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A client is 2 days postoperative from mitral valve replacement and is in pain at an 8 on a 0 to 10 scale. What intervention(s) can the nurse provide to control the pain before it gets to this level? Select all that apply.
- A. Suggest the client be placed on a patient-controlled analgesia (PCA) pump.
- B. Administer a non-narcotic analgesic between prescribed doses of narcotic analgesics.
- C. Administer the pain medication prior to the pain becoming severe.
- D. Wait until the client asks for the pain medication.
- E. Administer the narcotic analgesic more frequently.
Correct Answer: A,B,C
Rationale: Small, frequent self-administration of an opioid drug controls acute pain within consistently tolerable levels. Administer non-narcotic analgesics between prescribed doses of narcotic analgesics. Non-narcotics have a different mechanism of action and are not likely to cause respiratory depression or depressed level of consciousness if given concurrently with narcotics. Pain is more easily controlled by giving analgesic medication before the pain becomes severe, so the nurse would not wait until the client to ask for the pain medication. The nurse cannot administer more of the narcotic than the physician prescriptions.
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When discussing the nursing process, the instructor stresses that for clients undergoing cardiac surgery, it is important for the nurse to demonstrate competence. What is the rationale for this statement?
- A. To acknowledge the client's emotion
- B. To encourage verbal conversation
- C. To relieve the client's insecurity and anxiety
- D. To encourage the client to communicate
Correct Answer: C
Rationale: When the nurse is knowledgeable and competent, it relieves the client's insecurity and anxiety regarding the surgery.
A client has a pulmonary artery catheter for monitoring and to ensure fluid balance. When measuring pulmonary capillary wedge pressure, the nurse forgets to deflate the balloon and leaves it inflated. What outcome can be the result of this action by the nurse?
- A. Pulmonary embolism
- B. Pulmonary edema
- C. A myocardial infarction
- D. Pulmonary infarction
Correct Answer: D
Rationale: When measuring pulmonary capillary wedge pressure, the balloon must be deflated immediately after the pressure is measured to avoid pulmonary infarction from prolonged blockage of capillary blood flow. Pulmonary embolism, pulmonary edema, and myocardial infarction would not be the result of not deflating the balloon initially.
The pathophysiology instructor is discussing heart disease with a class of prenursing students. One of the students asks what indications there are for coronary artery bypass surgery. What would be an acceptable answer(s) from the instructor? Select all that apply.
- A. Atheromas are calcified and noncompressible.
- B. The heart cannot be repaired without compromising oxygenation of the body.
- C. The client has multiple coronary artery occlusions.
- D. Transluminal coronary angioplasty is necessary.
- E. The Anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter.
Correct Answer: A,B,E
Rationale: A coronary artery bypass is performed when (1) the client has multiple coronary artery occlusions, (2) the atheromas are calcified and noncompressible, or (3) the anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter. This makes the other options incorrect.
The nurse is preparing a client for coronary artery bypass surgery. What vessel does the nurse know is most commonly used for grafting?
- A. Saphenous vein
- B. Basilic vein
- C. Radial artery
- D. Gastroepiploic artery
Correct Answer: A
Rationale: The saphenous vein in the leg is the vessel most often used for grafting in coronary artery bypass. The basilic vein in the arm, radial artery in the arm, and gastroepiploic artery from the stomach are alternative graft vessels.
After being discharged from the hospital after undergoing cardiothoracic surgery, the client asks the nurse when it will be possible to resume sexual activity. What is the best response by the nurse?
- A. I can't believe you are worried about that so soon after your surgery.
- B. You won't be able to resume sexual activity until your 6-month checkup with the surgeon.
- C. In about 2 to 4 weeks if you are able to climb stairs without difficulty breathing or chest pain.
- D. You may have a difficult time resuming sexual activities after this surgery.
Correct Answer: C
Rationale: Sexual relations usually can be resumed in 2 to 4 weeks after cardiothoracic surgery depending on one's comfort level and tolerance for activity; climbing two flights of stairs without dyspnea or chest pain is a common guideline. The other options are nontherapeutic responses to the client's concern. Six months is an excessively long time period to wait if the client has been able to resume activities without shortness of breath or chest pain.