Deck 21: Care of Patients With Coronary Artery Disease and Cardiac Surgery

Question 1

Heart disease in women is manifested by a variety of subtle signs.Which sign is typically seen in women?

A)Fainting
B)Chest pain
C)Dizziness
D)Fatigue

Answer 1

Fatigue

Question 2

The patient was admitted with chest pain to rule out a myocardial infarction (MI).Which cardiac enzyme test is most indicative of an MI?

A)Troponin
B)Myoglobin
C)CPK
D)CK-MB

Answer 2

Troponin

Question 3

The post-myocardial infarction (MI)patient is placed on a low-fat diet as well as daily simvastatin (Zocor).The nurse instructs that while on this drug,the patient should:

A)have blood work every 2 months to check for liver damage.
B)drink grapefruit juice daily to help metabolize the drug.
C)take medication with a meal to diminish gastrointestinal discomfort.
D)report any rash on the face or neck to the physician.

Answer 3

have blood work every 2 months to check for liver damage.

Question 4

The nurse explains the difference between exertional angina and unstable angina is that unstable angina occurs:

A)on heavy exertion.
B)when the blood pressure increases sharply.
C)when the body reacts to high stress levels.
D)unpredictably, even in sleep.

Question 5

The patient being evaluated for a heart transplant asks the nurse what the survival rate is.Which is the correct response by the nurse?

A)"I'm not really sure. It is better if you ask your surgeon."
B)"Every patient has different circumstances, but the average 5-year survival rate is 70%."
C)"The survival rate is excellent. Almost all patients with a heart transplant live past 10 years."
D)"There are not any really good statistics for me to give you an accurate estimate."

Question 6

The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed.Which response by the nurse is most accurate?

A)"We will only roll you to the same side as the catheter insertion site."
B)"You will lay flat for several hours, and we will place a sandbag over the dressing in the groin."
C)"You will most likely be up and about within about 2 hours after the procedure if your doctor uses an arterial closure device at the catheter insertion site."
D)"We will encourage you to flex and extend your legs when you return from the procedure to prevent a clot from forming at the insertion site."

Question 7

Following patient teaching regarding a scheduled minimally invasive direct coronary artery bypass (MIDCAB),the nurse determines the need for further instruction when the patient makes which statement?

A)"It frightens me to think that my heart will be stopped during surgery."
B)"This surgery bypasses my artery that is blocked, and replaces it with sections of a vein or artery taken from another part of my body."
C)"This surgery will hopefully control my angina since nothing else we have tried has worked."
D)"I may come out of surgery with vessels removed from my legs."

Question 8

Following a cardiac catheterization with coronary angiography,the physician writes an order to increase the patient's fluid intake.The nurse knows that increasing the fluid intake is ordered for what reason?

A)Reducing the nausea related to the dye absorption
B)Maintaining adequate blood pressure and perfusion
C)Diluting the urine to prevent kidney damage
D)Making up for fluid lost during the angiogram

Question 9

The nurse explains that following a myocardial infarction (MI),the pumping efficiency of the heart is altered because there is:

A)loss of impulse from the sinoatrial node.
B)necrosis of the myocardium.
C)diminished blood flow.
D)inflammation and swelling of the myocardium.

Question 10

The patient in the emergency room with a myocardial infarction (MI)becomes pale,diaphoretic,and hypotensive and complains of feeling cold.The nurse recognizes that these signs are which post-MI complication?

A)Cardiogenic shock
B)Pleural effusion
C)Ventricular fibrillation
D)Pulmonary embolus

Question 11

The nurse reading admission data on a patient recognizes information that puts the patient at risk for coronary artery disease (CAD).Which characteristic place the patient at risk? (Select all that apply.)

A)38-year-old African American
B)Low-density lipoprotein (LDL) 120, high-density lipoprotein (HDL) 68
C)Taking oral birth control pills
D)Nonsmoker for 10 years
E)Diagnosed with diabetes 2 years ago

Question 12

The nurse clarifies that the stool softener is given as a part of routine post-myocardial infarction (MI)care in order to prevent:

A)bradycardia from straining at stool.
B)fluid retention from retained bowel contents.
C)respiratory difficulty from abdominal distention.
D)discomfort from painful gas.

Question 13

The nurse counsels a patient that the administration of thrombolytic drugs would be contraindicated in the patient who is:

A)hypotensive.
B)being treated for a bleeding ulcer.
C)presently taking warfarin (Coumadin).
D)prone to asthma attacks.

Question 14

The patient on a low-fat diet following a myocardial infarction (MI)states he can eat fish to help lower cholesterol because of its high content of:

A)fiber.
B)omega-3 fatty acids.
C)trans fat.
D)saturated fat.

Question 15

The drug alteplase (t-PA)is given to the patient with a myocardial infarction (MI).The nurse is aware the drug will:

A)dissolve the obstruction in the coronary artery.
B)dilate vessels to relieve pain.
C)strengthen cardiac contraction.
D)increase cardiac output.

Question 16

The nurse suggests to the patient with angina that a daily dose of 81 mg of aspirin is an inexpensive therapy to help:

A)reduce clotting.
B)dilate coronary vessels.
C)alleviate pain associated with angina.
D)lower cholesterol.

Question 17

The nurse explains that the pain of coronary artery disease (CAD)is related to:

A)congestion.
B)ischemia.
C)edema.
D)inflammation.

Question 18

The patient with angina asks what to do if the first nitroglycerin tablet (NGT)does not relieve the pain.What instruction by the nurse is correct?

A)"Take 2 tablets 10 minutes after the first dose and go to the ER if you are still having pain."
B)"Take a second tablet 15 minutes after the first dose and call the physician if you are still having pain."
C)"Take 2 more tablets 30 minutes apart, and then rest for 20 minutes."
D)"Take 2 more tablets 5 minutes apart and notify the physician if your pain is not relieved."

Question 19

The 60-year-old female in the post-coronary care unit confides to the nurse,"My life is over.I'll never be able to care for my family,take a vacation,or work in my garden." Which response by the nurse is most supportive?

A)"You are doing great! Of course you'll be able to do all those things in a few weeks."
B)"You may have to give up some things, but there are other activities you might enjoy."
C)"You are feeling a little blue today. I'll get you some medication to help your anxiety."
D)"You sound a little down. Tell me what you think is going to keep you from those activities; we might be able to address the problems."

Question 20

The nurse assesses a friction rub in a patient who is 2 days post-myocardial infarction (MI).The nurse recognizes this finding as an indicator of:

A)a recurrent MI.
B)pleural effusion.
C)pericarditis.
D)angina.

Question 21

Matching
Place the events of arterial obstruction in proper sequence.

Step: 6

A)Platelets adhere to plaque.
B)Deposits of low-density lipoproteins (LDLs) accumulate.
C)Fibrous plaque is laid down in vessel.
D)Streaks of fatty material are laid down in arteries.
E)Platelets clump.
F)Platelets calcify.

Question 22

The nurse is aware that the patient's cardiac rehabilitation levels of physical activity are designated through ____________ units.

Question 23

Matching
Place the events of arterial obstruction in proper sequence.

Step: 2

A)Platelets adhere to plaque.
B)Deposits of low-density lipoproteins (LDLs) accumulate.
C)Fibrous plaque is laid down in vessel.
D)Streaks of fatty material are laid down in arteries.
E)Platelets clump.
F)Platelets calcify.

Question 24

The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium,which is brought on by which factors? (Select all that apply.)

A)Exertion
B)Emotional excitement
C)Eating heavy meals
D)Exposure to cold
E)Allergic reaction

Question 25

The nurse uses a diagram to show how obstruction of an artery has caused an area of necrosis called a(n)_________.

Question 26

Matching
Place the events of arterial obstruction in proper sequence.

Step: 3

A)Platelets adhere to plaque.
B)Deposits of low-density lipoproteins (LDLs) accumulate.
C)Fibrous plaque is laid down in vessel.
D)Streaks of fatty material are laid down in arteries.
E)Platelets clump.
F)Platelets calcify.

Question 27

The nurse is aware that a positive diagnosis of a myocardial infarction (MI)is based on which diagnostic test results? (Select all that apply.)

A)Electrocardiographic (ECG) changes in the QRS complex
B)Elevation of low-density lipoprotein (LDH)
C)Elevation of troponin levels
D)Elevated white blood cell (WBC) count
E)Elevated T wave

Question 28

The nurse clarifies that the MONA protocol for drug administration in the emergent stage of a myocardial infarction (MI)involves the use of which therapies? (Select all that apply.)

A)Aspirin
B)Morphine
C)Nitrates
D)Antibiotics
E)Oxygen

Question 29

Matching
Place the events of arterial obstruction in proper sequence.

Step: 5

A)Platelets adhere to plaque.
B)Deposits of low-density lipoproteins (LDLs) accumulate.
C)Fibrous plaque is laid down in vessel.
D)Streaks of fatty material are laid down in arteries.
E)Platelets clump.
F)Platelets calcify.

Question 30

Matching
Place the events of arterial obstruction in proper sequence.

Step: 1

A)Platelets adhere to plaque.
B)Deposits of low-density lipoproteins (LDLs) accumulate.
C)Fibrous plaque is laid down in vessel.
D)Streaks of fatty material are laid down in arteries.
E)Platelets clump.
F)Platelets calcify.

Question 31

During the acute phase following a myocardial infarction (MI),the nurse prepares for the possibility of the patient receiving a temporary pacemaker in which circumstance(s)? (Select all that apply.)

A)The patient's heart rate continues to remain above 100 beats/minute.
B)The patient is experiencing continued angina pain.
C)The patient experiences complete heart block.
D)The patient's systolic BP drops below 100 consistently.
E)The patient's pulse rate remains below 40 beats/minute.

Question 32

Matching
Place the events of arterial obstruction in proper sequence.

Step: 4

A)Platelets adhere to plaque.
B)Deposits of low-density lipoproteins (LDLs) accumulate.
C)Fibrous plaque is laid down in vessel.
D)Streaks of fatty material are laid down in arteries.
E)Platelets clump.
F)Platelets calcify.

Question 33

The nurse encourages the patient who has had a myocardial infarction (MI)to enroll in the outpatient cardiac rehabilitation service,which offers: (Select all that apply.)

A)diet counseling.
B)supervised progressive exercise.
C)stress reduction techniques.
D)sexual counseling.
E)administration of cardiotonic drugs.

Question 34

Herbs and supplements that have been found to lower cholesterol naturally are: (Select all that apply.)

A)garlic.
B)bananas.
C)oatmeal.
D)St. John's wort.
E)soy products.