Nur 107 Chapters 21-27 Cardiovascular/
Brunner & Suddarth's Textbook of Medical-
Surgical Nursing, 15th ed.,
"Tailored for Peak Academic Performance"
When a client who has been diagnosed with angina pectoris reports experiencing chest pain more
frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to
occur, the nurse recognizes that the client is describing which type of angina? - -correct ans- -Unstable
Explanation:
Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in
treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not
respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-
segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory
angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed.,
Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular
Disorders, Angina Pectoris, p. 733.
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? - -correct ans-
-Inadequate fluid volume
Explanation:
Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity
indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume.
Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between
1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric
client does not produce urine.
,The nurse is reviewing the results of a total cholesterol level for a client who has been taking
simvastatin. What results display the effectiveness of the medication? - -correct ans- -160-190 mg/dL
Explanation:
Simvastatin is a statin frequently given as initial therapy for significantly elevated cholesterol and low-
density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood
pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in
the nursing management of CAD? - -correct ans- -To decrease workload of the heart
Explanation:
Beta-adrenergic blockers are used in the treatment of CAD to decrease the consumption of myocardial
oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid
drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit
the conversion of angiotensin.
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? - -
correct ans- -Protamine sulfate
Explanation:
Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin).
Alteplase is a thrombolytic agent. Clopidogrel is an antiplatelet medication that is given to reduce the
risk of thrombus formation after coronary stent placement. The antiplatelet effect of aspirin does not
reverse the effects of heparin.
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery.
What manifestation will alert the nurse to this syndrome? - -correct ans- -pericardial friction rub
Explanation:
Post-pericardiotomy syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea,
pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along
with elevation of the ESR. Hypothermia is not a symptom of post-pericardiotomy syndrome.
,The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the
cause for the elevated isoenzyme? - -correct ans- -myocardial necrosis
Explanation:
An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several
reasons, including brain injuries such as cerebral bleeding; skeletal muscle damage, which can result
from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
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 - -correct
ans- -high.
Explanation:
Treatment of blood cholesterol to reduce cardiovascular risk in adults calls for a fasting lipid profile to
demonstrate an LDL value below 100 mg/dL (or less than 70 mg/dL for very high-risk clients). An LDL
level of 115 mg/dL is higher than the target for treatment.
The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the
emergency room. What is the most important cardiac marker for the client? - -correct ans- -troponin
Explanation:
This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an
MI is troponin level. Creatine kinase, lactate dehydrogenase, and myoglobin tests can show evidence of
muscle injury, but the studies are less specific indicators of myocardial damage than troponin.
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not
to stop taking the medication abruptly? - -correct ans- -The abrupt stop can cause a myocardial
infarction.
Explanation:
, Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may
worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots,
internal bleeding, or the onset of a migraine headache.
A client comes to the emergency department (ED) reporting precordial chest pain. In describing the
pain, the client describes it as pressure with a sudden onset. What disease process would the nurse
suspect in this client? - -correct ans- -Coronary artery disease
Explanation:
The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or
discomfort typically is manifested as sudden pain or pressure that may be centered over the heart
(precordial) or under the sternum (substernal). Raynaud syndrome in the hands presents with
symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a
complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is
categorized as which type of drug? - -correct ans- -calcium-channel blocker
Explanation:
Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that
they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of
a calcium-channel blocker.
An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's
family members express concern to the nurse that the client is uncharacteristically confused. After
reporting this change in status to the health care provider, what additional action should the nurse
take? - -correct ans- -Assess for factors that may be causing the client's delirium.
Explanation:
Uncharacteristic changes in cognition following cardiac surgery are suggestive of delirium. Dementia has
a gradual onset with organic brain changes and is not an acute response to surgery. Assessment is a
higher priority than reorientation, which may or may not be beneficial. Even though delirium is not rare,
it is not considered to be an expected part of recovery.
Brunner & Suddarth's Textbook of Medical-
Surgical Nursing, 15th ed.,
"Tailored for Peak Academic Performance"
When a client who has been diagnosed with angina pectoris reports experiencing chest pain more
frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to
occur, the nurse recognizes that the client is describing which type of angina? - -correct ans- -Unstable
Explanation:
Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in
treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not
respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-
segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory
angina produces severe, incapacitating chest pain that does not respond to conventional treatment.
Reference:
Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed.,
Philadelphia, Wolters Kluwer, 2022, Chapter 23: Management of Patients with Coronary Vascular
Disorders, Angina Pectoris, p. 733.
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? - -correct ans-
-Inadequate fluid volume
Explanation:
Urine output less than 0.5 mL/kg/h may indicate a decrease in cardiac output. A high specific gravity
indicates increased concentration of solutes in the urine, which occurs with inadequate fluid volume.
Indices of normal glomerular filtration are output of 0.5 mL/kg/h or more and specific gravity between
1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric
client does not produce urine.
,The nurse is reviewing the results of a total cholesterol level for a client who has been taking
simvastatin. What results display the effectiveness of the medication? - -correct ans- -160-190 mg/dL
Explanation:
Simvastatin is a statin frequently given as initial therapy for significantly elevated cholesterol and low-
density lipoprotein levels. Normal total cholesterol is less than 200 mg/dL.
In the treatment of coronary artery disease (CAD), medications are often ordered to control blood
pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in
the nursing management of CAD? - -correct ans- -To decrease workload of the heart
Explanation:
Beta-adrenergic blockers are used in the treatment of CAD to decrease the consumption of myocardial
oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid
drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit
the conversion of angiotensin.
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? - -
correct ans- -Protamine sulfate
Explanation:
Protamine sulfate is known as the antagonist for unfractionated heparin (it neutralizes heparin).
Alteplase is a thrombolytic agent. Clopidogrel is an antiplatelet medication that is given to reduce the
risk of thrombus formation after coronary stent placement. The antiplatelet effect of aspirin does not
reverse the effects of heparin.
The nurse is assessing a client with suspected post-pericardiotomy syndrome after cardiac surgery.
What manifestation will alert the nurse to this syndrome? - -correct ans- -pericardial friction rub
Explanation:
Post-pericardiotomy syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea,
pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along
with elevation of the ESR. Hypothermia is not a symptom of post-pericardiotomy syndrome.
,The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the
cause for the elevated isoenzyme? - -correct ans- -myocardial necrosis
Explanation:
An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several
reasons, including brain injuries such as cerebral bleeding; skeletal muscle damage, which can result
from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.
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 - -correct
ans- -high.
Explanation:
Treatment of blood cholesterol to reduce cardiovascular risk in adults calls for a fasting lipid profile to
demonstrate an LDL value below 100 mg/dL (or less than 70 mg/dL for very high-risk clients). An LDL
level of 115 mg/dL is higher than the target for treatment.
The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the
emergency room. What is the most important cardiac marker for the client? - -correct ans- -troponin
Explanation:
This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an
MI is troponin level. Creatine kinase, lactate dehydrogenase, and myoglobin tests can show evidence of
muscle injury, but the studies are less specific indicators of myocardial damage than troponin.
The client is prescribed nadolol for hypertension. What is the reason the nurse will teach the client not
to stop taking the medication abruptly? - -correct ans- -The abrupt stop can cause a myocardial
infarction.
Explanation:
, Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may
worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots,
internal bleeding, or the onset of a migraine headache.
A client comes to the emergency department (ED) reporting precordial chest pain. In describing the
pain, the client describes it as pressure with a sudden onset. What disease process would the nurse
suspect in this client? - -correct ans- -Coronary artery disease
Explanation:
The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or
discomfort typically is manifested as sudden pain or pressure that may be centered over the heart
(precordial) or under the sternum (substernal). Raynaud syndrome in the hands presents with
symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a
complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is
categorized as which type of drug? - -correct ans- -calcium-channel blocker
Explanation:
Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that
they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of
a calcium-channel blocker.
An older adult is postoperative day one, following a coronary artery bypass graft (CABG). The client's
family members express concern to the nurse that the client is uncharacteristically confused. After
reporting this change in status to the health care provider, what additional action should the nurse
take? - -correct ans- -Assess for factors that may be causing the client's delirium.
Explanation:
Uncharacteristic changes in cognition following cardiac surgery are suggestive of delirium. Dementia has
a gradual onset with organic brain changes and is not an acute response to surgery. Assessment is a
higher priority than reorientation, which may or may not be beneficial. Even though delirium is not rare,
it is not considered to be an expected part of recovery.
