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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.
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A 48-year-old man presents to the ED complaining of severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU?
- A. Begin ECG monitoring
- B. Obtain information about family history of heart disease
- C. Auscultate lung fields
- D. Determine if the patient smokes
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. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored; life-threatening arrhythmias are the leading cause of death in the first hours after an MI. Obtaining information about family history of heart disease and whether the patient smokes are not immediate priorities in the acute phase of MI. Data may be obtained from family members later. Lung fields are auscultated after oxygenation and pain control needs are met.
A patient who is postoperative day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurses most appropriate action?
- A. Document the patients low urine output and monitor closely for the next several hours
- B. Contact the dietitian and suggest the need for increased oral fluid intake
- C. Contact the patients physician and suggest assessment of fluid balance and renal function
- D. Increase the infusion rate of the patients IV fluid to prompt an increase in renal function
Correct Answer: C
Rationale: Nursing management includes accurate measurement of urine output. An output of less than 1 mL/kg/h may indicate hypovolemia or renal insufficiency. Prompt referral is necessary. IV fluid replacement may be indicated, but is beyond the independent scope of the dietitian or nurse.
The public health nurse is participating in a health fair and interviews a patient with a history of hypertension, who is currently smoking one pack of cigarettes per day. She denies any of the most common manifestations of CAD. Based on these data, the nurse would expect the focuses of CAD treatment most likely to be which of the following?
- A. Drug therapy and smoking cessation
- B. Diet and drug therapy
- C. Diet therapy only
- D. Diet therapy and smoking cessation
Correct Answer: D
Rationale: Due to the absence of symptoms, dietary therapy would likely be selected as the first-line treatment for possible CAD. Drug therapy would be determined based on a number of considerations and diagnostics findings, but would not be directly indicated. Smoking cessation is always indicated, regardless of the presence or absence of symptoms.
The ED nurse is caring for a patient with a suspected MI. What drug should the nurse anticipate administering to this patient?
- A. Oxycodone
- B. Warfarin
- C. Morphine
- D. Acetaminophen
Correct Answer: C
Rationale: The patient with suspected MI is given aspirin, nitroglycerin, morphine, an IV beta-blocker, and other medications, as indicated, while the diagnosis is being confirmed. Tylenol, warfarin, and oxycodone are not typically used.
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.