Medical Surgical Nursing 34, 66,67
After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement?
"I can take up to five tablets every 3 minutes for relief of my chest pain."
In caring for the patient with angina, the patient said, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, but the pain is gone now." What further assessment data should the nurse obtain from the patient?
"In what areas did you feel this pain?"
A patient's daughter asks the nurse what SIMV means on the settings of the mechanical ventilator attached to her father. Which statement best describes this mode of ventilation?
"SIMV is a mode that allows your father to breathe on his own while receiving a preset number of breaths from the ventilator. He can breathe as much or as little as he wants beyond what the ventilator will breathe for him."
Which individuals would the nurse identify as having the highest risk for CAD?
A 45-year-old depressed male with a high-stress job
Which factor indicates that tracheotomy would be preferable to endotracheal intubation?
A long-term airway is probably necessary.
The patient is being dismissed from the hospital after ACS and will be attending rehabilitation. What information does the patient need to be taught about the early recovery phase of rehabilitation?
Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring.
The patient comes to the ED with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerotic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder?
Acute coronary syndrome (ACS)
For which problem is percutaneous coronary intervention (PCI) most clearly indicated?
Acute myocardial infarction
A patient's localized infection has progressed to the point where septic shock is now suspected. What medication is an appropriate treatment modality for this patient?
Aggressive IV crystalloid fluid resuscitation
The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI)
Ashen skin, diaphoresis, Nausea and vomiting, s3 or s4 heart sounds
Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication?
Atrial dysrhythmias
When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice?
Canned chicken noodle soup
A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate?
Cardiac dysrhythmias
The post-anesthesia care unit (PACU) has several patients with endotracheal tubes. Which patient should receive the least amount of endotracheal suctioning?
Cerebral aneurysm resection Correct
When caring for a critically ill patient who is being mechanically ventilated, the nurse will astutely monitor for which clinical manifestation of multiple organ dysfunction syndrome (MODS)?
Decreased respiratory compliance
The nurse is providing teaching to a patient recovering from an MI. How should resumption of sexual activity be discussed?
Discussed along with other physical activities
Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver (select all that apply)?
Ezetimibe (Zetia) Atorvastatin (Lipitor)
The nurse would recognize which clinical manifestation as suggestive of sepsis?
Hyperglycemia in the absence of diabetes
A patient experienced sudden cardiac death (SCD) and survived. What should the nurse expect to be used as preventive treatment for the patient?
Implantable cardioverter-defibrillator (ICD)
A 70-year-old patient in the ICU has become agitated and inattentive since his heart surgery. The nurse knows that this ICU psychosis frequently occurs in individuals with pre-existing dementia, history of alcohol abuse, and severe disease. What interventions should the nurse provide this patient to improve the patient's cognition (select all that apply)?
Improve oxygenation. Enable the patient to sleep on a schedule with dim lights. Decrease sensory overload by conversing away from patient's room.
When caring for a patient in acute septic shock, what should the nurse anticipate?
Infusing large amounts of IV fluids
The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact?
Inspect the patient's right side and back.
The patient has developed cardiogenic shock after a left anterior descending myocardial infection. Which circulatory-assist device should the nurse expect to use for this patient?
Intraaortic balloon pump (IABP)
A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression?
Keep Hgb A1C less than 7%.
The nurse is caring for a patient who has been on a mechanical ventilator for several days. Which weaning parameter would tell the nurse whether or not the patient has enough muscle strength to breathe without assistance?
Negative inspiratory force
When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administrating?
Oxygen, nitroglycerin, aspirin, and morphine
The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion?
Pathologic Q wave
Which interventions should the nurse perform prior to suctioning a patient who has an endotracheal (ET) tube using open-suction technique (select all that apply)?
Perform a cardiopulmonary assessment. Hyperoxygenate the patient for 30 seconds.
When planning care for a patient on a mechanical ventilator, the nurse understands that the application of positive end-expiratory pressure (PEEP) to the ventilator settings has which therapeutic effect?
Prevention of alveolar collapse during expiration
Following coronary artery bypass graft surgery a patient has postoperative bleeding that requires returning to surgery to repair the leak. During surgery, the patient has a myocardial infarction (MI). After restoring the patient's body temperature to normal, which patient assessment is the most important for planning nursing care?
Pulmonary artery pressure (PAP) 28/14 mm Hg
A male patient who has coronary artery disease (CAD) has serum lipid values of LDL cholesterol 98 mg/dL and HDL cholesterol 47 mg/dL. What should the nurse include in the patient teaching?
The lipid levels are normal.
Which hematologic problem most significantly increases the risks associated with pulmonary artery (PA) catheter insertion?
Thrombocytopenia
The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic group would the nurse select as the highest priority for this intervention?
White male
What laboratory finding fits with a medical diagnosis of cardiogenic shock?
increased blood urea nitrogen (BUN) and serum creatinine levels
A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a priority nursing diagnosis?
ineffective tissue perfusion
When providing nutritional counseling for patients at risk for CAD, which foods would the nurse encourage patients to include in their diet
tofu, walnuts, tuna fish
