Nokea
A patient with an occluded coronary artery is admitted and has an emergency percutaneous transluminal coronary angioplasty (PTCA). The patient is admitted to the cardiac critical care unit after the PTCA. For what complication should the nurse most closely monitor the patient?
- A. Hyperlipidemia
- B. Bleeding at insertion site
- C. Left ventricular hypertrophy
- D. Congestive heart failure
Correct Answer: B
Rationale: Complications of PTCA may include bleeding at the insertion site, abrupt closure of the artery, arterial thrombosis, and perforation of the artery. Complications do not include hyperlipidemia, left ventricular hypertrophy, or congestive heart failure; each of these problems takes an extended time to develop and none is emergent.
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In preparation for cardiac surgery, a patient was taught about measures to prevent venous thromboembolism. What statement indicates that the patient clearly understood this education?
- A. Ill try to stay in bed for the first few days to allow myself to heal
- B. Ill make sure that I dont cross my legs when Im resting in bed
- C. Ill keep pillows under my knees to help my blood circulate better
- D. Ill put on those compression stockings if I get pain in my calves
Correct Answer: B
Rationale: To prevent venous thromboembolism, patients should avoid crossing the legs. Activity is generally begun as soon as possible and pillows should not be placed under the popliteal space. Compression stockings are often used to prevent venous thromboembolism, but they would not be applied when symptoms emerge.
The nurse is caring for patient who tells the nurse that he has an angina attack beginning. What is the nurses most appropriate initial action?
- A. Have the patient sit down and put his head between his knees
- B. Have the patient perform pursed-lip breathing
- C. Have the patient stand still and bend over at the waist
- D. Place the patient on bed rest in a semi-Fowlers position
Correct Answer: D
Rationale: When a patient experiences angina, the patient is directed to stop all activities and sit or rest in bed in a semi-Fowlers position to reduce the oxygen requirements of the ischemic myocardium. Pursed-lip breathing and standing will not reduce workload to the same extent. No need to have the patient put his head between his legs because cerebral perfusion is not lacking.
When discussing angina pectoris secondary to atherosclerotic disease with a patient, the patient asks why he tends to experience chest pain when he exerts himself. The nurse should describe which of the following phenomena?
- A. Exercise increases the hearts oxygen demands
- B. Exercise causes vasoconstriction of the coronary arteries
- C. Exercise shunts blood flow from the heart to the mesenteric area
- D. Exercise increases the metabolism of cardiac medications
Correct Answer: A
Rationale: Physical exertion increases the myocardial oxygen demand. If the patient has arteriosclerosis of the coronary arteries, then blood supply is diminished to the myocardium. Exercise does not cause vasoconstriction or interfere with drug metabolism. Exercise does not shunt blood flow away from the heart.
The nurse is providing care for a patient with high cholesterol and triglyceride values. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following?
- A. High HDL values and high triglyceride values
- B. Absence of detectable total cholesterol levels
- C. Elevated blood lipids, fasting glucose less than 100
- D. Low LDL values and high HDL values
Correct Answer: D
Rationale: The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol.
The nurse is working with a patient who had an MI and is now active in rehabilitation. The nurse should teach this patient to cease activity if which of the following occurs?
- A. The patient experiences chest pain, palpitations, or dyspnea
- B. The patient experiences a noticeable increase in heart rate during activity
- C. The patients oxygen saturation level drops below 96%
- D. The patients respiratory rate exceeds 30 breaths/min
Correct Answer: A
Rationale: Any activity or exercise that causes dyspnea and chest pain should be stopped in the patient with CAD. Heart rate must not exceed the target rate, but an increase above resting rate is expected and is therapeutic. In most patients, a respiratory rate that exceeds 30 breaths/min is not problematic. Similarly, oxygen saturation slightly below 96% does not necessitate cessation of activity.