Chapter 27: Management of Patients With Coronary Vascular Disorders

A nurse completed a physical exam for an insurance company. The nurse noted a cluster of abnormalities that she knew was considered a major risk factor for coronary artery disease. Choose that condition. a) Metabolic syndrome b) Diabetes mellitus c) Hypolipidemia d) Congestive heart failure

a) Metabolic syndrome Metabolic syndrome includes three of six conditions that are recognized as a major risk factor for CAD. Insulin resistance is part of the syndrome but the patient may not yet have diabetes.

Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: a) Morphine IV b) Angiotensin-converting enzyme (ACE) inhibitor c) Aspirin d) Statin

a) 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.

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 the intention to stop smoking." b) "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." c) "Client will verbalize the intention to avoid exercise." d) "Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol."

a) "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. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).

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

a) 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.

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) 60 minutes d) 30 minutes

a) 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 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) A lack of oxygen in the heart muscle that causes the death of cells. b) Complete closure of an artery. c) Incomplete blockage of a major coronary artery. d) A destroyed part of the heart muscle.

a) 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.

A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which of the following risk factors will the nurse include? Choose all that apply. a) African-American descent b) Family history of coronary heart disease c) Elevated C-reactive protein d) Body mass index (BMI) of 23 e) Age greater than 45 years for men

a) African-American descent b) Family history of coronary heart disease c) Elevated C-reactive protein e) Age greater than 45 years for men Risk factors for coronary heart disease (CHD) include family history of CHD, age older than 45 years for men and 65 years for women, African-American race, BMI of 25 or greater, and elevated C-reactive protein.

A 65-year-old male client complains of pain and cramping in his thigh when climbing the stairs and numbness in his legs after exertion. The nurse anticipates the physician will perform which of the following diagnostic tests right in the office to determine PAD? a) Ankle-brachial index b) Exercise electrocardiography c) Photoplethysmography d) Electron beam computed tomography

a) Ankle-brachial index The client's symptoms indicate he may have peripheral artery disease (PAD). The ankle-brachial index is a simple, noninvasive test used for its diagnosis. An exercise electrocardiography may be ordered for a client with possible CAD. An EBCT is a radiologic test that produces x-rays of the coronary arteries using an electron beam. It is used to diagnose for CAD. Clients with suspected venous insufficiency will undergo photoplethysmography, a diagnostic test that measures light that is not absorbed by hemoglobin and consequently is reflected back to the machine.

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. a) Avoid over-the-counter decongestants and cold remedies. b) Wear gloves to protect hands from injury when performing tasks. c) Refrain from going outdoors in cold weather. d) Limit activities that place stress on the ulnar nerve. e) Do not smoke or stop smoking.

a) Avoid over-the-counter decongestants and cold remedies. b) Wear gloves to protect hands from injury when performing tasks. e) Do not smoke or stop smoking. 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.

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? a) Creatinine kinase-myoglobin (CK-MB) level b) Troponin C level c) Myoglobin level d) CK-MM

a) Creatinine kinase-myoglobin (CK-MB) level 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. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. There are three isomers of troponin: C, I, and T. Troponin I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury. 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.

Understanding atherosclerosis, the nurse identifies which of the following to be both a risk factor for the development of the disorder and an outcome? a) Hypertension b) Hyperlipidemia c) Obesity d) Glucose intolerance

a) Hypertension Increases in diastolic and systolic blood pressure are associated with an increased incidence of atherosclerosis, often an inherited factor. Elevation of blood pressure results when the vessels cannot relax and impairs the ability of the artery to dilate. Hyperlipidemia, diabetes, and obesity are all risk factors for atherosclerosis but do not result from the disorder.

While receiving a heparin infusion to treat deep vein thrombosis, a client reports that his gums bleed when he brushes his teeth. What should the nurse do first? a) Notify the physician. b) Administer a coumarin derivative, as ordered, to counteract heparin. c) Reassure the client that bleeding gums are a normal effect of heparin. d) Stop the heparin infusion immediately.

a) Notify the physician. Because heparin can cause bleeding gums that may indicate excessive anticoagulation, the nurse should notify the physician, who will evaluate the client's condition. The physician should order laboratory tests such as partial thromboplastin time before concluding that the client's bleeding is significant. The ordered heparin dose may be therapeutic rather than excessive, so the nurse shouldn't discontinue the heparin infusion unless the physician orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Heparin doesn't normally cause bleeding gums.

Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? a) Withhold anticoagulant therapy. b) Remove hair from skin insertion sites. c) Inform client of diagnostic tests. d) Assess distal pulses.

a) 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.

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) Worsening angina b) Internal bleeding c) Thrombocytopenia d) Formation of blood clots

a) 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.

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) troponin. b) lactate dehydrogenase. c) myoglobin. d) creatine kinase.

a) 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.

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 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." c) "I should avoid taking a tub bath until my catheter site heals." d) "I should avoid prolonged sitting."

b) "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 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) "Contact dermatitis and skin irritations are common when the patch remains on all day." b) "Removing the patch at night prevents drug tolerance while keeping the benefits." c) "Nitroglycerine causes headaches, but removing the patch decreases the incidence." d) "You do not need the effects of nitroglycerine while you sleep."

b) "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 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 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.

Which of the following methods to induce hemostasis after sheath removal post percutaneous transluminal coronary angioplasty (PTCA) is the least effective? a) Application of a vascular closure device, such as Angioseal, VasoSeal, Duett, or Syvek patch b) Application of a sandbag to the area c) Direct manual pressure d) Application of a pneumatic compression device (eg, Fem-Stop)

b) 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.

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) Hypertension b) Cardiac tamponade c) Elevated central venous pressure d) Hypothermia

b) 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. Preload can also decrease if there is a collection of fluid and blood in the pericardium (cardiac tamponade), which impedes cardiac filling. Cardiac output is also altered if too much volume returns to the heart, causing fluid overload.

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? a) Returning the patient to work and a preillness lifestyle b) Improvement of the quality of life c) Prevention of another cardiac event d) Limiting the effects and progression of atherosclerosis

b) Improvement of the quality of life Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.

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 6 hours c) Within 12 hours d) Within 24 to 48 hours

b) 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.

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) 250-275 mg/dL b) 210-240 mg/dL c) 160-190 mg/dL d) 280-300 mg/dL

c) 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.

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) 125 seconds or less. b) 100 seconds or less. c) 50 seconds or less. d) 75 seconds or less.

c) 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.

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) Decreased cardiac output b) Risk for imbalanced body temperature c) Acute pain d) Anxiety

c) Acute pain 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.

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) Coronary thrombosis c) Atherosclerosis d) Arteriosclerosis

c) 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.

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? a) Nitroprusside (Nipride) b) Furosemide (Lasix) c) Carvedilol (Coreg) d) Digoxin (Lanoxin)

c) Carvedilol (Coreg) 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.

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) Memory lapses b) Ankle edema c) Depression d) Dizziness

c) 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 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) Serum electrolytes b) Ativan 1 mg orally c) Nitroglycerin SL d) Chest x-ray

c) 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.

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 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.

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) 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.

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 begin a running program, working up to 2 miles per day. c) she'll ask the dietitian to talk with him about modifying his diet. d) 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. 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.

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. 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.

Which condition most commonly results in coronary artery disease (CAD)? a) Renal failure b) Myocardial infarction c) Diabetes mellitus d) Atherosclerosis

d) 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.

Which medication should a nurse have on hand when removing a sheath after cardiac catheterization? a) Heparin b) Adenosine (Adenocard) c) Protamine sulfate d) Atropine

d) Atropine 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 aware that a client who has been diagnosed with Prinzmetal's angina will present with which of the following symptoms? a) Radiating chest pain that lasts 15 minutes or less b) Chest pain of increased frequency, severity, and duration c) Prolonged chest pain that accompanies exercise d) Chest pain that occurs at rest and usually in the middle of the night

d) Chest pain that occurs at rest and usually in the middle of the night A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8 AM, is sporadic over 3-6 months, and diminishes over time. Client with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Client with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.

Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Diltiazem (Cardizem) b) Felodipine (Plendil) c) Amlodipine (Norvasc) d) Clopidogrel (Plavix)

d) 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.

In providing nursing management to a client post-varicose vein surgery, the nurse would include which of the following teaching measures? Select all that apply. a) Cool compresses b) Take warm showers in the morning. c) Stand rather than sit. d) Elastic stockings e) Exercise f) Lower the extremities.

d) Elastic stockings e) Exercise Movement/exercise and use of elastic stocking aid in venous return. Cool compresses can cause vasoconstriction, which can diminish arterial blood flow. Elevation of legs can be helpful in aiding venous return. Standing or sitting for prolonged periods of time should be avoided. Showers in the morning can dilate blood vessels and contribute to venous congestion and edema.

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) Hyperuricemia b) Hyperglycemia c) Gastrointestinal distress d) Increased liver enzymes

d) 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.

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) WBC (white blood cell) count b) Troponin I c) C-reactive protein d) Myoglobin

d) Myoglobin Myoglobin is a biomarker that rises in 2 to 3 hours after heart damage. Troponin is the gold standard for determining heart damage, but troponin I levels due not rise until 4 to 6 hours after MI. WBCs and C-reactive protein levels will rise but not until about day 3.

The nursing priority of care for a client exhibiting signs and symptoms of coronary artery disease should be to: a) educate the client about his symptoms. b) decrease anxiety. c) administer sublingual nitroglycerin. d) enhance myocardial oxygenation.

d) enhance myocardial oxygenation. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are import in care delivery, neither is a priority when a client is compromised.