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Iggy Chapter 38 Care of Patients with Acute Coronary Syndrome

Terms in this set (108)

1. The nurse is interviewing a patient reporting chest discomfort that occurs with moderate to prolonged exertion. The patient describes the pain as being "about the same over the past
several months and going away with nitroglycerin
or rest." Based on the patient's description
of symptoms, what does the nurse suspect in
this patient? (Select all that apply.)
a. CSA
b. unstable angina
c. ACS
d. AMI
e. CAD
a. Chronic stable angina (CSA)
e. Coronary Artery Disease
2. A patient with a history of angina is admitted
for surgery. The patient reports nausea, pressure
in the chest radiating to the left arm, appears
anxious, skin is cool and clammy, blood
pressure is 150/90 mm Hg, pulse is 100, and
respiratory rate is 32. What are the priorities of
nursing care for this patient? (Select all that apply.)
a. relieve nausea
b. maintain NPO status
c. Improve coronary perfusion
d. Improve coronary oxygenation
e. relieve chest pain
c. Improve coronary perfusion
d. Improve coronary oxygenation
e. Relieve chest pain
3. A patient has been admitted for acute angina. Which diagnostic test identifies if the patient will benefit from further invasive management after acute angina or an MI?
a. exercise tolerance test
b. cardiac cathertization
c. thallium scan
d. multigated angiogram (MUGA) scan
b. Cardiac catheterization
4. The nurse is talking to a patient with angina
about resuming sexual activity. Which statement
by the patient indicates a correct understanding
about the effects of angina on sexual
activity?
a. I wont be able to resume the same level of physical exertion as I did before I had chest pain
b. I will discuss alternative methods with my partner since I will no longer be able to have sex
c. If I cannot walk a mile, I am not strong enough to resume intercourse
d. With approval from my HCP, I should resume sexual activity in the mornings or after a rest period
d. "With approval from my health care provider, I should resume sexual activity in the mornings or after a rest period."
5. A patient with angina is prescribed nitroglycerin
tablets. What information does the nurse
include when teaching the patient about this
drug? (Select all that apply.)
a. If one tablet does not relieve the angina after 5 minutes, take two pills
b. You can tell the pills are active when your tongue feels a tingling sensation
c. Keep your nitroglycerin with you at all times
d. The prescription should last about 6 months before a refill is necessary
e. If the pain doesn't go away, just wait; the medication will eventually take effect
f. The medication can cause a temporary headache
b. "You can tell the pills are active when your
tongue feels a tingling sensation."
c. "Keep your nitroglycerin with you at all
times."
f. "The medication can cause a temporary
headache.
6. A patient reports chest pain that is unrelieved
with a sublingual nitroglycerin tablet. What
does the nurse administer next to this patient?
a. Valium IM
b. Morphine Sulfate IV
c. Supplemental oxygen
d. Chewable aspirin
c. Supplemental oxygen
7. A patient is hypertensive and continues to have
angina despite therapy with beta blockers. The
nurse anticipates which type of drug will be
prescribed for this patient?
a. Calcium channel blocker
b. Digoxin
c. ACE inhibitor
d. Dopamine
a. Calcium channel blocker
8. The nurse has just given a patient two doses of
sublingual nitroglycerin for anginal pain. The
patient's blood pressure is typically 130/80 mm
Hg. Which finding warrants immediate notification
of the health care provider?
a. Pt reports a headache
b. Systolic pressure is 140 mmHg
c. Systolic pressure is 90 mmHg
d. Anginal pain continues but is somewhat relieved
c. Systolic pressure is 90 mm Hg.
9. A patient is admitted for unstable angina. The
patient is currently asymptomatic and all vital
signs are stable. Which position does the nurse
place the patient in?
a. Any position of comfort
b. supine
c. sitting in chair
d. Fowlers
a. Any position of comfort
10. Which are characteristics of angina? (Select all
that apply.)
a. Pain is precipitated by exertion or stress
b. Pain occurs w/out cause, usually in the morning
c. Pain is relieved only by opioids
d. Pain is relieved by nitroglycerin or rest
e. Nausea, diaphoresis, feelings of fear, and dyspnea can occur
f. Pain lasts less than 15 mins
a. Pain is precipitated by exertion or stress.
d. Pain is relived by nitroglycerin or rest
f. Pain lasts less than 15 minutes.
11. Which statement about CAD is accurate?
a. Ischemia that occurs with angina lasts more than 30 mins and does not cause permanent damage of myocardial tissues
b. postmenopausal women in the 70s have the same incidence of MI as men
c. Many pts suffering sudden cardiac arrest die before reaching the hospital due to A. Fib
d. Studies have shown that CAD in women manifest with the same symptoms as men
b. Postmenopausal women in their 70s have
the same incidence of MI as men.
12. A patient is admitted for acute MI, but the
nurse notes that the traditional manifestation
of ST elevation myocardial infarction (STEMI)
is not occurring. What other evidence for
acute MI does the nurse expect to find in the
patient? (Select all that apply.)
a. positive troponin markers
b. CSA
c. NSTEMI elevation MI on ECG
d. Cardiac dysrhythmia
e. HF
a. Positive troponin markers
c. Non-ST elevation MI (non-STEMI) on
ECG
13. People should seek treatment for symptoms of
MI rather than delay because physical changes
will occur approximately how many hours after
an infarction?
a. 3 hours
b. 6 hours
c. 12 hours
d. 24 hours
b. 6 hours
14. The nurse is caring for a patient admitted with
unstable angina and elevated lipid levels. What
does the nurse include in teaching this patient
about his or her elevated lipid levels? (Select all
that apply.)
a. begin vigorous exercise program
b. Avoid trans-fatty acids.
c. Reduce intake of saturated fats.
d. Monitor the amount of cholesterol ingested,
staying below 200 mg/day.
e. Consider a weight loss program.
b. Avoid trans-fatty acids.
c. Reduce intake of saturated fats.
d. Monitor the amount of cholesterol ingested,
staying below 200 mg/day.
e. Consider a weight loss program.
15. The nurse is auscultating the heart of a patient
who had an MI. Which finding most strongly
indicates heart failure?
a. murmur
b. S3 gallop
c. Split S1 and S2
d. Pericardiac friction rub
b. S3- gallop
16. The nurse administers sublingual nitroglycerine
to a patient experiencing an angina episode.
How soon does the nurse expect the pain
to begin to subside?
a. 1-2 mins
b. 5-6 mins
c. 10-12 mins
d. 15-20 mins
a. 1-2 minutes
17. Which diagnostic tests are used to assess myocardial damage caused by an MI? (Select all that apply.)
a. positive CXR
b. CK elevation
c. ECG: ST depression
d. CK-MB isoenzymes elevation
e. Troponin I isoenzyme elevation
d. CK-MB isoenzymes elevation
e. Troponin I isoenzyme elevation
18. A patient has heart failure related to MI. What
intervention does the nurse plan for this patient's
care?
a. Administering digoxin 1.0 mg as a loading does and then daily
b. Infusing IV fluids to maintain a urinary output of 60 mL/hr
c. Titrating vasoactive drugs to maintain a sufficient CO
d. Observing for such complications as HTN and flushed, hot skin
c. Titrating vasoactive drugs to maintain a
sufficient cardiac output
19. Which pts has the highest risk for death because of ventricular failure and dysrhythmias related to damage to the LV?
a. pts with an anterior wall MI
b. pts with a posterior wall MI
c. pt with a lateral wall MI
d. Pt with an inferior wall MI
a. pt with an anterior wall MI
20. A patient had an IWMI. The nurse closely
monitors the patient for which dysrhythmia
associated with IWMI?
a. Bradycardia and second-degree heart block
b. premature ventricular contractions
c. SVT
d. A. fib
a. Bradycardia and second-degree heart block
21. The nurse is giving a community presentation
about heart disease. Because many sudden cardiac
arrest victims die of ventricular fibrillation
before reaching the hospital, which teaching
point does the nurse emphasize?
a. controlling alcohol consumption and quitting cigarette smoking
b. modifying risk factors such as diet and weight, and BP medication compliance
c. recognizing the difference between CSA and unstable angina
d. Learning to operate the automatic external defibrillators (AEDs) in the workplace
d. Learning to operate the automatic external
defibrillators (AEDs) in the workplace
22. Metabolic syndrome increases the risk for
coronary heart disease. Which are indicators of
this syndrome? (Select all that apply.)
a. Triglyceride level of 170 mg/dL
b. HDL cholesterol level of 45 mg/dL in a male
c. HDL cholesterol level of 45 mg/dL in a female
d. Blood pressure of 130/86 mm Hg while
taking a beta blocker
e. Fasting blood sugar level of 120 mg/dL
a. Triglyceride level of 170 mg/dL
c. HDL cholesterol level of 45 mg/dL in a female
d. Blood pressure of 130/86 mm Hg while
taking a beta blocker
e. Fasting blood sugar level of 120 mg/dL
23. Which early reaction is most common in patients with the chest discomfort associated with unstable angina or MI?
a. depression
b. anger
c. fear
d. denial
d. Denial
24. A patient is trying to make dietary modifications to reduce lipid levels. The patient would like information about omega-3 fatty acid food sources. What best source does the nurse recommend?
a. flaxseed
b. flaxseed oil
c. fish
d. walnuts
c. Fish
25. A patient comes to the walk-in clinic reporting left anterior chest discomfort with mild shortness of breath. The patient is alert, oriented, diaphoretic, and anxious. What is the priority action for the nurse?
a. obtain a complete cardiac hx to include a full description of the presenting symptoms
b. Place the patient in Fowler's position and start supplemental oxygen.
c. instruct the pt to go immediately to the closest full-service hospital
d. immediately alert the physician and establish IV access
b. Place the patient in Fowler's position and
start supplemental oxygen.
26. A patient reports having chest discomfort that
started during exercise. The patient is currently
pain-free, but is "concerned." What questions
must the nurse ask to assess the patient's pain
episode? (Select all that apply.)
a. "When did the pain start and how long did
it last?"
b. "What were you doing when the pain
started?"
c. "What did you do to alleviate the pain?"
d. "how did you feel about the pain?"
e. "Did the pain radiate to other locations?"
f. "On a scale of 0 to 10 with 10 as the worst
pain, what number would you use to categorize
the pain?"
a. "When did the pain start and how long did
it last?"
b. "What were you doing when the pain
started?"
c. "What did you do to alleviate the pain?"
e. "Did the pain radiate to other locations?"
f. "On a scale of 0 to 10 with 10 as the worst
pain, what number would you use to categorize
the pain?"
27. A patient is currently pain- and symptom-free,
but reports having intermittent episodes of
chest pain over the past week. The nurse asks
about which associated symptoms? (Select all
that apply.)
a. Nausea
b. diarrhea
c. Diaphoresis
d. Dizziness
e. joint pain
f. Shortness of breath
a. Nausea
c. Diaphoresis
d. Dizziness
f. Shortness of breath
28. The emergency department (ED) nurse is assessing
an 86-year-old patient with acute confusion,
increased respiratory rate, anxiety, and
chest pain. The nurse finds a respiratory rate of
36/min with crackles and wheezes on auscultation.
How does the nurse interpret these findings?
a. Left ventricular heart failure
b. atypical angina
c. CAD
d. unstable angina
a. Left ventricular heart failure
29. The nurse is assessing a middle-aged woman with diabetes who denies any history of known heart problems. However, on auscultation of the heart the nurse hears an S4 heart sound. The nurse alerts the physician and obtains an order for which diagnostic test?
a. BG level
b. Electrocardiogram
c. CXR
d. Echocardiogram
b. Electrocardiogram
30. A middle-aged patient with no known medical problems has acute-onset chest pain and dyspnea. In order to rule out acute MI, the nurse obtains orders for which diagnostic tests? (Select all that apply.)
a. Triglyceride levels and CRP
b. CXR
c. Total serum cholesterol, low-density lipoprotein, high-density lipoprotein
d. Troponin T and I
e. CK-MB
f. ABGs
d. Troponin T and I
e. Creatine kinase-MB
31. A patient had severe chest pain several hours
ago but is currently pain-free and has a normal
ECG. Which statement by the patient indicates
a correct understanding of the significance of
the ECG results?
a. I'll go home and make an appointment to see my family doctor next week
b. "The ECG could be normal since I am currently pain-free."
c. A normal ECG means I am okay
d. I have always had a strong heart, low BP, and a normal ECG
b. "The ECG could be normal since I am currently pain-free."
32. Which statement about silent MI is correct?
a. in a silent MI, the pt does not have any pain, so there is less myocardial damage
b. diabetic pts are prone to silent MI that goes undiagnosed without complications
c. Silent MI increases the incidence of new coronary events.
d. In silent MI, the myocardium is oxygenated by increased collateral circulation
c. Silent MI increases the incidence of new
coronary events.
33. The ED nurse is caring for a patient with acute pain associated with MI. What are the purposes of collaborative management that address the patient's pain? (Select all that apply.)
a. return the VSs and cardiac rhythm to baseline, so the pt can resume ADLS
b. Prevent further damage to the cardiac muscle by decreasing myocardial oxygen demand and increasing myocardial oxygen supply.
c. aggressively dx and treat life-threatening cardiac dysrhythmias and restore pulmonary wedge pressure
d. closely monitor the pt for accompanying symptoms such as N/V or indigestion
e. Eliminate discomfort by providing pain relief modalities, decrease myocardial oxygen demand, and increase myocardial oxygen supply.
b. Prevent further damage to the cardiac
muscle by decreasing myocardial oxygen
demand and increasing myocardial oxygen
supply.
e. Eliminate discomfort by providing pain
relief modalities, decrease myocardial
oxygen demand, and increase myocardial
oxygen supply.
34. The ED nurse, caring for a patient with severe
chest pain and ECG changes, gives supplemental
oxygen to the patient as ordered. Which
other medications does the nurse anticipate
giving to this patient? (Select all that apply.)
a. IV nitroglycerin
b. Beta blocker
c. IV morphine
d. Oral aspirin
e. ACE inhibitor
a. IV nitroglycerin
b. Beta blocker
c. IV morphine
d. Oral aspirin
35. The nurse is caring for a hospitalized patient being treated initially with IV nitroglycerin. What intervention must the nurse include in this patient's care?
a. Increase the dose rapidly to achieve pain relief
b. Restrict the pt to bedrest with bedpan use
c. monitor BP continuously
d. elevate the HOB to 90 degrees
c. Monitor blood pressure continuously.
36. During an annual physical exam, a patient receives an ECG and has an abnormal Q wave in several leads. What is the nurse's best interpretation of this result?
a. the pt is experiencing a silent MI
b. The patient has experienced an MI in the past.
c. The pt is having an AMI at the moment
d. The pt is experiencing ischemia at the moment
b. The patient has experienced an MI in the past.
37. The home health nurse receives a call from a patient with CAD who reports having new onset of chest pain and shortness of breath. What does the nurse instruct the patient to do?
a. rest quietly until the nurse can arrive at the house to check the patient
b. Chew 325 mg of aspirin and immediately call 911
c. use supplemental home oxygen until symptoms resolve
d. take three nitroglycerin tablets and have family drive the pt to the hospital
b. Chew 325 mg of aspirin and immediately
call 911.
38. A patient is newly diagnosed with cardiovascular disease. What psychosocial reactions does the nurse assess for? (Select all that apply.)
a. Fear
b. Anxiety
c. Anger
e. Denial
f. Depression
a. Fear
b. Anxiety
c. Anger
e. Denial
f. Depression
39. Which drug is given within 1 to 2 hours of an MI when the patient is hemodynamically stable, to help the heart to perform more work without ischemia?
a. vasodilators, such as sublingual or spray nitroglycerin
b. beta-adrenergic blocking agents, such as metoprolol
c. anti-platelet agents, such as clopidogrel
d. calcium channel blockers, such as diltiazem
b. Beta-adrenergic blocking agents, such as metoprolol (Lopressor)
40. Which statements are true about the use of thrombolytic agents for a patient with an acute MI? (Select all that apply.)
a. A patient who has received a thrombolytic agent must be continuously monitored before and after the medication is given.
b. Thrombolytic therapy is indicated for chest pain of longer than 30 minutes duration that is unrelieved by other medications.
c. there are no contraindications to thrombolytic therapy if the pt is having an AMI as evidenced by cardiac enzymes and ECG
d. Bleeding is a risk for patients receiving thrombolytic therapy.
e. The nurse need only monitor clotting studies of the pt who has received thrombolytic therapy. No further assessment is needed.
a. A patient who has received a thrombolytic agent must be continuously monitored before and after the medication is given.
b. Thrombolytic therapy is indicated for chest pain of longer than 30 minutes duration that is unrelieved by other medications.
d. Bleeding is a risk for patients receiving thrombolytic therapy.
41. The health care provider is considering use of thrombolytic therapy for a patient. What is the criterion for this therapy?
a. chest pain of greater than 15 minutes duration that is unrelieved by nitroglycerin
b. Indications of transmural ischemia and injury as shown by the ECG
c. ventricular dysrhythmias shown on the cardiac monitor
d. hx of chronic, severe, poorly controlled HTN
b. Indications of transmural ischemia and injury as shown by the ECG
42. A patient is being evaluated for thrombolytic therapy. What are absolute contraindications for this procedure? (Select all that apply.)

a. Ischemic stroke within 3 months
b. pregnancy
c. Suspected aortic aneurysm
d. major trauma in the last 12 months
e. Intracranial hemorrhage
f. Malignant intracranial neoplasm
a. Ischemic stroke within 3 months
c. Suspected aortic aneurysm
e. Intracranial hemorrhage
f. Malignant intracranial neoplasm
43. The health care provider is considering treating a 125-pound 76-year-old MI patient with thrombolytic therapy. What action does the nurse expect regarding this therapy for this patient?
a. due to her age, the pt will not receive this therapy
b. The thrombolytic therapy dosage may be decreased to decrease risk of bleeding.
c. heparin by continuous IV is the best choice after anti-platelet therapy with an aspirin
d. because the MI is recent, the pt will receive the usual dosage of thrombolytic drug
b. The thrombolytic therapy dosage may be decreased to decrease risk of bleeding.
44. A patient has received thrombolytic therapy for treatment of acute MI. What are post administration nursing responsibilities for this treatment? (Select all that apply.)
a. Document the patient's neurologic status.
b. Observe all IV sites for bleeding and patency.
c. monitor WBC count and differential
d. Monitor clotting studies.
e. Monitor hemoglobin and hematocrit.
f. Test stools, urine, and emesis for occult blood.
a. Document the patient's neurologic status.
b. Observe all IV sites for bleeding and patency.
d. Monitor clotting studies.
e. Monitor hemoglobin and hematocrit.
f. Test stools, urine, and emesis for occult blood.
45. A patient is receiving beta-blocker therapy for treatment of MI. What does the nurse monitor for in relation to this therapy? (Select all that apply.)
a. tachycardia
b. Hypotension
c. Decreased level of consciousness
d. Chest discomfort
e. increase UO
b. Hypotension
c. Decreased level of consciousness
d. Chest discomfort
46. A patient is being treated with medication therapy following an acute MI. The nurse questions the order for which type of drug?
a. calcium channel blocker
b. beta blocker
c. ACE inhibitor
d. ARB
a. Calcium channel blocker
47. A patient with angina is taking calcium channel blockers. For which complication does the nurse monitor with this patient?
a. wheezes
b. hypotension
c. bradycardia
d. forgetfulness
b. Hypotension
48. Which diagnostic test is performed after angina or MI to determine cardiac changes that are consistent with ischemia, to evaluate medical interventions, and to determine whether invasive intervention is necessary?
a. stress test
b. ECG
c. Echocardiography
d. CXR
a. Stress test
49. The nurse is monitoring a patient who received fibrinolytics and percutaneous coronary intervention (PCI). What is an indication that the clot has lysed and the artery reperfused?
a. abrupt increase of pain or discomfort
b. sudden onset of ventricular dysrhythmias
c. appearance of ST segment depression
d. obvious T wave inversion
b. Sudden onset of ventricular dysrhythmias
50. A patient has had an MI. The nurse anticipates which type of drug will be prescribed within 48 hours to prevent the development of heart failure?
a. calcium channel blocker
b. ACE inhibitor
c. beta blockers
d. Digoxin
b. ACE inhibitor
51. The nurse has identified the priority problem of activity intolerance for a patient who had an acute MI. What is the best expected outcome for this patient?
a. Patient will walk at least 200 feet four times a day without chest discomfort or shortness of breath.
b. pt will name three or four activities that will not cause SOB or chest pain
c. nurse will teach the pt to exercise and to take the pulse if symptoms of SOB or pain occur
d. nurse will assist the pt with ADLs until SOB or pain resolves
a. Patient will walk at least 200 feet four times a day without chest discomfort or shortness of breath.
52. A patient is in the acute phase (phase 1) of cardiac rehabilitation. Which task is best to delegate to the unlicensed assistive personnel (UAP)?
a. assist the pt to ambulate approximately 200 feet three times a day
b. assist the pt with ambulation to the bathroom
c. assess HR, BP, respiratory rate and fatigue with each higher level of activity
d. Assist the patient into the bathtub
b. Assist the patient with ambulation to the
bathroom.
53. A patient in the cardiac rehabilitation facility is having difficulty coping with the changes in her health status. Which statement by the patient is the strongest indicator of ineffective or harmful coping?
a. I don't mind going to therapy, but I'm not sure if I'm getting any benefit from it
b. I'll take the pills and just do whatever you want me to do
c. "I don't want to go to therapy; I had a bad experience yesterday with the therapist."
d. I know I need tot talk about going home soon, but could we discuss it later?
c. "I don't want to go to therapy; I had a bad
experience yesterday with the therapist."
54. A post-MI patient in phase 1 cardiac rehabilitation is encouraged to perform which activity?
a. ROM exercises
b. modified weight training
c. stair climbing
d. jogging
a. Range-of-motion exercises
55. The nurse is caring for a patient admitted for an IWMI. The patient develops heart block with bradycardia. Because the patient's pulse rate is low and the blood pressure is unstable, which procedure is the nurse prepared to assist with?
a. temporary pacemaker
b. defibrillation
c. 16 lead ECG
d. percutaneous intervention
a. Temporary pacemaker
56. The nurse is contacted by the cardiac monitoring technician who says a patient is having a dysrhythmia. What does the nurse do first?
a. notify the rapid response team
b. administer antidysrythmIc medication
c. Evaluate the pt for chest pain or discomfort
d. double check the lead placement
c. Evaluate the patient for chest pain or discomfort.
57. The nurse is evaluating a patient with CAD. What is an expected patient outcome that demonstrates hemodynamic stability?
a. BP and pulse are within range and adequate for metabolic demands
b. UO increases from 15-30 mL/hour
c. P waves are regular and there are no abnormal heart sounds
d. Pt expresses verbal understanding of risk factors and need for compliance
a. Blood pressure and pulse are within range
and adequate for metabolic demands.
58. The nurse is assessing a patient at risk for left ventricular failure and inadequate organ perfusion. Which signs and symptoms signal decreased cardiac output? (Select all that apply.)
a. Change in orientation or mental status
b. Urine output less than 1 mL/kg (2.2 lbs)/hr or less than 30 mL/hr
c. hot, dry skin with flushed appearance
d. Cool, clammy extremities with decreased or absent pulses
e. Unusual fatigue
f. Recurrent chest pain
a. Change in orientation or mental status
b. Urine output less than 1 mL/kg (2.2 lbs)/hr
or less than 30 mL/hr
d. Cool, clammy extremities with decreased
or absent pulses
e. Unusual fatigue
f. Recurrent chest pain
59. The nurse is reviewing medication orders for several cardiac patients. There is an order for beta-adrenergic blocking agent metoprolol XL (Toprol XR) once a day. This drug order is most appropriate for which class of patients, according to the Killip classification system?
a. all classes
b. class I only
c. class II and III
d. class IV only
c. Class II and III
60. The nurse is caring for a patient with an AWMI. The patient develops tachycardia, hypotension, urine output of 10 mL/hr, cold and clammy skin with poor peripheral pulses, and agitation. What does the nurse suspect in this patient?
a. ventricular dysrhythmia
b. cardiogenic shock
c. postpericardiotomy syndrome
d. ACS
b. Cardiogenic shock
61. The nurse is assessing a cardiac patient and finds a paradoxical pulse, clear lungs, and jugular venous distention that occurs when the patient is in a semi-Fowler's position. What are these findings consistent with?
a. right ventricular failure
b. unstable angina
c. CAD
d. valvular disease
a. Right ventricle failure
62. The intensive care nurse is monitoring a patient with a right ventricular MI. The pulmonary artery wedge pressure (PAWP) reading is 30 mm Hg. What does the nurse do next?
a. increase the IV fluid rate to 200ml/hr
b. auscultate the lungs to asses for LVHF
c. perform an ECH using right-sided precordial leads
d. place the pt in semi-fowler's position
c. Perform an ECG using right-sided precordial
leads.
63. A patient continues to have chest pain despite compliance with medical therapy. The nurse teaches the patient about which diagnostic test?
a. Left-sided cardiac catheterization with coronary angiogram
b. percutaneous transluminary coronary angioplasty (PTCA)
c. coronary artery bypass grafting (CABG)
d. stent placement in coronary artery
a. Left-sided cardiac catheterization with coronary angiogram
65. A patient is scheduled to have PCI. The nurse anticipates that an initial dose of which medication will be given before the procedure?
a. clopidogrel (plavix)
b. nitroglycerin (Nitrostat)
c. Isosorbide mononitrate (Imdur)
d. Carveilol (coreg)
a. Clopidogrel (Plavix)
66. A patient has angina and is scheduled for PCI. Based on negative outcomes of the PCI, the nurse prepares the patient for immediate transfer to undergo which procedure?
a. Intraaortic balloon pump
b. CABG
c. Cardiac catheterization
d. Carotid endarterectomy
b. CABG- Cardiac artery bypass grafting
67. The nurse is caring for a patient who had PCI. Which symptom indicates acute closure of the vessel and therefore warrants immediate notification of the health care provider?
a. chest pain
b. hyperkalemia
c. bleeding at the insertion site
d. cough and SOB
a. Chest pain
68. Which patients may be potential candidates for CABG? (Select all that apply.)
a. Patient with angina and greater than 50% occlusion of left main coronary artery that cannot be stented
b. pt with unstable angina with moderate vessel disease appropriate for stenting
c. Patient with valvular disease
d. Patient with coronary vessels unsuitable for PTCA
e. pt with AMI responding to therapy
f. Patient with signs of ischemia or impending MI after angiography or PTCA
a. Patient with angina and greater than 50% occlusion of left main coronary artery that cannot be stented
c. Patient with valvular disease
d. Patient with coronary vessels unsuitable for PTCA
f. Patient with signs of ischemia or impending MI after angiography or PTCA
69. The ICU patient with left ventricular failure has not responded to drug therapy to improve tissue perfusion. What intervention does the nurse expect may be tried next?
a. CABG surgery
b. percutaneous insertion of an intra-aortic balloon pump
c. IV infusion of a thrombolytic agent
d. insertion of a pulmonary artery catheter
b. Percutaneous insertion of an intraaortic
balloon pump
70. A patient is having an elective CABG with a minimally invasive surgical technique. What does the nurse include in the preoperative teaching?
a. prevention of edema and scarring at he harvest site
b. protection and splinting of the chest incision while coughing
c. availability of analgesics if needed, but probably unnecessary
d. limitation of ambulation for several days after the procedure
b. Protection and splinting of the chest incision while coughing
64. Immediate reperfusion is an invasive intervention
that shows some promise for managing
which disorder?
c. Cardiogenic shock
71. A patient is having a CABG with the traditional surgical procedure. What does the nurse include in the preoperative teaching? (Select all that apply.)
a. coughing will be avoided to keep stress off the sternal incision
b. There will be a sternal incision.
c. Expect one, two, or three chest tubes.
d. An indwelling urinary catheter will be placed.
e. An endotracheal tube will prevent talking.
b. There will be a sternal incision.
c. Expect one, two, or three chest tubes.
d. An indwelling urinary catheter will be placed.
e. An endotracheal tube will prevent talking.
72. The intensive care nurse is caring for a patient who has just had a CABG. The nurse notes that the patient has edema. In order to adjust fluid administration, the nurse collects which additional information and then consults the health care provider? (Select all that apply.)
a. Blood pressure
b. PAWP
c. skin turgor
d. Cardiac output
e. Blood loss
f. Urine output
a. Blood pressure
b. PAWP
d. Cardiac output
e. Blood loss
f. Urine output
73. A potassium bolus of 80 mEq mixed in 100 mL of IV solution at a rate of 40 mEq/hr is ordered for a patient in the critical care unit. What does the nurse do next?
a. contract the HCP because the order exceeds the recommended amount
b. Give the infusion; the order exceeds the recommended amount, but is within acceptable standards of practice for critical care patients.
c. contact the HCP because even though the dosage is acceptable, the rate is too fast
d. consult with the pharmacist because even though the rate is acceptable, the mixture is too concentrated
b. Give the infusion; the order exceeds the recommended amount, but is within acceptable standards of practice for critical care patients.
74. The intensive care nurse is caring for a patient who has just had CABG surgery. The patient has a systolic blood pressure of 80 mm Hg. What is the primary concern related to this patient's hypotension?
a. it is associated with warm cardioplegia
b. it may result in the collapse of the graft
c. it will result in acute tubular necrosis
d. it is related to mechanical ventilation
b. It may result in the collapse of the graft.
75. Following CABG surgery, a patient has a body temperature below 96.8° F (36° C). What measures should be used to rewarm the patient?
a. infuse warm IV fluids
b. do not rewarm; cold cardioplegia is protective
c. place the pt in a warm fluid bath
d. use lights of thermal blankets
d. Use lights or thermal blankets.
76. The intensive care nurse is caring for a patient who has just had CABG surgery. What does the nurse do to assess for postoperative bleeding?
a. Measure mediastinal and pleural chest tube drainage at least hourly and report drainage amounts over 150 mL/hr to the surgeon.
b. measure mediastinal and pleural chest tube drainage at least once a shift and report drainage amounts over 50 ml/hr to the surgeon
c. assess the dressing over the sternal site every 4 hours and reinforce the dressing with sterile gauze
d. assess the donor site q4h and report serous drainage and increasing pain to the surgeon
a. Measure mediastinal and pleural chest tube drainage at least hourly and report drainage amounts over 150 mL/hr to the surgeon.
77. Following CABG surgery, a pt in the ICU on a mechanical ventilator suddenly decompensates. the HCP makes dx of cardiac tamponade. the nurse prepares the patient for which emergency procedure?
a. chest tube
b. sternotomy
c. pericardocentesis
d. thoracentesis
c. pericardocentesis
78. The nurse is assessing a patient who had CABG surgery. Which finding is a permanent deficit that is associated with an intraoperative stroke?
a. decreased LOC that resolves when body temp is normal
b. arousal from anesthesia takes several hours
c. inability to speak clearly and coherently immediately after sugery
d. generalized seizure activity
d. Generalized seizure activity
79. A patient reports pain after CABG surgery. Which statement by the patient suggests that the pain is related to the sternotomy and not anginal in origin?
a. the pain goes down my arm or sometimes into my jaw
b. my pain increases when I cough or take a deep breath
c. the nitroglycerin helped to relieve the pain
d. I feel nausea and SOB when the pain occurs
b. "My pain increases when I cough or take a
deep breath."
80. A patient with CABG surgery is transferred from the ICU to the intermediate care unit. Which activity does the nurse assist the patient with?
a. Ambulating 25 to 100 feet three times a day as tolerated
b. turning the pt every 2 hours for the first 48 hours
c. dangling and turning every 2 hours for at least 24 hours
d. coughing and deep-breathing three times a day
a. Ambulating 25 to 100 feet three times a day as tolerated
81. A patient had CABG surgery with the radial artery used as a graft. The nurse performs which assessment specific to this patient?
a. check the BP every hour on the unaffected arm or use the legs
b. check the fingertips, hand, and arm for sensation and mobility every shift
c. Assess hand color, temperature, ulnar/radial pulses, and capillary refill every hour initially.
d. note edema, bleeding, and swelling at the donor site, which are expected
c. Assess hand color, temperature, ulnar/radial pulses, and capillary refill every hour initially.
82. A patient with CABG surgery has been diagnosed with mediastinitis. What information does the nurse expect to find in the patient's assessment documentation? (Select all that apply.)
a. Fever continuing beyond the first 4 days
after CABG
b. Bogginess of the sternum
c. Redness and drainage from suture sites
d. decreased WBC count
e. Induration or swelling at the suture sites
f. anginal-type chest pain
a. Fever continuing beyond the first 4 days
after CABG
b. Bogginess of the sternum
c. Redness and drainage from suture sites
e. Induration or swelling at the suture sites
83. A patient had CABG surgery with a vein graft. To help prevent collapse of the graft, what assessment does the nurse perform?
a. auscultate lung sounds
b. monitor for hypotension
c. assess for motion and sensation
d. observe for generalized hypothermia
b. Monitor for hypotension.
84. The nurse is caring for a patient who had CABG surgery. The nurse pays close attention to which electrolyte levels for this postoperative patient? (Select all that apply.)
a. sodium
b. Potassium
c. Calcium
d. Magnesium
e. phosphorus
b. Potassium
c. Calcium
d. Magnesium
85. After a CABG surgery, a postoperative patient suddenly has a decrease in mediastinal drainage, jugular vein distention with clear lung sounds, pulsus paradoxus, and equalizing PAWP and right atrial pressure. What do these signs suggest to the nurse?
a. acute MI
b. occlusion at the donor site
c. cardiac tamponade
d. prinzmetal's angina
c. Cardiac tamponade
86. The nurse coming on duty receives the change of shift report. Which patient must be assessed first by the nurse?
a. Patient with anxiety, nausea, diaphoresis, and shortness of breath
b. pt with diabetes mellitus and elevated serum lipid levels
c. pt with a friction rub and elevated temp
d. pt with fever, instability of sternum, and increased WBC count
a. Patient with anxiety, nausea, diaphoresis, and shortness of breath
87. The nurse is caring for a patient who had a minimally invasive direct coronary artery bypass (MIDCAB). Which sign/symptom prompts the nurse to immediately contact the health care provider?
a. acute incisional pain
b. ST-segment changes in the V leads
c. drainage from the chest tubes
d. problems with coughing
b. ST-segment changes in the V leads
88. A patient has discrete, proximal, noncalcified lesions of only one or two vessels. Which procedure is most likely to be recommended for this patient?
a. percutaneous coronary intervention (PCI)
b. stress test with pharmacologic agent
c. immediate thrombolytic reperfusion therapy
d. minimally invasive bypass surgery
a. Percutaneous coronary intervention (PCI)
89. The nurse is caring for a patient who had a PCI. Which postoperative interventions are included in the care for this patient? (Select all that apply.)
a. Monitor for acute closure of the vessel.
b. Observe for bleeding from the insertion site.
c. maintain bedrest for 48 hours
d. Observe for hypotension, hypokalemia, and dysrhythmias.
e. Teach about medications such as aspirin and beta blockers or ACE inhibitors.
f. Instruct about lifestyle changes relating to CAD.
a. Monitor for acute closure of the vessel.
b. Observe for bleeding from the insertion site.
d. Observe for hypotension, hypokalemia, and dysrhythmias.
e. Teach about medications such as aspirin and beta blockers or ACE inhibitors.
f. Instruct about lifestyle changes relating to CAD.
90. Treatment of hypothermia, a common problem after CABG surgery, is necessary because this condition may cause a patient to be at risk for which condition?
a. hypotension
b. hypertension
c. Hf
d. loss of consciousness
b. Hypertension
91. Which statement is true about postpericardiotomy syndrome?
a. it is a psychological disorder for which the pt needs emotional support
b. it is generally mild and self-limitiing
c. it places the pt at high risk for cardiac tamponade
d. it can be prophylactically managed with antibiotics
c. It places the patient at high risk for cardiac tamponade.
92. The patient is scheduled to have robotic heart surgery. Which advantages of this type of surgery does the nurse teach the patient about? (Select all that apply.)
a. Shorter (2-3 day) hospital stay
b. shorter surgical time than with traditional heart surgery
c. Less pain due to smaller incisions
d. shorter time on heart lung bypass machine
e. chest tubes are never needed
a. Shorter (2-3 day) hospital stay
c. Less pain due to smaller incisions
14. A client who had several episodes of chest pain is scheduled for an exercise electrocardiogram. Which explanation should the nurse include when teaching the client about this procedure?
1. "This is a noninvasive test to check your heart's response to physical activity"
2. "This test is the definitive method to ID the actual cause of your chest pain"
3. The findings of this test will be of minimal assistance in the tx of angina
4. The findings from this minimally invasive test will show how your body reacts to exercise
1. "This is a noninvasive test to check your heart's response to physical activity"
15. A client is admitted w/ chest pain unrelieved by nitroglycerin, an elevated temperature, decreased BP, and diaphoresis. A MI is dx. Which should the nurse consider as a valid reason for one of this client's physiologic responses?
1. Parasympathetic reflexes from the infarcted myocardium causes diaphoresis
2. Inflammation in the myocardium causes a rise in the systemic temperature
3. Catecholamines released at the site of the infarction cause intermittent localized pain
4. Constriction of central and peripheral blood vessels causes a decrease in BP
2. Inflammation in the myocardium causes a rise in the systemic temperature
17. After surgery for insertion of a coronary artery bypass graph (CABG), a client develops a temperature of 102 degrees F. What PRIORITY concern related to elevated temperatures does a nurse consider when notifying the health care provider about the client's temp?
1. A fever may lead to diaphoresis
2. A fever increases CO
3. An increased temp indicated cerebral edema
4. An increased temp may be a sign of hemorrhage
2. A fever increases CO
19. During an interview, the nurse discovers that the spouse of a debilitated, chronically constipated client digitally removes stool from the client's rectum. What response to disimpaction is the nurse attempting to prevent by presenting other strategies to regulate the client's bowel movements?
1. Increased pulse rate
2. Slowing of HR
3. Dilation of bronchioles
4. Coronary artery vasodilation
2. Slowing of HR
39. A nurse asks a client with ischemic heart disease to ID the foods that are MOST important to restrict. The nurse determines that the client understands the dietary instructions when the client IDs the following foods. SATA
1. Olive oil
2. Chicken broth
3. Enriched whole milk
4. Red meats, such as beef
5. Veggies and whole grains
6. Liver and other grandular organ meats
2. Chicken broth
3. Enriched whole milk
4. Red meats, such as beef
6. Liver and other grandular organ meats
44. What should the nurse ID as the PRIMARY cause of the pain experienced by a client with coronary occlusion?
1. Arterial spasm
2. Heart muscle ischemia
3. Blocking of the coronary veins
4. Irritation of nerve endings in the cardiac plexus
2. Heart muscle ischemia
45. What instructions about the use of nitroglycerin should the nurse provide to a client with angina?
1. ID when pain occurs, and place 2 tablets under the tongue
2. Place 1 tablet under the tongue, and swallow another when pain is intense
3. Before physical activity place 1 tablet under the tongue, and repeat the dose in 5 minutes if pain occurs
4. Place 1 tablet under the tongue when pain occurs, and use an additional tablet after the attack to prevent recurrence
3. Before physical activity place 1 tablet under the tongue, and repeat the dose in 5 minutes if pain occurs
47. For which common complication of MI should the nurse monitor clients in the coronary care unit?
1. Dysrhythmia
2. Hypokalemia
3. Anaphylactic shock
4. Cardiac enlargement
1. Dysrhythmia
53. What should the nurse teach a client to expect when preparing for discharge after surgery for a coronary artery bypass graft?
1. Mild fever and extreme fatigue for several weeks after surgery
2. Cessation of drainage from the incisions after hospitalization
3. Mild incisional pain and tenderness up to three weeks after surgery
4. Some edema in the leg used for the donor graft is expected with activity
4. Some edema in the leg used for the donor graft is expected with activity
68. A client who had an MI is in the coronary care unit on a cardiac monitor. The nurse observes ventricular irritability on the screen. What medications should the nurse prepare to administer?
1. Digoxin (Lanoxin)
2. Furosemide (Lasix)
3. Amiodarone (Cordarone)
4. Norepinephrine (Levophed)
3. Amiodarone (Cordarone)
84. A nurse is providing discharge instructions to a client who experienced an anterior septal MI. What statement by the client indicates to the nurse that there is need for further teaching?
1. I want to stay as pain-free as possible
2. I am not good at remembering to take my medications
3. I should not have any problems in reducing my salt intake
4. I wrote down my medication info for future reference
2. I am not good at remembering to take my medications
86. A client is returned to the surgical unit immediately after placement of a coronary artery stent that was accomplished via access through femoral artery. What response should the nurse consider the PRIORITY when assessing this client?
1. Acute pain
2. Impaired mobility
3. Impaired swallowing
4. Hematoma formation
4. Hematoma formation
87. A client is admitted with the dx of possible MI, and a series of diagnostic tests is ordered. Which blood level should the nurse expect will increase FIRST if this client has had a MI?
1. ALT
2. AST
3. total LDH
4. Troponin T
4. Troponin T
90. A nurse is leading a discussion in a senior citizen center about the risk factors for developing coronary heart disease for women versus men. What should the nurse respond when asked to ID the MOST significant risk factor?
1. Obesity
2. Diabetes
3. Elevate CRP levels
4. High levels of HDL-C
2. Diabetes
91. A nurse is teaching a group of clients about risk factors for heart disease. Which factors increase a client's risk for a MI? SATA
1. Obesity
2. HTN
3. Increased HDL
4. Diabetes insipidus
5. Asian-American ancestry
1. Obesity
2. HTN
95. Which sign cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? SATA
1. Tachycardia
2. HTN
3. Increased CVP
4. Increased urine output
5. JVD
1. Tachycardia
3. Increased CVP
5. JVD
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