HESI PN CORONARY ARTERY DISEASE 2023 with verified questions and answers

Which information in Kathy's history increases her risk for coronary artery disease (CAD)? Positive family history for hyperlipidemia. Genetic predisposition is a significant factor in the development of CAD. In responding to the client, the PN identifies the need to address what client problem? Ineffective self health management. Kathy's statement reflects that she is not adjusting as effectively as possible to the knowledge of her identified risk factors. What is the best response by the PN to Kathy's statement? You feel that you don't need to be involved in your health care? Clarification of the client's statement is a useful therapeutic technique that encourages further communication. When reviewing the written guidelines relating to cholesterol with Kathy, which information should the PN include? An HDL of less than 40 mg/dl indicates increased risk. HDL is considered the "good" cholesterol, which reduces the risk of heart disease. Current guidelines state that an HDL of less than 40 mg/dl is too low to safeguard the arteries. HDL= highly desirable level. Which instructions should the PN reinforce when reviewing Kathy's understanding about her antihyperlipidemic medication? Report excessive bruising. Antihyperlipidemics reduce the absorption of lipid-soluble vitamins, including Vitamin K, and can therefore affect prothrombin time. This increases the client's risk for bleeding, so the client should be instructed to report any signs of bleeding, such as excessive bruising. Which ongoing lab test should Kathy anticipate during treatment with antihyperlipidemics? Liver enzymes. Because antihyperlipidemics can cause increased liver enzymes, they should be monitored periodically during treatment. The PN should reinforce which information when reviewing the use of sublingual nitroglycerin with Kathy? Place a tablet under the tongue every 5 minutes until the pain is relieved, up to 3 tablets. Nitroglycerin tablets should be placed under the tongue when chest pain occurs. They may be taken 1 tablet every 5 minutes for 15 minutes, for a total maximum dose of 3 tablets. If the pain is not relieved after three doses, the client should be instructed to go to the Emergency Department. The PN should prepare Kathy for which adverse effect that can occur when starting a daily dose of transdermal nitroglycerin? Dizziness. Nitroglycerin is a nitrate, causing systemic vasodilation. This often leads to hypotension, which can cause the client to feel dizzy. The client should be instructed to change positions slowly and to avoid prolonged standing. In addition, the client may experience tachycardia and a headache. The PN reviews which instruction with Kathy prior to the test? It is important to return to the exam table immediately after exercising. This is important so the echocardiogram can be performed while the heart is still stressed from the exercise on the treadmill. Which intervention(s) should the PN and the RN initially implement? Obtain blood specimen for cardiac enzymes. Obtain an EKG. Administer oxygen. Which intervention should the PN implement first? Inform the emergency department physician of Kathy's recent surgery. Since this client has had recent surgery, she may not be a candidate for some past MI treatments, such as tPA. The emergency department physician should be notified immediately so that further evaluation can be made. tPA is a thrombolytic agent, or coagulation modifier, that breaks down clots in the coronary arteries. If blood flow is established quickly, the heart muscle will not become ischemic or necrotic. To be most effective, tPA should be given within the first 4 hours following an MI. What is a primary goal of IV nitroglycerin? Perfuse cardiac tissue by dilating coronary arteries. Nitrates cause the coronary blood vessels to dilate, allowing improved oxygen delivery to cardiac muscle. In addition, nitrates cause systemic vasodilation, reducing the workload on the heart, which in turn reduces the myocardium's need for oxygen. Which ECG change is indicative of myocardial injury? ST segment elevation. ST segment elevation is indicative of myocardial injury. ST segment depression and inverted T waves are indicative of ischemia, and the development of a pathological Q wave is indicative of myocardial necrosis. Which cardiac isoenzyme is the most sensitive indicator for myocardial damage? Creatine Kinase - MB Fraction (CK-MB). This is the most sensitive isoenzyme for myocardial damage. Peak elevation occurs within 24 hours. In addition to cardiac isoenzymes, a serum troponin level may be obtained. Troponin is a marker of myocardial injury with a broad diagnostic time frame, which is especially useful when clients are seen several hours after the suspected infarction has occurred. Which question should the PN include in the focused assessment of Kathy's chest pain? What other symptoms are you experiencing? The client should describe the onset, location, duration, and quality of the pain, as well as any pain radiation, such as to the arm, jaw, or back. Additional symptoms, such as dyspnea, palpitations, or diaphoresis should be noted, as well as any actions that were taken in an attempt to relieve the pain. Which nursing intervention should the PN plan to implement? Monitor the effects of morphine sulfate administered IV. Morphine sulfate is used to relieve the pain of myocardial infarction. Intravenous administration provides the fastest relief and avoids the muscle damage caused by IM injections. Other important interventions include: maintain oxygen per nasal cannula; ensure a calm, quiet environment; provide adequate rest with limited stimuli; and then gradually increase activity. The PN assists the charge nurse in the implementation of which initial intervention? Administer amiodarone (Cordarone) IV push. The treatment of choice for frequent premature ventricular contractions (PVCs) and ventricular tachycardia is an immediate IV bolus of amiodarone (Cordarone). Which nursing intervention should be implemented when Kathy returns to her room? Immobilize the affected leg. The prevention of catheter dislodgement and of bleeding or oozing at the insertion site are high priorities in the immediate post-procedure period. The site should be immobilized and closely monitored for signs of hematoma formation (bleeding, inflammation, tenderness, or swelling). In addition, distal circulation should be monitored closely by assessment of pedal pulses, color, warmth, and capillary refill. Which client should the PN assess first? Jack, a client with unstable angina who is complaining of chest discomfort and has been given one nitroglycerin tablet sublingually (SL). Jack is the least stable of the four clients. The PN needs to observe for effectiveness of the nitroglycerin and for other symptoms that may indicate the onset of a myocardial infarction. The PN should immediately intervene to prevent violation of which client rights? The right to have information about the qualifications of caregivers. The persons in the group should wear name tags that clearly identify their role, should introduce themselves, and should explain to her why they would like to ask her some questions. Clients have the right to privacy during examination and treatment, as well as the right to refuse observation by those not directly involved in their care. Which expected outcome indicates that the PN's review of the discharge teaching was effective? Kathy chooses walking as her initial form of exercise. Walking is the best initial activity/exercise for the post-MI client. The client should be instructed in a gradually progressive walking schedule to assess pulse and tolerance when increasing activity. Activities such as heavy lifting that cause straining should be avoided for several weeks.