Med_Surg_Chapter_27

MED-SURG Chapter 27: Management of Patients With Coronary Vascular Disorders Question A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? • Assess the client's level of pain and administer prescribed analgesics. Question A client comes to the emergency department complaining of 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 Question A nurse is teaching a client how to take nitroglycerin to treat angina pectoris. The client verbalizes an understanding of the need to take up to three sublingual nitroglycerin (Nitrostat) tablets at 5-minute intervals, if necessary, and to notify the physician immediately if chest pain doesn't subside within 15 minutes. The nurse tells the client that, after taking the nitroglycerin, he may experience: • headache, hypotension, dizziness, and flushing. Question Which condition most commonly results in coronary artery disease (CAD)? • Atherosclerosis Question A nurse is teaching about risk factors that increase the probability of heart disease to a community group. Which of the following risk factors will the nurse include? Choose all that apply. • Family history of coronary heart disease • Age greater than 45 years for men • African-American descent • Elevated C-reactive protein Question A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client’s cardiac risk? • smoking cessation Question 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) Question A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display? • Fatty deposits in the lumen of arteries Question The nurse, caring for a patient after cardiac surgery, is aware that fluid and electrolyte imbalance is a concern. Select the most immediate result that needs to be reported. • Potassium level of 6 mEq/L Question The analgesic of choice for a hospitalized patient with an MI is morphine sulfate. An important nursing responsibility, prior to administering morphine, is to do which of the following? • Count the respiratory rate for bradypnea. Question 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 Question A client with known coronary artery disease reports intermittent chest pain, usually on exertion. The physician diagnoses angina pectoris and orders sublingual nitroglycerin to treat acute angina episodes. When teaching the client about nitroglycerin administration, which instruction should the nurse provide? • "Be sure to take safety precautions because nitroglycerin may cause dizziness when you stand up." Question A patient is receiving anticoagulant therapy. The nurse should be alert to potential signs and symptoms of external or internal bleeding, as evidenced by which of the following? • Low blood pressure Question 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 Question Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? • Inability to speak. Question 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. Question 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 Question 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 experieincing 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 Question The nurse is assessing a postoperative patient who had a percutaneous transluminal coronary angioplasty (PTCA). Which possible complications should the nurse monitor for? (Select all that apply.) • Abrupt closure of the artery • Arterial dissection • Coronary artery vasospasm Question A nurse is monitoring the vital signs and blood results of a 53-year-old male patient who is receiving anti- coagulation therapy. Which of the following does the nurse identify as a major indication of concern? • Hematocrit of 30% Question A client comes to the physician's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). The nurse takes this opportunity to evaluate the client's knowledge of the ordered cardiac rehabilitation program. Which evaluation statement suggests that the client needs more instruction? • "Client walks 4 miles in 1 hour every day." Question Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome? • Pericardial friction rub Question 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 Question 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 Question The nurse has been asked to explain the cause of angina pain to a patient's family. Choose the best statement. The pain is due to: • A lack of oxygen in the heart muscle that causes the death of cells. Question A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? • Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Question The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? • Troponin Question Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: • Morphine IV Question A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which finding requires immediate intervention by the nurse? • Altered level of consciousness Question A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? • Increased liver enzymes Question A client comes to the emergency department complaining of 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 Question The nurse knows that women and the elderly are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? • Vague symptoms Question 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 Question A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is mostindicative of a possible myocardial infarction (MI)? • not relieved by rest or nitroglycerin Question A patient asks the nurse how long he will have to wait after taking nitroglycerin before experiencing pain relief. What is the best answer by the nurse? • 3 minutes Question 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 Question Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? • Inability to speak. Question 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.” Question 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 Question The nurse is caring for a patient who is having chest pain associated with a myocardial infarction (MI). What medication should the nurse administer intravenously to reduce pain and anxiety? • Morphine sulfate Question A physician treating a client in the cardiac care unit for atrial arrhythmia orders metoprolol (Lopressor), 25 mg P.O. two times per day. Metoprolol inhibits the action of sympathomimetics at beta1-receptor sites. Where are these sites mainly located? • Heart Question To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? • 60 minutes Question Which of the following is inconsistent as a condition related to metabolic syndrome? • Hypotension Question A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates • an old MI. Question Post-cardiac surgery assessment of renal function should be performed hourly for the first 12 to 24 hours. Identify the laboratory result that the nurse knows is a primary indicator of possible renal failure. • A serum BUN of 70 mg/dL Question A client in the emergency department complains of squeezing substernal pain that radiates to the left shoulder and jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do? • Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin. Question A client was transferring a load of fire wood from his front driveway to his backyard woodpile at 10 a.m. when he experienced a heaviness in his chest and dyspnea. He stopped working and rested, and the pain subsided. At noon, the pain returned. At 1:30 p.m., his wife took him to the emergency department. Around 2 p.m., the emergency department physician diagnoses an anterior myocardial infarction (MI). The nurse should anticipate which orders by the physician? • Sublingual nitroglycerin, tissue plasminogen activator (tPA), and telemetry Question To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? • 60 minutes Question As part of health education for a patient with an abnormal fasting lipid profile, the nurse explains that an excess of this lipid leads to the formation of plaque in the arteries. Identify the lipid. • Low-density lipoproteins (LDL) Question 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 and does not know where he is. After reporting these change in status to the care provider, the nurse should: • assess for factors that may be causing the client's delirium. Question While receiving a heparin infusion to treat deep vein thrombosis, a client reports that his gums bleed when he brushes his teeth. What should the nurse do first? • Notify the physician. Question Upon discharge from the hospital, patients diagnosed with a myocardial infarction (MI) must be placed on all of the following medications except: • Morphine IV Question 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.” Question 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. Question A patient's elevated cholesterol levels are being managed with Lipitor, 40 mg daily. The nurse practitioner reviews the patient's blood work every 6 months before renewing the prescription. The nurse explains to the patient's daughter that this is necessary because of a major side effect of Lipitor that she is checking for. What is that side-effect? • Increased liver enzymes