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Med Surge hinkle - Cardiac Ch 23-27
Ans: Lipids and fibrous tissue
Feedback:
As T-lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue
develops. This causes plaques to form on the inner lumen of arterial walls. These plaques do not consist of
white cells, lipoproteins, or high-density cholesterol. - ✔✔The nurse is caring for a patient who has been
diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is
composed chiefly of what?
A)
Lipids and fibrous tissue
B)
White blood cells
C)
Lipoproteins
D)
High-density cholesterol
Ans: Coronary arteriosclerosis
%
Feedback:
In most cases, angina pectoris is due to arteriosclerosis. The disease is not a result of impaired cardiac output
or contractility. Infarction may result from untreated angina, but it is not a cause of the disease. - ✔✔A patient
presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to
angina. The nurse should inform the patient that angina is most often attributable to what cause?
A)
Decreased cardiac output
B)
Decreased cardiac contractility
C)
Infarction of the myocardium
D)
Coronary arteriosclerosis
Ans: Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)
Feedback:
Ineffective cardiopulmonary tissue perfusion directly results in the symptoms of discomfort associated with
angina. Anxiety and ineffective breathing may result from angina chest pain, but they are not the causes. Skin
integrity is not impaired by the effects of angina. - ✔✔The nurse is caring for an adult patient who had
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symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort
associated with angina?
A)
Ineffective breathing pattern related to decreased cardiac output
B)
Anxiety related to fear of death
C)
Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)
D)
Impaired skin integrity related to CAD
Ans: It may have developed an increased area of infarction during the time without treatment.
Feedback:
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. Delays in treatment
equate with increased myocardial damage. Despite the length of time the symptoms have been present,
treatment needs to be initiated immediately to minimize further damage. Dead cells cannot be restored by any
means. - ✔✔The triage nurse in the ED assesses a 66-year-old male patient who presents to the ED with
complaints of midsternal chest pain that has lasted for the last 5 hours. If the patient's symptoms are due to an
MI, what will have happened to the myocardium?
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A)
It may have developed an increased area of infarction during the time without treatment.
B)
It will probably not have more damage than if he came in immediately.
C)
It may be responsive to restoration of the area of dead cells with proper treatment.
D)
It has been irreparably damaged, so immediate treatment is no longer necessary.
Ans: The symptoms indicate an acute coronary episode and should be treated as such.
Feedback:
Angina and MI have similar symptoms and are considered the same process, but are on different points along
a continuum. That the patient's symptoms are unrelieved by rest suggests an acute coronary episode rather
than angina. Pale cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be
initiated immediately regardless of diagnosis. - ✔✔Family members bring a patient to the ED with pale cool
skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best
interpret these initial data?
A)
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The symptoms indicate angina and should be treated as such.
B)
The symptoms indicate a pulmonary etiology rather than a cardiac etiology.
C)
The symptoms indicate an acute coronary episode and should be treated as such.
D)
Treatment should be determined pending the results of an exercise stress test.
Ans: Greater saphenous vein
Feedback:
The greater saphenous vein is the most commonly used graft site for CABG. The right and left internal
mammary arteries, radial arteries, and gastroepiploic artery are other graft sites used, though not as frequently.
The femoral artery, brachial artery, and brachial vein are never harvested. - ✔✔An OR nurse is preparing to
assist with a coronary artery bypass graft (CABG). The OR nurse knows that the vessel most commonly used
as source for a CABG is what?
A)
Brachial artery
B)
Brachial vein
C)
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Femoral artery
D)
Greater saphenous vein
Ans: Bleeding at insertion site
Feedback:
Complications of PTCA may include bleeding at the insertion site, abrupt closure of the artery, arterial
thrombosis, and perforation of the artery. Complications do not include hyperlipidemia, left ventricular
hypertrophy, or congestive heart failure; each of these problems takes an extended time to develop and none
is emergent. - ✔✔A patient with an occluded coronary artery is admitted and has an emergency percutaneous
transluminal coronary angioplasty (PTCA). The patient is admitted to the cardiac critical care unit after the
PTCA. For what complication should the nurse most closely monitor the patient?
A)
Hyperlipidemia
B)
Bleeding at insertion site
C)
Left ventricular hypertrophy
D)
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Congestive heart failure
Ans: With the patient, clarify the surgical procedure that will be performed.
Feedback:
Preoperatively, it is necessary to evaluate the patient's understanding of the surgical procedure, informed
consent, and adherence to treatment protocols. Teaching would begin on admission or even prior to admission.
The physician would write orders to alter the patient's medication regimen if necessary; this will vary from
patient to patient. Fears should be addressed directly and empathically. - ✔✔The nurse is caring for a patient
who is scheduled for cardiac surgery. What should the nurse include in preoperative care?
A)
With the patient, clarify the surgical procedure that will be performed.
B)
Withhold the patient's scheduled medications for at least 12 hours preoperatively.
C)
Inform the patient that health teaching will begin as soon as possible after surgery.
D)
Avoid discussing the patient's fears as not to exacerbate them.
Ans: Cardiopulmonary bypass
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Feedback:
Cardiopulmonary bypass is often used to circulate and oxygenate blood mechanically while bypassing the
heart and lungs. PTCA, atherectomy, and CABG are all surgical procedures, none of which achieves the two
goals listed. - ✔✔The OR nurse is explaining to a patient that cardiac surgery requires the absence of blood
from the surgical field. At the same time, it is imperative to maintain perfusion of body organs and tissues.
What technique for achieving these simultaneous goals should the nurse describe?
A)
Coronary artery bypass graft (CABG)
B)
Percutaneous transluminal coronary angioplasty (PTCA)
C)
Atherectomy
D)
Cardiopulmonary bypass
Ans: Explore the factors underlying the patient's anxiety.
Feedback:
An assessment of anxiety levels is required in the patient to assist the patient in identifying fears and
developing coping mechanisms for those fears. The nurse must further assess and explore the patient's
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