ch 23 coronary vascular disorders

Question 1

plaque on the inner lumen of arteries is mostly composed of what

Answer 1

lipids and fibrous tissue

Question 2

angina is most often attributed to what cause

Answer 2

coronary arteriosclerosis

Question 3

what nursing diagnosis underlies the discomfort associated with angina

Answer 3

ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)

Question 4

if the clients symptoms are due to an MI what will have happed to the myocardium

Answer 4

it may have developed an increased area of infarction during the time without treatment

Question 5

family members bring a client to the ed with pale cool skin, sudden mid stern al chest pain, and a history of cad. how would you interpret this data

Answer 5

the symptoms indicate an acute coronary episode and should be treated as such

Question 6

an or nurse is preparing to assist with a coronary artery bypass graft (CABG). what vessel is most commonly used as the source for the graft

Answer 6

greater saphenous vein

Question 7

what are the complications associated with percutaneous transluminal coronary angioplasty (PTCA)

Answer 7

bleeding at insertion site

Question 8

a patient with type 2 diabetes and hypertension weighs 250 lbs/113.4 kg, waist circumference 40 in/101.6cm, bp 162/84, fasting blood glucose 220

Answer 8

metabolic syndrome, major risk factor for cardiovascular disease

Question 9

for cardiac surgery to have absence of blood from surgical field while maintaining perfusion of body organs and tissues, what technique would the nurse describe

Answer 9

cardiopulmonary bypass

Question 10

if a client is afraid of dying during cardiac surgery, how should the nurse respond

Answer 10

explore the factors underlying the clients anxiety

Question 11

potential adverse effects nitroglycerin

Answer 11

throbbing headache and dizziness

Question 12

what risk factors for coronary artery disease (CAD) can be controlled or modified

Answer 12

cholesterol levels, hypertension, smoking

Question 13

for a diagnosis of myocardial infarction what nursing assessment is a priority upon admission

Answer 13

begin ecg monitoring

Question 14

a patient has a history of hypertension and smokes one pack of cigarettes a day but denies any of the most common manifestations of CAD. the nurse should expect the focuses of cad treatment to be

Answer 14

diet therapy and smoking cessation

Question 15

for a patient who has just had an MI and is now in rehab, the nurse should cease activity if which of the following occurs?

Answer 15

the client experiences chest pain, palpitations or dyspnea

Question 16

a client with cardiovascular disease is being treated with amlodipine, which has what therapeutic effect?

Answer 16

reducing the heart’s workload by decreasing heart rate and myocardial contraction

Question 17

the desired goal for cholesterol levels is which of the following

Answer 17

low LDL and high HDL

Question 18

what are the primary ways that tobacco use impacts CAD? select all that apply

Answer 18

-decreases the supply of oxygen to the myocardium
-increases platelet adhesion
-raises the heart rate and blood pressure
-increases blood carbon monoxide level

Question 19

what change on an ecg most strongly suggests that ischemia is occurring

Answer 19

t wave inversion

Question 20

an adult client is admitted to the ed with chest pain for more than 20 minutes. what intervention to minimize cardiac damage

Answer 20

morphine sulfate, oxygen, bed rest

Question 21

in a patient with hypertension and chest pain during ambulation, in which order would the nurse assess and treat the client?

Answer 21

1.the client is instructed to stop all activity
2. the nurse assesses the client’s angina
3. the first set of vitals are done
4. a 12 lead ecg is performed
5. the client is transferred to a higher acuity unit
6. the client receives first dose of nitroglycerin

Question 22

what statement indicated understanding of venous thromboembolism prevention?

Answer 22

ill make sure that i don’t cross my legs when im resting in bed

Question 23

when assessing a client with angina pectoris it is most important for the nurse to gather what information

Answer 23

the clients symptoms and the activities that precipitate attacks

Question 24

which nursing diagnosis suggests distress and shock by a diagnosis of angina pectoris

Answer 24

anxiety related to cardiac symptoms

Question 25

what is the most appropriate initial action for an angina attack

Answer 25

place the client on bed rest in a semi fowler position

Question 26

which clients test results best demonstrate the specific diagnosis of unstable angina (USA)

Answer 26

a 72 yr old patient with an increased myoglobin, no elevation in the ST segment, and no elevation in troponins

Question 27

what med for suspected mi

Answer 27

morphine, aspirin, nitroglycerin, iv beta blocker (-olol)

Question 28

s/s acute coronary syndrome (ACS)

Answer 28

dyspnea, unusual fatigue, syncope

Question 29

what nursing action should be included for patient care plan for acute coronary syndrome

Answer 29

administer supplementary oxygen as needed

Question 30

what goal should guide the care team’s selection of assessments, interventions, and treatments for ACS

Answer 30

balancing myocardial oxygen supply with demand

Question 31

how can the nurse best meet patients psychosocial needs for ACS

Answer 31

directly address anxieties and fears

Question 32

what is a major indicator that a percutaneous transluminal coronary angioplasty (PTCA) was successful

Answer 32

increase in the size of the artery’s lumen

Question 33

for a patient who had a coronary artery stent placed yesterday what medication would be administrated today

Answer 33

clopidogrel (antiplatlet)

Question 34

what nursing education for percutaneous coronary intervention (PCI)

Answer 34

a sheath will be placed over the insertion site after the procedure is finished

Question 35

what nursing education for intraoperative regimen for coronary artery revascularization

Answer 35

intubation and mechanical ventilation

Question 36

a patient has begun bleeding from PCI access site in femoral region. what is most appropriate action

Answer 36

call for help and apply pressure to the access site

Question 37

what complications for post PTCA

Answer 37

-abrupt closure of the coronary artery
-bleeding at insertion site
-retroperitoneal bleeding
-arteria occlusion

Question 38

a client who is post op following a CABG has produced 20 ml of urine in the past three hours has confirmed the patency of the urinary catheter. what is the most appropriate action

Answer 38

contact the health provider and continue to assess fluid balance and renal function

Question 39

what intervention best addresses risk for ineffective airway clearance related to pulmonary secretions?

Answer 39

client’s consistent performance of deep breathing and coughing exercises

Question 40

s/s MI seen in women

Answer 40

indigestion, nausea