Med Surg Quiz 2 Prep
Heparin therapy is usually considered therapeutic when the patient's activated partial thromboplastin time (aPTT) is how many times normal? a.) 0.5-1 b.) 2 -2.5 c.) 2.5-3
2 to 2.5
What is normal cardiac output?
5.6 L
What is normal ejection fraction?
60%
What are some nursing considerations to bear in mind when administering nitroglycerin? Select all that apply. a.) Assess for pain relief b.) Monitor for blood pressure, cease medication if systolic blood pressure <90 or 100 mmHg c.) Monitor for blood pressure, cease medication if systolic blood pressure >90 or 100 mmHg.
A and B Assess for pain relief and monitor for blood pressure (cease med if systolic pressure <90 or 100 mmHg.
What are some of the effects of beta blocker? Select all that apply. a.) reduce heart rate b.) slow conduction of impulses through conduction system c.) decrease blood pressure d.) reduce myocardial contractility e.) increase mycoardial contractility
A through D. Beta blockers reduce heart rate, slow conduction of impulses through conduction system, decrease blood pressure, and reduce myocardial contractility.
A nurse is teaching a client who receives nitrates for relief of chest pain. Which instruction should the nurse emphasize? Select all that apply. a.) Lie down or sit in a chair for 5 to 10 minutes after taking the drug. b.) Nitrates are taken at the first sign of chest pain and before activities that induce chest pain. c.) Sublingual nitroglycerin is taken every 5 minutes for two doses. d.) If pain persists, the client should seek medical assistance immediately. e.) Nitrates must be stored in a dark place in a closed container because sunlight causes the medication to lose its effectiveness. f.) Alcohol is allowed because nitrates do not enhance the effects of alcohol.
A, B, D, E a.) Lie down or sit in a chair for 5 to 10 minutes after taking the drug. b.) Nitrates are taken at the first sign of chest pain and before activities that induce chest pain. c.) Sublingual nitroglycerin is taken every 5 minutes for THREE doses. d.) If pain persists, the client should seek medical assistance immediately. e.) Nitrates must be stored in a dark place in a closed container because sunlight causes the medication to lose its effectiveness. f.) Alcohol is PROHIBITED because nitrates enhance the effects of alcohol.
A 40-year-old man has an HDL of 30 mg/DL, an LDL of 140 mg/dL, and smokes a pack a day. What are his risk factors to having CAD? Select all that apply: a.) elevated serum lipids (↑ LDL; ↓ HDL) b.) elevated serum lipids (↓ LDL, ↑ HDL) c.) smoking d.) being a middle-aged man
A, C, D. An HDL of <35 and an LDL >130 are contributing risk factors to having CAD, as well as him being a middle-aged male smoker.
A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? Select all that apply. A.) Low blood pressure. B.) Increased heart rate. C.) Decreased serum hemoglobin and hematocrit. D.) Decreased heart rate.
A.) Low blood pressure B.) Increased heart rate C.) Decreased serum hemoglobin and hematocrit.
A client in the ED complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?
Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
What are correct nursing considerations about giving oxygen for patients presenting with angina? a.) Oxygen should be administered at 2 to 4 L/min by nasal cannula to maintain an SaO2 level greater than 90%. b.) Nurses should be alert for signs of hypoxemia, such as confusion, agitation, restlessness, pallor, and changes in skin temp. c.) By increasing the amount of oxygen delivered to the myocardium, supplemental oxygen will decrease the pain associated with mycocardial ischemia.
All of the above.
What is the classic symptom of ACS?
Angina, or chest pain is the classic symptom of ACS.
If you for some reason have an option to lose 1 of your coronary arteries, which should you choose to lose? A.) Left B.) Right
B.) Lose your right one! Per Fetzer, we can give you pacemaker to take care of SA Node. This way you are not losing muscle/contractility/CO
What do beta blockers do in terms of supply and demand of oxygen?
Beta blockers balance the myocardial oxygen needs (demands) and the amount of oxygen available (supply)
A client is receiving nitroglycerin ointment (Nitro-Dur) to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? A.) Blood pressure 84/52 B.) Tachycardia C.) RR of 20 D.) Temp of 101.01
Blood pressure 84/52. Hypotension and headache are the most common adverse effects of nitroglycerin. The nurse should check the client's blood pressure 1 hour after administering the nitro ointment.
When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? A.) Stable B.) Variant C.) Intractable D.) Unstable
D.) Unstable Unstable angina indicates the need for a change in treatment. Intractable produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described at pain at rest w/ reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm.
What is an example of a noninvasive procedure to help assess the aortic valve?
Echocardiogram-- this is an ultrasound of heart that helps diagnose valve disorders and cardiomyopathy (disease of heart muscle). Note: It measures systolic and diastolic function of heart.
What does ischemia due in terms of supply and demand?
Increases demand and no change in supply.
What does nitroglycerin do in terms of preload and afterload? A.) reduces preload and increases afterload B.) increases preload and decreases afterload C.) reduces preload and afterload D.) increases preload and afterload
Nitro reduces preload and afterload, decreasing myocardial oxygen demand. Per ATI, it also prevents coronary artery vasospasm.
What differentiates an MI from angina?
Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates an MI from angina.
A client has had oral anticoagulation ordered. What should you monitor for when your client is taking this?
Prothrombin time (PT) or international normalized ratio (INR)
Per the video about Gender Matters on Fetzer's ppt, what are typical symptoms that women present with angina and coronary artery disease?
SOB, fatigue, weakness, overwhelming sense of panic or impending doom, activities that are used to doing are too strenous, feeling nervous and anxious that they can't do the things they are used to doing, flulike symptoms
What is the best noninvasive measurement of cardiac output?
Seeing how organs compromise (tissue perfusion)
How does tachycardia reduce oxygen supply and precipitate angina?
Tachycardia reduces oxygen supply by DECREASING preload (can't get it in, can't get it out, can't get it oxygenated)
You are caring for a patient with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD? a.) Assess the client's mental and emotional status b.) Assess the client's skin c.) Assess the characteristics for chest pain d.) Assess for drug abuse
The nurse should assess the characteristics of chest pain for a pt with CAD. This assessment should be aimed at evaluating for adequate blood flow to the heart.
When assessing a client who reports chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? a.) The pain reduced after I ate a full meal. b.) The pain reduced after I engaged in some deep breathing. c.) The pain occurred while I was mowing the lawn.
The pain occurred when I was mowing the lawn. Lawn mowing increases the cardiac workload, which increases the heart's need for oxygen and may precipitate this chest pain.
A client with chest pain doesn't respond to nitroglycerin. When he's admitted to the ED, the health care team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering ateplase (Activase). This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?
Within 6 hours after onset of chest pain or other signs or symptoms of MI.
After receiving nitroglycerin ointment to treat angina pectoris, the patient's BP decreases by 10 mm Hg. Is this within the therapeutic range?
Yes. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment, and report finding to physician immediately.
A nurse caring for a client in a clinic who asks the nurse why her provider prescribed 1 aspirin per day. Which of the following is an appropriate response by the nurse? a.) Aspirin reduces the formation of blood clots that could cause a heart attack. b.) Aspirin relieves the pain due to myocardial ischemia. c.) Aspirin dissolves clots that are forming in your coronary arteries. D.) Aspirin relieves headaches that are caused by other medications.
a.) Aspirin reduces the formation of blood clots that could cause a heart attack. Note: Aspirin also inhibits vasoconstriction.
What are some examples of precipitating events for angina that increase demand? Select all that apply. a.) anxiety b.) thrombosis c.) exercise d.) tachycardia e.) hyperthermia f.) htn g.) stimulating drugs
a.) anxiety, c.) exercise, e.) hyperthemia, f.) htn , g.) stimulating drugs
What are some examples of precipitating events for angina that decrease oxygen supply ? Select all that apply. a.) spasm b.) thrombosis c.) htn d.) tachycardia e.) anxiety f.) poor contraction
a.) spasm, b.) thrombosis, d.) tachycardia, f.) poor contraction
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: a.) diphenhydramine (Benadryl) b.) nitroglycerin (Nitrostat) c.) digoxin d.) Amantadine
b.) Nitro A cholinergic blocking agent may cause dry mouth and delay the sublingual absorption of nitroglycerin.
What medication helps relieve cardiac spasm REAL QUICK? a.) Nitro b.) Diltiazem c.) Verapamil d.) Nifedipine
d.) Nifedipine. This works REAL QUICK/immediately (per Fetzer). You puncture capsule, squirt under tongue and BAM. P.S. It's a CA Channel Blocker (blocks calcium which blocks muscle constriction)
A nurse is instructing a client who has angina about a new prescription for metoprolol tartrate (Lopressor). Which of the following statements by the client indicates understanding of the teaching? a.) I should place the tablet under my tongue b.) I should have my clotting time checked weekly. c.) I will report any ringing in my ears. d.) I will call my doc if my pulse rate is less than 60.
d.) The client is advised to notify the provider if bradycardia (pulse rate less than 60) occurs. This is per ATI.
What are nonmodifiable risk factors for CAD?
family history, advanced age, gender, race
What are modifiable risk factors for CAD?
obesity, hyperlipidemia, tobacco use, htn, diabetes, metabolic syndrome, obesity, physical inactivity
Give some examples of irritants that can lead to hemorrhages of lining of inner artery?
sugar, high BP, pH, nicotine, cholesterol