NURS401 Ch23: Coronary Vascular Disorders
The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation the nurse can give to the client?
"Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque."
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?
"Client will verbalize the intention to stop smoking."
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?
"I should expect a low-grade fever and swelling at the site for the next week."
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?
"Removing the patch at night prevents drug tolerance while keeping the benefits."
When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris?
"The pain occurred while I was mowing the lawn."
A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding?
"What color is your urine?"
A client is receiving intravenous heparin to prevent blood clots. The order is for heparin 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL of D5W. At how many milliliters per hour will the nurse infuse this solution? Record your answer using a whole number.
24
A client asks the nurse how long to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse?
5 minutes
The nurse provides care to a menopausal client, who states, "I read a news article that says I am at risk for coronary vascular disease due to inflammation." Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis?
Addressing obesity
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse?
Altered level of consciousness
coronary artery
An artery that supplies blood to the heart itself
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?
Assess for factors that may be causing the client's delirium.
The nurse is caring for a client with coronary artery disease (CAD). What is an appropriate nursing action when evaluating a client with CAD?
Assess the characteristics of chest pain.
The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack?
Avoid situations that contribute to ischemic episodes.
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.
Balance rest with activity. Stop smoking. Carry nitroglycerin at all times.
Which is a diagnostic marker for inflammation of vascular endothelium?
C-reactive protein (CRP)
CRP
C-reactive protein - inflammatory marker for cardiovascular risk. liver produces CRP in response to a stimulus such as tissue injury, and high levels of this protein may occur in people with diabetes and those who are likely to have an acute coronary event
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?
Central venous pressure reading of 1
A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)?
Chest discomfort not relieved by rest or nitroglycerin
A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent?
Clopidogrel
Which medication is given to clients who are diagnosed with angina but are allergic to aspirin?
Clopidogrel
The nurse is to administer morphine sulfate to a client with chest pain. What initial nursing action is required prior to administration?
Count the respiratory rate for bradypnea.
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?
Decreases resting heart rate
The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient?
Decreases the sinoatrial node automaticity
post-pericardiotomy syndrome
Due to blood remaining in pericardial sac; Signs: pericardial and pleural pain, pericarditis, friction rub, increased temp, increased WBC, dysrhythmias; May occur days to weeks after surgery; usually self-limiting - some may need treatment similar to treatment for pericarditis
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?
Elevated ST segment
The nurse is administering oral metoprolol. Where are the receptor sites mainly located?
Heart
A nurse is caring for a client after cardiac surgery. Upon assessment, the client appears restless and reports nausea and weakness. The client's ECG reveals peaked T waves. The nurse reviews the client's serum electrolytes, anticipating which abnormality?
Hyperkalemia
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.
Hyperlipidemia Obesity Tobacco use
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?
Hypotension
Which of the following is inconsistent as a condition related to metabolic syndrome?
Hypotension
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?
IV morphine
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?
Inadequate fluid volume
Cholesterol Absorption Inhibitor
Inhibits the absorption of cholesterol secreted in the bile and from food. Lowers LDL
A client has been recently placed on nitroglycerin. Which instruction by the nurse should be included in the client's teaching plan?
Instruct the client on side effects of flushing, throbbing headache, and tachycardia.
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.)
It is substernal in location. It is sudden in onset and prolonged in duration. It is viselike and radiates to the shoulders and arms.
Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure?
Monitor the site for bleeding or hematoma.
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?
Morphine sulfate (Morphine)
calcium channel blockers
Negative inotropic effects; indicated in patients not responsive to beta-blockers; used as primary treatment for vasospasm
A client presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. The client says that nitroglycerin has not been taken for months but upon experiencing this chest pain did take three nitroglycerin tablets. Although the pain has lessened, the client states, "They did not work all that well." The client shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. The nurse anticipates which order by the physician?
Nitroglycerin SL
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?
Potassium
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?
Protamine sulfate
Which medication is an antidote to heparin?
Protamine sulfate
A client has had oral anticoagulation ordered. What should the nurse monitor for when the client is taking oral anticoagulation?
Prothrombin time (PT) or international normalized ratio (INR)
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.
Reduces myocardial oxygen consumption Dilates blood vessels Decreases ischemia Relieves pain
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?
Relieved by rest and nitroglycerin
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?
ST elevation ST-segment elevation usually indicates a total blockage of the involved coronary artery and that the heart muscle is currently dying.
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?
Severe, incapacitating chest pain
A client reports chest pain that occurs when playing tennis but resolves when sitting down. The nurse knows these symptoms are common for which type of angina?
Stable
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not to stop taking the medication abruptly?
The abrupt stop can cause a myocardial infarction.
A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier. Which outcome indicates that the client is responding favorably to therapy?
The client demonstrates ability to tolerate more activity without chest pain.
Which term refers to preinfarction angina?
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 knows that women and older adult are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause?
Vague symptoms
Which nursing actions would be of greatest importance in the management of a client preparing for angioplasty?
Withhold anticoagulant therapy.
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?
Within 6 hours
metabolic syndrome
a cluster of metabolic abnormalities including insulin resistance, obesity, dyslipidemia, and hypertension that increase the risk of cardiovascular disease
thromolytic
a drug that dissolves clots
The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain?
a lack of oxygen in the heart muscle cells
stent
a metal mesh that provides structural support to a coronary vessel, preventing its closure
The nurse is caring for a client after cardiac surgery. What laboratory result will lead the nurse to suspect possible renal failure?
a serum BUN of 70 mg/dL he blood urea nitrogen test, which is also called a BUN or serum BUN test, measures how much of the waste product you have in your blood. If your levels are off the normal range, this could mean that either your kidneys or your liver may not be working properly.
contractility
ability of the cardiac muscle to shorten in response to an electrical impulse
atherosclerosis
abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and the lumen -> block and narrow coronary vessels -> reduce blood flow to myocardium
arteriosclerosis
abnormal hardening of the walls of an artery or arteries
sudden cardiac death
abrupt cessation of effective heart activity
ACS
acute coronary syndrome: signs and symptoms that indicate unstable angina or acute myocardial infarction
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.
adequate cough and gag reflexes acceptable arterial blood gas values breathing without assistance of the ventilator
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?
aspirin or clopidogrel.
The nurse is caring for a client diagnosed with coronary artery disease (CAD). What condition most commonly results in CAD?
atherosclerosis
troponin
cardiac muscle biomarker; measurement is used as an indicator of heart muscle injury
angina pectoris
chest pain brought about by myocardial ischemia (reduced blood flow in coronary artery)
A client who has been diagnosed with Prinzmetal's angina will present with which symptom?
chest pain that occurs at rest and usually in the middle of the night
CABG
coronary artery bypass graft: a surgical procedure in which a blood vessel from another part of the body is grafted onto the occluded coronary artery below the occlusion in such a way that blood flow bypasses the blockage
A client comes to the emergency department (ED) reporting 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?
coronary artery disease
CAD
coronary artery disease: narrowing or blockage of coronary arteries that may produce ischemia and necrosis of the myocardium. inability for vasodilation and as a result the arteries cannot meet the metabolic demands. will produce ischemia and ultimately necrosis. CAD includes thrombus, vasospasms, and atheroscelerosis. results from inheritance, environment, culture, nutrition and smoking. symptoms: appear after significant blockage is present, over 75%. pain in occluded artery's region. if untreated, MI or death.
statins
drugs used to lower cholesterol in the bloodstream
The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client?
enhance myocardial oxygenation
Prinzmetal angina
episodic chest pain unrelated to exertion
atheroma
fibrous cap composed of smooth muscle cells that forms over lipid deposits within arterial vessels and protrudes into the lumen of the vessel, narrowing the lumen and obstructing blood flow; also called plaque
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
high
HDL
high density lipoproteins (healthy type of cholesterol): transports cholesterol to the liver for excretion in the bile; composed of a higher proportion of protein to lipid than low-density lipoprotein; exerts a beneficial effect on the arterial wall
fibrates
increase HDL
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?
increased liver enzymes
ischemia
insufficient tissue oxygenation
LDL
low density lipoprotein (bad cholesterol): protein-bound lipid that transports cholesterol to tissues in the body; composed of a lower proportion of protein to lipid than high-density lipoprotein; exerts a harmful effect on the arterial wall
bile acid sequestrants
lowers LDL levels by causing liver to make more bile acids from cholesterol
MI
myocardial infarction: death of heart tissue caused by lack of oxygenated blood flow
PCI
percutaneous coronary intervention: procedure in which a catheter is placed in a coronary artery, and one of several methods is employed to reduce blockage within the artery
PTCA
percutaneous transluminal coronary angioplasty: a type of percutaneous coronary intervention in which a balloon is inflated within a coronary artery to break an atheroma and open the vessel lumen, improving coronary artery blood flow
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome?
pericardial friction rub
atheromas
plaques in blood vessel walls
The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse?
potassium level of 6 mEq/L Postoperative imbalances in potassium, magnesium, sodium, calcium, and blood glucose are related to surgical losses, metabolic changes, and the administration of medications and IV fluids (hypokalemia, etc)
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?
prior intracranial hemorrhage
PCSK9 inhibitors
prolongs receptor activity to promote clearance of cholesterol. lowers LDL
refractory angina
severe incapacitating chest pain
beta-blockers
treat angina by reducing myocardial oxygen consumption by blocking beta-adrenergic stimulation of the heart. reduce contractility, blood pressure
nitroglycerin
treats angina by reducing myocardial oxygen consumption through selective vasodilation
