the patient returns from this procedure.

A patient with a 10-year history of angina is admitted to the unit with chest pain. The working medical diagnosis is to rule out MI. Definitive diagnosis of MI will be based on which information? (Select all that apply.) A. CBC (complete blood count) with differential and ABGs (arterial blood gases) B. ECG C. Patient history and physical exam D. Fluid and electrolyte status E. Cardiac enzyme levels

1. ECG 2. Patient history and physical exam 3. Cardiac enzyme levels *Patient history is suggestive of MI; cardiac enzyme levels will be the most significant data, along with troponin levels, for diagnosing MI; ECG will show areas of damage as a result of the infarct. Fluid and electrolyte status as well as CBC with differential and ABGs may be obtained to gather more information about the patient's clinical status, but these are not used to diagnose an MI.

The nurse is aware that a positive diagnosis of a myocardial infarction (MI) is based on which diagnostic test finding(s)? (select all that apply) A. Electrocardiographic (ECG) changes in the QRS complex B. Elevation of low-density lipoprotein (LDL) C. Elevation of troponin levels D. Elevated white blood cell (WBC) count E. Elevated bilirubin levels

1. Electrocardiographic (ECG) changes in the QRS complex 2. Elevation of troponin levels *Diagnosis of MI is made by patient history, ECG, and serum cardiac enzyme levels. Elevated LDL, WBC, or bilirubin levels are not indicative of an MI

The nurse instructs a patient tha tthe pain of angina is due to ischemia of the myocardiu,. Which factors are causative agents for angina? (select all that apply) A. Exertion B. Emotional excitement C. Eating heavy meals D. Exposure to cold E. Allergic reactions

1. Exertion 2. Emotional excitement 3. Eating heavy meals 4. Exposure to cold *Angina may be caused by exertion, emotional excitement, eating heavy meals, and exposure to cold. Angina is not brought on by allergy

Which herbs and supplements lower cholesterol? (select all that apply) A. Garlic B. Bananas C. Oatmeal D. St. John's Wort E. Soy products

1. Garlic 2. Oatmeal 3. Soy products *Garlic, whole-grain foods, and soy products are thought to decrease cholesterol. Bananas and St. John's wort are not known to lower cholesterol

Immediate therapeutic measures provided for a patient entering the hospital with an acute myocardial infarction include which measure(s)? (select all that apply) A. Morphine sulfate B. Oxygen therapy C. Furosemide D. Nitroglycerin E. Aspirin

1. Morphine sulfate 2. Oxygen therapy 3. Nitroglycerin 4. Aspirin *MONA (morphine, oxygen, nitroglycerin, aspirin) is the standard treatment begun as soon as a patient experiencing an MI presents to the hospital. (3) Furosemide is a diuretic medication and is not indicated for an MI. It is used for heart failure and other problems.

The nurse encourages the patient who has had a myocardial indarction (MI) to enroll inthe outpatient clinic rehabilitation in order to receive which services(s)? (select all that apply) A. Nutritional counseling B. Supervised progressive exercise C. Stress-reduction techniques D. Sexual counseling E. Administration of cardiotonic drugs

1. Nutritional counseling 2. Supervised progressive exercise 3. Stress-reduction techniques *Cardiac rehab services include nutritional counseling, specialized exercise programs, and stress-reduction techniques.Sexual counseling and administration of medications are not services of cardiac rehab

The nurse is caring for a 38-year-old African American patient with diabetes. The patient manages her diabetes with dietary control, takes oral contraceptives, and is a nonsmoker. Which characteristic(s) in this patient's history increase the patient's risk for coronary artery disease (CAD)? (select all that apply) A. Age B. Race C. Diabetes D. Nonsmoker status E. Use of oral contraceptives

1. Race 2. Diabetes 3. Use of oral contraceptives *African Americans have an ethnic tendency to CAD. Taking birth control pills and diabetes are both risk factors for CAD. Older patients are at an increased risk for CAD, and a nonsmoking status decreases the likelihood of developingThe nur CAD

Place the events of atrial obstruction in proper sequence A. Platelets adhere to plaque B. Deposits of low-density lipoproteins (LDLs) accumulate C. Fibrous plaque is laid down in vessel D. Streaks of fatty material are laid down in arteries E. Platelets clump F. Platelets calcify

1. Streaks of fatty material are laid down in arteries 2. Deposits of low-density lipoproteins (LDLs) accumulate 3. Fibrous plaque is laid down in vessel 4. Platelets adhere to plaque 5. Platelets clump 6. Platelets calcify

During the acute phase following a myocardial infarction (MI), the nurse anticipates that the patient may require a temporary pacemaker in which situation(s)? (select all that apply) A. The patient's heart rate remains above 120 beats per minute B. The patient experiences worsening anginal pain C. The patient experiences worsening anginal pain D. The patient's systolic BP drops to 60 E. The patient's pulse rate remains below 40 beats per minute

1. The patient experiences worsening anginal pain 2. The patient's pulse rate remains below 40 beats per minute *A temporary pacemaker is warranted when the patient's pulse consistently remains below 40 beats per minute and when the patient experiences complete heart blocl. Complete heart block means that the electrical impulse for contraction does not go through the atrioventricular node to the ventricles and the ventricles are not signaled to contract. Tachycardia, above 100, continued angina pain, and hypotension are not correct indications for a pacemaker

The risk factors that lead to a higher incidence of atherosclerosis include: (Select all that apply.) A. high levels of high-density lipoproteins. B. cigarette smoking. C. a history of hypertension and diabetes mellitus. D. age (> age 40), gender, and race. E. women on oral contraceptives or estrogen replacement therapy.

1. cigarette smoking. 2. a history of hypertension and diabetes mellitus. 3. age (> age 40), gender, and race.

After reviewing risk factors for cardiac disease, a patient is prescribed atorvastatin (Lipitor) to reduce cholesterol levels. You must include which instruction(s) (select all that apply) A. report aby muscle weakness B. avoid exposure to sunlight C. keep appointments for laboratory work D. Drink grapefurit juice E. Maintain a low-protein diet

1. report aby muscle weakness 2. avoid exposure to sunlight 3. keep appointments for laboratory work *Statin drugs can cause muscle myopathies (muscle damage), so muscle pain should be reported. Lipitor causes photosensitivity. The drug acts in, and is metabolized in, the liver and adversely affects the liver in some patients. Liver function is monitored initially and as clinically indicated thereafter. (4) Grapefruit juice may interfere with the action of the drug. (5) There is no need for a low-protein diet; a low-fat diet should be followed.

After an MI, the patient is monitored for cardiogenic shock. A sign that cardiogenic shock is impending might be: A. crackles in the lungs upon auscultation. B. slowing of the pulse rate. C. PVCs on the ECG. D. decreasing urine flow to 20 mL per hour.

crackles in the lungs upon auscultation.

You are ready to begin your patient assessments after receiving report. Which patient will you assess first? A. A 36-year-old with mitral stenosis scheduled for a balloon valvuloplasty later in the morning B. An 82-year-old 2 days after coronary bypass surgery who has a temperature of 100.5° F C. A 52-year-old with cardiomyopathy who developed chest pain and shortness of breath during shift change D. A 63-year-old who had a coronary stent placed yesterday afternoon who has some bloody drainage on the procedure site dressing

A 52-year-old with cardiomyopathy who developed chest pain and shortness of breath during shift change

A patient has been admitted to the coronary care unit with a diagnosis of acute MI. The patient is experiencing severe chest pain. What intervention is MOST likely to relieve the patient's pain? A. Administration of codeine B. Proper positioning C. Administration of beta blockers D. Administration of morphine

Administration of morphine *Pain control is a high priority for the patient experiencing an acute MI. Morphine is the drug of choice because of its vasodilation property. Proper positioning and administration of codeine or beta blockers are not the most appropriate interventions.

A patient has experienced an MI and has ST-segment elevation on the ECG. The priority problem would be A. Altered gas exchange B. Limited coping ability C. Altered tissue perfusion D. Altered activity tolerance

Altered tissue perfusion *Altered tissue perfusion is the correct choice since cardiac damage has been caused by insufficient blood supply to an area of the myocardium. (1) Oxygen is used in the therapy for MI, but it is for the purpose of preventing further ischemia of the heart muscle and not because of an oxygenation problem. (2) The patient may display limited coping, but this is a psychosocial issue and does not take precedence over the physical problem of altered tissue perfusion. (4) Activity intolerance will occur during the acute stage of an MI, but it is the result of ineffective tissue perfusion.

How does a myocardial infarction (MI) alter the pumping efficiency of the heart? A. An MI reduces the impulse from the sinoatrial node B. An MI causes myocardial necrosis C. An MI shunts all myocardial blood flow to a specific cardiac region D. An MI causes myocardial swelling and inflammation

An MI causes myocardial necrosis *Myocardial necrosis (damaged or dead heart muscle tissue) cannot contract effectively, which decreases pumping efficiency (cardiac output)

There are several patients on a busy cardiac rehabilitation unit who need assistance. Which task would be appropriate to assign to the nursing assistant? A. Find out why a depressed patient is not doing his physical therapy. B. Answer a family member's question about how to contact a local support group. C. Escort a patient who has been discharged home to his wife's car. D. Listen to a patient who is complaining about the bad hospital food.

Answer a family member's question about how to contact a local support group.

The nurse is caring for a patient who was just admitted to the hospital with an acute MI. What complication is the nurse most concerned will occur with this patient? A. Respiratory failure B. Hyperkalemia C. Hypovolemic shock D. Dysrhythmia

Dysrhythmia *The most common complication following an MI is dysrhythmia due to increased myocardial irritability, which can be fatal. The patient would develop cardiogenic, not hypovolemic, shock. Hyperkalemia and respiratory failure are not the nurse's greatest concerns at this time.

The nurse is caring for a patient who underwent a trasfemoral cardiac catheterization with coronary angiography earlier in the day. The patient denies pain and no longer requires bed rest. The groin is soft with no palpable hematoma. Which postprocedure care is most important for the patient at this time? A. Encourage increased fluid intake B. Administer pain medication as ordered C. Obtain vital signs every 15 minutes D. Assist the patient with ambulation

Encourage increased fluid intake *The procedure uses a large volume of dye, which can be harmful to the kidneys. Increasing fluid intake is the priority focus for care at this time after homestasis is obtained. Keeping the patient hydrated increases the rate of urine flow, dilutes the urine, and helps prevent kidney damage as the contrast is excreted. The patient denies pain. Vital signs are taken every 15 minutes for the first hour and are checked progressively less frequently unless there is evidence of bleeding or instability. The patient can now ambulate, but ambulation is a lesser priority than flushing out the hypertonic dye

The nurse is caring for a female patient with a family history who is undergoing a workup for cardiovascular disease. Which finding is most concerning to the nurse? A. Fainting B. Dry mouth C. Dizziness D. Fatigue

Fatigue *Women frequently experience fatigue with heart disease. Many women do not even experience chest pain. Fainting, dry mouth, and dizziness are not typical signs of heart disease in women

Which individual would be the most likely candidate for coronary artery bypass grafting (CABG) surgery? A. Female, age 62, with malignant hypertension B. Female, age 48, with chronic angina and coronary artery disease (CAD) C. Male, age 25, with severe cardiomyopathy D. Male, age 85, with chronic heart failure (HF)

Female, age 48, with chronic angina and coronary artery disease (CAD) *The patient with chronic angina and CAD would be the most likely candidate for CABG. The patients with HF and malignant hypertension would most likely be treated with medications and diet; the patient with myopathy may be a candidate for a heart transplant.

Which food has ben found to reduce cholesterol levels? A. Garlic B. Onion C. Ginger D. Nutmeg

Garlic *Garlic has proven to be useful in lowering cholesterol. (2) Onions are helpful in controlling diabetes and do help prevent heart disease, but not by lowering cholesterol. (3) Ginger is good for nausea and for digestion, but it does not lower cholesterol. (4) Nutmeg has no effect on cholesterol levels.

The health care provider is considering using fibrinolytic therapy such as t-PA (Activase) for a patient who has come into the ED experiencing an MI. Which information is most important to relay to the provider? A. History of hypertension B. History of hemorrhagic stroke C. Symptom onset 3 hours ago D. Intraspinal surgery during childhood

History of hemorrhagic stroke

The nurse is caring for a patient with angina pectoris who asks what happens to make his body experience pain. The nurse explains that pain results from which underlying causative factor? A. Congestion that backs up into the lungs B. Inadequate blood flow and poor oxygen supply C. Edema from fluid overload D, Inflammation in the vessels

Inadequate blood flow and poor oxygen supply *Angina pectoris (chest pain) occurs when blood supply to the hear is decreased or totally obstructed. Pain results from ischemia (inadequate blood and oxygen supply

A patient who is admitted to the coronary care unit with an acute MI is complaining of severe substernal chest pain. What is the cause of the chest pain? A. Ischemia of the myocardium B. Vasodilation of the coronary veins C. Ischemia of the carotid artery D. Spasm of the coronary arteries

Ischemia of the myocardium *Myocardial ischemia causes crushing substernal pain, typically radiating to the left arm and/or left side of the jaw. Coronary artery spasm produces anginal pain. If it continues, however, it can lead to an MI. Crushing substernal pain is not caused by ischemia of the carotid artery or vasodilation of the coronary veins.

A patient with angina is being discharged and has been prescribed nitroglycerin (NTG) tablets. What instructions should the nurse give this patient regarding the medication? A. Lie down when using NTG tablets. B. It is necessary to refill the supply every 6 months. C. The tablet should be crushed and taken with water. D. One NTG tablet should be taken every 15 minutes if pain occurs.

Lie down when using NTG tablets. *The patient should lie down when taking NTG tablets. The expiration dates on the bottle should be checked frequently and the tablets should be replaced accordingly. One tablet should be taken every 5 minutes, up to three times. If the pain does not subside, the patient should then call for help and be taken to the emergency room. The tablets should be taken sublingually, not crushed or swallowed.

The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful. Which reply is best? A. Low-dose aspirin helps reduce clotting B. Low-dose aspirin helps dilate coronary vessels C. Low-dose aspiring helps alleviate pain associated with angina D. Low-dose asprin helps lower cholesterol

Low-dose aspirin helps reduce clotting *Daily doses of aspirin reduce clotting by prolonging clotting time, thus helping prevent clots that can cause an MI

The patient presents in the emergency department (ED) with severe chest pain. Which drugs are likely to be administered during the initial emergency care? A. Morphine, oxygen, nitrates, aspirin B. Beta-blockers, clopidogrel (Plavix) C. Simvastatin (Lipitor), lorazepam (Ativan) D. Oxygen, dobutamine (Dobutrex)

Morphine, oxygen, nitrates, aspirin

Which criterion would indicate that the interventions after an MI are helping meet the expected outcome of "patient will suffer no further cardiac damage"? A. Lessened chest pain B. Conscious and interacting appropriately C. No ST elevation on the ECG rhythm strip D. No complaints of heartburn

No ST elevation on the ECG rhythm strip

A patient who presented to the emergency room with a myocardial infarction (MI) becomes pale, diaphoretic, hypotensive. What action should the nurse take first? A. Notify the physician immediately B. Ensure that the patient has patent IV access C. Requenst assistance from respiratory therapy D. Inform the patient's family of the change in status

Notify the physician immediately *If the left ventirlc is badly damanged, cardiogenic shock may occur. Signs and symptoms are those that accompany decreased cardiac output, such as decreased BP, confusion, restlessness, diaphoresis, rapid and thready pulse, increased respiratory rate, cold and clammy skin, and diminishing urinary output to less than 20 mL/h. This condition is a medical emergency that requires immediate notification of the physician. The nurse should then ensure that the IV is patent. Respiratory therapy assistance will likely be beneficial, especially if the patient's condition further deteriorates. The nurse should finally notify the patient's family about the change in status

The nurse asesses a friction rub in a patient who is 2 days post-myocardial infarction (MI). The nurse recognizes this finding indicates which problem? A. A recurrent MI B. Pleural effusion C. Pericarditis D. Angina

Pericarditis *Friction rubs occur in pericarditis when the inflamed ares of the infart rubs the pericardium

A 44-year-old patient is admitted with sudden, severe chest tightness unrelieved by rest or nitroglycerin and profuse sweating. Which test would exhibit an elevated level only if the patient has has an MI? A. Serum troponin B. Blood urea nitrogen C. Myoglobin level D. Prothrombin time

Serum troponin *Elevated serum troponin levels are indicative of myocardial muscle damage from an MI. (2) BUN (blood urea nitrogen) is a test for kidney function. (3) The myoglobin level will rise after an MI, but it is not specific for MI. It also will be elevated with infection and in other disorders. (4) Prothrombin time is a test for blood clotting, not for MI.

The nurse is caring for a male patient with angina who has a new prescription for subingual nitroglycerin. What information is most important is most important for the nurse to include in the teaching plan? A. Nitroglycerin tablets expire after the bottle is opened B. Take a second tablet 15 minutes after the first dose and call the physician if pain persists C. Store nitroglycerin tablets in a cool, dark location D. Nitroglycerin may cause an unsafe drop in heart rate when combined with certain medications for erectile dysfunction

Store nitroglycerin tablets in a cool, dark location *Sublingual nitroglycerin tablets should be kept in a cool, dark place and should be carried by the patient at all times. If chest pain persists after the first dose, the patient should repeat the dose in 5 minutes. The patient should contact emergency services, not the physician. Nitroglycerin may cause an unsafe drop in blood pressure (BP) if combined with certain medications for erectile dysfunction

An elevated level of what is the most significant in diagnosing damage to the myocardium? A. Troponin B. Creatine phosphokinase (CPK) C. Creatine phosphokinase-MB (CK-MB) D. Lactate dehydrogenase (LDH)

Troponin

A 54-year-old man is admitted to the cardiac unit with chest pain radiating to his jaw and left arm. Which enzyme would be most specific in the diagnosis of a myocardial infarction (MI)? A. LDH (L-lactate dehydrogenase) B. CK-MB (creatine kinase MB) C. AST (aspartate aminotransferase) D. Troponin

Troponin *The most significant laboratory finding for diagnosis of MI is an elevated troponin level, especially if accompanied by an elevated CK-MB. Troponin is found only in cardiac tissue. LDH and AST are not the most significant laboratory findings for the diagnosis of MI.

The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI). The nurse observes that the patient is experiencing electrocardiogram (ECG) changes and reviews new laboratory results. Which laboratory value should the nurse report immediately? A. Troponin of 2.4 mcg/L B. Potassium of 3.4 mEq/L C. Creatine phosphokinase of 134 IU/L D. Sodium of 133 mEq/L

Troponin of 2.4 mcg/L *The patient has a significantly elevated troponin. The abnormal troponin, along with ECG changes, indicates that the patient is likely experiencing an MI. (Elevated troponin levels are most indicative of an MI as these enzymes are specific to heart muscle damage). While the nurse should report the low potassium and sodium, these findings are of lesser priority than the elevated troponin

The nurse is caring for a patient with uncontrolled hypertension, diabetes, asthma, and gastroesophageal disease (GERD). Which proble, serves as a contraindication for a thrombolytic agent? A. Uncontrolled hypertension B. Diabetes C. Asthma D. GERD

Uncontrolled hypertension *Thrombolytic agents are contraindicated in peoplr with uncontrolled hypertension. GI bleeds, recent intracranial or intraspinal surgery, or aneurysm because of threat of excessive bleeding

The nurse is explaining the difference between exertional angina and unstable angina. Which statement about unstable angina is accurate? A. Unstable angina occurs with moderate exercise B. Ubstable angina occurs when the blood pressure increases sharply C. Unstable angina occurs when the body reacts to high stress levels D. Unstable angina occurs unpredictably, even in sleep

Unstable angina occurs unpredictably, even in sleep *Ubstable angina attacks are unpredictable and do not follow a pattern, as do stable angina attacks. Unstable angina can progress into a myocardial infarction (MI) and a medical emergency.

A patient taking lovastatin (Mevacor) for treatment of hypercholesterolemia should have follow-up because of the potential for: A. nephrotoxicity. B. cardiotoxicity. C. hepatotoxicity. D. ototoxicity.

cardiotoxicity.

The health care provider explains the treatment options to a Hispanic woman diagnosed with occulsion of multiple coronary vessels. Before signing an informed consent, the patient is most likely to defer her health care decisions to her A. oldest adult son B. oldest adult daughter C. brother-in-law D. husband

husband *A Hispanic female traditionally within the culture will seek and follow her husband's wishes. (1, 2, 3) Other relatives will not be involved in the decision, although male relatives may be consulted. This question requires applying knowledge of cultures learned in the Fundamentals of Nursing course to issues with the cardiac system.

When an elderly person sustains an MI, symptoms expressed are often: A. severe chest pain, nausea, and dizziness. B. dyspnea, nausea, confusion, and indigestion. C. pain in the arms and clammy skin. D. palpitations, chest pain, and fatigue.

palpitations, chest pain, and fatigue.

For a patient who is taking a statin drug, an important teaching point to include would be to: A. report muscle tenderness or pain that persists for more than a few days. B. increase consumption of grapefruit juice to supply K+. C. have follow-up appointments to monitor platelet count. D. discontinue medication when the target weight goal is met.

report muscle tenderness or pain that persists for more than a few days.