Chapter 23: Management of Patients with Coronary Vascular Disorders Latest Questions and Answers Graded A

Chapter 23: Management of Patients with Coronary Vascular Disorders Latest Questions and Answers Graded A A client's lipid profile reveals an LDL level of 122 mg/dL. This is considered a: low LDL level. normal LDL level. fasting LDL level. high LDL level. - ANSWER high LDL level. LDL levels above 100 mg/dL are considered high. The goal is to decrease the LDL level below 100 mg/dL. 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 for any kind of drug abuse. Assess the characteristics of chest pain. Assess the skin of the client. Assess the client's mental and emotional status. - ANSWER Assess the characteristics of chest pain. The nurse should assess the characteristics of chest pain for a client with CAD. Assessing the client's mental and emotional status, skin, or for drug abuse will not assist the nurse in evaluating the client for CAD. The assessment should be aimed at evaluating for adequate blood flow to the heart. Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? Activity intolerance Blood glucose concentration Inadequate tissue perfusion Mental alertness - ANSWER Inadequate tissue perfusion The nurse must assess the client for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood glucose and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for clients undergoing cardiac surgery. A client is receiving morphine to relieve chest pain. The order is for 4 mg IV now. The pharmacy supplies morphine sulfate at 5 mg per mL. How many mL will the nurse give the client? Enter the correct number ONLY. - ANSWER 0.8 (4 mg/5 mg) X 1 mL = 0.8 mL. A nurse who works in a busy emergency department provides care for numerous patients who present with complaints of chest pain. Which of the following questions is most likely to help the nurse differentiate between chest pain that is attributable to angina and chest pain due to myocardial infarction (MI)? "When was the first time that you recall having chest pain?" "Does your chest pain make it difficult to move around like you normally would?" "Have you ever been diagnosed with high blood pressure or diabetes?" "Does resting and remaining still help your chest pain to decrease?" - ANSWER "Does resting and remaining still help your chest pain to decrease?" In most cases, chest pain due to MI is not relieved by rest. Chest pain from angina usually abates with rest. Questions about risk factors or the original onset of the patient's pain do not help differentiate the etiology of a patient's chest pain. A client is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluates the therapeutic effectiveness of this drug by assessing the client's response and checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin? Respiration 26 breaths/minute Blood pressure 84/52 mm Hg Temperature of 100.2° F (37.9° C) Pulse rate of 84 beats/minute - ANSWER Blood pressure 84/52 mm Hg Hypotension and headache are the most common adverse effects of nitroglycerin. Therefore, blood pressure is the vital sign most likely to reflect an adverse effect of this drug. The nurse should check the client's blood pressure 1 hour after administering nitroglycerin ointment. A blood pressure decrease of 10 mm Hg is within the therapeutic range. If blood pressure falls more than 20 mm Hg below baseline, the nurse should remove the ointment and report the finding to the physician immediately. An above-normal heart rate (tachycardia) is a less common adverse effect of nitroglycerin. Respiratory rate and temperature don't change significantly after nitroglycerin administration. 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? To dilate coronary arteries To prevent angiotensin II conversion To decrease workload of the heart To decrease homocysteine levels - ANSWER To decrease workload of the heart 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. A client is receiving anticoagulant therapy. What question will the nurse ask the client to detect any signs of bleeding? "What color is your urine?" "Do you have any breathing problems?" "Is your skin drier than normal?" "How is your appetite?" - ANSWER "What color is your urine?" The patient receiving anticoagulation therapy should be monitored for signs and symptoms of bleeding, such as changes in the color of the stool or urine. Anticoagulation therapy should not cause dry skin. The anticoagulation therapy should not change the client's breathing or appetite. 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. - ANSWER 24 (1200 units/25,000 units) X 500 mL = 24 mL. The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? Prepare to administer intravenous fluids. Check blood pressure. Assess pupils for reactiveness. Suction the airway. - ANSWER Check blood pressure. During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop-in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions. A client comes to the health care provider's office for a follow-up visit 4 weeks after suffering a myocardial infarction (MI). Which evaluation statement suggests that the client needs more instruction? "Client verbalizes an understanding of the need to seek emergency help if heart rate increases markedly while at rest." "Client performs relaxation exercises three times per day to reduce stress." "Client's 24-hour dietary recall reveals low intake of fat and cholesterol." "Client walks 4 miles in 1 hour every day." - ANSWER "Client walks 4 miles in 1 hour every day." Four weeks after an MI, a client's walking program should aim for a goal of 2 miles in less than 1 hour. Walking 4 miles in 1 hour is excessive and may induce another MI by increasing the heart's oxygen demands. Therefore, this client requires appropriate exercise guidelines and precautions. Performing relaxation exercises, following a low-fat, low-cholesterol diet, and seeking emergency help if the heart rate increases markedly at rest indicate understanding of the cardiac rehabilitation program. For example, the client should reduce stress, which speeds the heart rate and thus increases myocardial oxygen demands. Reducing dietary fat and cholesterol intake helps lower risk of atherosclerosis. A sudden rise in the heart rate while at rest warrants emergency medical attention because it may signal a life-threatening arrhythmia and increase myocardial oxygen demands. After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. Notify the health care provider. Apply manual pressure at the site of the insertion of the sheath. Decrease anticoagulant or antiplatelet therapy. - ANSWER Apply manual pressure at the site of the insertion of the sheath. The immediate nursing action would be to apply pressure to the femoral site. Reviewing blood studies will not stop the bleeding. The nurse cannot decrease anticoagulation therapy independently. If the bleeding does not stop, the health care provider needs to be notified. A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will be prescribed long-term administration of which drug?