Deck 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery

Question 1

The nurse is caring for a post-myocardial infarction (MI)patient.The patient questions the reason for a stool softener and denies constipation.Which statement indicates that the patient accurately understands the nurse's teaching?

A) "Stool softeners help me keep from straining during bowel movements, which can lower my heart rate."
B) "Stool softeners help me to get rid of extra wastes that can harm my heart."
C) "Stool softeners help reduce swelling that can increase work on my heart."
D) "Stool softeners help to reduce discomfort from gas pains."

Answer 1

"Stool softeners help me keep from straining during bowel movements, which can lower my heart rate."

Question 2

The nurse assesses a friction rub in a patient who is 2 days post-myocardial infarction (MI).The nurse recognizes this finding indicates which problem?

A) A recurrent MI
B) Pleural effusion
C) Pericarditis
D) Angina

Answer 2

Pericarditis

Question 3

The nurse is caring for a post-myocardial infarction (MI)patient who has been started on daily simvastatin (Zocor)and a low-fat diet.Which statement best indicates that the nurse's teaching has been successful?

A) "I will need to have blood work every month while taking Zocor."
B) "I should take my Zocor with grapefruit juice to help absorption.
C) "I should call my doctor if I experience unexplained muscle pain."
D) "I should take Zocor an hour before my biggest meal of the day."

Answer 3

"I should call my doctor if I experience unexplained muscle pain."

Question 4

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 able to ambulate within a few hours 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 5

The nurse performs patient teaching about minimally invasive direct coronary artery bypass (MIDCAB).Which statement indicates that the patient needs further instruction?

A) "It frightens me to think that my heart will be stopped for a long time 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 6

The nurse is caring for a 38-year-old African American patient with diabetes.The patient manages her diabetes with dietary control,takes oral contraceptives,and is a nonsmoker.Which characteristic(s)in this patient's history increase the patient's risk for coronary artery disease (CAD)?

A) Age
B) Race
C) Diabetes
D) Nonsmoker status
E) Use of oral contraceptives

Question 7

The nurse is educating a patient on a low-fat,low-cholesterol diet after a myocardial infarction (MI).Which food choice should the nurse recommend?

A) "Avoid eating frozen foods."
B) "Replace a serving of red meat with a serving of fish."
C) "Use nondairy creamer in your decaffeinated coffee."
D) "Drink a serving of grapefruit juice each day."

Question 8

The nurse is caring for a patient with uncontrolled hypertension,diabetes,asthma,and gastroesophageal reflux disease (GERD).Which problem serves as a contraindication for a thrombolytic agent?

A) Uncontrolled hypertension
B) Diabetes
C) Asthma
D) GERD

Question 9

The nurse is caring for a patient with agina pectoris who asks what happens to make his body experience pain.The nurse explains that pain results from which underlying causative factor?

A) Congestion that backs up into the lungs
B) Inadequate blood flow and poor oxygen supply
C) Edema from fluid overload
D) Inflammation in the vessels

Question 10

The nurse is caring for a patient who underwent a transfemoral cardiac catheterization with coronary angiography earlier in the day.The patient denies pain and no longer requires bed rest.The groin is soft with no palpable hematoma.Which postprocedure care is most important for the patient at this time?

A) Encourage increased fluid intake.
B) Administer pain medications as ordered.
C) Obtain vital signs every 15 minutes.
D) Assist the patient with ambulation.

Question 11

The patient with angina asks the nurse how a daily dose of 81 mg of aspirin is helpful.Which reply is best?

A) Low-dose aspirin helps reduce clotting.
B) Low-dose aspirin helps dilate coronary vessels.
C) Low-dose aspirin helps alleviates pain associated with angina.
D) Low-dose aspirin helps lower cholesterol.

Question 12

The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI).The nurse observes that the patient is experiencing electrocardiogram (ECG)changes and reviews new laboratory results.Which laboratory value should the nurse report immediately?

A) Troponin of 2.4 mcg/L
B) Potassium of 3.4 mEq/L
C) Creatine phosphokinase of 134 IU/L
D) Sodium of 133 mEq/L

Question 13

A patient who presented to the emergency room with a myocardial infarction (MI)becomes pale,diaphoretic,and hypotensive.What action should the nurse take first?

A) Notify the physician immediately.
B) Ensure that the patient has patent IV access.
C) Request assistance from respiratory therapy.
D) Inform the patient's family of the change in status.

Question 14

The drug alteplase (t-PA)is given to the patient with a myocardial infarction (MI).Which statement accurately describes the purpose of this medication?

A) "Alteplase (t-PA) dissolves the obstruction in the coronary artery."
B) "Alteplase (t-PA) dilates vessels to relieve pain."
C) "Alteplase (t-PA) strengthens cardiac contraction."
D) "Alteplase (t-PA) increases cardiac output."

Question 15

The patient being evaluated for a heart transplant asks the nurse what the survival rate is.Which response is best for the nurse to make?

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 79%."
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 16

The nurse is explaining the difference between exertional angina and unstable angina.Which statement about unstable angina is accurate?

A) Unstable angina occurs with moderate exercise.
B) Unstable angina occurs when the blood pressure increases sharply.
C) Unstable angina occurs when the body reacts to high stress levels.
D) Unstable angina occurs unpredictably, even in sleep.

Question 17

The nurse is caring for a female patient with a family history of heart disease who is undergoing a workup for cardiovascular disease.Which finding is most concerning to the nurse?

A) Fainting
B) Dry mouth
C) Dizziness
D) Fatigue

Question 18

The nurse is caring for a male patient with angina who has a new prescription for sublingual nitroglycerin.What information is most important for the nurse to include in the teaching plan?

A) Nitroglycerin tablets expire 3 months after the bottle is opened.
B) Take a second tablet 15 minutes after the first dose and call the physician if pain persists.
C) Store nitroglycerin tablets in a cool, dark location.
D) Nitroglycerin may cause an unsafe drop in heart rate when combined with certain medications for erectile dysfunction.

Question 19

How does a myocardial infarction (MI)alter the pumping efficiency of the heart?

A) An MI reduces the impulse from the sinoatrial node.
B) An MI causes myocardial necrosis.
C) An MI shunts all myocardial blood flow to a specific cardiac region.
D) An MI causes myocardial swelling and inflammation.

Question 20

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 is most supportive?

A) "You are doing great! You can do all of 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. Would you like 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 21

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 22

The nurse encourages the patient who has had a myocardial infarction (MI)to enroll in the outpatient cardiac rehabilitation in order to receive which service(s)?

A) Nutritional counseling
B) Supervised progressive exercise
C) Stress reduction techniques
D) Sexual counseling
E) Administration of cardiotonic drugs

Question 23

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 24

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?

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

Question 25

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

Question 26

The nurse is aware that a positive diagnosis of a myocardial infarction (MI)is based on which diagnostic test finding(s)?

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

Question 27

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 28

Which herbs and supplements lower cholesterol?

A) Garlic
B) Bananas
C) Oatmeal
D) St. John's wort
E) Soy products

Question 29

During the acute phase following a myocardial infarction (MI),the nurse anticipates that the patient may require a temporary pacemaker in which situation(s)?

A) The patient's heart rate remains above 120 beats/min.
B) The patient experiences worsening anginal pain.
C) The patient experiences complete heart block.
D) The patient's systolic BP drops to 60.
E) The patient's pulse rate remains below 40 beats/min.

Question 30

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 31

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 32

The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium.Which factors are causative agents for angina?

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

Question 33

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 34

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