Nokea
A patient with cardiovascular disease is being treated with amlodipine (Norvasc), a calcium channel blocking agent. The therapeutic effects of calcium channel blockers include which of the following?
- A. Reducing the hearts workload by decreasing heart rate and myocardial contraction
- B. Preventing platelet aggregation and subsequent thrombosis
- C. Reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart
- D. Increasing the efficiency of myocardial oxygen consumption, thus decreasing ischemia and relieving pain
Correct Answer: A
Rationale: Calcium channel blocking agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of the heart muscle contraction. These effects decrease the workload of the heart. Antiplatelet and anticoagulation medications are administered to prevent platelet aggregation and subsequent thrombosis, which impedes blood flow. Beta-blockers reduce myocardial consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced myocardial contractility (force of contraction) to balance the myocardium oxygen needs and supply. Nitrates reduce myocardial oxygen consumption, which decreases ischemia and relieves pain by dilating the veins and, in higher doses, the arteries.
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A nurse is working with a patient who has been scheduled for a percutaneous coronary intervention (PCI) later in the week. What anticipatory guidance should the nurse provide to the patient?
- A. He will remain on bed rest for 48 to 72 hours after the procedure
- B. He will be given vitamin K infusions to prevent bleeding following PCI
- C. A sheath will be placed over the insertion site after the procedure is finished
- D. The procedure will likely be repeated in 6 to 8 weeks to ensure success
Correct Answer: C
Rationale: A sheath is placed over the PCI access site and kept in place until adequate coagulation is achieved. Patients resume activity a few hours after PCI and repeated treatments may or may not be necessary. Anticoagulants, not vitamin K, are administered during PCI.
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 has just admitted a 66-year-old patient for cardiac surgery. The patient tearfully admits to the nurse that she is afraid of dying while undergoing the surgery. What is the nurses best response?
- A. Explore the factors underlying the patients anxiety
- B. Teach the patient guided imagery techniques
- C. Obtain an order for a PRN benzodiazepine
- D. Describe the procedure in greater detail
Correct Answer: A
Rationale: An assessment of anxiety levels is required in the patient to assist the patient in identifying fears and developing coping mechanisms for those fears. The nurse must further assess and explore the patients anxiety before providing interventions such as education or medications.
A patient presents to the ED in distress and complaining of crushing chest pain. What is the nurses priority for assessment?
- A. Prompt initiation of an ECG
- B. Auscultation of the patients point of maximal impulse (PMI)
- C. Rapid assessment of the patients peripheral pulses
- D. Palpation of the patients cardiac apex
Correct Answer: A
Rationale: The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a patient reports pain or arrives in the ED. Each of the other listed assessments is valid, but ECG monitoring is the most time dependent priority.
Family members bring a patient to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data?
- A. The symptoms indicate angina and should be treated as such
- B. The symptoms indicate a pulmonary etiology rather than a cardiac etiology
- C. The symptoms indicate an acute coronary episode and should be treated as such
- D. Treatment should be determined pending the results of an exercise stress test
Correct Answer: C
Rationale: Angina and MI have similar symptoms and are considered the same process, but are on different points along a continuum. That the patients symptoms are unrelieved by rest suggests an acute coronary episode rather than angina. Pale cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be initiated immediately regardless of diagnosis.