Nurs 332 Ch 27 MLQ
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. Widened QRS complex C. Absent Q wave D. Prolonged PR interval
A
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. serial liver enzyme testing, telemetry, and a lidocaine infusion C. streptokinase, aspirin, and morphine administration D. morphine administration, stress testing, and admission to the cardiac care unit
A
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 resting heart rate B. Increases cardiac output C. Decreases cholesterol level D. Decreases platelet aggregation
A
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. Apply manual pressure at the site of the insertion of the sheath. B. Decrease anticoagulant or antiplatelet therapy. C. Notify the health care provider. D. Review the results of the latest blood cell count, especially the hemoglobin and hematocrit.
A
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? A. To decrease workload of the heart B. To decrease homocysteine levels C. To prevent angiotensin II conversion D. To dilate coronary arteries
A
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. Morphine sulfate (Morphine) B. Meperidine hydrochloride (Demerol) C. Isosorbide mononitrate (Isordil) D. Nitroglycerin transdermal patch
A
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. Addressing obesity B. Encourage use of a multivitamin C. Drink at least 2 liters of water a day D. Avoid use of caffeine
A
The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure? A. a serum BUN of 70 mg/dL B. a serum creatinine of 1.0 mg/dL C. a urine specific gravity reading of 1.021 D. an hourly urine output of 50 to 70 mL
A
The nurse is caring for a client who is having chest pain associated with a myocardial infarction (MI). What medication will the nurse administer intravenously to reduce pain and anxiety? A. morphine sulfate B. hydromorphone hydrochloride C. fentanyl D. codeine sulfate
A
Which is a diagnostic marker for inflammation of vascular endothelium? A. C-reactive protein (CRP) B. High-density lipoprotein (HDL) C. Low-density lipoprotein (LDL) D. Triglyceride
A
Which term refers to preinfarction angina? A. Unstable angina B. Variant angina C. Silent ischemia D. Stable angina
A
A nurse is educating a community group about coronary artery disease. One member asks about how to avoid coronary artery disease. Which of the following items are considered modifiable risk factors for coronary artery disease? Choose all that apply. A. Hyperlipidemia B. Race C. Tobacco use D. Obesity E. Gender
A, C, D
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 is viselike and radiates to the shoulders and arms. B. It subsides after taking nitroglycerin. C. It is sudden in onset and prolonged in duration. D. It is substernal in location. E. It is relieved by rest and inactivity.
A, C, D
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
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. 3 minutes C. 30 minutes D. 15 minutes
B
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 place nitroglycerin tablets in a plastic pill box. B. Instruct the client on side effects of flushing, throbbing headache, and tachycardia. C. Instruct the client not to crush the tablet. D. Instruct the client to renew the nitroglycerin supply every 3 months.
B
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. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the health care provider. D. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs.
B
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? A. nitrate B. calcium-channel blocker C. beta-adrenergic blocker D. diuretic
B
A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: A. normal LDL level. B. high LDL level. C. low LDL level. D. fasting LDL level.
B
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 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." C. "I should expect bruising at the catheter site for up to 3 weeks." D. "I should avoid prolonged sitting."
B
A female patient is being seen in the ER complaining of fatigue and shoulder blade discomfort. She is also short of breath. Based on these symptoms, what will the nurse suspect? A. Deep vein thrombosis (DVT) B. Myocardial infarction (MI) C. Stroke D. Intracerebral hemorrhage
B
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. Altered level of consciousness C. Presence of reperfusion dysrhythmias D. Chest pain 2 of 10 (on a 1-to-10 pain scale)
B
A nurse teaches a client with angina pectoris that he or she needs to take up to three sublingual nitroglycerin tablets at 5-minute intervals and immediately notify the health care provider if chest pain doesn't subside within 15 minutes. What symptoms may the client experience after taking the nitroglycerin? A. Flushing, dizziness, headache, and pedal edema. B.Headache, hypotension, dizziness, and flushing. C.Nausea, vomiting, depression, fatigue, and impotence. D. Sedation, nausea, vomiting, constipation, and respiratory depression.
B
The nurse is administering oral metoprolol. Where are the receptor sites mainly located? A. Uterus B. Heart C. Blood vessels D. Bronchi
B
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
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? A. Assess distal pulses. B. Withhold anticoagulant therapy. C. Inform client of diagnostic tests. D. Remove hair from skin insertion sites.
B
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty? A. Inform client of diagnostic tests. B. Withhold anticoagulant therapy. C. Assess distal pulses. D. Remove hair from skin insertion sites.
B
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. Administer a coumarin derivative, as ordered, to counteract heparin. B. Notify the health care provider. C. Stop the heparin infusion immediately. D. Reassure the client that bleeding gums are a normal effect of heparin.
B
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? 1 . Venous occlusive disease 2. Coronary artery disease 3. Raynaud's disease 4. Cardiogenic shock
C
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 verbalizes an understanding of the need to seek emergency help if heart rate increases markedly while at rest." B. "Client performs relaxation exercises three times per day to reduce stress." C. "Client walks 4 miles in 1 hour every day." D. "Client's 24-hour dietary recall reveals low intake of fat and cholesterol."
C
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? A. Metoprolol B. Diltiazem C. Clopidogrel D. Isosorbide mononitrate
C
A client has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which respiratory complication? A. Urinary tract infection (UTI) B. Hyperkalemia C. Atelectasis D. Elevated blood glucose level
C
A client is admitted for treatment of Prinzmetal 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. An unpredictable amount of activity. B. Activities that increase myocardial oxygen demand. C. Coronary artery spasm. D. The same type of activity that caused previous angina episodes.
C
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 5 to 7 days B. Within 24 to 48 hours C. Within 6 hours D. Within 12 hours
C
A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? A. "Contact dermatitis and skin irritations are common when the patch remains on all day." B. "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. "Nitroglycerine causes headaches, but removing the patch decreases the incidence."
C
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. recent consumption of a meal B. shellfish allergy C. prior intracranial hemorrhage D. use of heparin
C
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 blood pressure and administer aspirin B. Assess the client's physical history C. Assess chest pain and administer prescribed drugs and oxygen D. It is not important to assess the client or to notify the physician
C
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
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. normal. B. low. C. high. D. extremely high.
C
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome? A. decreased erythrocyte sedimentation rate (ESR) B. hypothermia C. pericardial friction rub D. decreased white blood cell (WBC) count
C
The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? A. bilateral rales and rhonchi B. serum glucose of 124 mg/dL C. potassium level of 6 mEq/L D. weight gain of 6 ounces
C
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. Low density lipoprotein (LDL), 160 mg/dL B. A ratio of LDL to HDL, 4.5 to 1.0 C. High-density lipoprotein (HDL), 80 mg/dL D. Cholesterol, 280 mg/dL
C
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. Normal glomerular filtration B. Anuria C. Inadequate fluid volume D. Overhydration
C
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin? A. Felodipine B. Diltiazem C. Clopidogrel D. Amlodipine
C
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. prolonged chest pain that accompanies exercise C. radiating chest pain that lasts 15 minutes or less D. chest pain that occurs at rest and usually in the middle of the night
D
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? A. Anxiousness, restlessness, and lightheadedness B. Cool, clammy skin and a diaphoretic, pale appearance C. Intermittent nausea and emesis for 3 days D. Chest discomfort not relieved by rest or nitroglycerin
D
A nurse is teaching a client who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize? A. Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses. B. Store the drug in a cool, well-lit place. C. Restrict alcohol intake to two drinks per day. D. Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
D
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. Diphenhydramine B. Amantadine C. Digoxin D. Nitroglycerin
D
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 will precipitate internal bleeding. D. The abrupt stop can cause a myocardial infarction.
D
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. Sodium nitroprusside B. Digoxin C. Protamine sulfate D. Atropine
D
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. Assess pupils for reactiveness. B. Suction the airway. C. Prepare to administer intravenous fluids. D. Check blood pressure.
D
The nurse is caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client? A. Examine for pain around the shoulder and neck region. B. Examine the extremities for skin lesions. C. Examine the client's mental and emotional status. D. Examine the legs for color, capillary refill time, and tissue integrity.
D
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. Sinus tachycardia B. Frequent premature atrial contractions (PACs) C. Isolated premature ventricular contractions (PVCs) D. ST elevation
D
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? A. administer sublingual nitroglycerin B. decrease anxiety C. educate the client about his symptoms D. enhance myocardial oxygenation
D
The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration? A. Measure urinary output for dehydration. B. Measure the blood pressure for hypertension. C. Check the radial pulse for dysrhythmias. D. Count the respiratory rate for bradypnea.
D
The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? A. Decreased sensation to pain B. Chest pain is typical C. Gender bias D. Vague symptoms
D
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. Anuria B. Normal glomerular filtration C. Overhydration D. Inadequate fluid volume
D
Which of the following is inconsistent as a condition related to metabolic syndrome? A. Abdominal obesity B. Dyslipidemia C. Insulin resistance D. Hypotension
D
Which technique is used to surgically revascularize the myocardium? A. Peripheral bypass B. Balloon bypass C. Gastric bypass D. Minimally invasive direct coronary bypass
D
