med surge nursing cardio prep u ch 27 questions wi
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Med-Surge Nursing Cardio Prep U ch 27
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? -
-aspirin or clopidogrel
After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent
thromboembolism. Health care providers order heparin for anticoagulation during this
procedure; some health care providers discharge clients with a prescription for
long-term warfarin or low-molecular-weight heparin therapy. Pentoxifylline, a
vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because
the procedure itself opens the vessel. The health care provider may order short-term
acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't
warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a
brief period to prevent infection associated with an invasive procedure; long-term
therapy isn't necessary.
A client with severe angina pectoris and electrocardiogram changes is seen by a
✅✅
physician in the emergency department. In terms of serum testing, it's most
important for the physician to order cardiac: - -troponin
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 they're less specific
indicators of myocardial damage than troponin.
✅✅
Which of the following is inconsistent as a condition related to metabolic syndrome? -
-Hypotension
A diagnosis of metabolic syndrome includes three of the following conditions: insulin
resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state,
and prothrombotic state.
✅✅
Which of the following would be inconsistent as criterion of extubation in the patient
who has undergone a coronary artery bypass graft (CABG)? - -Inability to
speak.
Before being extubated, the patient should have cough and gag reflexes and stable
vital signs; be able to life the head off the bed or give firm hand grasps; have
adequate vital capacity, negative inspiratory force, and minute volume appropriate
for body size; and have acceptable ABG levels while breathing without the
assistance of the ventilator. Inability to talk is expected when intubated with an
endotracheal tube.
, ✅✅
The nurse knows that women and the elderly are at greater risk for a fatal myocardial
event. Which factor is the primary contributor of this cause? - -Vague
symptoms
Often, women and elderly do not have the typical chest pain associated with a
myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which
can lead to misdiagnosis. Some older adults may experience little or no chest pain.
Gender is not a contributing factor for fatal occurrence but rather a result of
symptoms association.
The nurse has completed a teaching session on self-administration of sublingual
✅✅
nitroglycerin. Which client statement indicates that the teaching has been effective? -
-"I can take nitroglycerin before sex so I won't develop chest pain".
Nitroglycerin can be taken in anticipation of any activity that may produce pain.
Because nitroglycerin increases tolerance for exercise and stress when taken
prophylactically (i.e., before an angina-producing activity such as exercise,
stair-climbing, or sexual intercourse), it is best taken before pain develops. The client
is instructed to take three tablets 5 minutes apart; if the chest pain is not relieved,
emergency medical services should be contacted. Nitroglycerin is very unstable; it
should be carried securely in its original container (e.g., a capped dark glass bottle),
and tablets should never be removed and stored in metal or plastic pillboxes. Side
effects of nitroglycerin include flushing, throbbing headache, hypotension, and
tachycardia.
A nurse is caring for a client who experienced an MI. The client is ordered to
✅✅
received metoprolol. The nurse understands that this medication has which
therapeutic effect? - -Decreases resting heart rate
The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to
reduce myocardial oxygen consumption by blocking beta-adrenergic sympathetic
stimulation to the heart. The result is reduced heart rate, slowed conduction of
impulses through the conduction system, decreased blood pressure, and reduced
myocardial contractility to balance the myocardial oxygen needs and amount of
oxygen available. This helps to control chest pain and delays the onset of ischemia
during work or exercise. This classification of medication also reduces the incidence
of recurrent angina, infarction, and cardiac mortality. In general, the dosage of
medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not
administered to decrease cholesterol levels, increase cardiac output, or decrease
platelet aggregation.
A patient with coronary artery disease (CAD) is having a cardiac catheterization.
What indicator is present for the patient to have a coronary artery bypass graft
, (CABG)? - ✅✅-The patient has at least a 70% occlusion of a major coronary
artery.
For a patient to be considered for CABG, the coronary arteries to be bypassed must
have approximately a 70% occlusion (60% if in the left main coronary artery).
✅✅
The nurse has been asked to explain the cause of angina pain to a patient's family.
Choose the best statement. The pain is due to: - -A lack of oxygen in the heart
muscle that causes the death of cells.
Impeded blood flow, due to blockage in a coronary artery, deprives the cardiac
muscle cells of oxygen thus leading to a condition known as ischemia.
The nurse, caring for a patient after cardiac surgery, is aware that fluid and
✅✅
electrolyte imbalance is a concern. Select the most immediate result that needs to be
reported. - -Potassium level of 6 mEq/L
Changes in serum electrolytes should be immediately reported, especially a
potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively,
and the weight gain isn't significant. The abnormal breath sounds are of concern, but
the electrolyte imbalance is the most immediate condition that needs to be
addressed.
A nurse is evaluating a client who had a myocardial infarction (MI) 7 days earlier.
✅✅
Which outcome indicates that the client is responding favorably to therapy? -
-The client demonstrates ability to tolerate more activity without chest pain.
The ability to tolerate more activity without chest pain indicates a favorable response
to therapy in a client who is recovering from an MI or who has a history of coronary
artery disease. The client should have a normal electrocardiogram with no
arrhythmias and a regular heart rate of 60 to 100 beats/minute. Smoking is a
cardiovascular risk factor that the client must be willing to eliminate. A client who
responds favorably to therapy shouldn't have chest pain.
✅✅
A nurse is teaching a client who receives nitrates for the relief of chest pain. Which
instruction should the nurse emphasize? - -Lie down or sit in a chair for 5 to 10
minutes after taking the drug.
Nitrates act primarily to relax coronary smooth muscle and produce vasodilation.
They can cause hypotension, which makes the client dizzy and weak. The nurse
should instruct the client to lie down or sit in a chair for 5 to 10 minutes after taking
the drug. Nitrates are taken at the first sign of chest pain and before activities that
might induce chest pain. Sublingual nitroglycerin is taken every 5 minutes for three
doses. If the pain persists, the client should seek medical assistance immediately.
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