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When assessing a patient diagnosed with angina pectoris it is most important for the nurse to gather what information?
- A. The patients activities limitations and level of consciousness after the attacks
- B. The patients symptoms and the activities that precipitate attacks
- C. The patients understanding of the pathology of angina
- D. The patients coping strategies surrounding the attacks
Correct Answer: B
Rationale: The nurse must gather information about the patients symptoms and activities, especially those that precede and precipitate attacks of angina pectoris. The patients coping, understanding of the disease, and status following attacks are all important to know, but causative factors are a primary focus of the assessment interview.
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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.
The nurse is participating in the care conference for a patient with ACS. What goal should guide the care teams selection of assessments, interventions, and treatments?
- A. Maximizing cardiac output while minimizing heart rate
- B. Decreasing energy expenditure of the myocardium
- C. Balancing myocardial oxygen supply with demand
- D. Increasing the size of the myocardial muscle
Correct Answer: C
Rationale: Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the patient with ACS. Treatment is not aimed directly at minimizing heart rate because some patients experience bradycardia. Increasing the size of the myocardium is never a goal. Reducing the myocardiums energy expenditure is often beneficial, but this must be balanced with productivity.
Preoperative education is an important part of the nursing care of patients having coronary artery revascularization. When explaining the pre- and postoperative regimens, the nurse would be sure to include education about which subject?
- A. Symptoms of hypovolemia
- B. Symptoms of low blood pressure
- C. Complications requiring graft removal
- D. Intubation and mechanical ventilation
Correct Answer: D
Rationale: Most patients remain intubated and on mechanical ventilation for several hours after surgery. It is important that patients realize that this will prevent them from talking, and the nurse should reassure them that the staff will be able to assist them with other means of communication. Teaching would generally not include symptoms of low blood pressure or hypovolemia, as these are not applicable to most patients. Teaching would also generally not include rare complications that would require graft removal.
A nurse has taken on the care of a patient who had a coronary artery stent placed yesterday. When reviewing the patients daily medication administration record, the nurse should anticipate administering what drug?
- A. Ibuprofen
- B. Clopidogrel
- C. Dipyridamole
- D. Acetaminophen
Correct Answer: B
Rationale: Because of the risk of thrombus formation within the stent, the patient receives antiplatelet medications, usually aspirin and clopidogrel. Ibuprofen and acetaminophen are not antiplatelet drugs. Dipyridamole is not the drug of choice following stent placement.
An adult patient is admitted to the ED with chest pain. The patient states that he had developed unrelieved chest pain that was present for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions?
- A. Thrombolytics, oxygen administration, and nonsteroidal anti-inflammatories
- B. Morphine sulphate, oxygen, and bed rest
- C. Oxygen and beta-adrenergic blockers
- D. Bed rest, albuterol nebulizer treatments, and oxygen
Correct Answer: B
Rationale: The patient with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine sulphate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. NSAIDs and beta-blockers are not normally indicated. Albuterol, which is a medication used to manage asthma and respiratory conditions, will increase the heart rate.