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The nurse is caring for a client who is suspected of having coronary artery disease. The client is scheduled to have a nuclear stress test using thallium. When would the thallium be injected to determine narrowing of the coronary arteries?
- A. During and a few hours after exercise electrocardiography
- B. Before and during exercise electrocardiography
- C. Before and a few hours after exercise electrocardiography
- D. Before, during, and a few hours after exercise electrocardiography
Correct Answer: A
Rationale: A nuclear stress test using a radionuclide, such as thallium, may be injected intravenously (IV) during and a few hours after exercise electrocardiography, followed by a heart scan. Narrowing of one or more coronary arteries is documented during coronary arteriography.
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Which nursing problem statement is most significant in planning the care for a client with Raynaud syndrome?
- A. Acute Pain
- B. Coping Impairment
- C. ADL Deficit
- D. Activity Intolerance
Correct Answer: A
Rationale: The hallmark symptom of Raynaud syndrome is acute pain related to the arterial insufficiency. ADL Deficit, Coping Impairment, and Activity Intolerance can occur but are less significant than Acute Pain.
The nurse provides care to a menopausal client who states, 'I read a news article that says I am at risk for coronary vascular disease due to inflammation.' Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis?
- A. Addressing obesity
- B. Avoiding the use of caffeine
- C. Taking a daily multivitamin
- D. Drinking at least 2 liters of water a day
Correct Answer: A
Rationale: The 2019 ACC/AHA Guideline on the Primary Prevention of Coronary Vascular Disease (CVD) indicates a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests that decreasing obesity and body fat stores via exercise, dietary modification, or developing drugs that target proinflammatory proteins may reduce risk factors for heart disease. The risk for CVD accelerates for clients after menopause due to withdrawal of endogenous estradiol levels, which can worsen many traditional CVD risk factors, including body fat distribution. Avoiding the use of caffeine, using a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to atherosclerosis.
Severe chest pain is reported by a client during an acute myocardial infarction. Which of the following is the most appropriate drug for the nurse to administer?
- A. Isosorbide mononitrate (Isordil)
- B. Meperidine hydrochloride (Demerol)
- C. Morphine sulfate (Morphine)
- D. Nitroglycerin transdermal patch
Correct Answer: C
Rationale: Morphine sulfate not only decreases pain perception and anxiety but also helps to decrease heart rate, blood pressure, and demand for oxygen. Nitrates are administered for vasodilation and pain control in clients with angina-type pain, but oral forms (such as isosorbide dinitrate) have a large first-pass effect, and transdermal patch is used for long-term management. Meperidine hydrochloride is a synthetic opioid usually reserved for treatment of postoperative or migraine pain.
A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client?
- A. Coronary artery disease
- B. Raynaud syndrome
- C. Cardiogenic shock
- D. Venous occlusive disease
Correct Answer: A
Rationale: The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud syndrome in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.
A client with a strong family history of coronary artery disease asks the nurse how to reduce the risk of developing the disorder. Which is the best response by the nurse?
- A. Moderation is the key to everything
- B. Ask your physician to prescribe the new reverse lipid drug
- C. Increase the soy in your diet
- D. Exercise, keep your blood sugar in check, and manage your stress
Correct Answer: D
Rationale: Although moderation is the key, this does not provide specific options for this client such as regular exercise and managing stress and cholesterol levels. The reverse lipid drug sounds good but is not available or approved by the FDA. Soy products have limited benefits for cholesterol control.