Cardiac Disorders (other / chapter 23)

Question 1

A nurse is teaching a patient who receives nitrates for the relief of chest pain. Which instruction should the nurse emphasize?

a.) Restrict EtOH intake to 2 drinks per day.
b.) Store the drug in a cool, well-lit place.
c.) Repeat the dose of sublingual nitroglycerin every 15 minutes for up to 3 doses.
d.) Lie down or sit in a chair for 5-10 minutes after taking the drug.

Answer 1

d.) Lie down or sit in a chair for 5-10 minutes after taking the drug.

Question 2

Which fo the following is inconsistent as a condition related to metabolic syndrome?

a.) Hypotension
b.) Abdominal obesity
c.) Dyslipidemia
d.) Insulin resistance

Answer 2

a.) Hypotension

Question 3

What are the 5 indicators of metabolic syndrome?

Answer 3

• Diabetes
• Obesity
• Dyslipidemia
• Hypertension
• ↑ Triglycerides

Question 4

The nurse is developing a teaching plan for a patient to address modifiable risk factors for coronary artery disease (CAD). Which modifiable factors will the nurse include in the teaching plan? (Select all that apply)

a.) Family history
b.) Increasing age
c.) Alcohol use
d.) Hypertension
e.) Physical inactivity
f.) Obesity

Answer 4

c.) Alcohol use
d.) Hypertension
e.) Physical inactivity
f.) Obesity

Question 5

The nurse is assessing a patient with suspected post-pericardiotomy syndrome after cardiac surgery. What manifestation will alert the nurse to this syndrome?

a.) ↓ erythrocyte sedimentation rate (ESR)
b.) ↓ WBC count
c.) hypothermia
d.) pericardial friction rub

Answer 5

d.) Pericardial friction rub

Post-Pericardiotomy Syndrome = inflammatory response after cardiac surgery

• worsening or new formation of pericardial and/or pleural effusion, perciardial rub, chest pain with or without dyspnea, fever, & elevated inflammatory markers

Question 6

The nurse is carding for a patient after cardiac surgery. What lab result will lead the nurse to suspect possible renal failure?

a.) Serum BUN of 70 mg/dL
b.) an hourly urine output of 50-70 mL
c.) urine specific gravity reading of 1.021
d.) serum creatinine of 1.0 mg/dL

Normal Ranges
* BUN = 7 - 20 mg/dL
* Urine output = 1mL/kg per hour
* Specific gravity = 1.005 - 1.030
* Serum creatinine = 0.7 - 1.3 mg/dL (men) & 0.6 - 1.1 mg/dL (women)

Answer 6

a.) Serum BUN of 70 mg/dL

Question 7

A patient’s lipid profile reveals an LDL level of 122 mg/dL. What is this level considered?

a.) normal LDL
b.) high LDL
c.) fasting LDL
d.) low LDL

Answer 7

b.) high LDL

Normal < 100 mg/dL

Question 8

The nurse is caring for a patient diagnosed with unstable angina who is receiving IV Heparin. The patient requires bleeding precautions. Which measures do bleeding precautions include?

a.) Avoid continuosu BP monitoring
b.) Avoid subcutaneous injections
c.) Use an electric toothbrush
d.) Avoid the use of nail clippers

Answer 8

a.) Avoid continuous BP monitoring

Question 9

The patient has had biomarkers tested after reporting chest pain. WHich diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks after a cardiac event?

a.) CK-MB
b.) Troponin
c.) CK (total creatinine kinase)
d.) Myoglobin

Answer 9

b.) Troponin

Question 10

When a post-cardiac surgery patient demonstates restlessness, nausea, weakness, & peaked T-waves, what electrolyte abnormality does the nurse anticipate when reviewing the patient’s serum electrolytes?

a.) Hyperkalemia
b.) Hypomagnesemia
c.) Hypernatremia
d.) Hypokalemia

Answer 10

a.) Hyperkalemia

Question 11

A nurse is caring for a patient who had a three-vessel coronary artery bypass graft 4 days prior. The patient’s cholesterol profile is as follows:

• total cholesterol = 265 mg/dL
• LDL = 139 mg/dL
• HDL = 32 mg/dL

The patient asks the nurse how to lower his cholesterol. What is the best response by the nurse?

a.) Cholesterol si within the recommended guidelines and the patient doesn’t need to lower it.
b.) The patient should take a statin medication & should not worry about their cholesterol.
c.) The patient should begin a running program, working up to 2 miles per day.
d.) The nurse will ask the dietitian to talk to the patient about modifying their diet.

Answer 11

d.) The nurse will ask the dietitian to talk to the patient about modifying their diet.

Question 12

A patient presents to the ED reporting anxiety and chest pain after shoveling heavy snow that morning. THe patient states that they have not taken nitroglycerin in months but upon experiencing this chest pain states they did take 3 nitroglycerin tablets. Although the pain has lessened, the patient states, “They did not work all that well.” The patient shows the nurse the nitroglycerin bottle; the prescription was filled 12 months ago. Which of the following orders does the nurse anticipate from the physician?

a.) Ativan 1 mg PO
b.) Nitroglycerin SL
c.) Chest x-ray
d.) Serum elecrolytes

Answer 12

b.) Nitroglycerin SL

Question 13

A patient is receiving morphine to relieve chest pain. THe order is for 4 mg IV morphine. The pharmacy supplies morphine sulfate 5 mg/mL. How many mL will the nurse administer (exact number only)

Answer 13

0.8 mL

(0.4 mg / 0.5 mg) x 1 mL = 0.8 mL

(Desired / Have) x Quantity

Question 14

A nurse is evaluating a patient who had an MI 7 days prior. Which outcome indicates that the patient is responding favorably to therapy?

a.) The patient verbalizes the intention of making all necessary lifestyle changes, except for stopping smoking.
b.) The patient demonstrates the ability to tolerate more activity without chest pain.
c.) The patient exchibits a heart rate > 100 bpm.
d.) The patient states that sublingual nitroglycerin ususally relieves the chest pain.

Answer 14

b.) The patient demonstrates the ability to tolerate more activity without chest pain.

Question 15

A patient comes to the ED reporting precordial chest pain. The patient describes the pain as pressure with a sudden onset. What disease process would the nurse suspect in this patient?

a.) Cardiogenic shock
b.) Venous occlusive disease
c.) Coronary artery disease
d.) Raynaud syndrome

Answer 15

c.) Coronary Artery Disease

Question 16

A nurse is monitoring the vital signs & lab results of a patient who is recieving anti-coagulation therapy. What does the nurse identify as a major indication of concern?

a.) hemoglobin of 16 g/dL
b.) BP of 129/72 mmHg
c.) hematocrit of 30%
d.) HR of 87 BPM

Answer 16

c.) Hematocrit of 30%

Question 17

The nurse is going to administer morphien sulfate to a patient with chest pain. What initial nursing action is required prior to the administration?

a.) Measure urinary output for dehydration.
b.) Count the respiratory rate for bradypnea.
c.) Measure the blood pressure for hypertension.
d.) Check the radial pulse for dysrhythmias.

Answer 17

b.) Count the respiratory rate for bradypnea.

Question 18

The nurse is reviewing lab results of a patient recently diagnosed with CAD. The patient’s LDL is 115 mg/dL. The nurse interprets this value as…

a.) high
b.) low
c.) within normal limits
d.) critically high

Answer 18

a.) high

Normal LDL is < 100 mg/dL

Slightly above normal = 100 - 129 mg/dL

Borderline = 130 - 159 mg/dL

High = 160 - 189 mg/dL

Very high

Question 19

The nurse is teaching a patient about atherosclerosis. The patient asks the nurse what the substance causing atherosclerosis is made of. How does the nurse respond?

a.) cholesterol plugs in the lumen of veins
b.) blood clots in the arteries
c.) fatty deposits in the lumen of arteries
d.) emboli in the veins

Answer 19

c.) fatty deposits in the lumen of arteries

Question 20

The nurse is caring for a patient with Raynaud syndrome. What is an important instruction for the nurse to infrom the patient with Raynaud syndrome of so that they prevent an attack?

a.) Avoid fatty foods & exercise.
b.) Take OTC decongestants.
c.) Avoid situations that contribute to ischemic episodes.
d.) Report changes in the usual pattern of chest pain.

Answer 20

c.) Avoid situations that contribute to ischemic episodes

Question 21

The nurse is caring for a patient with CAD. What condition most commonly results from CAD?

a.) myocardial infarction
b.) atherosclerosis
c.) diabetes mellitus
d.) renal failure

Answer 21

b.) atherosclerosis

Question 22

The nurse knows that women & older adults are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause?

a.) Vauge symptoms
b.) Decreased sensation to pain
c.) Gender bias
d.) Chest pain is typical

Answer 22

a.) Vague syptoms

Question 23

A patient is receiving nitroglycerin ointment to treat angina pectoris. The nurse evaluate the therapeutic effectiveness of this drug by assessing the patient’s response & checking for adverse effects. Which vital sign is most likely to reflect an adverse effect of nitroglycerin?

a.) Temperature of 100.2° F (37.9° C)
b.) Pulse of 84 BPM
c.) BP of 84/52 mmHg
d.) RR of 26 BPM

Answer 23

c.) BP of 84/52 mmHg

Question 24

Which medication is given to patients who are diagnosed with agnina pectoris, but are allergic to aspirin?

a.) diltiazem (Cardizem)
b.) clopidogrel (Plavix)
c.) amlodipine (Norvasc)
d.) felodipine (Cabren)

Answer 24

b.) clopidogrel (Plavix)

Question 25

A nurse reviews an EKG strip of a patient who is admitted with symptoms of an acute MI. THe nurse should recongize which classic EKG changes that occur with an MI? (Select all that apply)

a.) T-wave hyperactivity & inversions
b.) Abnormal Q-wave formation
c.) U-wave elevations
d.) Absent P-waves
e.) ST-segment elevations

Answer 25

a.) T-wave hyperactivity & inversions
b.) Abnormal Q-wave presence/formation
e.) ST-segment elevation

Question 26

A nurse is caring for a patient who is exhibiting signs & symptoms of an MI. Which statement describes priorities the nurse should establish when performing the physical exam for this patient?

a.) Assess the patient’s level of anxiety & provide emotional support.
b.) Ensure that the patient’s family is kept informed about the patient’s status.
c.) Assess the patient’s level of pain & administer prescribed analgesics.
d.) Prepare the patient for pulmonary artery catheterization.

Answer 26

c.) Assess the patient’s pain & administer prescribed analgesics

Question 27

A patient is receiving IV heparin. The heparin order is 1,200 units per hour. The pharmacy sends 25,000 units of heparin in 500 mL D5W. How many mL per hour should the nurse infuse the heparin at? (round to whole number)

Answer 27

24 mL/hr

1.) units x kg = units / hr

2.) 25,000 units / 500 mL = 1.) units / hr / x (mL/hr)

a.) 1,200 units

b.) 25,000 units / 500 mL = 1,200 units/hr / X (mL/hr)

c.) 25,000 X = (500 x 1,200) → 25,000 X = 600,000 → X = 600,000/25,000 → X = 24 mL/hr

Question 28

Define chronic stable angina

Answer 28

Chest pain that has not increased in frequency or severity over time

• episodes are usually predictable
• often caused by exertion, mental / emotional stress, or cold temps
• Episodes normally relieved w/ rest or SL nitroglycerin

Question 29

Define unstable angina

Answer 29

Chest pain that is unexpected, occurs at rest, is new onset, lasts more than 20 minutes, & has changed in frequency, severity, and/or duration

• unexpected
• at rest
• 20+ minutes
• change in frequency, severity, or duration

Question 30

What is Prinzmetal’s (Variant) Angina?

Answer 30

Resting chest pain due to coronary spams

• occurs at rest
• caused by coronary artery spasm
• usually occurs between 12 AM & 8 AM
• associated with acute MIs & sudden cardiac death; does not follow exertion

Question 31

Define an NSTEMI

Answer 31

Intermittent blockage (occlusion) of blood flow to the heart

Signs & Symptoms:
* chest pain at rest or w/ exertion
* no relief from nitroglycerin or rest
* lasts longer & is more severe than usual

Question 32

Which 3 coronary artery syndromes have the same symptoms?

Answer 32

NSTEMI & STEMI have same S/S as unstable angina

• pain at rest or on exertion
• no relief from nitro or rest
• worse & more severe than usual

Question 33

What an occlusive thrombus (in terms of a STEMI)?

Answer 33

thrombus occluding a coronary vessel for a prolonged period of time

• ↓ blood flow = myocardial ischemia, injury & necrosis with damage extending through all myocardial layers

Question 34

Questions to ask when assessing a patient’s chest pain in someone with a suspected MI

Answer 34

Provoke – what was going on when this started?
Quality – describe the pain / what it feels like
Radiation – does it go anywhere?
Severity – rate on scale of 1 to 10
Timing – onset