1. The nurse is caring for a client with a history of atherosclerosis. The client has chest pain that
occurs with physical exertion or stress and is relieved with sublingual nitroglycerin. The nurse
recognizes that the client is most likely experiencing which disorder ?
Stable angina is a predictable form ofangina, which usually occurs when the work of the heart
is increased by physicalexertion, exposure tocold, or stress. Prinzmetal(variant) angina occurs
unpredictably and often at night. The client is currently experiencing a predictable form of
angina. Clinical manifestations of myocardial infarction include pain that is lesspredictable,
moreprolonged, and unrelieved bysublingual nitroglycerin. Clinical manifestations of acute
coronary syndrome include pain that is more severe and longer than previously experienced.
The pain is not predictable and is unrelieved by sublingual nitroglycerin.
2. The client with a history of atherosclerosis has chest pain that is unrelated toactivity,
unpredictable, and often occurs while at rest. The client reports the pain has been becoming
morefrequent andsevere, rating the current pain as 9 on a scale of 1 to 10.You recognize that
the client is at severe risk of which disorder?
Prinzmetal(variant) angina occurs unpredictably and often at night.
The client is currently experiencing either Prinzmetal or unstable angina and is at severe risk of
a myocardial infarction. Stable angina is a predictable form ofangina, which usually occurs
when the work of the heart is increased by physicalexertion, exposure tocold, or stress.
Thisclient's angina is unpredictable and occurs at res Coronary artery disease is the cause
,ofangina, not the disorder which develops as a result of it.
3. You are developing a plan of care for a client with coronary artery dis- ease.Which
pharmacological treatment would help increase blood flow to the client's coronaryarteries?
Use of salicylic acid daily
Discontinue the use of statins
Use an analgesic to control chest pain
Discontinue the use of daily ibuprofen
Answer
Use of salicylic acid daily
To increase theclient's bloodflow, one goal is to prevent the aggregatio of platelets in the
arteries. Salicylic acid(aspirin) is a pharmacological measure to control the aggregation. Statins
are used to decrease cholesterol and would be a part of theclient's protocol unless the client
experienced side effects. Analgesics are given for chestpain, but do not increase blood flow.
Nitrates for angina would increase blood flow. There is no reason to discontinue the use of daily
ibuprofen as a means of increasing blood flow to the coronary arteries.
4. The nurse is developing a plan of care for a client with coronary artery disease. Which
mechanism contributes to a decreased blood flow to the client's coronary arteries?
Fat and fibrin deposits on the arterial walls
Increased vasodilation of the arteries
Decreasedplatelet aggregation
Injury to arterial walls from increased arterial pressures
Answer
Fat and fibrin deposits on the arterial walls
Fat and fibrin deposits on the arterial walls are called plaque. They cause the artery to become
thick and hardened with narrowing of the lumen and decreased blood flow.Platelet
aggregation(clumping together)increases, notdecreases, le ing to the formation of clots that
narrow the lumen of the arterial vessel.Vasodilation, or opening of thearteries, would increase
blood flow. The walls of the arteries become hardened and have decreasedelasticity, which
makes vasodilation more difficult. Spasms of the arterial vessels cause constriction and
narrowing of the vessels. Injury that occurs from increased arterial pressure causes an increased
risk of the formation of fibrin plaques.The injury does not cause a decrease in blood flow.
5. The nurse is providing care to a client admitted to the coronary care unit for a suspected heart
attack. Which diagnostic tests does the nurse anticipate to confirm the diagnosis? (Select all
, that apply.)
CK-MB WBC
CBC CPK
ECG
Answer
CK-MB CPK
ECG
When the healthcare provider believes that a client has experienced
a heartattack, or myocardial infarction(MI), diagnostic tests will include cardiac markers
including CPK andCK-MB and an ECG. A CBC and WBC will not be useful to confirm the
diagnosis of an MI.
6. functions as an antiplatelet aggregate; platelets become "less sticky" and flow smoother
through the vessels.
Answer
Aspirin
7. work by slowing the heart rate and lowering blood pressure, thereby decreasing the oxygen
demand on the heart.
Answer
Beta-blockers
8. work by lowering the client's cholesterol, specifically re- moving the "bad" cholesterol from
the blood (LDL).
Answer
Statins
9. may be used to dilate the smooth muscles of arteries and veins. By dilating veins, preload
can be reduced, thus allowing the heart to work less.
Answer
Nitrates
10. work to reduce blood pressure, and in some cases, reduce heart rate.
Answer
Calcium channel blockers
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