chapter 36 Flashcards
The nurse is developing a health teaching plan for a 60-year-old man with the following
risk factors for coronary artery disease (CAD). Which of the following risk factors should
the nurse focus on when teaching the client?
a. Family history of coronary artery disease
b. Increased risk associated with the client’s gender
c. High incidence of cardiovascular disease in older people
d. Elevation of the client’s serum low density lipoprotein (LDL) level
D
Because family history, gender, and age are nonmodifiable risk factors, the nurse should
focus on the client’s LDL level. Decreases in LDL will help reduce the client’s risk for
developing CAD.
To assist the client with coronary artery disease (CAD) in making appropriate dietary
changes, which of the following nursing interventions will be most effective?
a. Instruct the client that a diet containing no saturated fat and minimal sodium will
be necessary.
b. Emphasize the increased risk for cardiac problems unless the client makes the
dietary changes.
c. Assist the client to modify favourite high-fat recipes by using polyunsaturated oils
when possible.
d. Provide the client with a list of low-sodium, low-cholesterol foods that should be
included in the diet.
C
Lifestyle changes are more likely to be successful when consideration is given to the
client’s values and preferences. The highest percentage of calories from fat should come
from polyunsaturated fats. Although low-sodium and low-cholesterol foods are
appropriate, providing the client with a list alone is not likely to be successful in making
dietary changes. Removing saturated fat from the diet completely is not a realistic
expectation. Telling the client about the increased risk without assisting further with
strategies for dietary change is unlikely to be successful.
Which of the following information collected by the nurse who is admitting a client with
chest pain suggests that the pain is caused by an acute myocardial infarction?
a. The pain increases with deep breathing.
b. The pain has persisted longer than 30 minutes.
c. The pain worsens when the client raises the arms.
d. The pain is relieved after the client takes nitroglycerin.
B
Chest pain that lasts for 20 minutes or more is characteristic of an acute myocardial
infarction. Changes in pain that occur with raising the arms or with deep breathing are
more typical of pericarditis or musculo-skeletal pain. Stable angina is usually relieved
when the client takes nitroglycerin.
Which of the following information given by a client admitted with chronic stable angina
will help the nurse confirm this diagnosis?
a. The client rates the pain at a level 3–5 (0–10 scale).
b. The client states that the pain “wakes me up at night.”
c. The client says that the frequency of the pain has increased over the last few
weeks.
d. The client states that the pain is resolved after taking one sublingual nitroglycerin
tablet.
D
Chronic stable angina is typically relieved by rest or nitroglycerin administration. The
level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or
with increased frequency is typical of unstable angina.
The nurse is providing teaching to a client about use of sublingual nitroglycerin. Which of
the following client statements indicates that the teaching has been effective?
a. “I can expect indigestion as an adverse effect of nitroglycerin.”
b. “I can only take the nitroglycerin if I start to have chest pain.”
c. “I will call an ambulance if I still have pain 5 minutes after taking the
nitroglycerin.”
d. “I will help slow down the progress of the plaque formation by taking
nitroglycerin.”
C
The emergency medical services (EMS) system should be activated when chest pain or
other symptoms are not completely relieved 5 minutes after taking one nitroglycerin.
Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g.,
before intercourse). Gastric upset is not an expected adverse effect of nitroglycerin.
Nitroglycerin does not impact the underlying pathophysiology of coronary artery
atherosclerosis.
Which of the following statements made by a client with coronary artery disease after the
nurse has completed teaching about nutritional therapy for CAD indicates that further
teaching is needed?
a. “I will switch from whole milk to 1% or nonfat milk.”
b. “I like fresh salmon and I will plan to eat it more often.”
c. “I will miss being able to eat peanut butter sandwiches.”
d. “I can have a cup of coffee with breakfast if I want one.”
C
Although only 30% of the daily calories should come from fats, most of the fat should
come from monosaturated fats such as are found in nuts, olive oil, and canola oil. The
client can include peanut butter sandwiches as part of their diet. The other client comments
indicate a good understanding of diet.
The nurse is providing teaching to a client about the use of atenolol in preventing anginal
episodes. Which of the following client statements indicate that the teaching has been
effective?
a. “It is important not to suddenly stop taking the atenolol.”
b. “Atenolol will increase the strength of my heart muscle.”
c. “I can expect to feel short of breath when taking atenolol.”
d. “Atenolol will improve the blood flow to my coronary arteries.”
A
Clients who have been taking b-blockers can develop intense and frequent angina if the
medication is suddenly discontinued. Atenolol decreases myocardial contractility.
Shortness of breath that occurs when taking b-blockers for angina may be due to
bronchospasm and should be reported to the health care provider. Atenolol works by
decreasing myocardial oxygen demand, not by increasing blood flow to the coronary
arteries.
The nurse is caring for a client who has had severe chest pain for several hours and a
diagnosis of possible acute myocardial infarction. Which of the following prescribed
laboratory tests should the nurse monitor to help determine the diagnosis?
a. Homocysteine
b. C-reactive protein
c. Cardiac-specific troponin I and troponin T
d. High-density lipoprotein (HDL) cholesterol
C
Troponin levels increase about 3–12 hours after the onset of myocardial infarction (MI).
The other laboratory data are useful in determining the client’s risk for developing
coronary artery disease (CAD) but are not helpful in determining whether an acute MI is
in progress.
The nurse is caring for a client with newly diagnosed Prinzmetal’s (variant) angina and has
a prescription for amlodipine. Which of the following information is accurate about
amlodipine?
a. Reduce the “fight or flight” response
b. Decrease spasm of the coronary arteries
c. Increase the force of myocardial contraction
d. Help prevent clotting in the coronary arteries
B
Prinzmetal’s angina is caused by coronary artery spasm. Calcium channel blockers (e.g.,
amlodipine, nifedipine) are a first-line therapy for this type of angina. Platelet inhibitors,
such as Aspirin, help prevent coronary artery thrombosis, and b-blockers decrease
sympathetic stimulation of the heart. Medications or activities that increase myocardial
contractility will increase the incidence of angina by increasing oxygen demand.
The nurse will suspect that the client with stable angina is experiencing an adverse effect
of the prescribed metoprolol if which of the following findings are assessed?
a. The client is restless and agitated.
b. The blood pressure is 190/110 mm Hg.
c. The client complains about feeling anxious.
d. The cardiac monitor shows a heart rate of 45.
D
Clients taking b-adrenergic blockers should be monitored for bradycardia. Because this
category of medication inhibits the sympathetic nervous system, restlessness, agitation,
hypertension, and anxiety will not be adverse effects.
The nurse is caring for a client with angina who has been prescribed nadolol. Which of the
following parameters should the nurse assess to determine whether the drug is effective?
a. Decreased blood pressure and apical pulse rate
b. Fewer complaints of having cold hands and feet
c. Improvement in the quality of the peripheral pulses
d. The ability to do daily activities without chest discomfort
D
Because the medication is ordered to improve the client’s angina, effectiveness is
indicated if the client is able to accomplish daily activities without chest pain. Blood
pressure (BP) and apical pulse rate may decrease, but these data do not indicate that the
goal of decreased angina has been met. The noncardioselective b-blockers can cause
peripheral vasoconstriction, so the nurse would not expect an improvement in peripheral
pulse quality or skin temperature.
The nurse is caring for a client with a non–ST-segment-elevation myocardial infarction
(NSTEMI) who is receiving heparin. Which of the following information explains the
purpose of the heparin?
a. Platelet aggregation is enhanced by IV heparin infusion.
b. Heparin will dissolve the clot that is blocking blood flow to the heart.
c. Coronary artery plaque size and adherence are decreased with heparin.
d. Heparin will prevent the development of new clots in the coronary arteries.
D
Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery
thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or
enhance platelet aggregation.
The nurse is administering IV nitroglycerin to a client with a myocardial infarction (MI).
Which of the following actions should the nurse take to evaluate the effectiveness of the
medication?
a. Check blood pressure.
b. Monitor apical pulse rate.
c. Monitor for dysrhythmias.
d. Ask about chest discomfort.
D
The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the
balance between myocardial oxygen supply and demand. The nurse also will monitor heart
rate and BP and observe for dysrhythmias, but these parameters will not indicate whether
the medication is effective.
A client with ST segment elevation in several electrocardiographic (ECG) leads is
admitted to the emergency department (ED) and diagnosed as having an
ST-segment-elevation myocardial infarction (STEMI). Which of the following questions
should the nurse ask to determine whether the client is a candidate for fibrinolytic therapy?
a. “Do you take Aspirin on a daily basis?”
b. “What time did your chest pain begin?”
c. “Is there any family history of heart disease?”
d. “Can you describe the quality of your chest pain?”
B
Fibrinolytic therapy should be started within 6 hours of the onset of the myocardial
infarction (MI), so the time at which the chest pain started is a major determinant of the
appropriateness of this treatment. The other information also will be needed, but it will not
be a factor in the decision about fibrinolytic therapy.
Following an acute myocardial infarction, a client ambulates in the hospital hallway.
When the nurse is evaluating the client’s response, which of the following assessment data
would indicate that the exercise level should be decreased?
a. BP changes from 118/60 to 126/68 mm Hg.
b. Oxygen saturation drops from 100% to 98%.
c. Heart rate increases from 66 to 90 beats/minute.
d. Respiratory rate goes from 14 to 22 breaths/minute.
C
A change in heart rate of more than 20 beats or more indicates that the client should stop
and rest. The increases in BP and respiratory rate, and the slight decrease in oxygen
saturation, are normal responses to exercise.
The nurse is administering a fibrinolytic agent to a client with an acute myocardial
infarction. Which of the following assessments should cause the nurse to stop the drug
infusion?
a. Bleeding from the gums
b. Surface bleeding from the IV site
c. A decrease in level of consciousness
d. A nonsustained episode of ventricular tachycardia
C
The change in level of consciousness indicates that the client may be experiencing
intracranial bleeding, a possible complication of fibrinolytic therapy. Bleeding of the gums
and prolonged bleeding from IV sites are expected adverse effects of the therapy. The
nurse should address these by avoiding any further injuries, but they are not an indication
to stop infusion of the fibrinolytic medication. A nonsustained episode of ventricular
tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is
effective.
Three days after a myocardial infarction (MI), the client develops chest pain that increases
when taking a deep breath and is relieved by leaning forward. Which of the following
actions should the nurse take next?
a. Palpate the radial pulses bilaterally.
b. Assess the feet for peripheral edema.
c. Auscultate for a pericardial friction rub.
d. Check the cardiac monitor for dysrhythmias.
C
The client’s symptoms are consistent with the development of pericarditis, a possible
complication of MI. The other assessments listed are not consistent with the description of
the client’s symptoms.
The nurse is providing teaching to a client with chronic stable angina about how to use the
prescribed short-acting and long-acting nitrates. Which of the following client statements
indicates that the teaching has been effective?
a. “I will put on the nitroglycerin patch as soon as I develop any chest pain.”
b. “I will check the pulse rate in my wrist just before I take any nitroglycerin.”
c. “I will be sure to remove the nitroglycerin patch before using any sublingual
nitroglycerin.”
d. “I will stop what I am doing and sit down before I put the nitroglycerin under my
tongue.”
D
The client should sit down before taking the nitroglycerin to decrease cardiac workload
and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically rather
than to treat acute pain and can be used concurrently with sublingual nitroglycerin.
Although the nurse should check blood pressure before giving nitroglycerin, clients do not
need to check the pulse rate before taking nitrates.
Four days after having a myocardial infarction (MI), a client who is scheduled for
discharge asks for assistance with all the daily activities, saying, “I don’t understand how
to care for myself.” Based on this information, which of the following nursing diagnoses is
appropriate?
a. Ineffective health management related to insufficient knowledge
b. Activity intolerance related to physical deconditioning
c. Ineffective denial related to ineffective coping strategies
d. Social isolation related to insufficient personal resources
A
The client data indicate ineffective health management related to lack of knowledge of
disease process, and care after discharge. The other nursing diagnoses may be appropriate
for some clients after an MI, but the data for this client do not support denial, activity
intolerance, or social isolation.
The nurse is caring for a client who has survived a sudden cardiac death (SCD) event and
has no evidence of an acute myocardial infarction. Which of the following information
should the nurse teach the client?
a. That sudden cardiac death events rarely reoccur
b. About the purpose of outpatient Holter monitoring
c. How to self-administer low-molecular-weight heparin
d. To limit activities after discharge to prevent future events
B
Holter monitoring is used to determine whether the client is experiencing dysrhythmias
such as ventricular tachycardia during normal daily activities. SCD is likely to recur.
Heparin will not have any effect on the incidence of SCD, and SCD can occur even when
the client is resting.
The nurse is caring for a client who is 3 days post myocardial infarction and the client
states, “I just had a little chest pain. As soon as I get out of here, I’m going for my
vacation as planned.” Which of the following responses should the nurse make?
a. “Where are you planning to go for your vacation?”
b. “What do you think caused your chest pain episode?”
c. “Sometimes plans need to change after a heart attack.”
d. “Recovery from a heart attack takes at least a few weeks.”
B
When the client is experiencing denial, the nurse should assist the client in testing reality
until the client has progressed beyond this step of the emotional adjustment to MI. Asking
the client about vacation plans reinforces the client’s plan, which is not appropriate in the
immediate post-MI period. Reminding the client in denial about the MI is likely to make
the client angry and lead to distrust of the nursing staff.
The nurse is evaluating the outcomes of preoperative teaching with a client scheduled for a
coronary artery bypass graft (CABG) using the internal mammary artery. Which of the
following client statements indicates that additional teaching is needed?
a. “I will have incisions in my leg where they will remove the vein.”
b. “They will circulate my blood with a machine during the surgery.”
c. “I will need to take an Aspirin a day after the surgery to keep the graft open.”
d. “They will use an artery near my heart to bypass the area that is obstructed.”
A
When the internal mammary artery is used there is no need to have a saphenous vein
removed from the leg. The other statements by the client are accurate and indicate that the
teaching has been effective.
The nurse is caring for a client who has had an acute myocardial infarction and the client
asks the nurse about when sexual intercourse can be resumed. Which of the following
responses by the nurse is best?
a. “Most clients are able to enjoy intercourse without any complications.”
b. “Sexual activity uses about as much energy as climbing two flights of stairs.”
c. “The doctor will discuss sexual intercourse when your heart is strong enough.”
d. “Holding and cuddling are good ways to maintain intimacy after a heart attack.”
B
Sexual activity places about as much physical stress on the cardiovascular system as
climbing two flights of stairs. The other responses do not directly address the client’s
question, or may not be accurate for this client
The nurse is caring for a client with hyperlipidemia who has a new prescription for
colestipol. Which of the following nursing actions is best when giving the medication?
a. Administer the medication at the client’s bedtime.
b. Have the client take this medication with an Aspirin.
c. Encourage the client to take the colestipol with a sip of water.
d. Give the client’s other medications 2 hours after the colestipol.
D
The bile acid sequestrants interfere with the absorption of other drugs, and giving other
medications at the same time should be avoided. Taking an Aspirin concurrently with the
colestipol may increase the incidence of gastrointestinal adverse effects such as heartburn.
An increased fluid intake is encouraged for clients taking the bile acid sequestrants to
reduce the risk for constipation. For maximum effect, colestipol should be administered
with meals.
