Nokea
The nurse is caring for a patient who has undergone percutaneous transluminal coronary angioplasty (PTCA). What is the major indicator of success for this procedure?
- A. Increase in the size of the arterys lumen
- B. Decrease in arterial blood flow in relation to venous flow
- C. Increase in the patients resting heart rate
- D. Increase in the patients level of consciousness (LOC)
Correct Answer: A
Rationale: PTCA is used to open blocked coronary vessels and resolve ischemia. The procedure may result in beneficial changes to the patients LOC or heart rate, but these are not the overarching goals of PTCA. Increased arterial flow is the focus of the procedures.
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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.
The nurse is caring for a patient who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what?
- A. Lipids and fibrous tissue
- B. White blood cells
- C. Lipoproteins
- D. High-density cholesterol
Correct Answer: A
Rationale: As T-lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue develops. This causes plaques to form on the inner lumen of arterial walls. These plaques do not consist of white cells, lipoproteins, or high-density cholesterol.
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.
A patient presents to the walk-in clinic complaining of intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the patient that angina is most often attributable to what cause?
- A. Decreased cardiac output
- B. Decreased cardiac contractility
- C. Infarction of the myocardium
- D. Coronary arteriosclerosis
Correct Answer: D
Rationale: In most cases, angina pectoris is due to arteriosclerosis. The disease is not a result of impaired cardiac output or contractility. Infarction may result from untreated angina, but it is not a cause of the disease.
The nurse is caring for an adult patient who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina?
- A. Ineffective breathing pattern related to decreased cardiac output
- B. Anxiety related to fear of death
- C. Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD)
- D. Impaired skin integrity related to CAD
Correct Answer: C
Rationale: Ineffective cardiopulmonary tissue perfusion directly results in the symptoms of discomfort associated with angina. Anxiety and ineffective breathing may result from angina chest pain, but they are not the causes. Skin integrity is not impaired by the effects of angina.