Unit 4: Cardiovascular

The nurse is caring for a patient admitted with chest pain. The patient reports the pain began during a staff meeting and went away after 3 nitro's. What type of pain is this most likely? A. Stable Angina B. Unstable Angina C. Variant Angina D. Prinzmetal's Angina - answer-A. Stable Angina Rationale: Because it can occur during emotional stress or exertion. It is generally relieved by rest or nitroglycerin. What lab must be obtained on a patient before going to a Coronary Computed Tomography Angiography (CCTA)? A. Platelet Aggregation B. Serum Creatinine C. Potassium D. Hemoglobin - answer-B. Serum Creatinine Rationale: IV contrast dye can worsen renal function. The most significant factor in long-term survival of a patient with sudden cardiac death is: A. Absence of underlying heart disease. B. Rapid institution of emergency services and procedures. C. Performance of perfect technique in resuscitation procedures. D. Maintenance of 50% of normal cardiac output during resuscitation efforts. - answer-B. Rapid institution of emergency services and procedures. Rationale: Rapid cardiopulmonary resuscitation, prompt defibrillation (with an automated external defibrillator), and early advanced cardiac life support can produce high long-term survival rates for a witnessed arrest. If a patient has an allergy to IV contrast dye, would you still schedule them for a Coronary Computed Tomography Angiography (CCTA)? A. Yes B. No - answer-A. Yes Rationale: Patients can be premedicated with an antihistamine such as Benadryl or a corticosteroid such as Prednisone A patient is admitted to the coronary care unit following a cardiac arrest and successful cardiopulmonary resuscitation. When reviewing the health care provider's admission orders, which order should the nurse question? A. Oxygen at 4 L/min per nasal cannula B. Morphine sulfate 2 mg IV every 10 minutes until the pain is relieved C. Tissue plasminogen activator (tPA) 100 mg IV infused over 3 hours D. IV nitroglycerin at 5 mcg/minute and increase 5 mcg/minute every 3 to 5 minutes - answer-C. Tissue plasminogen activator (tPA) 100 mg IV infused over 3 hours Rationale: Traumatic or prolonged (10 minutes) cardiopulmonary resuscitation is a relative contraindication for the administration of fibrinolytic therapy. A 54-year-old man comes to triage complaining of severe, left-sided, pressure-like chest pain and left arm numbness. The pain began 2 hours ago and is unrelieved by rest. The patient is anxious, diaphoretic, and complaining of nausea. Cardiac monitoring is begun, and oxygen is given at 2 L/min. An intermittent infusion device (IID) is in place, and vital signs are as follows: BP of 128/68 mm Hg; pulse, 76 beats/min; respirations easy and regular at 20 breaths/min. ECG reveals normal sinus rhythm with occasional unifocal premature ventricular contractions (PVCs). The nurse suspects an MI based on an elevation in which lab study? A. CK-MB and LDH B. LDH and troponin I C. CK-MB and troponin I D. Troponin I and SGPT - answer-C. CK-MB and troponin I Rationale: CK-MB is an enzyme specific to myocardial muscle and is released when there has been damage to the muscle; therefore, it will be present when there has been an MI. Additionally, troponin I is a protein that is released exclusively from the myocardial muscle; therefore, a "positive" troponin I is indicative of an MI. The patient had an MI two weeks ago. Their troponin levels are elevated. Should the nurse call the health care provider? A. Yes B. No - answer-B. No Rationale: Troponin levels can stay elevated for up to two weeks after the patient had an MI. Two hours after cardiac catheterization that was accessed via the right femoral artery route, an adult client complains of numbness and pain in the right foot. What action should the nurse take first? A. Call the provider immediately. B. Check the client's peripheral pulses (pedal/posterior tibial). C. Take the client's blood pressure. D. Recognize that this is an expected response and reassess the patient in 1 hour. - answer-B. Check the client's peripheral pulses (pedal/posterior tibial). Rationale: Complications after accessing the femoral artery are bleeding or clotting of the vessel. Any complaint of the patient must be assessed immediately. The nurse assesses limb perfusion as the priority intervention and then notifies the healthcare provider of the results of the findings. The nurse is caring for a nonsmoking female patient with the diagnosis of coronary atherosclerosis who has been admitted to the hospital with angina. The patient states that she never experiences chest pain going down her arm or in the middle of her chest. The nurse is not surprised at this statement and explains to the patient: A. Women who have ischemia are usually totally asymptomatic. B. Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. C. Chest pain occurs only with strenuous exercise. D. Cigarette smoking is usually the contributing factor to chest pain. - answer-B. Women have been found to have more atypical symptoms such as dyspnea, nausea, and weakness. Rationale: Women with acute coronary syndromes report atypical symptoms such as indigestion, nausea, fatigue, and palpitations rather than chest pain. What does the nurse recognize as an absolute contraindication for thrombolytic therapy? A. Active Bleeding B. Current Anticoagulant Therapy C. Over the age of 75 D. Severe Hepatic Disease - answer-A. Active Bleeding Rationale: Because bleeding is a major complication of thrombolytic therapy, any patient with active bleeding should not be administered this treatment. The nurse is caring for a patient immediately following the insertion of a permanent pacemaker via the right subclavian vein approach. Which intervention should the nurse include in the client's plan of care to best prevent pacemaker lead dislodgment? A. Request a STAT chest x-ray upon return from the procedure B. Inspect the incision for bleeding and approximation C. Assist the client with using a walker when out of bed D. Prevent the right arm from extending above shoulder level - answer-D. Prevent the right arm from extending above shoulder level Rationale: In the first several hours after insertion of either a permanent or temporary pacemaker, the most common complication is pacing electrode dislodgment. The nurse helps prevent this complication by limiting the client's activities. The nurse has prepared medications for a 75-year-old client with hypertension. The nurse notes that the client has an elevated serum potassium level. Which medication is most important for the nurse to address with the HCP before administration? A. Lisinopril B. Metoprolol C. Atorvastatin D. Sertraline - answer-A. Lisinopril Rationale: Hyperkalemia can occur as a side effect of lisinopril (Prinivil, Zestril), an ACE inhibitor. The HCP should be notified prior to administration. The drug or dose may need to be changed; 40mg is the maximum daily dose for an elderly client. The nurse is teaching the client newly diagnosed with chronic stable angina. Which instructions on measures to prevent future angina should the nurse include? Select all that apply. A. Take nitroglycerin before stressful activities or events, even if pain-free B. Discontinue use of all tobacco products if you use these C. Wear a facemask when outdoors in cold weather D. Increase isometric arm exercises to build endurance E. Take a daily stool softener to avoid straining with bowel movements F. Perform most exertional activities in the morning - answer-A. Take nitroglycerin before stressful activities or events, even if pain-free B. Discontinue use of all tobacco products if you use these C. Wear a facemask when outdoors in cold weather E. Take a daily stool softener to avoid straining with bowel movements The nurse completes teaching the client about CAD and self-care at home. The nurse determines the teaching is effective when the client makes which statements? Select all that apply. A. "I should always take 3 nitroglycerine tablets 5 minutes apart" B. "I should carry my nitroglycerin in my front pants pocket so it is handy" C. "I plan to stay away from people when they are smoking" D. "If I have chest pain, I should contact my HCP immediately" E. "If I have chest pain, I stop the activity and chew a nitroglycerin tablet" F. "I plan on walking most days of the week for at least 30 minutes" - answer-C. "I plan to stay away from people when they are smoking" F. "I plan on walking most days of the week for at least 30 minutes" The nurse is assessing a client following an inferior septal wall MI. Which potential complication should the nurse further explore when noting that the client has JVD and ascites? A. Left-sided heart failure B. Right-sided heart failure C. Ruptured septum D. Pulmonic valve malfunction - answer-B. Right-sided heart failure The client is admitted with the acute coronary syndrome (ACS). Which should be the nurse's priority assessment?