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Chapter 23 Management of Patients With Coronary Vascular Disorders
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Chapter 23 Management of Patients With Coronary Vascular Disorders
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Chapter 23 Management of Patients With Coronary Vascular Disorders1. 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: A
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.
2. 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: D
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.
,3. The nurse is caring for an adult patient who had 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: C
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.
4. 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?
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: A
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.
,5. 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) 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: C
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.
6. 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) Femoral artery
D) Greater saphenous vein
Ans: D
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.
7. 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) Congestive heart failure
Ans: B
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.
8. 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: A
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