Nokea
The pathophysiology instructor is discussing heart disease with a class of prenursing students. One of the students asks what indications there are for coronary artery bypass surgery. What would be an acceptable answer(s) from the instructor? Select all that apply.
- A. Atheromas are calcified and noncompressible.
- B. The heart cannot be repaired without compromising oxygenation of the body.
- C. The client has multiple coronary artery occlusions.
- D. Transluminal coronary angioplasty is necessary.
- E. The Anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter.
Correct Answer: A,B,E
Rationale: A coronary artery bypass is performed when (1) the client has multiple coronary artery occlusions, (2) the atheromas are calcified and noncompressible, or (3) the anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter. This makes the other options incorrect.
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The nurse is obtaining vital signs for a client in the clinic who has had a cardiac transplant. The nurse obtains an apical heart rate of 110 beats/minute. What is a priority action by the nurse?
- A. Obtain an electrocardiogram.
- B. Notify the physician.
- C. No action is required because the transplanted heart beats faster than the natural heart.
- D. Administer a calcium channel blocker to decrease the heart rate.
Correct Answer: C
Rationale: The transplanted heart beats faster than the client's natural heart, averaging about 100 to 110 beats/minute, because nerves that affect heart rate have been severed. The new heart also takes longer to increase the heart rate in response to exercise. If the client is asymptomatic, there is no reason to obtain an ECG or notify the physician. The nurse would not administer the calcium channel blocker without a physician's prescription.
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.
The nurse is caring for a client who is having a mitral valve replacement with a mechanical valve. What instructions should the nurse be sure the client understands prior to being discharged?
- A. The valve should last for 10 to 15 years.
- B. The client will require anticoagulation.
- C. There is a low potential for thrombi formations so anticoagulation is not necessary.
- D. The valve is prone to calcification.
Correct Answer: B
Rationale: A mechanical valve should last at least 20 years. The disadvantages are the risk for thrombi and emboli, so anticoagulation is necessary. There is a risk of bleeding, and there can be a sudden malfunction in the valve. An allograft will last 10 to 15 years. A bioprosthetic valve does not require anticoagulation but is prone to deterioration and calcification.
A client has just had cardiothoracic surgery and tells the nurse about having a 6-month-old grandchild. The client states, 'I can't wait to hold my grandchild!' What is the best response by the nurse?
- A. I bet your grandchild is wonderful, and I know you are glad you made it through the surgery.
- B. I am sure you are excited to see your grandchild, but you must refrain from lifting, pushing, or pulling anything over 10 pounds for at least 6 to 12 weeks.
- C. You will not be able to lift that grandchild for at least 6 months, but you can sit with him and play.
- D. You have done so well after your surgery, and there are no restrictions for your activities.
Correct Answer: B
Rationale: The client must refrain from lifting, pushing, or pulling anything that weighs more than 10 lb. until the physician relieves the restriction in approximately 6 to 12 weeks. Telling the client 'I know you are glad you made it through the surgery' is not an informative or therapeutic response. Six months for lifting is an excessive time frame for activity to resume. There are several restrictions that the client should be made aware of during the postoperative time period.
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.