HONAN CHAPTER 14 NURSING
MANAGEMENT PATIENTS WITH
CORONARY VASCULAR DISORDER EXAM
QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES UPDATED VERSION.
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 the which lab study?
A. CK-MB and LDH
B. LDH and troponin I
C. CK-MB and troponin I
D. Troponin I and SGPT - CorreCt Answers -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 triage nurse in the emergency department assesses a 66-year-old male
patient who has presented to the emergency department with complaints of
midsternal chest pain that has lasted for the last 5 hours. The care team
suspects a myocardial infarction (MI). The nurse is aware that, because of
the length of time the patient has been experiencing symptoms, the
following may have happened to the myocardium:
May have developed an increased area of infarction
Will probably not have more damage than if he came in immediately
Can have restoration of the area of dead cells with proper treatment
Has been damaged already, so immediate treatment is no longer necessary -
CorreCt Answers -May have developed an increased area of infarction
Explanation:
When the patient experiences lack of oxygen to myocardium cells during an
MI, the sooner treatment is initiated the more likely the treatment will
prevent or minimize myocardial tissue necrosis. Despite the length of time
the symptoms have been present, treatment needs to be initiated
immediately to minimize further damage.
A patient with cardiovascular disease is being treated with Norvasc, a
calcium channel blocking agent. The nurse is aware that calcium channel
blockers have a variety of effects. What is one of the therapeutic effects?
Decrease sinoatrial node and atrioventricular node conduction and
decrease workload of the heart
Prevent platelet aggregation and subsequent thrombosis
Reduce myocardial oxygen consumption by blocking beta-adrenergic
stimulation to the heart
,Reduce myocardial oxygen consumption thus decreasing ischemia and
relieving pain - CorreCt Answers -Decrease sinoatrial node and
atrioventricular node conduction and decrease workload of the heart
Explanation:
Calcium channel blocking agents decrease sinoatrial node automaticity and
atrioventricular node conduction resulting in a slower heart rate and a
decrease in the strength of the heart muscle contraction. These effects
decrease the workload of the heart. They are also used to prevent and treat
vasospasm. Antiplatelet and anticoagulation medications are administered
to prevent platelet aggregation and subsequent thrombosis that impede
blood flow. Beta-blockers reduce myocardial consumption by blocking
beta-adrenergic sympathetic stimulation to the heart. The result is reduced
myocardial contractility (force of contraction) to balance the myocardium
oxygen needs and supply. Nitrates reduce myocardial oxygen consumption,
which decreases ischemia and relieves pain by dilating the veins and in
higher doses, the arteries.
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?
Educate the family about how confusion is expected in older adults
postoperatively.
Assess for factors that may be causing the client's delirium.
Document the early signs of dementia and ensure the client's safety.
Reorient the client to place and time. - CorreCt Answers -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.
A client had a percutaneous transluminal coronary angioplasty (PTCA).
What medication will the nurse administer to prevent thrombus formation
in the stent?
Clopidogrel
Isosorbide mononitrate
Metoprolol
Diltiazem - CorreCt Answers -Clopidogrel
Explanation:
Because of the risk of thrombus formation following a coronary stent
placement, the patient receives antiplatelet medications, such as
clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for
vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels
and slowing heart rate. Diltiazem is a calcium channel blocker used to relax
heart muscles and blood vessels.
The nurse is caring for a client diagnosed with coronary artery disease
(CAD). What condition most commonly results in CAD?
atherosclerosis
diabetes mellitus
myocardial infarction
renal failure - CorreCt Answers -atherosclerosis
MANAGEMENT PATIENTS WITH
CORONARY VASCULAR DISORDER EXAM
QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES UPDATED VERSION.
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 the which lab study?
A. CK-MB and LDH
B. LDH and troponin I
C. CK-MB and troponin I
D. Troponin I and SGPT - CorreCt Answers -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 triage nurse in the emergency department assesses a 66-year-old male
patient who has presented to the emergency department with complaints of
midsternal chest pain that has lasted for the last 5 hours. The care team
suspects a myocardial infarction (MI). The nurse is aware that, because of
the length of time the patient has been experiencing symptoms, the
following may have happened to the myocardium:
May have developed an increased area of infarction
Will probably not have more damage than if he came in immediately
Can have restoration of the area of dead cells with proper treatment
Has been damaged already, so immediate treatment is no longer necessary -
CorreCt Answers -May have developed an increased area of infarction
Explanation:
When the patient experiences lack of oxygen to myocardium cells during an
MI, the sooner treatment is initiated the more likely the treatment will
prevent or minimize myocardial tissue necrosis. Despite the length of time
the symptoms have been present, treatment needs to be initiated
immediately to minimize further damage.
A patient with cardiovascular disease is being treated with Norvasc, a
calcium channel blocking agent. The nurse is aware that calcium channel
blockers have a variety of effects. What is one of the therapeutic effects?
Decrease sinoatrial node and atrioventricular node conduction and
decrease workload of the heart
Prevent platelet aggregation and subsequent thrombosis
Reduce myocardial oxygen consumption by blocking beta-adrenergic
stimulation to the heart
,Reduce myocardial oxygen consumption thus decreasing ischemia and
relieving pain - CorreCt Answers -Decrease sinoatrial node and
atrioventricular node conduction and decrease workload of the heart
Explanation:
Calcium channel blocking agents decrease sinoatrial node automaticity and
atrioventricular node conduction resulting in a slower heart rate and a
decrease in the strength of the heart muscle contraction. These effects
decrease the workload of the heart. They are also used to prevent and treat
vasospasm. Antiplatelet and anticoagulation medications are administered
to prevent platelet aggregation and subsequent thrombosis that impede
blood flow. Beta-blockers reduce myocardial consumption by blocking
beta-adrenergic sympathetic stimulation to the heart. The result is reduced
myocardial contractility (force of contraction) to balance the myocardium
oxygen needs and supply. Nitrates reduce myocardial oxygen consumption,
which decreases ischemia and relieves pain by dilating the veins and in
higher doses, the arteries.
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?
Educate the family about how confusion is expected in older adults
postoperatively.
Assess for factors that may be causing the client's delirium.
Document the early signs of dementia and ensure the client's safety.
Reorient the client to place and time. - CorreCt Answers -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.
A client had a percutaneous transluminal coronary angioplasty (PTCA).
What medication will the nurse administer to prevent thrombus formation
in the stent?
Clopidogrel
Isosorbide mononitrate
Metoprolol
Diltiazem - CorreCt Answers -Clopidogrel
Explanation:
Because of the risk of thrombus formation following a coronary stent
placement, the patient receives antiplatelet medications, such as
clopidogrel or aspirin. Isosorbide mononitrate is a nitrate used for
vasodilation. Metoprolol is a beta blocker used for relaxing blood vessels
and slowing heart rate. Diltiazem is a calcium channel blocker used to relax
heart muscles and blood vessels.
The nurse is caring for a client diagnosed with coronary artery disease
(CAD). What condition most commonly results in CAD?
atherosclerosis
diabetes mellitus
myocardial infarction
renal failure - CorreCt Answers -atherosclerosis
