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The nurse is caring for an older adult client who is deciding whether to have cardiovascular surgery. The client asks the nurse why the risks are greater for them than for a younger person. What would be the nurse's answer?
- A. Many older adults have comorbidities in addition to their cardiac problems.
- B. Older adults have the same risk factors as younger adults.
- C. Older adults have hypersensitive renal systems, and younger adults don't.
- D. Older adults have different thought processes than younger adults do.
Correct Answer: A
Rationale: Many older adults have comorbidities such as diabetes, heart failure, cardiac dysrhythmias, hypertension, and poor renal function, necessitating careful consideration regarding the potential risks and benefits of cardiovascular surgery. These clients require close observation during the postoperative period. The other options are incorrect.
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The nursing instructor is giving a class on assessing cardiac clients after thoracic surgery. What assessment is most important for the nurse to perform when caring for this client?
- A. Pulmonary artery pressure
- B. Temperature
- C. Skin and mentation
- D. Blood pressure
Correct Answer: D
Rationale: The nurse assesses the blood pressure (BP) and pulse rate in both arms after thoracic surgery. Although it is necessary for the nurse to also assess pulmonary artery pressure, temperature, skin, and mentation after thoracic surgery, blood pressure and pulse rate are the most essential assessments.
A client has experienced a myocardial infarction (MI). After the acute stage of the MI, what is the most lethal complication the nurse should be aware can occur?
- A. Thrombophlebitis
- B. Ventricular aneurysm
- C. Mitral valve prolapse
- D. Septic shock
Correct Answer: B
Rationale: A ventricular aneurysm is the most lethal complication among clients who survive the acute stage of a myocardial infarction (MI). Thrombophlebitis is a complication of immobility. Mitral valve prolapse is an acquired disorder that is not a complication from having an MI. Cardiogenic shock, not septic shock, is a complication after sustaining an MI.
A client recently had a myocardial infarction (MI) and asks the nurse if he will require a heart transplant. Based on the nurse's knowledge of indications for heart transplant, what is the best response?
- A. No. Heart transplant is indicated for cardiomyopathy, end-stage coronary artery disease, and end-stage heart failure.
- B. No. Heart transplant is only indicated for congenital heart defects.
- C. Yes. You may require a heart transplant if you have another heart attack.
- D. Yes. Your heart will not function as well as it did before the heart attack, and a new heart will give you the best chance for survival.
Correct Answer: A
Rationale: In adults, heart transplantation is indicated for cardiomyopathy, end-stage coronary artery disease, and end-stage heart failure. In newborns and infants, heart transplantation is indicated for a severe congenital cardiac defect. It is performed only when other treatment modalities fail or are unavailable. It is not used to treat clients after an MI unless they meet any of the given criteria.
The nurse is answering questions that the client and family have about the upcoming cardiovascular surgery the client is having. What expected outcome would be best for a nursing diagnosis of Knowledge Deficiency related to unfamiliarity with diagnostic tests, preoperative preparations, and postoperative care?
- A. Client and family will understand the purpose, preparation, and aftercare of tests and surgery.
- B. Provide verbal and written information concerning the surgical procedure and aftercare.
- C. Ask the client or family member to explain the surgical procedure before signing the consent form.
- D. Clarify misconceptions concerning surgery.
Correct Answer: A
Rationale: Client and family will understand the purpose, preparation, and aftercare of tests and surgery is an outcome statement that would be appropriate for the diagnostic statement. The other statements are all interventions that are associated with the diagnostic statement.
A client is in the intensive care unit with a diagnosis of severe uncontrolled hypertension. What method of monitoring would best meet the needs of this client?
- A. Central venous pressure monitoring
- B. Direct blood pressure monitoring
- C. Pulmonary artery pressure monitoring
- D. Manual blood pressure readings with a sphygmomanometer
Correct Answer: B
Rationale: Direct blood pressure monitoring continuously displays the waveform and indicates the client's systolic, diastolic, and mean arterial pressures. This type of equipment eliminates the need to auscultate the BP. Direct BP monitoring may be used in clients with severe and sustained hypertension or hypotension and during and after cardiac surgery. Central venous pressure monitoring would be used to detect an excess or deficit in venous blood volume and would not be indicated for this client. Pulmonary artery pressure monitoring aids in the early treatment of fluid imbalances prevents left-sided heart failure or promotes its early correction and helps monitor the client's response to treatment and would not be indicated for this client. A manual reading is dependent on who takes the BP and can vary in its readings. It is not as accurate as the direct blood pressure monitoring.