Deck 24: Nursing Care of Patients With Occlusive Cardiovascular Disorders

Question 1

A patient who is apprehensive, gray, cold, and clammy reports pain that "is as if an elephant is standing on my chest." The nurse should recognize these manifestations as indicative of which of these conditions?

A)An anginal attack
B)Acute myocardial infarction
C)Pericarditis
D)Heartburn

Answer 1

Acute myocardial infarction

Question 2

Which of these, if stated by a patient, indicates to the nurse correct understanding of the importance of promptly seeking medical treatment for symptoms of a myocardial infarction?

A)"Angina is prevented."
B)"Coronary artery disease is cured."
C)"Less heart muscle is damaged."
D)"Risk factors are decreased."

Answer 2

"Less heart muscle is damaged."

Question 3

A patient who has a myocardial infarction should be placed by the nurse into which of these positions to decrease preload and the heart's workload?

A)Prone
B)Supine
C)Sims' position
D)Semi-Fowler's position

Answer 3

Semi-Fowler's position

Question 4

A patient who develops chest pain says the pain is a 9 on a scale of 0 to 10. Which of the following actions should the nurse take?

A)Administer aspirin.
B)Listen to breath sounds.
C)Notify the RN.
D)Apply telemetry.

Question 5

For a patient who has had a cardiac catheterization that accessed the right femoral site, which information is most essential to collect immediately after the procedure?

A)Left pedal pulse
B)Right pedal pulse
C)Left brachial pulse
D)Right brachial pulse

Question 6

A patient who has peripheral venous disease (PVD) is sitting in a chair and has edematous and purple feet. What is the appropriate action for the nurse to take?

A)Cover the patient with a blanket.
B)Notify the physician.
C)Place the patient's legs on a tall footstool.
D)Have the patient lie in bed with pillow under knees.

Question 7

The nurse has reinforced teaching about symptoms of a myocardial infarction and the importance of seeking medical treatment promptly to a patient who has angina. Which of these would the nurse explain is a common reason prompt treatment is not sought?

A)Lack of transportation
B)Denial of symptoms
C)Lack of insurance
D)Not aware of symptoms

Question 8

A patient reports acute pain and numbness in the left leg. The nurse notes the left leg is pale and cooler than the right leg. What should the nurse do?

A)Elevate the left leg.
B)Apply an extra blanket to the left leg.
C)Administer pain medication.
D)Notify the RN.

Question 9

A patient who has varicose veins says, "How did I get this anyhow?" Which of the following responses by the nurse is best?

A)"They are caused by poor function of the valves in your veins."
B)"Veins become blocked by plaque from high-fat diets over time."
C)"Swelling of the vein is caused by bacteria."
D)"Veins spasm and twist when they get damaged."

Question 10

Which of the following risk factors, if identified in a patient's history, should be included in a teaching plan for modification?

A)Heredity and ethnicity
B)Smoking and high fat intake
C)Age and gender
D)Gender and ethnicity

Question 11

Which of these, if stated by a patient, indicates to the nurse correct understanding of the primary reason for performing leg exercises when on bedrest?

A)"Prepare for ambulation."
B)"Promote urinary and intestinal elimination."
C)"Prevent thrombophlebitis and blood clot formation."
D)"Decrease the likelihood of pressure ulcer formation."

Question 12

The nurse receives a telephone call from a relative who was diagnosed with angina last year. The relative reports taking 5 nitroglycerin (NTG) tablets but still has chest pain. What would be the best advice for the nurse to give this relative?

A)"I will call an ambulance and report your chest pain."
B)"Drive yourself to the emergency department immediately."
C)"Take two more NTG tablets and lie down."
D)"Have someone drive you to the emergency department now."

Question 13

A patient has brown, leathery, edematous ankles and reports increased pain when sitting. Which of these, if stated by the patient, indicates to the nurse correct understanding of discharge instructions?

A)"I should keep my legs lower than my heart."
B)"I should increase my intake of red meat and dairy products."
C)"Elastic bandages should be wrapped from the knee down."
D)"I should elevate my legs on pillows."

Question 14

The nurse is contributing to the teaching plan for a patient who is taking nitroglycerin. Which of these actions should be included if chest pain occurs?

A)Take 1 tablet every 5 minutes for three doses until pain is relieved.
B)Take 2 tablets every 2 minutes for three doses until pain is relieved.
C)Take 2 tablets every 3 hours for four doses until pain is relieved.
D)Take 3 tablets every 3 minutes for four doses until pain is relieved.

Question 15

A patient is brought to the emergency room by a daughter who reports that the patient has had multiple episodes of chest pain in the past few days and has refused to seek care. The patient states, "I feel fine and the pain has only lasted for brief periods." The nurse recognizes that the patient is most likely using which of the following coping techniques?

A)Anger
B)Denial
C)Projection
D)Regression

Question 16

The nurse is reinforcing teaching for managing the pain of peripheral arterial disease. Which of these patient statements would indicate correct understanding of discharge instructions?

A)"I will lie down frequently."
B)"I will use a reclining chair."
C)"I will sit with my legs down."
D)"I will do knee flexion exercises."

Question 17

The nurse is assisting with admission of a patient who presents with symptoms of an acute myocardial infarction. Which of the following activities would be the highest priority?

A)Limit fluid intake.
B)Relieve pain.
C)Support the family.
D)Note emotions.

Question 18

What laboratory tests should the nurse review for a patient with a possible myocardial infarction (MI)?

A)Urinalysis and complete blood count
B)Alkaline phosphatase and prothrombin time
C)Troponin I and myoglobin
D)Bleeding time and total cholesterol

Question 19

A patient has chronic peripheral arterial disease. During neurovascular checks, the nurse finds an absent left pedal pulse and a cyanotic leg. What should the nurse do?

A)Reassess the pulse in 30 minutes.
B)Encourage patient to flex the leg 10 times.
C)Notify the RN immediately.
D)Massage the patient's left foot.

Question 20

A patient who develops chest pain that radiates down the left arm has all of these measures prescribed. Which one should the nurse do first?

A)Administer nitroglycerin SL.
B)Repeat vital signs.
C)Apply oxygen at 2 L/min.
D)Obtain an electrocardiogram (ECG).

Question 21

The nurse is collecting data on a patient with varicose veins. What would the nurse document as a subjective finding of varicosities?

A)Palpable nodules
B)Ankle edema
C)Purple lesions
D)Aching of legs

Question 22

The nurse is reinforcing teaching for a patient who has coronary artery disease. Which of these is a risk factor for myocardial infarction which should be included in a teaching plan?

A)Gender
B)Stress
C)Age
D)Ethnicity

Question 23

A patient who has had a myocardial infarction asks, "What kinds of meats should I eat?" What would be an appropriate response by the nurse?

A)"Eat lean red meat to help increase your iron levels."
B)"Eat chicken and fish, keeping red meats to a minimum."
C)"Eat only vegetables; you do not need to eat meat."
D)"Eat small amounts of any type of meat."

Question 24

The nurse is assisting with the care of a patient who is receiving an IV with potassium. The nurse recognizes that IV fluids containing potassium are administered slowly and cautiously to prevent which of the following?

A)Cardiac arrest
B)Metabolic acidosis
C)Allergic reaction
D)Fluid overload

Question 25

The nurse is reinforcing teaching for a patient who has Raynaud's disease. Which of these measures should the nurse include to prevent an attack?

A)Keep affected body areas covered at all times.
B)Take vasopressors to prevent exacerbation of symptoms.
C)Avoid stimulation that causes vasoconstriction.
D)Get plenty of outdoor exercise all year.

Question 26

The nurse is caring for a patient who is being prepared for coronary atherectomy. Which of the following orders would the nurse expect to administer?

A)Administration of an antiplatelet
B)Administration of a beta blocker
C)Administration of a calcium channel blocker
D)Administration of a diuretic

Question 27

The nurse is contributing to a patient's plan of care for varicose veins. Which of these positioning measures should be included in the care plan for a patient who experiences pain from the varicose veins?

A)Keep legs dependent.
B)Cross legs.
C)Elevate legs.
D)Lie prone.

Question 28

The nurse is caring for a patient who was treated for cardiogenic shock and has an order for captopril (Capoten). Vital signs are blood pressure 120/70 mm Hg, pulse 85 beats/min, and respirations 16 breaths/min. What action should the nurse take regarding this medication?

A)Administer the dose.
B)Hold the medication and notify the physician.
C)Give the medication 1 hour later.
D)Ambulate the patient until blood pressure increases.

Question 29

The nurse is reinforcing teaching for a patient who has an aneurysm. Which of these patient statements indicates correct understanding of a dissecting aneurysm?

A)"An outpouching of one side of the arterial wall."
B)"An enlargement of the entire circumference of the artery."
C)"A communication between an artery and a vein."
D)"A separation of the inner layer of the arterial wall."

Question 30

In teaching a patient about an upcoming cardiac catheterization and coronary arteriogram, which of these statements should the nurse include?

A)"You will be able to hear your heart beating."
B)"You will see a lot of equipment in the room."
C)"You will not feel anything because you will be anesthetized."
D)"You will feel a heavy sensation throughout your body."

Question 31

A patient who has an acute myocardial infarction reports severe chest pressure, "as if someone is standing on my chest." What should the nurse do first?

A)Order an electrocardiogram.
B)Notify the physician.
C)Obtain vital signs.
D)Administer nitroglycerin.

Question 32

The nurse is assisting with care for a patient's who had a myocardial infarction. Which of these specialized diets would be ordered initially?

A)Soft diet
B)Full liquid
C)Clear liquid diet
D)Edentulous diet

Question 33

The nurse is contributing to a patient's teaching plan. The patient is prescribed niacin. What specific recommendation should be included in the teaching plan?

A)Increase intake of fruits and vegetables to reduce constipation.
B)Take with meals or milk to avoid gastrointestinal upset.
C)Take aspirin 30 minutes before niacin to reduce flushing.
D)Take 30 minutes before morning and evening meals to avoid gastrointestinal upset.

Question 34

The nurse is caring for a patient who has a history of angina and all of the following medications prescribed. Which medication would the nurse administer when the patient reports chest pain?

A)Aspirin PO
B)Digoxin PO
C)Nitroglycerin SL
D)Nitropaste

Question 35

The nurse is caring for a patient who has an abdominal aortic aneurysm. Which of these patient statements would indicate understanding of this condition?

A)"A deposit of plaque in the wall of an artery."
B)"An outpouching in the wall of an artery."
C)"An incompetent valve in a large vein."
D)"A blood clot in a vein."

Question 36

Which of these, if stated by a patient, indicates to the nurse correct understanding of appropriate prevention of varicose veins?

A)"Stand for long periods of time."
B)"Wear support stockings."
C)"Sleep with the head of the bed elevated."
D)"Sit with legs crossed."

Question 37

The nurse is collecting data for a patient who has chronic venous insufficiency of the lower extremities. Which of the following findings would be expected?

A)Leathery, brown skin
B)Diminished pedal pulse
C)Absence of pedal pulses
D)Pallor in the extremities

Question 38

The nurse is collecting data for a patient who is experiencing a myocardial infarction (MI). Which of the following findings would be expected?

A)Flushed face
B)Extreme thirst
C)A moist cough
D)Profuse diaphoresis

Question 39

The nurse reinforced teaching on decreasing the risk of atherosclerosis. Which of these responses by a patient would indicate understanding of teaching on how to reduce triglycerides with lifestyle changes and prescribed medication?

A)"Eat a high-fat diet, avoid smoking, and take daily furosemide (Lasix)."
B)"Limit activity, eat a high-protein diet, and take aspirin."
C)"Eat a low-protein diet, limit activity, and take niacin."
D)"Perform daily exercise, eat a low-fat diet, and take gemfibrozil (Lopid)."

Question 40

The nurse is collecting data on a patient with an aortic aneurysm. Which of these manifestations would the nurse expect to find?

A)Paralysis
B)Chest pain
C)Ankle edema
D)Back pain

Question 41

A neighborhood friend has been scheduled for a carotid endarterectomy and tells the nurse, "I didn't really understand the doctor, do you know what they plan to do?" Which of the following responses by the nurse is best?

A)"Procedures are constantly changing, so I don't know what might be planned."
B)"An endarterectomy is usually done on major vessels of the heart to prevent the need for bypass surgery."
C)"Typically a catheter is passed through a large vessel in your groin and threaded up into your heart to allow the injection of dye."
D)"The procedure usually involves removing plaque from the lining of the carotid artery."
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 42

For patients who are candidates for thrombolytic therapy, a "door to needle" interval of ________________minutes should be the goal.

Question 43

For thrombolytic treatment to be most effective in dissolving a blood clot, it should be given within ________________hour(s) of the onset of symptoms.

Question 44

The nurse is caring for a patient who has long-standing asthma and stable angina. Which drug could be safely given?

A)Atenolol (Tenormin)
B)Pindolol (Visken)
C)Propranolol (Inderal)
D)Nadolol (Corgard)

Question 45

Modifiable risk factors for atherosclerosis include which of the following? (Select all that apply.?

A)Hypertension
B)Familial hyperlipidemia
C)Increased homocysteine levels
D)Increased serum iron levels
E)Diabetes mellitus
F)Ethnic group

Question 46

The nurse is reinforcing teaching for a patient who has been prescribed a new medication. For which of the following types of medications should the patient be instructed there is the possibility of developing a cough when taking the drug?

A)Beta blocker
B)Statin
C)Angiotensin-converting enzyme inhibitor
D)Calcium channel blocker

Question 47

The physician has ordered nitroglycerin for a patient with anterior myocardial infarction. The nurse is obtaining vital signs before administering the medication. The apical pulse is 52 beats/min, and blood pressure is 80/60 mm Hg. What action should the nurse take?

A)Administer the drug as ordered.
B)Report the vital signs to the RN.
C)Give medication at half the prescribed dose.
D)Recheck vital signs in 30 minutes.

Question 48

A patient should be taught to replace a nitroglycerin supply every ________________month(s).

Question 49

The nurse is caring for a patient with a cardiac history. Which of the following actions should the nurse take when administering diltiazem (Cardizem)? (Select all that apply.?

A)Obtain apical pulse and blood pressure before giving medication.
B)Monitor for development of a round face.
C)Notify physician if blood pressure is less than 90 mm Hg systolic.
D)Monitor liver and renal functions during therapy.
E)Monitor for constipation.
F)Notify physician if heart rate is less than 50 beats per minute.

Question 50

The nurse is contributing to the plan of care for a patient who has a diagnosis of chest pain of 7 hours duration. The laboratory tests reveal an elevated troponin I and myoglobin level. What action would be appropriate in providing care to this patient? (Select all that apply.?

A)Provide bedpan for elimination.
B)Offer regular diet with hot tea.
C)Provide rest in bed or chair.
D)Elevate head of bed.

Question 51

The nurse is reinforcing teaching for a patient who has Buerger's disease on the most important modifiable risk factor for Buerger's disease. Which of the following statements by the client would indicate a correct understanding of the teaching?

A)Exposure to cold temperature
B)Smoking
C)Diet
D)Sedentary lifestyle

Question 52

The nurse is contributing to a patient's teaching plan. Which of the following should be included for teaching a patient about the use of nitroglycerin? (Select all that apply.?

A)Take tablet every morning.
B)Take before activity known to cause angina.
C)Place tablet under the tongue.
D)Sit or lie down when taking tablet.
E)Rise slowly after taking tablet.
F)Have a year's supply of the medication at home.Completion
Complete each statement.

Question 53

The nurse is providing care for a patient admitted with low back pain who recently returned from an abdominal computed tomography (CT) scan that revealed an aortic aneurysm. Which of the following would require an immediate intervention by the nurse?

A)Patient reports a sense of abdominal fullness after eating.
B)Patient BP goes from 144/78 mm Hg to 152/80 mm Hg.
C)Patient reports sudden severe flank pain.
D)Patient informs the nurse of a family history of hypertension.

Question 54

Total cholesterol levels greater than ________________mg/dL increase the risk of myocardial infarction.