Chapter 27: Management of Patients with Coronary Vascular Disorders

The nurse recognizes that the treatment for a non-ST-elevation myocardial infarction (NSTEMI) differs from that for a STEMI, in that a STEMI is more frequently treated with A. percutaneous coronary intervention (PCI). B. IV nitroglycerin. C. IV heparin. D. thrombolytics.

A. percutaneous coronary intervention (PCI). The client with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate PCI. Superior outcomes have been reported with the use of PCI compared to thrombolytics. IV heparin and IV nitroglycerin are used to treat NSTEMI.

A client is being evaluated for coronary artery disease (CAD) and is scheduled for an electron beam computed tomography (EBCT). The nurse understands that the primary advantage of this radiologic test is which of the following? A. Clear images B. Less invasive procedure C. Quantifies calcified plaque D. Less exposure to radiation

C. Quantifies calcified plaque The primary advantage of EBCT is to detect and quantify calcified plaque in the coronary arteries even before symptoms arise. EBCT is noninvasive and provides clearer images with less exposure to radiation than a CT scan but not the primary reason for use.

The nurse administers propranolol hydrochloride to a patient with a heart rate of 64 beats per minute (bpm). One hour later, the nurse observes the heart rate on the monitor to be 36 bpm. What medication should the nurse prepare to administer that is an antidote for the propranolol? A. Atropine B. Sodium nitroprusside C. Digoxin D. Protamine sulfate

A. Atropine Sheath removal and the application of pressure on the vessel insertion site may cause the heart rate to slow and the blood pressure to decrease (vasovagal response). A dose of IV atropine is usually given to treat this response.

A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding? A. "What color is your urine?" B. "How is your appetite?" C. "Is your skin drier than normal?" D. "Do you have any breathing problems?"

A. "What color is your urine?" The patient receiving anticoagulation therapy should be monitored for signs and symptoms of bleeding, such as changes in the color of the stool or urine. Anticoagulation therapy should not cause dry skin. The anticoagulation therapy should not change the client's breathing or appetite.

A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? A. Assess chest pain and administer prescribed drugs and oxygen B. Assess the client's physical history C. Assess blood pressure and administer aspirin D. It is not important to assess the client or to notify the physician

A. Assess chest pain and administer prescribed drugs and oxygen The nurse assesses the client for chest pain and administers the prescribed drugs that dilate the coronary arteries. The nurse administers oxygen to improve the oxygen supply to the heart. Assessing blood pressure or the client's physical history does not clearly indicate that the client has CAD. The nurse does not administer aspirin without a prescription from the physician.

The nurse understands it is important to promote adequate tissue perfusion following cardiac surgery. Which measures should the nurse complete to prevent the development of deep venous thrombosis (DVT) and possible pulmonary embolism (PE)? Select all that apply. A. Avoid elevating the knees on the bed. B. Initiate passive exercises. C. Encourage the client to cross their legs. D. Place pillows in the popliteal space. E. Apply antiembolism stockings.

A. Avoid elevating the knees on the bed B. Initiate passive exercises. E. Apply antiembolism stockings. Preventive measures used to prevent venous stasis include application of sequential pneumatic compression devices; discouraging crossing of legs; avoiding elevating the knees on the bed; omitting pillows in the popliteal space; and beginning passive exercises followed by active exercises to promote circulation and prevent venous stasis.

The nurse is providing education about angina pectoris to a hospitalized client who is about to be discharged. What instruction does the nurse include about managing this condition? Select all that apply. A. Balance rest with activity. B. Carry nitroglycerin at all times. C. Stop smoking. D. Follow a diet high in saturated fats. E. Avoid all physical activity.

A. Balance rest with activity. B. Carry nitroglycerin at all times C. Stop smoking. Managing angina pectoris at home includes balancing rest with activity, participating in a regular daily program of activities that do not induce angina pain, stopping smoking, carrying nitroglycerin at all times, and following a diet low in saturated fat.

The nurse is providing education about the nutrient content of the Therapeutic Lifestyle Changes (TLC) diet to a community group. What information will the nurse provide? Select all that apply. A. Carbohydrates should make up 50% to 60% of the total calories. B. Cholesterol should be less than 1 gram per day. C. Dietary fiber should be 20 to 30 grams per day. D. Protein should make up approximately 15% of total calories. E. Total fat should make up only 5% of the total calories.

A. Carbohydrates should make up 50% to 60% of the total calories. C. Dietary fiber should be 20 to 30 grams per day. D. Protein should make up approximately 15% of total calories. According to the nutrient content of the TLC diet, cholesterol should make up less than 200 mg/day, carbohydrates should make up 50% to 60% of the total calories, dietary fiber should be 20 to 30 grams per day, protein should make approximately 15% of the total calories, and fat should make up 25% to 30% of the total calories.

Which complication of cardiac surgery occurs when fluid and clots accumulate in the pericardial sac, which compresses the heart, preventing blood from filling the ventricles? A. Cardiac tamponade B. Hypothermia C. Hypertension D. Fluid overload

A. Cardiac tamponade Cardiac tamponade is fluid and clot accumulation in the pericardial sac, which compresses the heart, preventing the blood from filling the ventricles. Fluid overload is exhibited by high pulmonary artery wedge pressure, central venous pressure, and pulmonary artery diastolic pressure, as well as crackles in the lungs. Hypertension results from postoperative vasoconstriction. Hypothermia is a low body temperature that leads to vasoconstriction.

An electrocardiogram (ECG) taken during a routine checkup reveals that a client has had a silent myocardial infarction. Changes in which leads of a 12-lead ECG indicate damage to the left ventricular septal region? A. Leads V3 and V4 B. Leads II, III, and aVF C. Leads I, aVL, V5, and V6 D. Leads V1 and V2

A. Leads V3 and V4 Leads V3 and V4 record electrical events in the septal region of the left ventricle. Leads I, aVL, V5, and V6 record electrical events on the lateral surface of the left ventricle. Leads II, III, and aVF record electrical events on the inferior surface of the left ventricle. Leads V1 and V2 record electrical events on the anterior surface of the right ventricle and the anterior surface of the left ventricle.

The nurse reviews laboratory tests for cardiac biomarkers for a client suspected of suffering an MI. What is the earliest marker of an MI? A. Myoglobin B. Total creatinine kinase (CK) C. Troponin I and T D. Creatinine kinase-myocardial band (CK-MB)

A. Myoglobin Myoglobin is a heme protein that transports oxygen. Its levels can increase as early as 1 hour after an MI. Negative results are an excellent parameter for ruling out an acute MI. The other biomarker choices start to increase in 2 to 4 hours.

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)? A. The patient has at least a 70% occlusion of a major coronary artery. B. The patient has an ejection fraction of 65%. C. The patient has had angina longer than 3 years. D. The patient has compromised left ventricular function.

A. The patient has at least a 70% occlusion of a major coronary artery. For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).

An client who has been diagnosed with arteriosclerosis is confused by what this means. The nurse explains that arteriosclerosis is: A. an expected part of the aging process. B. high level of blood fat. C. a condition in which the lumen of arteries fill with scar tissue. D. a vascular occlusive disease.

A. an expected part of the aging process Arteriosclerosis is loss of elasticity or hardening of the arteries that accompanies the aging process. While arteriosclerosis is a contributing factor to vascular occlusive disease, it is a term that refers to a loss of elasticity or hardening of the arteries that accompanies the aging process. Arteriosclerosis does not involve scar tissue formation. Hyperlipidemia, or high levels of blood fat, triggers atherosclerotic changes.

A client is recovering from coronary artery bypass graft (CABG) surgery. During discharge preparation, the nurse should advise the client and family members to expect which common symptom that typically resolves spontaneously? A. depression B. ankle edema C. memory lapses D. dizziness

A. 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 notification to a health care provider.

A client who had coronary artery bypass surgery is exhibiting signs of heart failure. What medications will the nurse anticipate administering for this client? Select all that apply. A. digoxin B. nitroprusside C. amlodipine D. diuretics E. inotropic agents

A. digoxin D. diuretics E. inotropic agents Medical management of cardiac failure includes digoxin, diuretics, and IV inotropic agents. Amlodipine and calcium channel blockers are not used due to systolic dysfunction. Nitroprusside is a vasodilator that is not used for heart failure.

A client presents to the emergency department reporting chest pain. Which order should the nurse complete first? A. Troponin level B. 12-lead ECG C. 2 L oxygen via nasal cannula D. Aspirin 325 mg orally

B. 12-lead ECG The nurse should complete the 12-lead ECG first. The priority is to determine whether the client is suffering an acute MI and implement appropriate interventions as quickly as possible. The other orders should be completed after the ECG.

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 (MI)? A. 30 minutes B. 60 minutes C. 9 days D. 6 to 12 months

B. 60 minutes The 60-minute interval is known as "door-to-balloon time" in which a PTCA can be performed on a client with a diagnosed MI. The 30-minute interval is known as "door-to-needle time" for the administration of thrombolytics after MI. The time frame of 9 days refers to the time until the onset of vasculitis after administration of streptokinase for thrombolysis in a client with an acute MI. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same client for acute MI.

A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication? A. Hyperkalemia B. Atelectasis C. Urinary tract infection (UTI) D. Elevated blood glucose level

B. Atelectasis Respiratory complications that may occur include atelectasis. An incentive spirometer and the use of deep breathing exercises are necessary to prevent atelectasis and pneumonia. Elevated blood sugar levels, hyperkalemia, UTI, and are complications that can occur but are unrelated to the respiratory system.

The nurse is caring for a client diagnosed with unstable angina who is receiving IV heparin. The client requires bleeding precautions. Bleeding precautions include which measure? A. Avoid subcutaneous injections B. Avoid continuous BP monitoring C. Use an electric toothbrush D. Avoid the use of nail clippers

B. Avoid continuous BP monitoring The client receiving heparin receives bleeding precautions, which can include applying pressure to the site of any needle punctures for a longer time than usual, avoiding intramuscular injections, and avoiding tissue injury and bruising from trauma or constrictive devices (e.g., continuous use of an automatic BP cuff). Subcutaneous injections are permitted; a soft toothbrush should be used, and the client may use nail clippers, but with caution.

A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse? A. Pain score 5/10 B. Central venous pressure reading of 1 C. Heart rate 66 bpm D. Blood pressure 110/68 mm Hg

B. Central venous pressure reading of 1 The central venous pressure (CVP) reading of 1 is low (2-6 mm Hg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.

The nurse is reviewing the laboratory results for a patient having a suspected myocardial infarction (MI). What cardiac-specific isoenzyme does the nurse observe for myocardial cell damage? A. Alkaline phosphatase B. Creatine kinase MB C. Troponin D. Myoglobin

B. Creatine kinase MB There are three creatine kinase (CK) isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle), and CK-BB (brain tissue). CK-MB is the cardiac-specific isoenzyme; it is found mainly in cardiac cells and therefore increases when there has been damage to these cells. Elevated CK-MB is an indicator of acute MI; the level begins to increase within a few hours and peaks within 24 hours of an infarct.

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

B. Family history of coronary heart disease C. Elevated C-reactive protein D. Age greater than 45 years for men E. African-American descent 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.

Which is a modifiable risk factor for coronary artery disease (CAD)? A. Family history B. Hyperlipidemia C. Male gender D. Increasing age

B. Hyperlipidemia Other modifiable risk factors for CAD include tobacco use, hypertension, diabetes, metabolic syndrome, obesity, and physical inactivity. Increasing age, male gender, and family history are nonmodifiable risk factors for CAD.

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. Obesity B. Hypertension C. Hyperlipidemia D. Glucose intolerance

B. 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.

A client admitted to the coronary care unit (CCU) diagnosed with a STEMI is anxious and fearful. Which medication will the nurse administer to relieve the client's anxiety and decrease cardiac workload? A. Atenolol B. IV morphine C. IV nitroglycerin D. Amlodipine

B. IV morphine IV morphine is the analgesic of choice for the treatment of an acute MI. It is given to reduce pain and treat anxiety. It also reduces preload and afterload, which decreases the workload of the heart. IV nitroglycerin is given to alleviate chest pain. Administration of atenolol and amlodipine are not indicated in this situation.

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. Troponin I B. Myoglobin C. WBC (white blood cell) count D. C-reactive protein

B. 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.

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? A. Magnesium B. Potassium C. Sodium D. Calcium

B. Potassium Hyperkalemia (high potassium) can result in the following ECG changes: tall peaked T waves, wide QRS, and bradycardia. The nurse should be prepared to administer a diuretic or an ion-exchange resin (sodium polystyrene sulfonate [Kayexalate]); IV sodium bicarbonate, or IV insulin and glucose. Imbalances in the other electrolytes listed would not result in peaked T waves.

A nurse reviews an ECG strip for a client who is admitted with symptoms of an acute MI. The nurse should recognize what classic ECG changes that occur with an MI? Select all that apply. A. Absent P-waves B. ST-segment elevations C. U-wave elevations D. Abnormal Q-waves E. T-wave hyperactivity and inversions

B. ST-segment elevations D. Abnormal Q-waves E. T-wave hyperactivity and inversions These three signs are classic ECG changes suggestive of a myocardial infarction. Changes can be diagnostic to the area of cellular damage. P wave and U wave changes are not characteristic of an 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. What assessment is the nurse's highest priority? A. cardiac output B. acute pain C. anxiety D. body temperature

B. acute pain The assessment of 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. The client's blood pressure and heart rate do not suggest adecreased cardiac output. Anxiety may be an important assessment, but addressing acute pain (the priority concern) may alleviate the client's anxiety.

The nurse is beginning discharge teaching with a client diagnosed with a myocardial infarction (MI). The nurse will include teaching on what medications? Select all that apply. A. morphine B. aspirin C. enalapril D. atorvastatin E. sildenafil

B. aspirin C. enalapril D. atorvastatin Upon client discharge, there needs to be documentation that the client was discharged on a statin (atorvastatin), an ACE or angiotensin receptor blocking agent (enalapril), and aspirin. Morphine is used to reduce the client's pain and anxiety. Sildenafil is a medication used for pulmonary hypertension.

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

C. "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 nitroglycerin are headaches and contact dermatitis but not the reason for removing the patch at night. It is true that while the client rests, there is less demand on the heart but not the primary reason for removing the patch.

A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) immediately following confirmed diagnosis of acute myocardial infarction. The client is overtly anxious and crying. Which response by the nurse is most appropriate? A. "Would you like something to calm your nerves?" B. "Don't cry; you have the best team of doctors." C. "Tell me what concerns you most." D. "Everything will be fine. Your family is here for you."

C. "Tell me what concerns you most." Allowing the client to share feelings tends to relieve or reduce emotional distress. Telling a client that everything is fine negates the feelings they are expressing. Telling a client not to cry can be viewed as insensitive to the feelings being expressed. Providing a prescribed sedative may be helpful but does not address the fears and concerns of the client.

Heparin therapy is usually considered therapeutic when the client's activated partial thromboplastin time (aPTT) is how many times normal? A. .25 to .75 B. .75 to 1.5 C. 2.0 to 2.5 D. 2.5 to 3.0

C. 2.0 to 2.5 The amount of heparin administered is based on aPTT results, which should be obtained during the follow-up to any alteration of dosage. The client's aPTT value would have to be greater than .25 to .75 or .75 to 1.5 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.

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. With regards to partial thromboplastin time (PTT), when should the nurse plan to remove the femoral sheath? A. 100 seconds or less. B. 125 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.

When starting a client on oral or I.V. diltiazem, for which potential complication should the nurse monitor? A. Hypertension B. Renal failure C. Atrioventricular block D. Flushing

C. Atrioventricular block The chief complications of diltiazem are hypotension, atrioventricular blocks, heart failure, and elevated liver enzyme levels. Other reported reactions include flushing, nocturia, and polyuria, but not renal failure. Although flushing may occur, it's an adverse reaction, not a potential complication.

The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? A. Suction the airway. B. Prepare to administer intravenous fluids. C. Check blood pressure. D. Assess pupils for reactiveness.

C. Check blood pressure. During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.

A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? A. Cool, clammy skin and a diaphoretic, pale appearance B. Intermittent nausea and emesis for 3 days C. Chest discomfort not relieved by rest or nitroglycerin D. Anxiousness, restlessness, and lightheadedness

C. Chest discomfort not relieved by rest or nitroglycerin Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with acute coronary syndrome or MI, may also occur with angina and, alone, are not indicative of an MI.

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? A. Diltiazem B. Isosorbide mononitrate C. Clopidogrel D. Metoprolol

C. Clopidogrel Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels and slowing heart rate. Diltiazem is a calcium channel blocker used to relax heart muscles and blood vessels.

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 the nurse suspect in this client? A. Raynaud's disease B. Cardiogenic shock C. Coronary artery disease D. Venous occlusive disease

C. Coronary artery disease The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.

The nurse is caring for a client who was admitted to the telemetry unit with a diagnosis of "rule/out acute MI." The client's chest pain began 3 hours earlier. Which laboratory test would be most helpful in confirming the diagnosis of a current MI? A. CK-MM B. Troponin C level C. Creatinine kinase-myoglobin (CK-MB) level D. Myoglobin level

C. 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 (as a result of thrombotic therapy or PCI), it peaks earlier. CK-MM (skeletal muscle) is not an indicator of cardiac muscle damage. Three isomers of troponin exist: C, I, and T. Troponins 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.

A clientt is given a prescription for metoprolol after being examined by the health care provider. What is the most important teaching for the nurse to give to the client? A. If dizziness occurs, adjust the medication. B. Take the medication at the same time each day. C. Don't suddenly stop taking the medication without calling your health care provider. D. Dress warmly. Blood circulation may be reduced in the extremities.

C. Don't suddenly stop taking the medication without calling your health care provider. All teaching points need to be covered, but the nurse needs to emphasize that metoprolol should not be suddenly stopped because some conditions can become worse.

When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which electrolyte imbalance? A. Hypokalemia B. Hyperkalemia C. Hypermagnesemia D. Hypomagnesemia

C. Hypermagnesemia Untreated hypomagnesemia may result in coma, apnea, and cardiac arrest. Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV block, flat or inverted T waves). Signs of hyperkalemia include mental confusion, restlessness, nausea, weakness, paresthesias of extremities, dysrhythmias (tall, peaked T waves; increased amplitude, widening QRS complex; prolonged QT interval). Signs and symptoms of hypomagnesemia include paresthesias, carpopedal spasm, muscle cramps, tetany, irritability, tremors, hyperexcitability, hyperreflexia, cardiac dysrhythmias (prolonged PR and QT intervals, broad flat T waves), disorientation, depression, and hypotension.

The nurse is reevaluating a client 2 hours after a percutaneous transluminal coronary angioplasty (PTCA) procedure. Which assessment finding may indicate the client is experiencing a complication of the procedure? A. Heart rate of 100 bpm B. Potassium level of 4.0 mE/qL C. Dried blood at the puncture site D. Urine output of 40 mL

D. Urine output of 40 mL Complications that may occur following a PTCA include myocardial ischemia, bleeding and hematoma formation, retroperitoneal hematoma, arterial occlusion, pseudoaneurysm formation, arteriovenous fistula formation, and acute renal failure. The urine output of 40 mL over a 2-hour period may indicate acute renal failure. The client is expected to have a minimum urine output of 30 mL/h. Dried blood at the insertion site is a finding that warrants no acute intervention. A serum potassium level of 4.0 mEq/L is within the normal range. The heart rate of 100 bpm is within the normal range and indicates no acute distress.

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 be prescribed long-term administration of which drug? A. penicillin V or erythromycin. B. pentoxifylline or acetaminophen. C. aspirin or acetaminophen. D. aspirin or clopidogrel.

D. aspirin or clopidogrel. After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Health care providers order heparin for anticoagulation during this procedure; some health care providers discharge clients with a prescription for long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The health care provider may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.

The nurse is removing a client's femoral sheath after cardiac catheterization. What medication will the nurse have available? A. protamine sulfate B. adenosine C. heparin D. atropine sulfate

D. atropine sulfate Removing the sheath after cardiac catheterization may cause a vasovagal response, including bradycardia. The nurse should have atropine sulfate on hand to increase the client's heart rate if this occurs. Heparin changes clotting of 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 tachydysrhythmias.

The nurse has completed a teaching session on self-administration of sublingual nitroglycerin. Which client statement indicates that the teaching has been effective? A. "I can take nitroglycerin before sex so I won't develop chest pain". B. "I can put the nitroglycerin tablets in my daily pill dispenser with my other medications". C. "Side effects of nitroglycerin include flushing, throbbing headache, and hypertension". D. "After taking two tablets with no relief, I should call EMS."

A. "I can take nitroglycerin before sex so I won't develop chest pain".

Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? A. Cleanse the site with disinfectants and dress the wound appropriately B. Normal activities of daily living can be resumed the first day after surgery C. Refrain from sexual activity for 1 month D. Monitor the site for bleeding or hematoma.

D. Monitor the site for bleeding or hematoma. The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or the development of a hard mass indicative of hematoma. A nurse does not advise the client to clean the site with disinfectants or refrain from sexual activity for 1 month.

A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation? A. Urine output B. Hourly IV infusion C. Vascular sites for bleeding D. Prothrombin time (PT) or international normalized ratio (INR)

D. Prothrombin time (PT) or international normalized ratio (INR) The nurse should monitor PT or INR when oral anticoagulation is prescribed. Vascular sites for bleeding, urine output, and hourly IV infusions are generally monitored in all clients.

The laboratory values for a client diagnosed with coronary artery disease (CAD) have just come back from the lab. The client's low-density lipoprotein (LDL) level is 112 mg/dL. This nurses recognizes that this value is A. extremely high. B. low. C. normal. D. high.

D. high. If the LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered to be high. The goal is to decrease the LDL level below 100 mg/dL.

A client who is resting quietly reports chest pain to the nurse. The cardiac monitor indicates the presence of reversible ST-segment elevation. What type of angina is the client experiencing? A. silent angina B. stable angina C. intractable angina D. variant angina

D. variant angina Variant or Prinzmetal's angina is distinguished by pain occurrence during rest. Stable angina occurs with activity. Silent angina occurs without symptoms, and intractable angina is evidenced by incapacitating pain.

The client is asking the nurse about heart-healthy food choices for lunch. What are foods that are heart healthy? Select all that apply. A. baked chicken leg B. broiled trout c. white rice with butter D. soy yogurt E. blueberries

B. broiled trout D. soy yogurt E. blueberries Heart-healthy foods include soy products, fish high in omega-3s, and fruit. The chicken leg has more fat than a chicken breast. The white rice does not have enough fiber, so brown rice is a better option.

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

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.

When providing discharge instructions for a client who has been prescribed sublingual nitroglycerin for angina, the nurse should plan to include which instructions? A. "Only take one nitroglycerin tablet for each episode of angina." B. "See if rest relieves the chest pain before using the nitroglycerin." C. "Place the nitroglycerin tablet between cheek and gum." D. "Call 911 if you develop a headache following nitroglycerin use."

B. "See if rest relieves the chest pain before using the nitroglycerin." Decreased activity may relieve chest pain; sitting will prevent injury should the nitroglycerin lower BP and cause fainting. The client should expect to feel dizzy or flushed or to develop a headache following sublingual nitroglycerin use. The client should place one nitroglycerin tablet under the tongue if 2-3 minutes of rest fails to relieve pain. Clients may take up to three nitroglycerin tablets within 5 minutes of each other to relieve angina. However, they should call 911 if the three tablets fail to resolve the chest pain.

What is a modifiable risk factor for the development of atherosclerosis? A. gender B. consumption of a high-fat diet C. infection with chlamydia pneumonia D. family history

B. consumption of a high-fat diet There are many known risk factors for development of atherosclerosis. Factors that are modifiable, or that a client can change, include diet, activity level, and smoking cessation. Some that are nonmodifiable include gender, heredity, certain diseases, and history of infection with Chlamydia pneumoniae. These factors individually or collectively contribute to hyperlipidemia, which then triggers atherosclerotic changes.

A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? A. exercise avoidance B. smoking cessation C. a protein-rich diet D. antioxidant supplements

B. smoking cessation The first line of defense for clients with CAD is lifestyle changes including smoking cessation, weight loss, stress management, and exercise. Clients with CAD should eat a balanced diet. Clients with CAD should exercise, as tolerated, to maintain a healthy weight. Antioxidant supplements, such as those containing vitamin E, beta carotene, and selenium, are not recommended because clinical trials have failed to confirm beneficial effects from their use.

The nurse notes that the post cardiac surgery client demonstrates low urine output (< 25 mL/hr) with high specific gravity (> 1.025). What will the nurse anticipate the health care provider will order? A. Decrease intravenous fluids B. Prepare the client for diaylsis C. Increase intravenous fluids D. Irrigate the urinary catheter

C. Increase intravenous fluids Urine output of less than 25 mL/hr may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. The heallthcare provider may increase intravenous fluids. Irrigating the urinary catheter will be done if there is a suspected blockage. Dialysis is not indicated by urinary volumes.

The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly? A. The abrupt stop can trigger a migraine headache. B. The abrupt stop can lead to formation of blood clots. C. The abrupt stop can cause a myocardial infarction. D. The abrupt stop will precipitate internal bleeding.

C. The abrupt stop can cause a myocardial infarction. 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 the onset of a migraine headache.

After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? A. Notify the health care provider. B. Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. C. Decrease anticoagulant or antiplatelet therapy. D. Apply manual pressure at the site of the insertion of the sheath.

D. Apply manual pressure at the site of the insertion of the sheath. The immediate nursing action would be to apply pressure to the femoral site. Reviewing blood studies will not stop the bleeding. The nurse cannot decrease anticoagulation therapy independently. If the bleeding does not stop, the health care provider needs to be notified.

Which of the following is inconsistent as a condition related to metabolic syndrome? A. Dyslipidemia B. Insulin resistance C. Abdominal obesity D. Hypotension

D. Hypotension A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.

When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? A. Variant B. Intractable C. Refractory D. Unstable

D. Unstable Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates A. an evolving MI. B. variant angina. C. an old MI. D. a cardiac dysrhythmia.

C. an old MI. An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI.

The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? A. weight gain of 6 ounces B. bilateral rales and rhonchi C. potassium level of 6 mEq/L D. serum glucose of 124 mg/dL

C. potassium level of 6 mEq/L Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain is not significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed.

A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display? A. Cholesterol plugs in the lumen of veins B. Blood clots in the arteries C. Emboli in the veins D. Fatty deposits in the lumen of arteries

D. Fatty deposits in the lumen of arteries Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Therefore, the other options are incorrect.

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 dilate coronary arteries B. To decrease homocysteine levels C. To prevent angiotensin II conversion D. To decrease workload of the heart

D. 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.

Which technique is used to surgically revascularize the myocardium? A. Minimally invasive direct coronary bypass B. Balloon bypass C. Peripheral bypass D. Gastric bypass

A. Minimally invasive direct coronary bypass Several techniques are used to surgically revascularize the myocardium; one of them is minimally invasive direct coronary bypass. Balloon bypass is not used to revascularize the myocardium. If the client is experiencing acute pain in the leg, peripheral bypass is performed. Gastric bypass is a surgical procedure that alters the process of digestion.

A client comes to the health care provider's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction? A. "Client walks 4 miles in 1 hour every day." B. "Client performs relaxation exercises three times per day to reduce stress." C. "Client verbalizes an understanding of the need to seek emergency help if heart rate increases markedly while at rest." D. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol."

A. "Client walks 4 miles in 1 hour every day." Four weeks after an MI, a client's walking program should aim for a goal of 2 miles in less than 1 hour. Walking 4 miles in 1 hour is excessive and may induce another MI by increasing the heart's oxygen demands. Therefore, this client requires appropriate exercise guidelines and precautions. Performing relaxation exercises, following a low-fat, low-cholesterol diet, and seeking emergency help if the heart rate increases markedly at rest indicate understanding of the cardiac rehabilitation program. For example, the client should reduce stress, which speeds the heart rate and thus increases myocardial oxygen demands. Reducing dietary fat and cholesterol intake helps lower risk of atherosclerosis. A sudden rise in the heart rate while at rest warrants emergency medical attention because it may signal a life-threatening arrhythmia and increase myocardial oxygen demands.

An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's family members express concern to the nurse that the client is uncharacteristically confused. After reporting this change in status to the health care provider, what additional action should the nurse take? A. Assess for factors that may be causing the client's delirium. B. Educate the family about how confusion is expected in older adults postoperatively. C. Reorient the client to place and time. D. Document the early signs of dementia and ensure the client's safety.

A. Assess for factors that may be causing the client's delirium. Uncharacteristic changes in cognition following cardiac surgery are suggestive of delirium. Dementia has a gradual onset with organic brain changes and is not an acute response to surgery. Assessment is a higher priority than reorientation, which may or may not be beneficial. Even though delirium is not rare, it is not considered to be an expected part of recovery.

A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? A. Elevated ST segment B. Absent Q wave C. Prolonged PR interval D. Widened QRS complex

A. Elevated ST segment Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.

A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? A. Relieved by rest and nitroglycerin B. Associated with nausea and vomiting C. Accompanied by diaphoresis and dyspnea D. Described as crushing and substernal

A. Relieved by rest and nitroglycerin One characteristic that can differentiate the pain of angina from a myocardial infarction is pain that is relieved by rest and nitroglycerine. There may be some exceptions (unstable angina), but the distinction is helpful especially when combined with other assessment data.

A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? A. calcium-channel blocker B. beta-blocker C. nitrate D. thrombolytic

A. calcium-channel blocker

The nurse is assessing a client with suspected postpericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? A. pericardial friction rub B. hypothermia C. decreased erythrocyte sedimentation rate (ESR) D. Decreased white blood cell (WBC) count

A. pericardial friction rub Postpericardiotomy syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR. Hypothermia is not a symptom of postpericardiotomy syndrome.

A client in the emergency department reports squeezing substernal pain that radiates to the left shoulder and jaw. The client also complains of nausea, diaphoresis, and shortness of breath. What is the nurse's priority action? A. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team. B. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. C. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs. D. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider.

B. 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 health care provider before completing the initial assessment is premature.

The nurse is presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would the nurse name as the most common cause of peripheral arterial problems in the older adult? A. Coronary thrombosis B. Atherosclerosis C. Arteriosclerosis D. Raynaud's disease

B. 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 is admitted for treatment of Prinzmetal's angina. When developing this client's care plan, the nurse should keep in mind that this type of angina is a result of what trigger? A. The same type of activity that caused previous angina episodes. B. Coronary artery spasm. C. An unpredictable amount of activity. D.Activities that increase myocardial oxygen demand.

B. Coronary artery spasm. Prinzmetal's angina results from coronary artery spasm. Activities that increase myocardial oxygen demand may trigger angina of effort. An unpredictable amount of activity may precipitate unstable angina. Worsening angina is brought on by the same type or level of activity that caused previous angina episodes; anginal pain becomes increasingly severe.

The nurse is educating a patient diagnosed with angina pectoris about the difference between the pain of angina and a myocardial infarction (MI). How should the nurse describe the pain experienced during an MI? (Select all that apply.) A. It subsides after taking nitroglycerin. B. It is viselike and radiates to the shoulders and arms. C. It is sudden in onset and prolonged in duration. D. It is substernal in location. E. It is relieved by rest and inactivity.

B. It is viselike and radiates to the shoulders and arms. C. It is sudden in onset and prolonged in duration. D. It is substernal in location. Chest pain that occurs suddenly, continues despite rest and medication, is substernal, and is sometimes viselike and radiating to the shoulders and arms is associated with an MI. Angina pectoris pain is generally relieved by rest and nitroglycerin.

Which client with a venous stasis ulcer is a candidate for topical hyperbaric oxygen therapy? A. a nonambulatory client B. a client with a chronic, nonhealing skin lesion C. a client whose ulcer includes necrotic tissue D. a client with an infected stasis ulcer

B. a client with a chronic, nonhealing skin lesion Chronic, nonhealing skin lesions are treated with topical hyperbaric oxygen therapy. This approach delivers oxygen above atmospheric pressure directly to the wound rather than to the full body as with other disorders such as carbon monoxide poisoning. Necrotic tissue is debrided from a stasis ulcer. A client's infection is treated with an application of Silvadene, an antibacterial cream, or an antibiotic ointment and an occlusive transparent dressing such as Tegaderm that traps moisture and speeds healing.

The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? A. an hourly urine output of 50 to 70 mL B. a serum BUN of 70 mg/dL C. a serum creatinine of 1.0 mg/dL D. a urine specific gravity reading of 1.021

B. a serum BUN of 70 mg/dL These four laboratory results should always be assessed after cardiac surgery. Serum osmolality (N = >800 mOsm/kg) should also be included. A BUN reading of greater than 21 mg/dL is abnormal; a reading of greater than 60 mg/dL is indicative of renal failure. Urine output needs to be greater than 30 mL/hr. Normal urine specific gravity is 1.005-1.030. Normal serum creatinine values are between 0.5-1.2 mg/dL.

The nurse is reviewing the results of a total cholesterol level for a client who has been taking simvastatin. What results display the effectiveness of the medication? A. 280-300 mg/dL B. 210-240 mg/dL C. 160-190 mg/dL D. 250-275 mg/dL

C. 160-190 mg/dL Simvastatin 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.

The nurse is caring for a client with Raynaud's disease. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? A. Report changes in the usual pattern of chest pain. B. Avoid fatty foods and exercise. C. Avoid situations that contribute to ischemic episodes. D. Take over-the-counter decongestants

C. Avoid situations that contribute to ischemic episodes. Teaching for clients with Raynaud's disease and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.

The nurse is caring for a client following a coronary artery bypass graft (CABG). The nurse notes persistent oozing of bloody drainage from various puncture sites. The nurse anticipates that the physician will order which medication to neutralize the unfractionated heparin the client received? A. Clopidogrel B. Aspirin C. Protamine sulfate D. Alteplase

C. Protamine sulfate Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin). Alteplase is a thrombolytic agent. Clopidogrel is an antiplatelet medication that is given to reduce the risk of thrombus formation after coronary stent placement. The antiplatelet effect of aspirin does not reverse the effects of heparin.

Two female nursing assistants approach a nurse on a cardiac step-down unit to report that a client who experienced an acute myocardial infarction made sexual comments to them. How should the nurse intervene? A. The nurse should explain that the client most likely wants extra attention. B. The nurse should instruct the nursing assistants to avoid answering his call light. C. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. D. The nurse should report the incident to her supervisor immediately.

C. The nurse should explain that the client might have concerns about resuming sexual activity but is afraid to ask. Sometimes clients are concerned about resuming sexual activity but are afraid to ask. Making inappropriate sexual comments provides a forum for asking questions. It isn't necessary to report the incident to the nursing supervisor immediately without investigating the situation further. The client's call light must be answered in a timely fashion. More information is needed before assuming that the client is asking for extra attention.

The nurse is explaining the cause of angina pain to a client. What will the nurse say caused the pain? A. complete closure of an artery B. incomplete blockage of a major coronary artery C. a lack of oxygen in the heart muscle that causes the death of cells D. a destroyed part of the heart muscle

C. 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. Artery blockage or closure leads to myocardial death. The destroyed part of the heart is a myocardial infarction.

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? A. "The pain got worse when I took a deep breath." B. "The pain resolved after I ate a sandwich." C. "The pain lasted about 45 minutes." D. "The pain occurred while I was mowing the lawn."

D. "The pain occurred while I was mowing the lawn." Decreased oxygen supply to the myocardium causes angina pectoris. Lawn mowing increases the cardiac workload, which increases the heart's need for oxygen and may precipitate this chest pain. Anginal pain typically is self-limiting, lasting 5 to 15 minutes. Food consumption doesn't reduce angina pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain.

The nurse is caring for a client experiencing an acute MI (STEMI). The nurse anticipates the physician will prescribe alteplase. Before administering this medication, which question is most important for the nurse to ask the client? A. "Do your parents have heart disease?" B. "What is your pain level on a scale of 1 to 10?" C. "How many sublingual nitroglycerin tablets did you take?" D. "What time did your chest pain start today?"

D. "What time did your chest pain start today?" The client may be a candidate for thrombolytic (fibrolytic) therapy. These medications are administered if the client's chest pain lasts longer than 20 minutes and is unrelieved by nitroglycerin, if ST-segment elevation is found in at least two leads that face the same area of the heart, and if it has been less than 6 hours since the onset of pain. The most appropriate question for the nurse to ask is in relations to when the chest pain began. The other questions would not aid in determining whether the client is a candidate for thrombolytic therapy.

A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? A. 60 minutes B. 15 minutes C. 30 minutes D. 3 minutes

D. 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 is administering oral metoprolol. Where are the receptor sites mainly located? A. Blood vessels B. Bronchi C. Uterus D. Heart

D. Heart Metoprolol works at beta 1 -receptor sites. Most beta1-receptor sites are located in the heart. Beta2-receptor sites are located in the uterus, blood vessels, and bronchi.

A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? A. Urinary incontinence B. Hyperactive bowel sounds C. Hypertension D. Hypotension

D. Hypotension The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.

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

D. 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.

A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: A. low LDL level. B. normal LDL level. C. fasting LDL level. D. high LDL level.

D. high LDL level. LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL.

The nurse is reviewing the laboratory results for a client diagnosed with coronary artery disease (CAD). The client's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as A. high. B. low. C. critically high. D. within normal limits.

A. high. The normal LDL range is 100 to 130 mg/dL. A level of 115 mg/dL is considered to be high. The goal of treatment is to decrease the LDL level below 100 mg/dL (less than 70 mg/dL for very high-risk clients).

The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply. A. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. B. Put some of the tablets in a small metal or plastic pillbox that can be easily carried at all times and be accessible quickly, when needed. C. Renew the supply every 6 months. D. Keep the tablets at home on the kitchen counter or bedside table so they can be reached quickly. E. Take the tablet in anticipation of any activity that can produce pain. F. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed.

A. Call emergency services if, after taking three tablets (one every 5 minutes), pain persists. C. Renew the supply every 6 months. E. Take the tablet in anticipation of any activity that can produce pain. F. Let the tablet dissolve in the mouth and keep the tongue still. The tablet can be crushed between the teeth but not swallowed. Nitroglycerine is very unstable and should be carried securely in its original container (capped, dark, glass bottle). The tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerine is also volatile and is inactivated by heat, moisture, air, light, and time. Therefore, storage and replacement is recommended every 6 months. Refer to Box 14-3 in the text.

A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine, oxygen, and aspirin. The health care provider diagnoses acute coronary syndrome. When the client arrives on the unit, vital signs are stable and the client does not report any pain. In addition to the medications already given, which medication does the nurse expect the health care provider to order? A. Carvedilol B. Digoxin C. Nitroprusside D. Furosemide

A. Carvedilol 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 nurse is educating a client with coronary artery disease about nitroglycerin administration. The nurse tells the client that nitroglycerin has what actions? Select all that apply. A. Dilates blood vessels B. Relieves pain C. Decreases ischemia D. Decreases the urge to use tobacco E. Reduces myocardial oxygen consumption

A. Dilates blood vessels B. Relieves pain C. Decreases ischemia E. Reduces myocardial oxygen consumption Nitroglycerin dilates blood vessels and reduces the amount of blood returning to the heart, which reduces the workload of the heart and myocardial oxygen consumption. As the dilated vessels allow more blood supply to the heart, ischemia and pain are reduced. Nitroglycerin does not affect the urge to use tobacco.

A client with CAD has been prescribed a transdermal nitroglycerin patch. What instructions should the nurse provide to to the client? Select all that apply. A. Remove the transdermal patch at night and reapply in the morning. B. Seek emergency treatment if flushing or nausea occurs. C. Store the patch in its original container when not in use. D. Cover the patch in plastic wrap after applying.

A. Remove the transdermal patch at night and reapply in the morning. C. Store the patch in its original container when not in use. Transdermal nitroglycerin systems are applied to the skin and slowly release nitroglycerin. Clients should be instructed to store the patch in its original container when not in use and keep tightly closed, remove the patch each night and reapply in the morning to prevent diminishing vasodilating effects, and expect possible side effects, such as headache, flushing, or nausea.

The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) A. Aortic dissection B. Abrupt closure of the artery C. Nerve root pressure D. Arterial dissection E. Coronary artery vasospasm

B. Abrupt closure of the artery D. Arterial dissection E. Coronary artery vasospasm Complications that can occur during a PTCA procedure include coronary artery dissection, perforation, abrupt closure, or vasospasm. Additional complications include acute myocardial infarction, serious dysrhythmias (e.g., ventricular tachycardia), and cardiac arrest. Some of these complications may require emergency surgical treatment. Complications after the procedure may include abrupt closure of the coronary artery and a variety of vascular complications, such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion (Bhatty, Cooke, Shettey, et al., 2011).

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? A. Assess the client's level of anxiety and provide emotional support. B. Assess the client's level of pain and administer prescribed analgesics. C. Ensure that the client's family is kept informed of the client's status. D.Prepare the client for pulmonary artery catheterization.

B. Assess the client's level of pain and administer prescribed analgesics. The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and family members should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.

The nurse is caring for a client who is being evaluated for lipid-lowering medication. The client's laboratory results reveal the following: total cholesterol 230 mg/dL, LDL 120 mg/dL, triglyceride level 310 mg/dL. Which class of medications would be most appropriate for the client based on these laboratory findings? A. HMG-CoA reductase inhibitor B. Nicotinic acid C. Fibric acid D. Bile acid sequestrant

B. Nicotinic acid The most appropriate class of medications based on the client's laboratory findings would be nicotinic acid. This class of medications is prescribed for clients with minimally elevated cholesterol and LDL levels or as an adjunct to a statin when the lipid goal has not been has not been achieved and triglyceride levels are elevated.

After undergoing cardiac surgery, a client discovers a painless lump and reports this to the nurse. What is the most important nursing intervention for this client? A. Inform the client that the lump will be removed by the surgeon. B. Reassure the client by informing him or her that the lump will disappear with time. C. Reassure the client by informing him or her that the lump will disappear after a course of drug therapy. D. Reassure the client and direct the client to the health care provider.

B. Reassure the client by informing him or her that the lump will disappear with time. The nurse will reassure the client by informing him or her that the lump will disappear with time and will not require surgery, drug therapy, or a visit to the health care provider.

A nurse is assigned to care for a recently admitted client who has been diagnosed with refractory angina. What symptom will the nurse expect the client to exhibit? A. Pain that occurs more frequently and lasts longer than the pain usually seen with stable angina B. Severe, incapacitating chest pain C. Predictable and consistent pain that occurs on exertion and is relieved by rest D. Pain that may occur at rest, but the threshold for pain is lower than expected

B. Severe, incapacitating chest pain

The nurse is teaching a client with suspected acute myocardial infarction about serial isoenzyme testing. When is it best to have isoenzyme creatinine kinase of myocardial muscle (CK-MB) tested? A. 2 to 3 hours after admission B. 12 to 18 hours after admission C. 4 to 6 hours after pain D. 30 minutes to 1 hour after pain

C. 4 to 6 hours after pain Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.

Following cardiac surgery, the nurse assesses the client for any common complication of hypovolemia. What significant indication of a complication should the nurse monitor? A. Central venous pressure (CVP) reading of 8 mm Hg B. Heart rate of 60 bpm C. Pulmonary artery wedge pressure (PAWP) of 6 mm Hg D. Blood pressure reading of 130/95 mm Hg

C. Pulmonary artery wedge pressure (PAWP) of 6 mm Hg In the presence of hypovolemia, the circulating blood volume would be significantly decreased. Therefore, the PAWP would be lower than 8 to 10 mm Hg. The normal CVP reading (2 to 8 mm Hg) would be decreased. The heart rate would be increased and the blood pressure decreased.

A client with a myocardial infarction (MI) develops pulmonary crackles and dyspnea. A chest X-ray shows evidence of pulmonary edema. What type of MI did this client have? A. lateral. B. inferior. C. anterior. D. posterior.

C. anterior. An anterior MI causes left ventricular dysfunction and can lead to manifestations of heart failure, which include pulmonary crackles and dyspnea. Posterior, lateral, and inferior MI aren't usually associated with heart failure.

A client is beginning to have more breathlessness with aortic stenosis. What is the treatment does the nurse anticipate for the client? A. cardiac catheterization B. cardiac graft procedure C. balloon valvuloplasty D. balloon angioplasty

C. balloon valvuloplasty Additional treatment eventually becomes critical because average survival is 2 to 3 years once symptoms develop. Balloon valvuloplasty is an invasive, nonsurgical procedure to enlarge a narrowed valve opening. Balloon angioplasty, cardiac catheterization, and cardiac graft procedure are not indicated treatments for symptomatic aortic stenosis.

The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? A. cerebral bleeding B. skeletal muscle damage due to a recent fall C. myocardial necrosis D. I.M. injection

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 injuries 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 client has a blockage in the proximal portion of a coronary artery and decides to undergo percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse expect to administer during the procedure? A. metoprolol B. hydrochlorothiazide C. ticagrelor D. ceftriaxone

C. ticagrelor During PTCA, the client receives heparin, an anticoagulant (ticagrelor), as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses do not routinely give antibiotics such as ceftriaxone during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive like metoprolol and a diuretic like hydrochlorothiazide may cause hypotension, which should be avoided during the procedure.

A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a goal of rehabilitation for the client with an MI? A. Prevention of another cardiac event B. Ability to return to work and a preillness functional capacity C. Limitation of the effects and progression of atherosclerosis D. Improvement in quality of life

D. Improvement in quality of life Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life. Immediate objectives of rehabilitation of a client with an MI patient are to limit the effects and progression of atherosclerosis, to return the client to work and a preillness lifestyle, and to prevent another cardiac event.

A nurse is teaching a client about maintaining a healthy heart. What information will the nurse include with the teaching? A. Exercise one or two times per week. B. Smoke in moderation. C. Consume a diet high in saturated fats. D. Use alcohol in moderation.

D. Use alcohol in moderation. The nurse should advise the client that alcohol may be used in moderation as long as there are no other contraindications for its use. Smoking, a diet high in cholesterol and saturated fat, and a sedentary lifestyle are all known risk factors for cardiac disease. The client should be encouraged to quit smoking, exercise three to four times per week, and consume a diet low in cholesterol and saturated fat.

A client's elevated cholesterol levels are being managed with atorvastatin daily. What is a common side effect the nurse will teach the client that will require monitoring? A. hyperglycemia B. severe muscle pain C. hyperuricemia D. increased liver enzymes

D. increased liver enzymes Myopathy and increased liver enzymes are significant side effects of the statin Lipitor. Hyperuricemia occurs when too much uric acid is present in the blood; it is not a side effect of the statins. Hyperglycemia is increased blood glucose, which is not a side effect of the statins. Severe muscle pain is an adverse effect of statins, but it does not require monitoring.

The nurse is working a cardiac care unit with a client on a diltizem intravenous drip for atrial fibrillation. What are electrocardiogram (ECG) changes that suggest the client is responding to the treatment? Select all that apply. A. decreasing R to R interval B. an absent P wave C. T-wave inversion D. slowing heart rate E. ST elevation

A. decreasing R to R interval D. slowing heart rate The ECG changes that occur with an MI are seen in the leads that view the involved surface of the heart. The expected ECG changes are T-wave inversion, ST-segment elevation, and development of an abnormal Q wave. The diltezam will slow the heart rate and decrease the R to R interval.

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? A. High-density lipoprotein (HDL), 80 mg/dL B. Cholesterol, 280 mg/dL C. A ratio of LDL to HDL, 4.5 to 1.0 D. Low density lipoprotein (LDL), 160 mg/dL

A. High-density lipoprotein (HDL), 80 mg/dL A fasting lipid profile should demonstrate the following values (Alberti et al., 2009): LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients); total cholesterol less than 200 mg/dL; HDL cholesterol greater than 40 mg/dL for males and greater than 50 mg/dL for females; and triglycerides less than 150 mg/dL.

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 the intention to avoid exercise." C. "Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours." 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).

A client asks the clinic nurse what the difference is between arteriosclerosis and atherosclerosis. What is the nurse's best response? A. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. B. Atherosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. C. Arteriosclerosis is a formation of clots in the inner lining of the arteries. D. Atherosclerosis is a formation of clots in the inner lining of the arteries.

A. Arteriosclerosis is a loss of elasticity, or hardening of the arteries, that happens as we age. Arteriosclerosis refers to the loss of elasticity or hardening of the arteries, that accompanies the aging process. Therefore, options B, C, and D are incorrect.

When the nurse notes that, after cardiac surgery, the client demonstrates low urine output (less than 25 mL/h) with high specific gravity (greater than 1.025), the nurse suspects which condition? A. Inadequate fluid volume B. Anuria C. Normal glomerular filtration D. Overhydration

A. Inadequate fluid volume Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric client does not produce urine.

An ED nurse is assessing a 71-year-old female client 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 clients? Select all that apply. A. Indigestion B. Chest pain C. Nausea D. Shortness of breath E. Anxiety

A. Indigestion C. Nausea Many women experiencing coronary events including--unstable angina, MIs, or sudden cardiac death events--are asymptomatic or present with atypical symptoms including indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among clients of all ages and genders.

The nurse is teaching a client diagnosed with coronary artery disease about nitroglycerin. What is the cardiac premise behind administration of nitrates? A. Preload is reduced. B. More blood returns to the heart. C. It increases myocardial oxygen consumption. D. It functions has a vasoconstrictor.

A. Preload is reduced. Nitroglycerin dilates primarily the veins, and in higher dosages, also the arteries. Dilation of the veins causes venous pooling of the blood throughout the body. As a result, less blood returns to the heart, and filling pressure (preload) is reduced. Nitroglycerine is administered to reduce myocardial oxygen consumption, which decreases ischemia and relieves pain.

The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? A. ST elevation B. Frequent premature atrial contractions (PACs) C. Isolated premature ventricular contractions (PVCs) D. Sinus tachycardia

A. ST elevation The first signs of an acute MI are usually seen in the T wave and the ST segment. The T wave becomes inverted; the ST segment elevates (it is usually flat). An elevated ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e., ST-elevation MI). This client requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.

A nurse is caring for a client who had a three-vessel coronary bypass graft 4 days earlier. The client's 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. What is the best response by the nurse? A. The nurse will ask the dietitian to talk with the client about modifying the diet. B. Cholesterol is within the recommended guidelines and the client doesn't need to lower it. C. Client should begin a running program, working up to 2 miles per day. D. Client should take statin medication and not worry about cholesterol.

A. The nurse will ask the dietitian to talk with the client about modifying the diet. A dietitian can help the client decrease the fat in the 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 statin medication, the client should still be concerned about cholesterol levels and make other lifestyle changes, such as dietary changes, to help lower it. The client should increase activity level, but doesn't need to run 2 miles per day.

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? A. Troponin B. Total creatine kinase C. CK-MB D. Myoglobin

A. Troponin Troponin remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin peaks within 12 hours after the onset of symptoms. Total creatine kinase (CK) returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.

Which term refers to preinfarction angina? A. Unstable angina B. Variant angina C. Refractory angina D. Silent angina

A. Unstable angina Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs upon exertion and is relieved by rest. Variant angina is exhibited by pain at rest and reversible ST-segment elevation. Silent angina manifests through evidence of ischemia, but the client reports no symptoms.

The nurse is caring for a ventilated client after coronary artery bypass graft surgery. What are the criterions for extubation for the client? Select all that apply. A. adequate cough and gag reflexes B. breathing without assistance of the ventilator C. acceptable arterial blood gas values D. labile vital signs E. inability to speak

A. adequate cough and gag reflexes B. breathing without assistance of the ventilator C. acceptable arterial blood gas values Before being extubated, the client should have cough and gag reflexes and stable vital signs; be able to lift the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable arterial blood gas levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.

The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? A. enhance myocardial oxygenation B. decrease anxiety C. educate the client about his symptoms D. administer sublingual nitroglycerin

A. 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 important in care, neither is a priority when a client is compromised.

A nurse is monitoring the vital signs and blood results of a client who is receiving anticoagulation therapy. What does nurse identify as a major indication of concern? A. hematocrit of 30% B. hemoglobin of 16 g/dL C. heart rate of 87 bpm D. blood pressure of 129/72 mm Hg

A. hematocrit of 30% Hematocrit is a measurement of the proportion of blood volume that is occupied by red blood cells. A lower hematocrit can imply internal bleeding. Blood pressure of 129/72 and heart rate of 87 bpm are normal. A hemoglobin count of 16 g/dL is also normal.

A client was transferring a load of firewood in the morning and experienced a heaviness in the chest and dyspnea. The client arrives in the emergency department four hours after the heaviness and the health care provider diagnoses an anterior myocardial infarction (MI). What orders will the nurse anticipate? A. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry B. morphine administration, stress testing, and admission to the cardiac care unit C. serial liver enzyme testing, telemetry, and a lidocaine infusion D. streptokinase, aspirin, and morphine administration

A. sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry The nurse should anticipate an order for sublingual nitroglycerin, tPA, and telemetry, as the client's chest pain began 4 hours before diagnosis. The preferred choice is tPA, which is more specific for cardiac tissue than streptokinase. Stress testing shouldn't be performed during an MI. The client doesn't exhibit symptoms that indicate the use of lidocaine.

Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? A. Diltiazem B. Clopidogrel C. Felodipine D. Amlodipine

B. Clopidogrel Clopidogrel or ticlopidine is given to clients who are allergic to aspirin or are given in addition to aspirin to clients who are at high risk for MI. Amlodipine, diltiazem, and felodipine are calcium channel blockers.

Which is a modifiable risk factor for coronary artery disease (CAD)? A. Increasing age B. Diabetes mellitus C. Race D. Gender

B. Diabetes mellitus While diabetes mellitus cannot be cured, blood glucose and symptomatology can be managed through healthy living. Gender, race, and increasing age are nonmodifiable risk factors.

A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? A. Store the drug in a cool, well-lit place. B. Lie down or sit in a chair for 5 to 10 minutes after taking the drug. C. Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. D. Restrict alcohol intake to two drinks per day.

B. Lie down or sit in a chair for 5 to 10 minutes after taking the drug. Nitrates act primarily to relax coronary smooth muscle and produce vasodilation. They can cause hypotension, which makes the client dizzy and weak. The nurse should instruct the client to lie down or sit in a chair for 5 to 10 minutes after taking the drug. Nitrates are taken at the first sign of chest pain and before activities that might induce chest pain. Sublingual nitroglycerin is taken every 5 minutes for three doses. If the pain persists, the client should seek medical assistance immediately. Nitrates must be stored in a dark place in a closed container because sunlight causes the medication to lose its effectiveness. Alcohol is prohibited because nitrates may enhance the effects of the alcohol.

A nurse reviews a client's medication history before administering a cholinergic blocking agent. Adverse effects of a cholinergic blocking agent may delay absorption of what medication? A. Amantadine B. Nitroglycerin C. Digoxin D. Diphenhydramine

B. Nitroglycerin A cholinergic blocking agent may cause dry mouth and delay the sublingual absorption of nitroglycerin. The nurse should offer the client sips of water before administering nitroglycerin. Amantadine, digoxin, and diphenhydramine can interact with a cholinergic blocking agent but not through delayed absorption. Amantadine and diphenhydramine enhance the effects of anticholinergic agents.

The nurse is teaching the client about coronary artery damage after an abnormal fasting lipid profile. The client asks the nurse what type of lipid is most troublesome. What is the nurse's best response? A. "The higher the high-density lipoproteins (HDL), the more at risk you are for heart damage or a stroke." B. "The total cholesterol level of 252 mg/dL warrants medication treatment alone." C. "The low-density lipoproteins (LDL) pose a threat to plague formation and can cause a heart attack of stroke." D. "The triglycerides levels measure good fat, so the higher the level, the less risk you are for a heart attack or stroke."

C. "The low-density lipoproteins (LDL) pose a threat to plague formation and can cause a heart attack of stroke." When there is an excess of LDL, these particles adhere to vulnerable points in the arterial endothelium. Here, macrophages ingest them, leading to the formation of foam cells and the beginning of plaque formation. A harmful effect is exerted on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. The cholesterol level should be <200 mg/dL but it is not the only indication for treatment. The lower the HDL, the more the client is at risk for heart attack or stroke. The combination of the client's triglycerides, LDL, and HDL levels is used to direct treatment.

A client has just arrived in the ER with a possible myocardial infarction (MI). The electrocardiogram (ECG) should be obtained within which time frame of arrival to the ER? A. 5 minutes B. 20 minutes C. 10 minutes D. 15 minutes

C. 10 minutes The ECG provides information that assists in diagnosing acute MI. It should be obtained within 10 minutes from the time a client reports pain or arrives in the emergency department. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored.

The charge nurse was discussing with the nursing student that studies have been published that suggest inflammation increases the risk of heart disease. Which modifiable factor would the nursing student target in teaching clients about prevention of inflammation that can lead to atherosclerosis? A. Encourage use of a multivitamin B. Avoid use of caffeine C. Addressing obesity D. Drink at least 2 liters of water a day

C. Addressing obesity Published information by Balistreri et al. (2010) indicated a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests decreasing obesity and body fat stores may help to reduce the risk. Avoiding the use of caffeine, encouraging the use of a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to artherosclerosis.

A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? A. Decreases platelet aggregation B. Increases cardiac output C. Decreases resting heart rate D. Decreases cholesterol level

C. Decreases resting heart rate The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. In general, the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.

A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan? A. Instruct the client to renew the nitroglycerin supply every 3 months. B. Instruct the client to place nitroglycerin tablets in a plastic pill box. C. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. D. Instruct the client not to crush the tablet.

C. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. The client should be instructed about side effects of the medication, which include flushing, throbbing headache, and tachycardia. The client should renew the nitroglycerin supply every 6 months. If the pain is severe, the client can crush the tablet between the teeth to hasten sublingual absorption. Tablets should never be removed and stored in metal or plastic pillboxes. Nitroglycerin is very unstable and should be carried in its original container.

While receiving a heparin infusion to treat deep vein thrombosis, a client reports bleeding in the gums when brushing teeth. What should the nurse do first? A. Stop the heparin infusion immediately. B. Administer a coumarin derivative, as ordered, to counteract heparin. C. Notify the health care provider. D. Reassure the client that bleeding gums are a normal effect of heparin.

C. Notify the health care provider. Because heparin can cause bleeding gums that may indicate excessive anticoagulation, the nurse should notify the health care provider, who will evaluate the client's condition. The health care provider 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 health care provider orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Heparin doesn't normally cause bleeding gums.

A client who has been diagnosed with Prinzmetal's angina will present with which symptom? A. chest pain of increased frequency, severity, and duration B. radiating chest pain that lasts 15 minutes or less C. chest pain that occurs at rest and usually in the middle of the night D. prolonged chest pain that accompanies exercise

C. 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 8:00 AM, is sporadic over 3-6 months, and diminishes over time. Clients 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. Clients with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.

A client presents to the ED with a myocardial infarction. Prior to administering a prescribed thrombolytic agent, the nurse must determine whether the client has which absolute contraindication to thrombolytic therapy? A. shellfish allergy B. recent consumption of a meal C. prior intracranial hemorrhage D. use of heparin

C. prior intracranial hemorrhage History of a prior intracranial hemorrhage is an absolute contraindication for thrombolytic therapy. An allergy to iodine, shellfish, radiographic dye, and latex are of primary concern before a cardiac catheterization but not a known contraindication for thrombolytic therapy. Administration of a thrombolytic agent with heparin increases risk of bleeding; the primary healthcare provider usually discontinues the heparin until thrombolytic treatment is completed.

A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? A. Minimal oozing of blood from the IV site B. Presence of reperfusion dysrhythmias C. Chest pain 2 of 10 (on a 1-to-10 pain scale) D. Altered level of consciousness

D. Altered level of consciousness A client 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 client's chest pain is subsiding, an expected outcome of this therapy.

Following a percutaneous coronary intervention (PCI), a client is returned to the nursing unit with large peripheral vascular access sheaths in place. The nurse understands that which method to induce hemostasis after sheath is contraindicated? A. Direct manual pressure B. Application of a vascular closure device C. Application of a mechanical compression device D. Application of a sandbag to the area

D. Application of a sandbag to the area Applying a sandbag to the sheath insertion site is ineffective in reducing the incidence of bleeding and is not an acceptable standard of care. Application of a vascular closure device (Angio-Seal, VasoSeal), direct manual pressure to the sheath introduction site, and application of a mechanical compression device (a C-shaped clamp) are all appropriate methods used to induce hemostasis after removal of a peripheral sheath.

Which method to induce hemostasis after sheath removal after percutaneous transluminal coronary angioplasty (PTCA) is most effective? A. Direct manual pressure B. Application of a sandbag to the area C. Application of a pneumatic compression device (e.g., FemoStop) D. Application of a vascular closure device such as Angio-Seal or VasoSeal

D. Application of a vascular closure device such as Angio-Seal or VasoSeal Application of a vascular closure device has been demonstrated to be very effective. Direct manual pressure to the sheath introduction site and application of a pneumatic compression device after PTCA have been demonstrated to be effective; the former was the first method used to induce hemostasis after PTCA. 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.

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. Elevated central venous pressure B. Hypothermia C. Hypertension D. Cardiac tamponade

D. 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.

Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? A. Mental alertness B. Blood glucose concentration C. Activity intolerance D. Inadequate tissue perfusion

D. Inadequate tissue perfusion The nurse must assess the client for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood glucose and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for clients undergoing cardiac surgery.

Which s the analgesic of choice for acute myocardial infarction (MI)? A. Ibuprofen B. Meperidine C. Aspirin D. Morphine

D. Morphine The analgesic of choice for acute MI is morphine administered in IV boluses to reduce pain and anxiety. Aspirin is an antiplatelet medication. Meperidine and Ibuprofen are not the analgesics of choice.

Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer? A. Isosorbide mononitrate (Isordil) B. Nitroglycerin transdermal patch C. Meperidine hydrochloride (Demerol) D. Morphine sulfate (Morphine)

D. Morphine sulfate (Morphine) Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.

A client is admitted to the emergency department with chest pain and doesn't respond to nitroglycerin. The health care team obtains an electrocardiogram and administers I.V. morphine. The health care provider also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms? A. Within 12 hours B. Within 24 to 48 hours C. Within 5 to 7 days D. Within 6 hours

D. 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. Health care providers initiate I.V. heparin therapy after administration of a thrombolytic agent; it usually continues for 5 to 7 days.