NUR 301 | Chapter #14: Nursing Management-Patients With Coronary Vascular Disorders
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 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
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 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%
Jack Donohue, a 62-year-old stock broker, attends his annual physical appointment and indicates physical changes since his last examination. He reports chest pain and palpitation during and after his morning jogs. Jack's family history reveals includes coronary artery disease. His lipid profile reveals his LDL level to be 122 mg/dl. Which of the following correctly states the Jack's condition?
High LDL level
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 indicative of which of the following?
High LDL level
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?
High-density lipoprotein (HDL), 80 mg/dL
Which of the following is inconsistent as a condition related to metabolic syndrome?
Hypotension
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery?
Inadequate tissue perfusion
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
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 lipoproteins (LDL)
Which of the following techniques is used to surgically revascularize the myocardium?
Minimally invasive direct coronary bypass
Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except:
Morphine IV
Which of the following is the analgesic of choice for acute MI?
Morphine sulfate
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
A patient complains to the nurse about chest pain and palpitations during and after his morning jogs. The patient's family history reveals a history of coronary artery disease (CAD). What should the nurse recommend to minimize cardiac risk?
Smoking cessation
The nurse is educating the patient about administering nitroglycerin prior to discharge from the hospital. What information should the nurse include in the instructions?
Take a nitroglycerin and repeat every 5 minutes if the pain is not relieved until a total of 3 are taken. If pain is not relieved, activate the emergency medical system.
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.
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
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.
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
Which of the following is also termed preinfarction angina?
Unstable angina
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
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
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 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."
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."
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
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
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.
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 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.
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
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.
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).
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
You are caring for a client with CAD. What is an appropriate nursing action when evaluating a client with coronary artery disease (CAD)?
Assess the characteristics of chest pain.
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.
Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin?
Clopidogrel (Plavix)
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
