chapter 23: management of patients with coronary vascular disorders

A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absence of precipitating factors. How would the nurse best describe this type of anginal pain? 1.Stable angina 2.Variant angina 3.Unstable angina 4.Nonanginal pain

3. unstable angina

The triage nurse in the ED assesses a 66-year-old male patient who presents to the ED with complaints of midsternal chest pain that has lasted for the last 5 hours. If the patient's symptoms are due to an MI, what will have happened to the myocardium? A) It may have developed an increased area of infarction during the time without treatment. B) It will probably not have more damage than if he came in immediately. C) It may be responsive to restoration of the area of dead cells with proper treatment. D) It has been irreparably damaged, so immediate treatment is no longer necessary.

A) It may have developed an increased area of infarction during the time without treatment. when the client experiences a lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated, the more likely the treatment will prevent or minimize myocardial tissue necrosis. a delay will lead to increase myocardial damage.

2. In preparation for cardiac surgery, a client was taught about measures to prevent venous thromboembolism. What statement indicates that the client clearly understood this education? A. "I'll try to stay in bed for the first few days to allow myself to heal." B. "I'll make sure that I don't cross my legs when I'm resting in bed." C. "I'll keep pillows under my knees to help my blood circulate better." D. "I'll put on those compression stockings if I get pain in my calves."

B. "I'll make sure that I don't cross my legs when I'm resting in bed."

26. A nurse is assigned four clients with diagnoses that rule out myocardial infarction (MI) due to chest pain. Which client's test results best demonstrate the specific diagnosis of unstable angina (USA)? A. A 63-year-old client with elevated troponins and no elevation in the ST segment. B. A 72-year-old client with an increase in myoglobin, no elevation in the ST segment, and no elevation in troponins. C. A 54-year-old client with elevated creatine kinase myocardial band (CK-MB) and ST segment elevations in two contiguous leads on the electrocardiogram (ECG). D. A 48-year-old client with T wave inversions, ST elevation, and abnormal Q waves.

B. A 72-year-old client with an increase in myoglobin, no elevation in the ST segment, and no elevation in troponins.

The nurse is creating a plan of care for a client with acute coronary syndrome. What nursing action should be included in the client's care plan? A. Facilitate daily arterial blood gas (ABG) sampling. B. Administer supplementary oxygen, as needed. C. Have client maintain supine positioning when in bed. D. Perform chest physiotherapy, as indicated.

B. Administer supplementary oxygen, as needed.

A client with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The client is admitted to the cardiac critical care unit after the PTCA. The complications for which the nurse should monitor the client include which of the following? A. Peripheral edema B. Bleeding at insertion site C. Left ventricular hypertrophy D. Pulmonary edema

B. Bleeding at insertion site

The nurse is caring for a client who is believed to have just experienced an MI. The nurse notes changes in the ECG of the client. What change on an ECG most strongly suggests to the nurse that ischemia is occurring? A. P-wave inversion B. T-wave inversion C. Qwave changes with no change in ST or T wave D. P-wave enlargement

B. T-wave inversion

The nurse is writing a care plan for a client who has been diagnosed with angina pectoris. the client describes herself as being "distressed" and "shocked" by the new diagnosis. What nursing diagnosis is most clearly suggested by the client's statement? A. Spiritual distress related to change in health status B. Acute confusion related to prognosis for recovery C. Anxiety related to cardiac symptoms D. Deficient knowledge related to treatment of angina pectoris

C. Anxiety related to cardiac symptoms

The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments? A. Maximizing cardiac output while minimizing heart rate B. Decreasing energy expenditure of the myocardium C. Balancing myocardial oxygen supply with demand

C. Balancing myocardial oxygen supply with demand

A nurse has taken on the care of a patient who had a coronary artery stent placed yesterday. When reviewing the patient's daily medication administration record, the nurse should anticipate administering what drug? A) Ibuprofen B) Clopidogrel C) Dipyridamole D) Acetaminophen

Clopidogrel

An ED nurse is assessing an adult woman for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female patients? Select all that apply. A) Shortness of breath B) Chest pain C) Anxiety D) indigestion E) nausea

D, E atypical s/s of Mi in females include indigestion, nausea, palpitations, and numbness.

An OR nurse is preparing to assist with a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used as source for a CABG is what? A) Brachial artery B) Brachial vein C) Femoral artery D) Greater saphenous vein

D. Greater saphenous vein this is the vein commonly used grafting sire for CABG.

a nurse educator is conducting an inservice for nursing students about how tobacco use impacts coronary artery disease (CAD)? what are the primary ways that tobacco use impacts CAD? select all that apply. a. decreases the supply of oxygen to the myocardium b. increases platelet adhesion c. raises the heart rate and blood pressure d. causes the coronary arteries to dilate e. increases the blood carbon monoxide level

a, b, c, e Nicotinic acid in tobacco triggers the release of catecholamines, which raise the heart rate and blood pressure. also cause the coronary arteries to constrict.

the nurse is assessing a client with acute coronary syndrome (ACS). the nurse includes a careful history in the assessment, especially with regard to signs and symptoms. what signs and symptoms are suggestive of ACS? SATA a. dyspnea b. unusual fatigue c. hypotension d. syncope e. peripheral cyanosis

a, b, d

a client presents to ED reporting severe substernal chest pain radiating down the left arm. the client is admitted to the coronay care unit (CCU) with a diagnosis of myocardial infarction(MI). what nursing assessment activity is a priority on admission to the CCU? a. begin ECG monitor b. obtain info about family hx of heart disease c. auscultate lung fields d. determine if the client smokes

a. begin ECG monitor 12 lead ECG provides info that assists in ruling out or diagnosing an acute MI.

the nurse has just admitted a client for cardiac surgery. the client tearfully describes feeling afraid of dying while undergoing the surgery. what is the nurse's best response? a. explore the factors underlying the client's anxiety. b. teach the client guided imagery techniques c. obtain an order for a pRN benzodiazepine d. describe the procedure in greater detail

a. explore the factors underlying the client's anxiety. identifying the fears and assist in developing coping mechanism for those fears.

the nurse is caring for client who has been diagnosed with an elevated cholesterol level. the nurse is aware that plaque on the inner lumen of the arteries is composed chiefly of what? a. lipids and fibrous tissue b. white blood cells c. lipoproteins d. high-density cholesterol

a. lipids and fibrous tissue

a client with cardiovascular disease is being treated with amlodipine, which is intended to cause what therapeutic effect? a. reducing the heart's workload by decreasing heart rate and myocardial contraction b. preventing platelet aggregation and subsequent thrombosis c. reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart. d. increasing the efficiency of myocardial oxygen consumption, thus decreasing ischemia and relieving pain.

a. reducing the heart's workload by decreasing heart rate and myocardial contraction

the nurse is working with a client who had an MI and is now in active rehabilitation. the nurse should teach this client to cease activity if which of the follow occurs? a. the client experiences chest pain, palpitations, or dyspnea b. the client experiences a noticeable increase in heart rate during activity c. the client's oxygen saturation level drop below 96% d. the client's respiratory rate exceeds 30 breaths/min

a. the client experiences chest pain, palpitations, or dyspnea any activity or exercise that cause these s/s should be stop in pt w/CAD

a client with hypertension is ambulating in the hospital hallway and reports chest pain. in which order would the nurse assess and treat this client? a. the first set of vital signs are done. b. the nurse assesses the client angina c. a 12 lead electrocardiogram d. the client is instructed to stop all activity e. the client receives the first dose of nitroglycerin f. the client is transferred to a higher acuity unit

all of the above

An adult client is admitted to the ED with chest pain. the client states that there was unrelieved chest pain for approximately 20 minutes before coming to the hospital. to minimize cardiac damage, the nurse should expect to administer which of the following interventions? a. thrombolytic, oxygen administration, and non-steroidal anit-inflammatories b. morphine sulfate, oxygen, and bed rest. c. oxygen and beta-adrenergic blockers d. bed rest, albuterol nebulizer treatments, and oxygen

b. morphine sulfate, oxygen, and bed rest. MONA: morphine, oxygen, nitroglycerin, aspirin

when assessing a client with angina pectoris, it is most important for the nurse to gather what information? a. the client's activities, limitations, and level of consciousness after the attacks b. the client's symptoms and the activities that precipitate attacks c. the client's understanding of the pathology of angina d. the client's coping strategies surrounding the attacks

b. the client's symptoms and the activities that precipitate attacks

A client with angina has ben prescribed nitroglycerin. before administering the drug, the nurse should inform the client about what potential adverse effects? a. nervousness or paresthesia b. throbbing headache or dizziness c. drowsiness or blurred vision d. tinnitus or diplopia

b. throbbing headache or dizziness these symptom are common when nitroglycerin is taken at the beginning of therapy.

a nurse is working with a client who has been scheduled for percutaneous coronary intervention (PCI) later in the week. What anticipatory guidance should the nurse provide to the client? a. the client will remain on bed rest for 48 to 72 hours after the procedure b. the client will be given vitamin K infusion to prevent bleeding following PCI. c. a sheath will be placed over the insertion site after the procedure d. the procedure will likely be repeated in 6-8 weeks to ensure success.

c. a sheath will be placed over the insertion site after the procedure it will kept in place until adequate coagulation is achieved.

the nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. the nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. which risk factors should the nurse list that can be controlled or modified? a. gender, obesity, family history, and smoking b. inactivity, stress, gender, and smoking c. cholesterol levels, hypertension, and smoking d. stress, family history, and obesity

c. cholesterol levels, hypertension, and smoking

a client is recovering from cardiac surgery, the nurse has identified the diagnosis of risk for ineffective airway clearance related to pulmonary secretions. what intervention best addresses this risk? a. administration of bronchodilators by nebulizer b. administration of inhaled corticosteroids by metered dose inhaler c. client consistent performance of deep-breathing and coughing exercises d. client's active participation in a cardiac rehab program.

c. client consistent performance of deep-breathing and coughing exercises clearance of pulmonary secretions is accomplished by frequent repositioning, suctioning, chest physical therapy, deep breathing and coughing.

a client who is postoperative day 1 following a CABG has produced 20 ML of urine in the past 3 hours and the nurse has confirmed the patency of the urine catheter. what is the nurse's most appropriate actions? a. document the client low urine output and monitor closely for the next hour b. contact the dietitian and suggest the need for increased oral fluid intake c. contact the provider and continue to assess fluid balance and renal functions. d. increase the infusion rate of the client's IV fluid to prompt an increase in renal function.

c. contact the provider and continue to assess fluid balance and renal functions. nurse management includes accurate measurement of urine output. an output less than 0.5 ml/kg/hr may indicate hypovolemia or renal insufficiency.

the nurse is caring for an adult client who had symptoms of unstable angina upon admission to the hospital. what nursing diagnosis underlines the discomfort associated with angina? a. ineffective breathing pattern related to decreased cardiac output b. anxiety related to fear of death c. ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) d. impaired skin integrity related to CAD

c. ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) this nursing DX results in the symptoms of discomfort associated with angina.

a client with type 2 and hypertension has a routine follow up appointment after a cardiac stent placement. On assessment the nurse notes that client weighs 250lb, waist circumference of 40 inches, blood pressure is 162/84, and fasting blood sugar is 220 mg/dl. based on these findings, which syndrome should the nurse most suspect? a. adams-nance syndrome b. postpericardiotomy syndrome c. metabolic syndrome d. alagille syndrome

c. metabolic syndrome a cluster of metabolic abnormalities known as metabolic syndrome is a major risk factor for cardiovascular disease. the diagnosis is made when the client has 3 of the 5 risk factors. -waist circumference greater than 35.4 -HTN -high triglycerides -reduced HDL -fasting bs greater than 100 mg/dl

the ED nurse is caring for a client with suspected MI. what drug should the nurse anticipate administering to this client? a. oxycodone b. warfarin c. morphine d. acetaminophen

c. morphine MONA: morphine, oxygen, nitroglycerin, aspirin.

family members bring a client to the ED with pale skin, sudden mid-sternal chest pain unrelieved with rest, and a history of CAD. how should the nurse best interpret these initial data? a. the symptoms indicate angina and should be treated as such. b. the symptoms indicate a pulmonary etiology rather than a cardiac etiology. c. the symptoms indicate an acute coronary episode and should be treated as such. d. treatment should be determined pending the results of an exercise stress test.

c. the symptoms indicate an acute coronary episode and should be treated as such. the symptoms are unrelieved by rest suggest an acute coronary episode rather than angia.

a client in a cardiac step down unit has begun bleeding from the PCI access site in the femoral region. what is the nurse's most appropriate action? a. call for assistance and initiate CPR b. reposition the client's leg in a nondependent position c. promptly remove the femoral sheath d. call for help and apply pressure to the access site

d. call for help and apply pressure to the access site The sheath produces pressure on the access site, pressure will temporarily reduce bleeding and allow for follow up interventions.

a client presents to the clinic reporting intermittent chest pain on exertion, which is eventually attributed to angina. the nurse should inform the client that angina is most often attributable to what cause? a. decreased cardiac output b. decreased cardiac contractility c. infarction of the myocardium d. coronary arteriosclerosis

d. coronary arteriosclerosis arteriosclerosis is a cause of angina pectoris

the public health nurse is participating in a health fair and interviews a client with a history of hypertension, who is currently smoking one pack of cigarettes per day. the client denies any of the most common manifestation of CAD. the nurse should expect the focuses of CAD treatment to be a. drug therapy and smoking cessation b. diet and drug therapy c. diet therapy only d. diet therapy and smoking cessation

d. diet therapy and smoking cessation due to the absence of symptoms, diet & smoking cessation would be the first-line treatment for possible CAD.

the nurse working on the coronary care unit is caring for a client with ACS, how can the nurse best meet the client psychosocial needs? a. reinforce the fact that treatment will be successful b. facilitate a referral to a chaplain or spiritual leader c. increase the client's participation in rehabilitation actives d. directly address the client's anxieties and fears.

d. directly address the client's anxieties and fears.

A nurse is providing care for a client with high cholesterol and triglyceride values. in teaching the client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following? a. high HDL values and high triglyceride values b. absence of detectable total cholesterol level c. elevated blood lipids, fasting glucose less than 100 d. low LDL values and high HDL values

d. low LDL values and high HDL values LDL are harmful and HDL promotes the use of total cholesterol.

the hospital nurse is caring for a client who reports that an angina attack is beginning. which action is the nurse's most appropriate initial action? a. have the client sit down and put the head between the knees b. have the client perform pursed-lip breathing c. have the client stand still and bend over at waist d. place the client on bed rest in a semi-fowler position

d. place the client on bed rest in a semi-fowler position rest in bed in semi-fowler position reduce the oxygen requirements of the ischemic myocardium.