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The nurse is performing an intake assessment on a patient with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?
- A. Whether the patient and involved family members understand the role of genetics in the etiology of the disease
- B. Whether the patient and involved family members understand dietary changes and the role of nutrition
- C. Whether the patient and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately
- D. Whether the patient and involved family members understand the importance of social support and community agencies
Correct Answer: C
Rationale: During the health history, the nurse needs to determine if the patient and involved family members are able to recognize symptoms of an acute cardiac problem, such as acute coronary syndrome (ACS) or HF, and seek timely treatment for these symptoms. Each of the other listed topics is valid, but the timely and appropriate response to a cardiac emergency is paramount.
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The nurse is caring for a patient who has a history of heart disease. What factor should the nurse identify as possibly contributing to a decrease in cardiac output?
- A. A change in position from standing to sitting
- B. A heart rate of 54 bpm
- C. A pulse oximetry reading of 94%
- D. An increase in preload related to ambulation
Correct Answer: B
Rationale: Cardiac output is computed by multiplying the stroke volume by the heart rate. Cardiac output can be affected by changes in either stroke volume or heart rate, such as a rate of 54 bpm. An increase in preload will lead to an increase in stroke volume. A pulse oximetry reading of 94% does not indicate hypoxemia, as hypoxia can decrease contractility. Transitioning from standing to sitting would more likely increase rather than decrease cardiac output.
The physical therapist notifies the nurse that a patient with coronary artery disease (CAD) experiences a much greater-than-average increase in heart rate during physical therapy. The nurse recognizes that an increase in heart rate in a patient with CAD may result in what?
- A. Development of an atrial-septal defect
- B. Myocardial ischemia
- C. Formation of a pulmonary embolism
- D. Release of potassium ions from cardiac cells
Correct Answer: B
Rationale: Unlike other arteries, the coronary arteries are perfused during diastole. An increase in heart rate shortens diastole and can decrease myocardial perfusion. Patients, particularly those with CAD, can develop myocardial ischemia. An increase in heart rate will not usually result in a pulmonary embolism or create electrolyte imbalances. Atrial-septal defects are congenital.
The nurse is calculating a cardiac patients pulse pressure. If the patients blood pressure is 122/76 mm Hg, what is the patients pulse pressure?
- A. 46 mm Hg
- B. 99 mm Hg
- C. 198 mm Hg
- D. 76 mm Hg
Correct Answer: A
Rationale: Pulse pressure is the difference between the systolic and diastolic pressure. In this case, this value is 46 mm Hg (122 - 76 = 46).
The nurse is caring for a patient admitted with angina who is scheduled for cardiac catheterization. The patient is anxious and asks the reason for this test. What is the best response?
- A. Cardiac catheterization is usually done to assess how blocked or open a patients coronary arteries are
- B. Cardiac catheterization is most commonly done to detect how efficiently a patients heart muscle contracts
- C. Cardiac catheterization is usually done to evaluate cardiovascular response to stress
- D. Cardiac catheterization is most commonly done to evaluate cardiac electrical activity
Correct Answer: A
Rationale: Cardiac catheterization is usually used to assess coronary artery patency to determine if revascularization procedures are necessary. A thallium stress test shows myocardial ischemia after stress. An ECG shows the electrical activity of the heart.
The critical care nurse is caring for a patient with a pulmonary artery pressure monitoring system. The nurse is aware that pulmonary artery pressure monitoring is used to assess left ventricular function. What is an additional function of pulmonary artery pressure monitoring systems?
- A. To assess the patients response to fluid and drug administration
- B. To obtain specimens for arterial blood gas measurements
- C. To dislodge pulmonary emboli
- D. To diagnose the etiology of chronic obstructive pulmonary disease
Correct Answer: A
Rationale: Pulmonary artery pressure monitoring is an important tool used in critical care for assessing left ventricular function (cardiac output), diagnosing the etiology of shock, and evaluating the patients response to medical interventions, such as fluid administration and vasoactive medications. Pulmonary artery monitoring is preferred for the patient with heart failure over central venous pressure monitoring. Arterial catheters are useful when arterial blood gas measurements and blood samples need to be obtained frequently. Neither intervention is used to clear pulmonary emboli.