Quiz 5 Cardiovascular Part Two: Acute Coronary Syndrome

A client with acute coronary syndrome is receiving a continuous heparin infusion. The client is to receive 700 units/hour. Based on the heparin concentration on the label (20,000 Units per 500 mL), the nurse will set the infusion pump to deliver how many mL/hour?

17.5 mL/hr

The nurse is ambulating a cardiac surgery client whose heart suddenly increases to 146 beats/min. In which order will the nurse take the following actions? 1. Call the health care provider 2. Have the client sit down 3. Check the client's blood pressure 4. Administer as needed (PRN) oxygen by nasal cannula

2, 4, 3, 1 2. Have the client sit down 4. Administer as needed (PRN) oxygen by nasal cannula 3. Check the client's blood pressure 1. Call the health care provider

A patient is scheduled to have a percutaneous coronary intervention (PCI). The nurse anticipates that an initial dose of which medication will be given before the procedure? A. Clopidogrel B. Nitroglycerin C. Isosorbide mononitrate D. Carvedilol

A. Clopidogrel

The nurse is caring for a client who has heart failure and has a new prescription for sacubitril-valsartan. Which client information is most important to discuss with the healthcare provider before administration of the medication? A. The client's oxygen saturations is 92% B . The client receives lisinopril 10 mg/day C. The client's blood pressure is 150/90 mm Hg D. The client's potassium is 3.3 mEq/L

B . The client receives lisinopril 10 mg/day

A patient has angina and is scheduled for percutaneous coronary intervention (PCI). Based on negative outcomes of the PCI, the nurse prepares the patient for immediate transfer to undergo which procedure? A. Intra-aortic balloon pump B. Coronary artery bypass graft (CABG) C. Cardiac catheterization D. Carotid endarterectomy

B. Coronary artery bypass graft (CABG)

A nurse is leading a discussion in a senior citizen center about the risk factors for developing coronary heart disease (CHD) for women versus men. What should the nurse respond when asked to identify the most significant risk factor? A. Obesity B. Diabetes C. Elevated CRP levels D. High levels of HLD-C

B. Diabetes

The healthcare provider orders potassium 50 mEq in 100 mL of IV bolus at a rate of 40 mEq/hr for a patient in the critical care unit through a central line. What does the nurse do next? A. Contact the health care provider because the order exceeds the recommended amount B. Give the infusion: the order exceeds recommended amount but is within acceptable standards of practice for critical care patients C. Contact the health care provider because even though the dosage is acceptable, the rate is too fast D. Consult with the pharmacist because even through the rate is acceptable, the mixture is too concentrated

B. Give the infusion: the order exceeds recommended amount but is within acceptable standards of practice for critical care patients

A patient is receiving beta-blocker therapy for treatment of myocardial infarction (MI). What does the nurse monitor for in relation to this therapy? SATA A. Tachycardia B. Hypotension C. Decreased level of consciousness D. Chest discomfort E. Increased urinary output F. Auscultate lungs for crackles or wheezes

B. Hypotension C. Decreased level of consciousness D. Chest discomfort F. Auscultate lungs for crackles or wheezes

The patient with left ventricular myocardial infarction (MI) is to have coronary artery bypass graft (CABG) surgery. which interventions does the nurse perform to protect against sternal wound infections? SATA A. Shave the patient's body from neck to knees B. Instruct the patient to shower with 4% chlorhexidine gluconate (CHG) C. Prepare the surgical site by clipping hair and applying CHG with isopropyl alcohol (either 0.5% or 2%) D. Send urine and sputum to the lab for culture and sensitivity E. Administer IV antibiotics one hour prior to the surgical procedure F. Wear gown, gloves, and a mask while preparing the patient for surgery

B. Instruct the patient to shower with 4% chlorhexidine gluconate (CHG) C. Prepare the surgical site by clipping hair and applying CHG with isopropyl alcohol (either 0.5% or 2%) E. Administer IV antibiotics one hour prior to the surgical procedure

The clinic nurse obtains this information about a client who is taking warfarin after having a deep vein thrombosis. Which finding is most indicative of a need for change in therapy? A. Blood pressure is 106/54 mm Hg B. International normalized ratio (INR) is 1.2 C. Bruises are noted at sites where blood has been drawn D. Client reports eating a green salad for lunch everyday

B. International normalized ratio (INR) is 1.2

What instructions about the use of nitroglycerin should the nurse provide to a client with angina? A. "Identify when pain occurs, and place 2 tablets under the tongue" B. "Place 1 tablet under the tongue, and swallow another when pain is intense" C. "Before physical activity place 1 tablet under the tongue, and repeat the dose in 5 minutes if pain occurs" D. "Place 1 tablet under the tongue when pain occurs, and use an additional tablet after the attack to prevent reoccurrence"

C. "Before physical activity place 1 tablet under the tongue, and repeat the dose in 5 minutes if pain occurs"

A patient in a cardiac rehabilitation program is having difficulty coping with the changes in her health status. Which statement by the patient is the strongest indicator of ineffective or harmful coping? A. "I don't mind going to therapy, but I'm not sure if I'm getting any benefit from it." B. "I'll take the pills and just do whatever you want me to do." C. "I don't want to go to therapy; I had a bad experience yesterday with the therapist." D. "I know I need to talk about going home soon, but could we discuss it later?"

C. "I don't want to go to therapy; I had a bad experience yesterday with the therapist."

The emergency department nurse is caring for a client who was just admitted with left anterior chest pain, possible acute myocardial infarction (MI). Which action will the nurse take first? A. Insert an IV catheter B. Auscultate heart sounds C. Administer sublingual nitroglycerin D. Draw blood for troponin I measurement

C. Administer sublingual nitroglycerin

A client whose systolic blood pressure is always higher than 140 mm Hg in the clinic tells the nurse, "My blood pressure at home is always fine!" What action should the nurse take next? A. Instruct the client about the effects of untreated high blood pressure on the cardiovascular and cerebrovascular systems B. Educate the client about lifestyle changes such as low-sodium diet, daily exercise, and restricting alcohol use to no more than 2 beers per day C. Ask the client to obtain blood pressures twice daily with an automatic blood pressure cuff at home and bring the results to the clinic in a week D. Provide the client with a handout describing the various types of antihypertensive medications with the medication effects and adverse effects

C. Ask the client to obtain blood pressures twice daily with an automatic blood pressure cuff at home and bring the results to the clinic in a week

A patient had coronary artery bypass graft (CABG) surgery with the radial artery used as a graft. The nurse performs which assessment specific to this patient? A. Check the blood pressure every hour on the unaffected arm or use the legs B. Check the fingertips, hand, and arm for sensation and mobility every shift C. Assess hand color, temperature , ulnar/radial pulses, and capillary refill every hour initially D. Note edema, bleeding, and swelling at the donor site, which are expected

C. Assess hand color, temperature , ulnar/radial pulses, and capillary refill every hour initially

The nurse makes a home visit to evaluate a hypertensie client who has been taking enalapril. Which finding is most important to report to the health care provider? A. Client reports frequent urination B. Client's blood pressure is 138/86 mm Hg C. Client complains about a frequent dry cough D. Client says, "I get dizzy sometimes if I stand up fast."

C. Client complains about a frequent dry cough

A client with stable angina has a prescription for ranolazine 500 mg twice a day. Which client finding is most important for the nurse to discuss with the healthcare provider? A. Heart rate is 52 beats/min B. Client is also taking carvedilol for angina C. Client reports having chronic constipation D. Blood pressure is 106/56 mm Hg

C. Client reports having chronic constipation

The nurse is developing a standardized care plan for the postoperative care of clients undergoing cardiac surgery. The unit is staffed with RNs, LPNs/LVNs, and unlicensed assistive personnel. Which nursing activity will need to be performed by RN staff members? A. Removing chest and leg dressings on the second postoperative day and cleaning the incisions with antibacterial swabs B. Reinforcing client and family teaching about the need to deep breathe and cough at least every 2 hours while awake C. Developing an individual plan for discharge teaching based on discharge medications and needed lifestyle changes D. Administering oral analgesic medications as needed before helping the client out of bed on the first postoperative day

C. Developing an individual plan for discharge teaching based on discharge medications and needed lifestyle changes

The nurse is caring for a hospitalized patient being treated initially with IV nitroglycerin. What intervention must the nurse include in the patient's care? A. Increase the dose rapidly to achieve pain relief B. Restrict the patient to bedrest with bedpan use C. Monitor blood pressure continuously D. Elevate the head of the bed to 90 degrees

C. Monitor blood pressure continuously

A client who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain. The nurse notes that no pulse is palpable in the left foot and that it is cold and pale. Which action should the nurse take first? A. Lower the client's left foot below heart level B. Administer oxygen 4 L/min to the client C. Notify the health care provider about the change in status D. Reassure the client that embolization is common in endocarditis

C. Notify the health care provider about the change in status

The intensive care nurse is monitoring a patient with a diagnosis of myocardial infarction (MI). The pulmonary artery wedge pressure (PAWP) reading is 30 mm Hg. WHat does the nurse do next? A. Increase the IV fluid rate to 200 mL/hr B. Auscultate the lungs to assess for left-sided heart failure C. Perform an ECG using right-sided precordial leads D. Place the patient in semi-Fowler's position

C. Perform an ECG using right-sided precordial leads

The nurse is caring for a hospitalized client with heart failure who is receiving captopril and spironolactone. Which laboratory value will be most important to monitor? A. Sodium level B.Blood glucose level C. Potassium level D. Alkaline phosphatase level

C. Potassium level

A patient reports chest pain, and the nurse administers sublingual nitroglycerin tablet. After 5 minutes what is the nurse's next intervention for this patient? A. Apply oxygen at 2 to 4 L by nasal cannula B. Administer morphine sulfate IV push C. Recheck the patient's pain intensity and check vital signs D. Notify the health care provider and administer a chewable aspirin

C. Recheck the patient's pain intensity and check vital signs

Which diagnostic tests are used to assess myocardial damage caused by a myocardial infarction (MI)? SATA A. Positive chest x-ray B. ST depression on ECG C. Thallium scan D. Troponin I isoenzyme elevation E. Cardiac catheterization F. Fasting lipid panel

C. Thallium scan D. Troponin I isoenzyme elevation E. Cardiac catheterization

A patient has heart failure related to myocardial infarction (MI). What intervention does the nurse plan for this patient's care? A. Administering digoxin 1.0 mg PO as a loading dose and then daily B. Infusing IV fluids to maintain a urinary output of 60 mL/hr C. Titrating vasoactive drugs to maintain a sufficient cardiac output D. Observing for such complications as hypertension and flushed, hot skin

C. Titrating vasoactive drugs to maintain a sufficient cardiac output

During a home visit to an 88-year-old client who is taking digoxin 0.25 mg/day to treat heart failure and atrial fibrillation, the nurse obtains the assessment information. Which finding is most important to communicate to the health care provider? A. Apical pulse 68 beats/min and irregular B. Digoxin taken with meals C. Vision that is becoming "fuzzy" D. Lung crackles that clear after coughing

C. Vision that is becoming "fuzzy"

The nurse is talking to a patient with angina about resuming sexual activity. Which statement by the patient indicates a correct understanding about the effects of angina on sexual activity? A. "I won't be able to resume the same level of physical exertion as I did before I had chest pain" B. "I will discuss alternative methods with my partner since I will no longer be able to have sexual intercourse" C. "If I cannot walk a mile, I am not strong enough to resume intercourse" D. "With approval from my healthcare provider, I should resume sexual activity in the mornings or after a rest period"

D. "With approval from my healthcare provider, I should resume sexual activity in the mornings or after a rest period"

Based on this information in a client's medical record, which topic is the highest priority for the nurse to include in the initial teaching plan for a 26-year-old client who has blood pressure ranging from 150/84 to 162/90 mm Hg? Health history: denies chronic health problems, takes no medications currently. Physical exam: Height: 5 ft 6 in, Weight: 115 lb, BMI: 18.6. Social and Diet history: Works as an accountant, 1 glass of wine once or twice weekly, eats "fast food" frequently. A. Symptoms of acute stroke and myocardial infarction B. Adverse effects of alcohol on blood pressure C. Methods for decreasing dietary calorie intake D. Low-sodium food choices when eating out

D. Low-sodium food choices when eating out

Which is the primary medical-surgical concept for a patient with unstable angina or myocardial infarction? A. Comfort B. Tissue integrity C. Gas exchange D. Perfusion

D. Perfusion

What should the nurse teach a client to expect when preparing for discharge after surgery for a coronary artery bypass graft? A. Mild fever and extreme fatigue for several weeks after surgery B. Cessation of drainage from the incision after hospitalization C. Mild incisional pain and tenderness up to three weeks after surgery D. Some edema in the leg used for the donor graft is expected with activity

D. Some edema in the leg used for the donor graft is expected with activity

At 2100, the nurse admits a 63-year-old client with a diagnosis of acute myocardial infarction. Which finding is most important to communicate to the healthcare provider who is considering the use of fibrinolytic therapy with tissue plasminogen activator (Alteplase) for the client? A. The client was treated with alteplase about 8 months ago B. The client takes famotidine for gastroesophageal reflux disease C. The client has ST-segment elevations on the electrocardiogram (ECG) D. The client reports having continuous chest pain since 0800

D. The client reports having continuous chest pain since 0800

Which statement is true about postpericardiotomy syndrome? A. It is a psychological disorder for which the patient needs emotional support B. It is mild and self-limiting for all patients C. It places the patient at risk for acute cardiac tamponade D. It can be prophylactically managed with antibiotics

C. It places the patient at risk for acute cardiac tamponade

A client who had several episodes of chest pain is scheduled for an exercise electrocardiogram. Which explanation should the nurse include when teaching the client about this procedure? A. "This is a noninvasive test to check your heart's response to physical activity" B. "This test is the definitive method to identify the actual cause of your chest pain" C. "The findings of this test will be of minimal assistance in the treatment of angina" D. "The findings from this minimally invasive test will show how your body reacts to exercise"

A. "This is a noninvasive test to check your heart's response to physical activity"

A patient reports having chest discomfort that started during exercise. The patient is currently pain free but is "concerned". What questions must the nurse ask to assess the patient's pain episode? SATA A. "When did the pain start and how long did it last?" B. "What were you doing when the pain started?" C. "What did you do to alleviate the pain?" D. "How did you feel about the pain?" E. "Did the pain radiate to other locations?" F. "On a scale of 0 to 10 with 10 as the worst pain, what number would you use to categorize your pain?"

A. "When did the pain start and how long did it last?" B. "What were you doing when the pain started?" C. "What did you do to alleviate the pain?" E. "Did the pain radiate to other locations?" F. "On a scale of 0 to 10 with 10 as the worst pain, what number would you use to categorize your pain?"

The nurse administers sublingual nitroglycerin to a patient experiencing an episode of angina. How soon does the nurse expect the pain to begin to subside? A. 1-2 minutes B. 5-6 minutes C. 10-12 minutes D. 15-20 minutes

A. 1-2 minutes

Which statements are true about the use of thrombolytic agents for a patient with an acute myocardial infarction (MI)? SATA A. A patient who has received a thrombolytic agent must be continuously monitored before and after the medication is administered B. Thrombolytic therapy is indicated for chest pain of less than 15 minutes duration that is unrelieved by other medications C. There are no contraindications to thrombolytic therapy if the patient is having an acute MI D. Bleeding is a risk for patients receiving thrombolytic therapy E. The nurse monitors only clotting studies of the patient who has received thrombolytic therapy F. Patients who receive thrombolytics require percutaneous coronary intervention (PCI) for more definitive treatment such as stent placements

A. A patient who has received a thrombolytic agent must be continuously monitored before and after the medication is administered D. Bleeding is a risk for patients receiving thrombolytic therapy F. Patients who receive thrombolytics require percutaneous coronary intervention (PCI) for more definitive treatment such as stent placements

The nurse is working with an experienced unlicensed assistive personnel (UAP) and an LPN/LVN on the telemetry unit. A client who had an acute myocardial infarction 3 days ago has been reporting fatigue and chest discomfort when ambulating. Which nursing activity included in the care plan is best assigned to the LPN/LVN? A. Administering nitroglycerin 0.4 mg sublingually if chest discomfort occurs during client activities B. Monitoring pulse, blood pressure, and oxygen saturation before and after client ambulation C. Teaching the client energy conservation techniques to decrease myocardial oxygen demand D. Explaining the rationale for alternating rest periods with exercise to the client and family

A. Administering nitroglycerin 0.4 mg sublingually if chest discomfort occurs during client activities

A patient with coronary artery bypass graft (CABG) surgery is transferred from the ICU to the intermediate care unit. Which activity does the nurse assist the patient with? A. Ambulating 25-100 feet three times a day as tolerated B. Turning the patient every 2 hours for the first 48 hours C. Dangling and turning every 2 hours for at least 24 hours D. Coughing and deep-breathing three times a day

A. Ambulating 25-100 feet three times a day as tolerated

A patient is admitted for unstable angina. The patient is currently asymptomatic and all vital signs are stable. Which position does the nurse place the position in? A. Any position of comfort B. Supine C. Sitting in a chair D. Fowler's

A. Any position of comfort

During the initial postoperative assessment of a client who has just been transferred to the postanesthesia care unit after repair of an abdominal aortic aneurysm, the nurse obtains these data. Which finding has the most immediate implications for the client's care? A. Arterial line indicates a blood pressure of 190/112 mm Hg B. Cardiac monitor shows frequent premature atrial contractions C. There is no response to verbal stimulation D. Urine output is 40 mL of amber urine

A. Arterial line indicates a blood pressure of 190/112 mm Hg

The healthcare provider prescribes these actions for a client who was admitted with acute substernal chest pain. Which actions are appropriate to assign to an experienced LPN/LVN who is working in the emergency department? SATA A. Attaching cardiac monitor leads B. Giving heparin 5000 units IV push C. Administering morphine sulfate 4 mg IV D. Obtaining a 12-lead electrocardiogram (ECG) E. Asking the client about pertinent medical history F. Having the client chew and swallow aspirin 162 mg

A. Attaching cardiac monitor leads D. Obtaining a 12-lead electrocardiogram (ECG) F. Having the client chew and swallow aspirin 162 mg

A patient has been discharged after CABG surgery and is to start a simple walking program at home. What does the nurse teach the patient about a home walking program? SATA A. Begin by walking 400 feet twice a day at the rate of 1 mile/hr the first week after discharge B. Each week increase the distance and rate as tolerated until you can walk 2 miles at 3 to 4 miles/hr C. Take a break after walking each mile to avoid pain or shortness of breath D. Check your pulse reading before, halfway through, and after exercise E. Walk even when the weather is either hot or cold F. Stop exercising if your pulse rate increases more than 20 beats per minute or if you develop dyspnea or angina

A. Begin by walking 400 feet twice a day at the rate of 1 mile/hr the first week after discharge B. Each week increase the distance and rate as tolerated until you can walk 2 miles at 3 to 4 miles/hr D. Check your pulse reading before, halfway through, and after exercise F. Stop exercising if your pulse rate increases more than 20 beats per minute or if you develop dyspnea or angina

The intensive care nurse is caring for a patient who just had a coronary artery bypass graft (CABG) surgery. The nurse notes that the patient has peripheral edema. To adjust fluid administration, the nurse collects which additional information and then consults the health care provider? SATA A. Blood pressure B. Pulmonary artery wedge pressure (PAWP) C. Skin turgor D. Cardiac output E. Blood loss F. Urine output

A. Blood pressure B. Pulmonary artery wedge pressure (PAWP) D. Cardiac output E. Blood loss F. Urine output

The nurse is evaluating a patient with coronary artery disease (CAD). What is an expected patient outcome that demonstrates hemodynamic stability? A. Blood pressure and pulse are within range and adequate for metabolic demands B. Urine output increases from 15 to 30 mL per hour C. P waves are regular and there are no abnormal heart sounds D. Patient expresses verbal understanding of risk factors and need for compliance

A. Blood pressure and pulse are within range and adequate for metabolic demands

A patient had an inferior wall myocardial infarction (IWMI). The nurse closely monitors the patient for which dysrhythmia associated with this type of MI? A. Bradycardia and second-degree heart block B. Premature ventricular contractions C. Supraventricular tachycardia D. Atrial fibrilation

A. Bradycardia and second-degree heart block

A patient is being treated with medication therapy following an acute myocardial infarction (MI). The nurse questions the order for which type of drug? A. Calcium channel blocker B. Beta blocker C. ACE inhibitor D. Angiotensin receptor blocker (ARB)

A. Calcium channel blocker

A patient is hypertensive and continues to have angina despite therapy with beta blockers. The nurse anticipates which type of drug will be prescribed for this patient? A. Calcium channel blocker B. Potassium channel blocker C. Angiotensin-converting enzyme inhibitor D. Vasopressor

A. Calcium channel blocker

The nurse is teaching a patient diagnosed with acute coronary syndrome (ACS) about when to notify the health care provider and seek medical advice. Which precautions would the nurse teach this patient? SATA A. Call your healthcare provider if your heart rate remains at less than 50 after arising from bed B. Notify your healthcare provider if you experience weight gain of 3 pounds in 1 week or 1 to 2 pounds overnight C. Let your healthcare provider know every time you need to use nitroglycerin for angina D. Be sure to tell your healthcare provider if you experience dizziness, faintness, or shortness of breath with activity E. Have your spouse bring you to the hospital if you experience extremely severe chest pain or epigastric discomfort with weakness nausea, or fainting F. Notify your health care provider if your nitroglycerin produces a tingling sensation when you place it under your tongue

A. Call your healthcare provider if your heart rate remains at less than 50 after arising from bed B. Notify your healthcare provider if you experience weight gain of 3 pounds in 1 week or 1 to 2 pounds overnight D. Be sure to tell your healthcare provider if you experience dizziness, faintness, or shortness of breath with activity

A patient continues to have chest pain despite compliance with medical therapy. The nurse teaches the patient about which diagnostic test? A. Cardiac catheterization B. Percutaneous transluminal coronary angioplasty (PTCA) C. Coronary artery bypass grafting (CABG) D. Stent placement in coronary artery

A. Cardiac catheterization

The nurse is caring for a patient who had percutaneous coronary intervention (PCI). Which symptom indicates acute closure of the vessel and warrants immediate notification of the health care provider? A. Chest pain B. Hyperkalemia C. Bleeding at the insertion site D. Cough and shortness of breath

A. Chest pain

The nurse is interviewing a patient who reports chest discomfort that occurs with moderate to prolonged exertion. The patient describes the pain as being "about the same over the past several months and going away with nitroglycerin or rest". Based on the patient's description of symptoms, what does the nurse suspect in this patient? SATA A. Chronic stable angina (CSA) B. Unstable angina C. Acute coronary syndrome (ACS) D. Acute myocardial infarction (MI) E. Coronary Artery Disease (CAD) F. Variant (Prinzmetal's) angina

A. Chronic stable angina (CSA) E. Coronary Artery Disease (CAD)

The nurse is assessing a patient who is labeled Class I based on the Killip classification of heart failure. Which manifestation(s) does the nurse expect to find? A. Clear lung sounds and absence of S3 B. Crackles in the lower half of the lung fields and possible S3 C. Crackles more than halfway up the lung fields and frothy sputum D. Systolic blood pressure less than 90 mm Hg and oliguria

A. Clear lung sounds and absence of S3

The nurse is caring for a patient diagnosed with acute coronary syndrome (ACS). Which manifestations indicate cardiogenic shock? SATA A. Cold, clammy skin with poor peripheral pulses B. Urine output less than 0.5-1 mL/kg/hr C. Bradycardia and hypotension D. Systolic BP less than 90 mm Hg or 30 mm Hg less than the patient's baseline E. Agitation, restlessness, or confusion F. Tachypnea and crackles

A. Cold, clammy skin with poor peripheral pulses B. Urine output less than 0.5-1 mL/kg/hr D. Systolic BP less than 90 mm Hg or 30 mm Hg less than the patient's baseline E. Agitation, restlessness, or confusion F. Tachypnea and crackles

A client in the emergency department who is being monitored with a portable cardiac monitor/defibrillator develops this rhythm. Which action will the nurse take first? A. Defibrillate at 200 joules B. Start cardiopulmonary resuscitation (CPR) C. Administer epinephrine 1 mg IV D. Intubate and manually ventilate

A. Defibrillate at 200 joules

For which common complication of myocardial infarction should the nurse monitor clients in the coronary care unit? A. Dysrhythmia B. Hypokalemia C. Anaphylactic shock D. Cardiac enlargement

A. Dysrhythmia

Which diagnostic test is performed after angina or myocardial infarction (MI) to determine cardiac changes that are consistent with ischemia, to evaluate medical interventions, and to determine whether invasive intervention is necessary? A. Exercise tolerance test B. Electrocardiogram C. Echocardiography D. Chest x-ray

A. Exercise tolerance test

A patient is newly diagnosed with cardiovascular disease. What psychosocial reactions does the nurse assess for? SATA A. Fear B. Anxiety C. Anger D. Suspicion E. Denial F. Depression

A. Fear B. Anxiety C. Anger E. Denial F. Depression

A patient with a coronary artery bypass graft (CABG) surgery has been diagnosed with mediastinitis. What information does the nurse expect to find in the patient's assessment documentation? SATA A. Fever continuing beyond the first 4 days after CABG B. Bogginess of the sternum C. Redness and drainage from suture sites D. Decreased white blood cell count E. Induration or swelling at the suture sites F. Anginal-type chest pain

A. Fever continuing beyond the first 4 days after CABG B. Bogginess of the sternum C. Redness and drainage from suture sites E. Induration or swelling at the suture sites

Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? SATA A. How to monitor and record daily weight B. Importance of stopping exercise if heart rate increases C. Symptoms of worsening heart failure D. Purpose of chronic antibiotic therapy E. How to read food labels for sodium content F. Date and time for follow-up appointment

A. How to monitor and record daily weight C. Symptoms of worsening heart failure E. How to read food labels for sodium content F. Date and time for follow-up appointment

The emergency department (ED) nurse, caring for a patient with severe chest pain and ECG changes, gives supplemental oxygen to the patient as ordered. Which other medications does the nurse anticipate giving to this patient? SATA A. IV nitroglycerin B. Beta blocker C. IV morphine D. Calcium channel blocker E. ACE inhibitor F. Aspirin

A. IV nitroglycerin B. Beta blocker C. IV morphine D. Calcium channel blocker F. Aspirin

A patient is being evaluated for thrombolytic therapy. What are absolute contraindications for this procedure? SATA A. Ischemic stroke within 3 months B. Pregnancy C. Suspected aortic aneurysm D. Major trauma in the last 12 months E. Significant closed head or facial trauma within 3 months F. Malignant intracranial neoplasm

A. Ischemic stroke within 3 months C. Suspected aortic aneurysm E. Significant closed head or facial trauma within 3 months F. Malignant intracranial neoplasm

The emergency department (ED) nurse is assessing an 86-year-old patient with acute confusion, increased respiratory rate, anxiety, and chest pain. The nurse finds a respiratory rate of 36/minute with crackles and wheezes on auscultation. How does the nurse interpret these findings? A. Left ventricular heart failure B. Atypical angina C. Coronary artery disease D. Unstable angina

A. Left ventricular heart failure

The intensive care nurse is caring for a patient who has just had coronary artery bypass graft (CABG) surgery. What does the nurse do to assess for postoperative bleeding? A. Measure mediastinal and pleural chest tube drainage at least hourly and report drainage amounts over 150 mL/hr to the surgeon B. Measure mediastinal and pleural chest tube drainage at least once a shift and report drainage amounts over 50 mL/hr to the surgeon C. Assess the dressing over the sternal site every 4 hours and reinforce the dressing with sterile gauze as ordered D. Assess the donor site every 4 hours and report serous drainage and increasing pain to the surgeon

A. Measure mediastinal and pleural chest tube drainage at least hourly and report drainage amounts over 150 mL/hr to the surgeon

The nurse is working in an outpatient clinic where many vascular diagnostic tests are performed. Which task associated with vascular testing is most appropriate to delegate to an experienced unlicensed assistive personnel (UAP)? A. Measuring ankle and brachial pressures in a client for whom the ankle-brachial pulse is to be calculated B. Checking the blood pressure and pulse every 10 minutes in a client who is undergoing exercise testing C. Obtaining information about allergies from a client who is scheduled for left left contrast venography D. Providing brief client teaching for a client who will undergo a right subclavian vein Doppler study

A. Measuring ankle and brachial pressures in a client for whom the ankle-brachial pulse is to be calculated

The nurse is assessing a middle-aged woman with diabetes who denies any history of known heart problems. WHich are gender considerations for women with coronary artery disease (CAD)? SATA A. Microvascular disease is a likely cause of CAD in women B. Women typically have smaller coronary arteries than men C. Women are often 5 to 10 years younger than men when CAD develops D. Women with CAD have a lower risk of death when hospitalized than men E. In postmenopausal women the incidence of CAD is equal to that of men F. Women with CAD manifest with atypical signs and symptoms

A. Microvascular disease is a likely cause of CAD in women B. Women typically have smaller coronary arteries than men E. In postmenopausal women the incidence of CAD is equal to that of men F. Women with CAD manifest with atypical signs and symptoms

The nurse is caring for a patient who had a percutaneous coronary intervention (PCI). Which postprocedure interventions are included in the care for this patient? SATA A. Monitor for acute closure of the vessel B. Observe for bleeding from the insertion site C. Maintain bedrest for 48 hours D. Observe for hypotension, hypokalemia, and dysrhythmias E. Teach about medications such as aspirin and beta blockers or ACE inhibitors F. Instruct about lifestyle changes relating to CAD

A. Monitor for acute closure of the vessel B. Observe for bleeding from the insertion site D. Observe for hypotension, hypokalemia, and dysrhythmias E. Teach about medications such as aspirin and beta blockers or ACE inhibitors F. Instruct about lifestyle changes relating to CAD

A patient is currently pain and symptom-free but reports having intermittent episodes of chest pain over the past week. The nurse asks about which associated symptoms? SATA A. Nausea B. Diarrhea C. Diaphoresis D. Dizziness E. Joint pain F. Shortness of breath

A. Nausea C. Diaphoresis D. Dizziness F. Shortness of breath

A nurse is teaching a group of clients about risk factors for heart disease. Which factors increase a client's risk for a myocardial infarction? SATA A. Obesity B. Hypertension C. Increased HDL D. Diabetes insipidus E. Asian-American ancestry

A. Obesity B. Hypertension

Which are characteristics of angina? SATA A. Pain is precipitated by exertion or stress B. Pain occurs without cause, usually in the morning C. Pain is relieved only by opioids D. Pain is relieved by nitroglycerin or rest E. Nausea, diaphoresis, feelings of fear, and dyspnea may occur F. Pain lasts less than 15 minutes

A. Pain is precipitated by exertion or stress D. Pain is relieved by nitroglycerin or rest F. Pain lasts less than 15 minutes

THe nurse has identified the priority problem of activity intolerance for a patient who had an acute myocardial infarction (MI). What is the best expected outcome for this patient? A. Patient will progressively walk up to 200 feet four times a day without chest discomfort or shortness of breath B. Patient will name three or four activities that will not cause shortness of breath or chest pain C. Nurse will teach the patient to exercise and to take the pulse isf symptoms of shortness of breath or pain occur D. Nurse will assist the patient with ADLs until shortness of breath or pain resolves

A. Patient will progressively walk up to 200 feet four times a day without chest discomfort or shortness of breath

Which patient has the highest risk for death because of ventricular failure and dysrhythmias related to damage to the left ventricle? A. Patient with an anterior wall MI (AWMI) B. Patient with a posterior wall MI (PWMI) C. Patient with a lateral wall MI (LWMI) D. Patient with an inferior wall MI (IWMI)

A. Patient with an anterior wall MI (AWMI)

Which patients may be potential candidates for coronary artery bypass graft (CABG)? SATA A. Patient with angina and greater than 50% occlusion of the left main coronary artery that cannot be stented B. Patient with unstable angina with moderate one vessel disease appropriate for stenting C. Patient with valvular disease D. Patient with coronary vessels unsuitable for PCI E. Patient with acute myocardial infarction (MI) responding to therapy F. Patient with signs of ischemia or impending MI after angiography or PCI

A. Patient with angina and greater than 50% occlusion of the left main coronary artery that cannot be stented C. Patient with valvular disease D. Patient with coronary vessels unsuitable for PCI F. Patient with signs of ischemia or impending MI after angiography or PCI

The nurse coming on duty receives the change of shift report. Which patient must be assessed first by the nurse? A. Patient with anxiety, nausea, diaphoresis, and shortness of breath B. Patient with diabetes mellitus and elevated serum lipid levels C. Patient with a friction rub and elevated temperature D. Patient with fever, instability of sternum, and increased white blood cell count

A. Patient with anxiety, nausea, diaphoresis, and shortness of breath

A patient has discrete, proximal, noncalcified lesions of only one or two vessels. Which procedure is most likely to be recommended for this patient? A. Percutaneous coronary intervention (PCI) B. Stress test with pharmacologic agent C. Immediate thrombolytic reperfusion therapy D. minimally invasive bypass surgery

A. Percutaneous coronary intervention (PCI)

A patient is admitted for acute myocardial infarction (MI), but the nurse notes that absence of ST segment elevation in the electrocardiogram (ECG). What other evidence for acute myocardial infarction (MI) does the nurse expect to find in the patient? SATA A. Positive troponin markers B. Chronic stable angina C. Non-ST elevation MI (NSTEMI) on ECG D. Cardiac dysrhythmia E. Heart failure F. ST elevation in two contiguous leads

A. Positive troponin markers C. Non-ST elevation MI (NSTEMI) on ECG

Which alternative therapies may be helpful in reducing the patient's anxiety about progressive activity both in the immediate postoperative period and during the rehabilitation phase? SATA A. Progressive muscle relaxation B. Acupuncture C. Guided imagery D. Music therapy E. Herbal remedies F. Therapeutic touch

A. Progressive muscle relaxation C. Guided imagery D. Music therapy F. Therapeutic touch

At 1000, a hospitalized client receives a new order for transesophageal echocardiography as soon as possible. Which action will the nurse take first? A. Put the client on "nothing by mouth" (NPO) status B. Teach the client about the procedure C. Insert an IV catheter in the client's forearm D. Attach the client to a cardiac monitor

A. Put the client on "nothing by mouth" (NPO) status

A post-myocardial infarction (MI) patient in phase I of cardiac rehabilitation is encouraged to perform which activity? A. Range-of-motion exercises B. Modified weight training C. Stair climbing D. Jogging

A. Range-of-motion exercises

While reviewing a hospitalized client's medical record, the nurse obtains this information about cardiovascular risk factors. Which interventions will be important to include in the discharge plan for this client? SATA Health history: Hypertension for 10 years, takes hydrochlorothiazide 25 mg daily, blood pressure range 110/60-132/72 mm Hg. Family history: Client's mother and 2 siblings have had myocardial infarctions. Social history: 20-pack year history of cigarette use, walks 2 to 3 miles daily. A. Referral to community programs that assist in smoking cessation B. Teaching about the impact of family health on cardiovascular risk C. Education about the need for a change in antihypertensive therapy D. Assistance in reducing emotional stress E. Discussion of the risks associated with having a sedentary lifestyle

A. Referral to community programs that assist in smoking cessation B. Teaching about the impact of family health on cardiovascular risk

The nurse is assessing a cardiac patient and finds a paradoxical pulse, clear lungs, and jugular venous distention that occurs when the patient is in a semi-Fowler's position. What are these findings consistent with? A. Right ventricular failure B. Unstable angina C. Coronary artery disease (CAD) D. Valvular disease

A. Right ventricular failure

The patient is scheduled to have robotic heart surgery. Which advantages of this type of surgery does the nurse teach the patient about? SATA A. Shorter (2-to-3 day) hospital stay B. Shorter surgical time than with traditional heart surgery C. Less pain due to smaller incision D. Shorter time on heart-lung bypass machine E. Chest tubes are never needed F. Ability to reach otherwise inaccessible blockage sites

A. Shorter (2-to-3 day) hospital stay C. Less pain due to smaller incision F. Ability to reach otherwise inaccessible blockage sites

The clinic nurse is evaluating a client who had a coronary artery stenting through the right femoral artery a week previously and is taking metoprolol, clopidogrel, and aspirin. Which information reported by the client is most important to report to the health care provider? A. Stools have been black in color B. Bruising is present at the right groin C. Home blood pressure today was 104/52 mm Hg D. Home radial pulse rate has been 55 to 60 beats/min

A. Stools have been black in color

Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? A. Tachycardia B. Hypertension C. Increased CVP D. Increased urine output E. Jugular vein distension

A. Tachycardia C. Increased CVP E. Jugular vein distension

Which finding in a client with aortic stenosis will be most important for the nurse to report to the healthcare provider? A. Temperature of 102.1F B. Loud systolic murmur over sternum C. Blood pressure of 110/88 mm Hg D. Weak radial and pedal pulse to palpation

A. Temperature of 102.1F

The nurse is caring for a patient admitted for an inferior wall myocardial infarction (IWMI). The patient develops heart block with bradycardia. Which procedure is the nurse prepared to assist with? A. Temporary pacemaker B. Defibrillation C. 16-lead ECG D. Percutaneous intervention

A. Temporary pacemaker

The nurse is assessing a patient with heart disease for indicators of metabolic syndrome. Which are indicators of this syndrome? SATA A. Triglyceride level of 170 mg/dL B. HDL cholesterol level of 45 mg/dL in a male C. HDL cholesterol level of 45 mg/dL in a female D. Blood pressure of 130/86 mm Hg while taking a beta blocker E. Fasting blood sugar level of 120 mg/dL F. Waist size over 38 inches in a male

A. Triglyceride level of 170 mg/dL C. HDL cholesterol level of 45 mg/dL in a female D. Blood pressure of 130/86 mm Hg while taking a beta blocker E. Fasting blood sugar level of 120 mg/dL

The nurse is preparing to implement teaching about a heart-healthy diet and activity levels for a client who has had a myocardial infarction and the client's spouse. The client says, "I don't see why I need any teaching. I don't think I need to change anything right now." Which response is most appropriate? A. "Do you think your family may want you to make some lifestyle changes?" B. "Can you tell me why you don't feel that you need to make any changes?" C. "You are still in the stage of denial, but you will want this information later on." D. "Even though you don't want to change, it's important that you have this teaching."

B. "Can you tell me why you don't feel that you need to make any changes?"

A nurse is providing discharge instructions to a client who experienced an anterior septal myocardial infarction. What statement by the client indicates to the nurse that there is a need for further teaching? A. "I want to stay as pain-free as possible" B. "I am not good at remembering to take medications" C. "I should not have any problems in reducing my salt intake" D. "I wrote down my medication information for future reference"

B. "I am not good at remembering to take medications"

A patient reports chest pain after coronary artery bypass graft (CABG) surgery. Which statement by the patient suggests that the pain is related to the sternotomy and not anginal origin? A. "The pain goes down my arm or sometimes into my jaw" B. "My pain increases when I cough or take a deep breath" C. "The nitroglycerin helped to relieve the pain" D. "I feel nausea and shortness of breath when the pain occurs"

B. "My pain increases when I cough or take a deep breath"

A patient had severe chest pain several hours ago but is currently pain-free and has a normal ECG. Which statement by the patient indicates a correct understanding of the significance of the ECG results? A. "I'll go home and make an appointment to see my family doctor next week" B. "The ECG could be normal since I am currently pain-free" C. "A normal ECG means I am okay" D. "I have always had a strong heart, low blood pressure, and a normal ECG"

B. "The ECG could be normal since I am currently pain-free"

A patient with angina is prescribed nitroglycerin tablets. What information does the nurse include when teaching the patient about this drug? SATA A. "If one tablet does not relieve the angina after 5 minutes, take two pills" B. "You can tell the pills are active when your tongue feels a tingling sensation" C. "Keep your nitroglycerin with you at all times" D. "The prescription should last about 6 months before a refill is necessary" E. "If the pain doesn't go away, just wait; the medication will eventually take effect" F. "The medication can cause a temporary headache"

B. "You can tell the pills are active when your tongue feels a tingling sensation" C. "Keep your nitroglycerin with you at all times" F. "The medication can cause a temporary headache"

People should seek treatment for symptoms of myocardial infarction (MI) rather than delay because physical changes will occur approximately how many hours after an infarction? A. 3 hours B. 6 hours C. 12 hours D. 24 hours

B. 6 hours

While working on a cardiac step-down unit, the nurse is precepting a newly graduated RN who has been in a 6-week orientation program. Which client will be best to assign to the new graduate? A. A 19-year-old client with rheumatic fever who needs discharge teaching before going home with a roommate today B. A 33-year-old client admitted a week ago with endocarditis who will be receiving a scheduled dose of ceftriaxone 2 mg IV C. A 50-year-old client with newly diagnosed stable angina who hasmany questions about medications and nursing care D. A 75-year-old client who has just been transferred to the unit after undergoing coronary artery bypass grafting yesterday

B. A 33-year-old client admitted a week ago with endocarditis who will be receiving a scheduled dose of ceftriaxone 2 mg IV

The nurse has just received a change-of-shift report about these clients on the coronary step-down unit. Which one will the nurse assess first? A. A 26-year-old client with heart failure caused by congenital mitral stenosis who is scheduled for balloon valvuloplasty later today B. A 45-year-old client with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before the shift change C. A 56-year-old client who underwent coronary angioplasty and stent placement yesterday and has reported occasional chest pain since the procedure D. A 77-year-old client who was transferred from the intensive care unit 2 days ago after coronary artery bypass grafting and has a temperature of 100.6F

B. A 45-year-old client with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before the shift change

After surgery for insertion of a coronary artery bypass graft (CABG), a client develops a temperature of 102F. What priority concern related to elevated temperatures does a nurse consider when notifying the health care provider about the client's temperature? A. A fever may lead to diaphoresis B. A fever increase the cardiac output C. An increased temperature indicates cerebral edema D. An increased temperature may be a sign of hemorrhage

B. A fever increase the cardiac output

A patient has had a myocardial infarction (MI). The nurse anticipates which type of drug will be prescribed within 48 hours to prevent the development of ventricular remodeling and heart failure? A. Calcium channel blocker B. ACE inhibitor C. Beta blocker D. Diuretic

B. ACE inhibitor

A patient is in the acute phase (phase 1) of cardiac rehabilitation. Which task is best to delegate to the unlicensed assistive personnel (UAP)? A. Assist the patient to ambulate approximately 200 feet three times a day B. Assist the patient with ambulation to the bathroom C. Assess heart rate, blood pressure, respiratory rate, and fatigue with each higher ;level of activity D. Assist the patient into the bathtub

B. Assist the patient with ambulation to the bathroom

The nurse is caring for a patient admitted with unstable angina and elevated lipid levels. What does the nurse include in teaching this patient about elevated lipid levels? SATA A. Begin a vigorous exercise program B. Avoid trans-fatty acids C. Reduce intake of saturated fats D. Monitor the amount of cholesterol ingested, staying below 200 mg/day E. Consider a weight loss program F. Avoid adding salt to food at the table

B. Avoid trans-fatty acids C. Reduce intake of saturated fats D. Monitor the amount of cholesterol ingested, staying below 200 mg/day E. Consider a weight loss program

A client is seen with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be most useful to monitor? A. Serum potassium B. B-type natriuretic peptide C. Blood urea nitrogen D. Hematocrit

B. B-type natriuretic peptide

Which drug is given within 1 to 2 hours of a myocardial infarction (MI), when the patient is hemodynamically stable, to help the heart to perform more work without ischemia? A. Vasodilators, such as sublingual or spray nitroglycerin B. Beta-adrenergic blocking agents, such as metoprolol C. Antiplatelet agents, such as clopidogrel D. Calcium channel blockers, such as diltiazem

B. Beta-adrenergic blocking agents, such as metoprolol

A patient has been admitted for acute angina. Which diagnostic test identifies if the patient will benefit from further invasive management after acute angina or a myocardial infarction? A. Exercise tolerance test B. Cardiac catheterization C. Thallium scan D. Multigated angiogram (MUGA) scan

B. Cardiac catheterization

The health care provider is considering use of thrombolytic therapy for a patient. What is the criterion for this therapy? A. Chest pain of greater than 15 minutes duration that is unrelieved by nitroglycerin B. Chest pain lasting longer than 30 minutes that is unrelieved by ntiroglycerin with ST segment elevation on the ECG C. Ventricular dysrhythmias shown on the cardiac monitor D. History of chronic, severe, poorly controlled hypertension

B. Chest pain lasting longer than 30 minutes that is unrelieved by ntiroglycerin with ST segment elevation on the ECG

The home health nurse receives a call from a patient with coronary artery disease (CAD) who reports having new onset of chest pain and shortness of breath. What does the nurse instruct the patient to do? A. Rest quietly until the nurse can arrive at the house to check the patient B. Chew 325 mg of aspirin and immediately call 911 C. Use supplemental home oxygen until symptoms resolve D. Take three nitroglycerin tablets and have family drive the patient to the hospital

B. Chew 325 mg of aspirin and immediately call 911

A nurse asks a client with ischemic heart disease to identify the foods that are most important to restrict. The nurse determines that the client understands the dietary instructions when the client identifies the following foods. SATA A. Olive oil B. Chicken broth C. Enriched whole milk D. Red meats, such as beef E. Vegetables and whole grain pasta F. Liver and other glandular organ meats

B. Chicken broth C. Enriched whole milk D. Red meats, such as beef F. Liver and other glandular organ meats

Which client is best for the coronary care charge nurse to assign to a float RN who has come for the day from the general medical-surgical unit? A. Client requiring discharge teaching about coronary artery stenting before going home today B. Client receiving IV furosemide to treat acute left ventricular failure C. Client who just transferred in from the radiology department after a coronary angioplasty D. Client just admitted with unstable angina who has orders for a heparin infusion and aspirin

B. Client receiving IV furosemide to treat acute left ventricular failure

The nurse in the cardiovascular clinic receives telephone calls for four clients. Which client should be scheduled to be seen most urgently? A. Client with peripheral arterial disease who complains of leg cramps when walking B. Client with atrial fibrillation who reports episodes of lightheadedness and syncope C. Client with a new permanent pacemaker who has severe itchiness at the wound site D. Client with angina who took nitroglycerin twice in the last week while exercising

B. Client with atrial fibrillation who reports episodes of lightheadedness and syncope

What should the nurse identify as the primary cause of the pain experienced by a client with coronary occlusion? A. Arterial spasm B. Heart muscle ischemia C. Blocking of the coronary veins D. Irritation of nerve endings in the cardiac plexus

B. Heart muscle ischemia

The patient who has diagnosed with acute coronary syndrome (ACS) will be discharged soon. Which type of drug that will reduce the risk of developing recurrent myocardial infarction (MI), stroke, and mortality does the nurse expect the health care provider to prescribe prior to discharge? A. Stool softener B. High-intensity statin therapy C. Anti-inflammatory D. Central vasodilator

B. High-intensity statin therapy

Treatment of hypothermia, a common problem after coronary artery bypass graft (CABG) surgery, is necessary because this condition may cause a patient to be at risk for which condition? A. Hypotension B. Hypertension C. Heart failure D. Loss of consciousness

B. Hypertension

A patient with chronic stable angina is taking calcium channel blockers. For which complication does the nurse monitor with this patient? A. Wheezes B. Hypotension C. Tachycardia D. Forgetfulness

B. Hypotension

The healthcare provider telephones the nurse with new prescriptions for a client with angina who is already taking aspirin. Which medication is most important to clarify further with the healthcare provider? A. Clopidogrel 75 mg/day B. Ibuprofen 200 mg every 4 hours as needed C. Metoprolol succinate 50 mg/day D. Nitroglycerin patch 0.4 mg/hr

B. Ibuprofen 200 mg every 4 hours as needed

A client is admitted with chest pain unrelieved by nitroglycerin, an elevated temperature, decreased blood pressure, and diaphoresis. A myocardial infarction is diagnosed. Which should the nurse consider as a valid reason for one of this client's physiologic responses? A. Parasympathetic reflexes from the infarcted myocardium cause diaphoresis B. Inflammation in the myocardium causes a rise in the systemic body temperature C. Catecholamines released at the site of the infarction cause intermittent localized pain D. Constriction of central and peripheral blood vessels cause a decrease in blood pressure

B. Inflammation in the myocardium causes a rise in the systemic body temperature

The ICU nurse is caring for a patient with a diagnosis of acute coronary syndrome (ACS) who has developed left heart failure that is unresponsive to drug therapy. What intervention does the nurse expect may be next for this patient? A. Positive inotropic drugs IV B. Intra-aortic balloon pump insertion C. Fibrinolytic therapy D. Percutaneous coronary intervention (PCI)

B. Intra-aortic balloon pump insertion

The intensive care nurse is caring for a patient who has just had coronary artery bypass graft (CABG) surgery. The patient has a systolic blood pressure of 80 mm Hg. What is the primary concern related to this patient's hypotension? A. It is associated with warm cardioplegia B. It may result in the collapse of the graft C. It will result in acute tubular necrosis D. It is related to mechanical ventilation

B. It may result in the collapse of the graft

Cardiac rehabilitation is recommended for patients after MI or CABG. What are commonly cited reasons that patients do not participate in cardiac rehab programs? SATA A. Lack of transportation B. Lack of insurance coverage C. Health care provider does not believe it is necessary D. Inability to perform the program activities E. Patient decision that it is no necessary F. Necessity of returning to work as soon as possible

B. Lack of insurance coverage C. Health care provider does not believe it is necessary E. Patient decision that it is no necessary

The patient received thrombolytic therapy. Which manifestation indicate that the clot has been dissolved? A. The patient continues to have chest pain but the intensity is much less B. There is sudden onset of nonsustained ventricular dysrhythmias C. ST segment remains elevated with inverted T waves D. Cardiac markers peak 3 to 4 hours after thrombolytic therapy

B. There is sudden onset of nonsustained ventricular dysrhythmias

The charge nurse in a long-term care facility employes RNs, LPNs/LVNs, and unlicensed assistive personnel (UAPs) has developed a plan for the ongoing assessment of all residents with the diagnosis of heart failure. What activity included in the plan is most appropriate to assign to an LPN/LVN team member? A. Weighing all residents with heart failure each morning B. Listening to lung sounds and checking for edema each week C. Reviewing all heart failure medications with residents each month D. Updating activity plans for residents with heart-failure every quarter

B. Listening to lung sounds and checking for edema each week

A patient had a coronary artery bypass graft (CABG) surgery with a vein graft. To help prevent collapse of the graft, what assessment does the nurse perform? A. Auscultate lung sounds B. Monitor for hypotension C. Assess for motion and sensation D. Observe for generalized hypothermia

B. Monitor for hypotension

Which class of drugs has a strong FDA warning about increased risk for stroke or heart attack? A. Beta blockers B. Non-aspirin NSAIDs C. Calcium channel blockers D. ACE inhibitors

B. Non-aspirin NSAIDs

A patient has received thrombolytic therapy for treatment of acute myocardial infarction (MI). What are post administration nursing responsibilities for this treatment? SATA A. Document the patient's emotional reaction to thrombolytic therapy B. Observe all IV sites for bleeding and patency C. Monitor white blood cell (WBC) count and differential D. Monitor clotting studies E. Place all new IC lines to prevent infection F. Test stools, urine, and emesis for occult blood

B. Observe all IV sites for bleeding and patency D. Monitor clotting studies F. Test stools, urine, and emesis for occult blood

A patient comes to the walk-in clinic reporting left anterior chest discomfort with mild shortness of breath. The patient is alert, oriented, diaphoretic, and anxious. What is the first priority action for the nurse? A. Obtain a complete cardiac history to include a full description of the presenting symptoms B. Place the patient in semi-Fowler's position and start supplemental oxygen C. Instruct the patient to go immediately to the closest full-service hospital D. Immediately alert the physician and establish IV access

B. Place the patient in semi-Fowler's position and start supplemental oxygen

Which statements about acute coronary syndrome (ACS) is accurate? A. Ischemia that occurs with angina lasts more than 30 minutes and does not cause permanent damage of myocardial tissue B. Postmenopausal women in their 70s have the same incidence of myocardial infarction (MI) as men C. Many patients suffering sudden cardiac arrest die before reaching the hospital because of atrial fibrillation D. Studies have shown that CAD in women manifests with the same symptoms as with men

B. Postmenopausal women in their 70s have the same incidence of myocardial infarction (MI) as men

The nurse is caring for a patient who had coronary artery bypass graft (CABG) surgery. The nurse pays close attention to which electrolyte levels for this postoperative patient? SATA A. Sodium B. Potassium C. Calcium D. Magnesium E. Phosphorus F. Creatinine

B. Potassium C. Calcium D. Magnesium

The emergency department (ED) nurse is caring for a patient with acute pain associated with myocardial infarction (MI). What are the goals of collaborative management that address the patient's pain? SATA A. Return the vital signs and cardiac rhythm to baseline so the patient can resume activities of daily living B. Prevent further damage to the cardiac muscle by decreasing myocardial oxygen demand and increase myocardial oxygen supply C. Aggressively diagnose and treat life-threatening cardiac dysrhythmias and restore pulmonary wedge pressure D. Closely monitor the patient for accompanying symptoms such as nausea and vomiting or indigestion E. Eliminate discomfort by providing pain relief modalities, decrease myocardial oxygen demand, and increased myocardial oxygen supply F. Teach the patient about alternative therapies that can help decrease or replace need for pain drugs

B. Prevent further damage to the cardiac muscle by decreasing myocardial oxygen demand and increase myocardial oxygen supply E. Eliminate discomfort by providing pain relief modalities, decrease myocardial oxygen demand, and increased myocardial oxygen supply

A patient is having an elective coronary artery bypass graft (CABG) with a minimally invasive surgical technique. What does the nurse include in the preoperative teaching? A. Prevention of edema and scarring at the harvest site B. Protection and splinting of the chest incision while coughing C. Availability of analgesics if needed, but probably unnecessary D. Limitation of ambulation for several days after the procedure

B. Protection and splinting of the chest incision while coughing

The nurse is auscultating the heart of a patient who had a myocardial infarction (MI). Which finding most strongly indicates heart failure? A. Murmur B. S3 gallop C. Split S1 and S2 D. Pericardial friction rub

B. S3 gallop

The nurse is caring for a patient who had a minimally invasive direct coronary artery bypass (MIDCAB). Which sign/symptom prompts the nurse to immediately contact the health care provider? A. Acute incisional pain B. ST-segment changes on the monitor C. Drainage from the chest tubes D. Problems with coughing

B. ST-segment changes on the monitor

During an interview, the nurse discovers that the spouse of a debilitated, chronically constipated client digitally removes stool from the client's rectum. What response to disimpaction is the nurse attempting to prevent by presenting other strategies to regulate the client's bowel movement? A. Increased pulse rate B. Slowing of the heart C. Dilation of the bronchioles D. Coronary artery vasodilation

B. Slowing of the heart

Following coronary artery bypass graft (CABG) surgery, a patient in the ICU on a mechanical ventilator suddenly decompensates. The health care provider makes a diagnosis of cardiac tamponade. The nurse prepares the patient for which emergency procedure? A. Chest tube B. Sternotomy C. Pericardiocentesis D. Thoracentesis

B. Sternotomy

During an annual physical exam, a patient receives an ECG and has an abnormal Q wave in several leads. What is the nurse's best interpretation of this result? A. The patient is experiencing a silent MI B. The patient has experienced an MI in the past C. The patient is having an acute MI at the moment D. The patient is experiencing ischemia at the moment

B. The patient has experienced an MI in the past

A patient is having a coronary artery bypass graft (CABG) with the traditional surgical procedure. What does the nurse include in the preoperative teaching? SATA A. Coughing will be avoided to keep stress off the sternal incision B. There will be a sternal incision C. Except one, two, or three chest tubes D. An indwelling urinary catheter will be placed E. An endotracheal tube will prevent talking F. You will be on bedrest for up to 48 hours after the surgery

B. There will be a sternal incision C. Except one, two, or three chest tubes D. An indwelling urinary catheter will be placed E. An endotracheal tube will prevent talking

A client who has just arrived in the emergency department reports substernal and left arm discomfort that has been going on for about 3 hours. Which laboratory test will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol? A. Creatine kinase MB level B. Troponin I level C. Myoglobin level D. C-reactive protein level

B. Troponin I level

A client who had a myocardial infarction is in the coronary care unit on a cardiac monitor. The nurse observes ventricular irritability on the screen. What medication should the nurse prepare to administer? A. Digoxin (Lanoxin) B. Furosemide (Lasix) C. Amiodarone (Cordarone) D. Norepinephrine (Levophed)

C. Amiodarone (Cordarone)

After coronary artery bypass graft (CABG) surgery, a postoperative patient suddenly has a decrease in mediastinal drainage, jugular vein distention with clear lung sounds, pulsus paradoxus, and equalizing pulmonary artery wedge pressure (PAWP) and right atrial pressure. What do these signs suggest to the nurse? A. Acute myocardial infarction (MI) B. Occlusion at the donor site C. Cardiac tamponade D. Prinzmetal's angina

C. Cardiac tamponade

Immediate reperfusion is an invasive intervention that shows some promise for managing which disorder? A. Right ventricular failure B. Metabolic syndrome C. Cardiogenic shock D. Acute coronary syndrome

C. Cardiogenic shock

The nurse is reviewing medication orders for several cardiac patients. There is an order for beta-adrenergic blocking agent metoprolol XL once a day. According to the Killip classification, this drug order is most appropriate for which classes of patient? A. All classes B. Class I only C. Classes II and III D. Class IV only

C. Classes II and III

The nurse is monitoring the cardiac rhythms of clients in the coronary care unit. Which client will need immediate intervention? A. Client admitted with heart failure who has atrial fibrillation with a rate of 88 beats/min while at rest B. Client with newly implemented demand ventricular pacemaker who has occasional periods of sinus rhythm at a rate of 90 to 100 beats/min C. Client who has had an acute myocardial infarction and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions D. Client who recently started taking atenolol and has a first-degree heart block, with a rate of 58 beats/min

C. Client who has had an acute myocardial infarction and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions

An 80-year-old client on the coronary step-down unit tells the nurse, "I do not need to take that docusate. I never get constipated!" Which action by the nurse is most appropriate? A. Document the medication on the client's chart as "refused" B. Mix the medication with food and administer it to the client C. Explain that his decreased activity level may cause constipation D. Reinforce that the docusate has been prescribed for a good reason

C. Explain that his decreased activity level may cause constipation

A patient is trying to make dietary modifications to reduce lipid levels. The patient would like information about omega-3-fatty acid food sources. What best source does the nurse recommend? A. Flaxseed B. Flaxseed oil C. Fish D. Walnuts

C. Fish

A patient with a history of chronic stable angina is admitted for surgery. The patient now reports nausea and pressure in the chest radiating to the left arm and appears anxious; skin is cool and clammy, blood pressure is 150/90 mm Hg, pulse is 100, and respiratory rate is 3. What are the priorities of nursing care for this patient? SATA A. Relieve nausea B. Maintain NPO status C. Improve coronary perfusion D. Improve coronary oxygenation E. Relieve chest pain F. Draw troponin blood samples

C. Improve coronary perfusion D. Improve coronary oxygenation E. Relieve chest pain F. Draw troponin blood samples

Which statement about silent myocardial ischemia is correct? A. In silent myocardial ischemia, the patient has no pain so there is less myocardial damage B. Diabetic patients are susceptible to silent myocardial ischemia that is undiagnosed and without complications C. Silent myocardial ischemia increases the incidence of new coronary events D. In silent myocardial ischemia, the myocardium is oxygenated by increased collateral circulation

C. Silent myocardial ischemia increases the incidence of new coronary events

Two weeks ago, a client with heart failure received a new prescription for carvedilol 12.5 mg orally. Which finding by the nurse who is evaluating the client in the cardiology clinic is of most concern? A. Reports of increased fatigue and activity intolerance B. Weight increase of 0.5 kg over a 1-week period C. Sinus bradycardia at a rate of 48 beats/min D. Traces of edema noted over both ankles

C. Sinus bradycardia at a rate of 48 beats/min

The nurse is performing as a team member in the resuscitation of a client who had a cardiac arrest. The healthcare provider who is directing the resuscitation asks the nurse to administer epinephrine 1 mg IV. After giving the medication, which action should the nurse take next? A. Prepare to defibrillate the client B. Offer to take over chest compressions C. State: "Epinephrine 1 mg IV has been given" D. Continue to monitor the client's responsiveness

C. State: "Epinephrine 1 mg IV has been given"

The nurse has just given a patient two doses of sublingual nitroglycerin for anginal pain. The patient's baseline blood pressure is 130/80 mm Hg. For which finding would the nurse immediately notify the health care provider? A. Patient reports a headache B. Systolic pressure is 140 mm Hg C. Systolic pressure is 90 mm Hg D. Anginal pain continues but is somewhat is relieved

C. Systolic pressure is 90 mm Hg

The nurse assesses a client who has just returned to the recovery area after undergoing coronary arteriography. Which information is of most concern? A. Blood pressure is 154/78 mm Hg B. Pedal pulses are palpable at 1+ C. Left groin has a 3-cm bruised area D. Apical pulse is 122 beats/min and regular

D. Apical pulse is 122 beats/min and regular

A resident in a long-term care facility who has venous stasis ulcer is treated with an Unna boot. Which nursing activity included in the resident's care is best for the nurse to delegate to the unlicensed assistive personnel (UAP)? A. Teaching family members the signs of infection B. Monitoring capillary perfusion once every 8 hours C. Evaluating foot sensation and movement each shift D. Assisting the client in cleaning around the Unna boot

D. Assisting the client in cleaning around the Unna boot

When the nurse is monitoring a 53-year-old client who is undergoing a treadmill stress test, which finding will require the most immediate action? A. Blood pressure of 152/88 mm Hg B. Heart rate of 134 beats/min C. Oxygen saturation of 91% D. Chest pain level of 3 (on a scale of 0 to 10)

D. Chest pain level of 3 (on a scale of 0 to 10)

A client who is scheduled for a coronary arteriogram is admitted to the hospital on the day of the procedure. Which client information is most important for the nurse to communicate to the health care provider (HCP) before the procedure? A. Blood glucose level is 144 mg/dL B. Cardiac monitor shows sinus bradycardia, rate 56 beats/min C. Client reports chest pain that occurred yesterday D. Client took metformin 500 mg this morning

D. Client took metformin 500 mg this morning

Which early reaction is most common in patients with chest discomfort associated with unstable angina or myocardial infarction (MI)? A. Depression B. Anger C. Fear D. Denial

D. Denial

The nurse is assessing a patient who had coronary artery bypass graft (CABG) surgery. Which finding is a permanent deficit that is associated with an intraoperative stroke? A. Decreased level of consciousness that resolves when body temperature is normal B. Arousal from anesthesia takes several hours C. Inability to speak clearly and coherently immediately after surgery D. Generalized seizure activity

D. Generalized seizure activity

A client is returned to the surgical unit immediately after placement of a coronary artery stent that was accomplished via access through the femoral artery. What response should the nurse consider the priority when assessing this client? A. Acute pain B. Impaired mobility C. Impaired swallowing D. Hematoma formation

D. Hematoma formation

The nurse is giving a community presentation about heart disease. Because many sudden cardiac arrest victims die of ventricular fibrillation before reaching the hospital, which teaching point does the nurse emphasize? A. Controlling alcohol consumption and quitting smoking B. Modifying risk factors such as diet and weight, and blood pressure medication compliance C. Recognizing the difference between chronic stable angina and unstable angina D. Learning to operate the automatic external defibrillators (AEDs) in the workplace

D. Learning to operate the automatic external defibrillators (AEDs) in the workplace

The nurse is reviewing the laboratory results for a client with an elevated cholesterol level who is taking atorvastatin. Which result is most important to discuss with the healthcare provider? A. Serum potassium is 3.4 mEq/L B. Blood urea nitrogen (BUN) is 9 mg/dL C. Aspartate aminotransferase (AST) is 30 units/L D. Low-density lipoprotein (LDL) cholesterol is 170 mg/dL

D. Low-density lipoprotein (LDL) cholesterol is 170 mg/dL

The nurse has given morphine sulfate 4 mg IV to a client who is having an acute myocardial infarction. When evaluating the client's response 5 minutes after giving the medication, which finding indicates a need for immediate further action? A. Blood pressure decrease from 114/65 mm Hg B. Respiratory rate drop from 18 to 12 breaths/min C. Cardiac monitor indicating sinus rhythm at a rate of 96 beats/min D. Persisting chest pain at a level of 1 (on a scale of 0 to 10)

D. Persisting chest pain at a level of 1 (on a scale of 0 to 10)

A middle-aged patient with no known medical problems has acute-onset chest pain and dyspnea. To rule out acute myocardial infarction (MI), the nurse obtains orders for which diagnostic test? A. C-reactive protein B. Chest x-ray C. Total serum cholesterol, low-density lipoprotein, high-density lipoprotein D. Serial troponin T and I

D. Serial troponin T and I

A client is admitted with the diagnosis of possible myocardial infarction, and a series of diagnostic tests is ordered. Which blood level should the nurse expect will increase first if this client has had a myocardial infarction? A. ALT B. AST C. Total LDH D. Troponin T

D. Troponin T

Following a coronary artery bypass graft (CABG)surgery, a patient has a body temperature below 96.8. What measure should be used to rewarm the patient? A. Infuse warm IV fluids B. Do not rewarm: cold cardioplegia is protective C. Place the patient in a warm fluid bath D. Use lights or thermal blankets

D. Use lights or thermal blankets

The nurse is preparing to administer the following medications to a client with multiple health problems who has been hospitalized with deep vein thrombosis. Which medication is most important to double-check with another licensed nurse? A. Famotidine 20 mg IV B. Furosemide 40 mg IV C. Digoxin 0.25 mg PO D. Warfarin 2.5 mg PO

D. Warfarin 2.5 mg PO