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?

Accepted Answer

The patient's presentation is classic for an acute myocardial infarction (heart attack). The gray, cold, and clammy skin is due to decreased blood flow to the extremities, and the pain description is commonly reported with heart attacks. Angina may produce similar symptoms but is typically described as chest pain or pressure rather than an elephant on the chest. Pericarditis may cause chest pain but is not typically associated with the other manifestations described. Heartburn may cause chest discomfort but is not associated with the other symptoms mentioned.

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?

Accepted Answer

Promptly seeking medical treatment for symptoms of a myocardial infarction can help to minimize the amount of damage to the heart muscle. Option A is incorrect because angina can signify a potential myocardial infarction and its prevention is not the goal of treatment for an acute episode. Option B is incorrect because coronary artery disease cannot be cured, but it can be managed with appropriate medical treatment, lifestyle modifications, and monitoring. Option D is incorrect because risk factors for myocardial infarction may not be decreased through treatment of an acute episode, and ongoing management is necessary to reduce risk factors.

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?

Accepted Answer

Semi-Fowler's position is the best choice for a patient with myocardial infarction as it helps to decrease preload and the heart's workload by placing the patient in a slightly elevated position with the head and feet slightly elevated. This position promotes venous return and allows for better lung expansion and oxygenation. Prone position is not recommended as it can increase preload and the heart's workload, supine position can cause pressure on the vena cava leading to reduced venous return and Sims' position is used for patients undergoing certain medical procedures such as rectal exams.

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?

Accepted Answer

Chest pain is a serious symptom that requires immediate attention. Nurses should follow a chain of command to ensure appropriate interventions are taken. In this scenario, the nurse should notify the RN to assess the patient, initiate appropriate interventions, and possibly call for emergency assistance. Administering aspirin, listening to breath sounds, and applying telemetry may all be appropriate interventions, but they should not be done without first assessing the patient and obtaining orders from the RN.

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?

Accepted Answer

The right pedal pulse is most essential to collect immediately after a cardiac catheterization that accessed the right femoral site because any disruption to blood flow could indicate a complication such as bleeding, hematoma, or arterial occlusion. Collecting the left pedal pulse would also be important, but the right pedal pulse is more directly related to the site of access. The brachial pulses are not as relevant in this situation as they are not directly related to the site of access.

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?

Accepted Answer

Elevating the legs can help reduce edema and improve venous return in patients with peripheral venous disease.

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?

Accepted Answer

Denial of symptoms is a common reason why patients with angina do not seek prompt medical treatment. Some patients may dismiss their symptoms as just "indigestion" or "heartburn."

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?

Accepted Answer

The symptoms of acute pain, numbness, paleness, and coolness in one leg may indicate a potential vascular problem or blood clot. It is important to notify the RN immediately to assess the patient further and potentially initiate emergency treatment. Elevation or applying an extra blanket may not be appropriate interventions, and administering pain medication should not be the priority until the underlying issue is addressed.

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?

Accepted Answer

Varicose veins are caused by the poor function of the valves in the veins, which allow blood to flow backwards and pool in the veins. This can be caused by factors such as genetics, pregnancy, obesity, and standing or sitting for long periods of time. Plaque from high-fat diets does not block the veins, swelling is not caused by bacteria, and damage does not cause veins to spasm and twist.

Question 10

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

Accepted Answer

Smoking and high fat intake are modifiable risk factors that can be addressed through lifestyle changes and behavior modification. Heredity, ethnicity, age, and gender are non-modifiable risk factors that cannot be changed. Therefore, the teaching plan should focus on the modifiable risk factors.

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?

Accepted Answer

Leg exercises can help prevent thrombophlebitis and blood clot formation in patients on bedrest by promoting circulation and preventing stasis of blood flow in the legs. While the other options may be important considerations for patients on bedrest, they are not the primary reason for performing leg exercises.

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?

Accepted Answer

If chest pain persists after taking nitroglycerin, it may indicate a heart attack. Calling an ambulance ensures immediate medical attention and care en route to the hospital.

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?

Accepted Answer

Elevating the legs on pillows helps to reduce edema and pressure, which can also alleviate pain for patients with circulatory issues in their ankles. Keeping the legs lower than the heart would worsen the edema. Increasing intake of red meat and dairy products does not have any significant impact on ankle edema. Elastic bandages should not be wrapped from the knee down as it can cause impaired circulation.

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?

Accepted Answer

The correct action is to take 1 tablet every 5 minutes for three doses until pain is relieved. This is in accordance with the prescribed dosing schedule for nitroglycerin, which instructs patients to take one tablet every 5 minutes for up to three doses if chest pain persists. The other options involve either taking too many tablets too quickly or spacing out the doses too far apart.

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?

Accepted Answer

The patient's refusal to seek care and statement that they feel fine despite experiencing chest pain indicates that they are using denial as a coping mechanism.

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?

Accepted Answer

Keeping the legs down promotes blood flow to the lower extremities and can help manage pain from peripheral arterial disease. Lying down frequently and using a reclining chair may also be helpful, but these options were not listed as choices. Knee flexion exercises may not be helpful for managing pain from peripheral arterial disease.

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?

Accepted Answer

Relieving pain is the highest priority in treating an acute myocardial infarction (heart attack) as it can help improve blood flow and decrease stress on the heart. Limiting fluid intake, supporting the family, and noting emotions are also important aspects of care, but they are not the highest priority in this situation.

Question 18

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

Accepted Answer

Troponin I and myoglobin are specific markers for myocardial damage and are commonly used for the diagnosis of myocardial infarction. Urinalysis and complete blood count may provide helpful information but are not specific for MI. Alkaline phosphatase and prothrombin time are not usually used to diagnose MI. Bleeding time and total cholesterol may be important in assessing risk factors for cardiovascular disease but are not diagnostic for MI.

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?

Accepted Answer

An absent pulse and cyanosis are signs of decreased blood flow and can indicate an emergency situation for patients with peripheral arterial disease. The RN should be notified immediately to initiate appropriate interventions and prevent further complications. Encouraging leg flexion or massaging the foot could potentially worsen the condition and is not appropriate in this situation. Reassessing the pulse in 30 minutes could lead to a delay in treatment and is not recommended.

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?

Accepted Answer

Applying oxygen is the first priority in a patient experiencing chest pain with radiation down the left arm, as it addresses the immediate need to maximize oxygenation to the heart tissue, potentially affected by ischemia or infarction. This intervention helps to prevent further myocardial damage.

Quiz 24: Nursing Care of Patients With Occlusive Cardiovascular Disorders