PrepU questions ch27

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A client with a family history of coro-

nary artery disease reports experienc-
ing chest pain and palpitations during Smoking cessation
and after morning jogs. What would re-
duce the client's cardiac risk
In the treatment of coronary artery dis-
ease (CAD), medications are often or-
dered to control blood pressure in the
Decrease the workload of the heart
client. Which of the following is a primary
purpose of using beta-adrenergic block-
ers in the nursing management of CAD?
The nurse is reviewing the results of a
total cholesterol level for a client who has
been taking simvastatin. What results 160-190 mg/dL
display the effectiveness of the medica-
tion?
The nurse is to administer morphine sul-
fate to a client with chest pain. What
Count the respiratory rate for bradypnea
initial nursing action is required prior to
administration?
The nurse is reviewing the laboratory
results for a client diagnosed with coro-
nary artery disease (CAD). The client's High
low-density lipoprotein (LDL) level is 115
mg/dL. The nurse interprets this value as
Which is the most important postoper-
ative assessment parameter for a client inadequate tissue perfusion
recovering from cardiac surgery?
A client has recently undergone a coro-
nary artery bypass graft (CABG). The
Atelectasis
nurse should be alert to which respira-
tory complication?
A client with venous insufficiency is in-
structed to exercise, apply elastic stock- Improve venous return
ings, and elevate the extremities. Which

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is the primary benefit for this nursing
management regime?
The nurse is educating the patient about
Take a nitroglycerin and repeat every 5
administering nitroglycerin prior to dis-
minutes if the pain is not relieved until a
charge from the hospital. What informa-
total of 3 are taken. If pain is not relieved,
tion should the nurse include in the in-
activate the emergency medical system
structions?
A nurse teaches a client with angina pec-
toris that he or she needs to take up to
three sublingual nitroglycerin tablets at
5-minute intervals and immediately noti- Headache, hypotension, dizziness, and
fy the health care provider if chest pain flushing
doesn't subside within 15 minutes. What
symptoms may the client experience af-
ter taking the nitroglycerin?
A client is receiving nitroglycerin oint-
ment to treat angina pectoris. The nurse
evaluates the therapeutic effectiveness
of this drug by assessing the client's re- Blood pressure 84/52 mmHg
sponse and checking for adverse effects.
Which vital sign is most likely to reflect
an adverse effect of nitroglycerin?
A nurse reviews a client's medication
history before administering a choliner-
gic blocking agent. Adverse effects of Nitroglycerin
a cholinergic blocking agent may delay
absorption of what medication?
The nurse is caring for a client with coro-
nary artery disease (CAD). What is an
Assess the characteristics of chest pain
appropriate nursing action when evalu-
ating a client with CAD?
Which is a diagnostic marker for inflam-
C-reactive protein (CRP)
mation of vascular endothelium?
A nurse is teaching about risk factors
Family history of coronary heart disease
that increase the probability of heart dis-
Age greater than 45 years for men
ease to a community group. Which risk

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factors will the nurse include in the dis- African-American descent
cussion? Select all that apply Elevated C-reactive protein
A client with CAD thinks diltiazem
(Cardizem) has been causing nausea.
Calcium channel blocker
Diltiazem (Cardizem) is categorized as
which type of drug?
A client presents to the ED reporting
anxiety and chest pain after shoveling
heavy snow that morning. The client
says that nitroglycerin has not been tak-
en for months but upon experiencing this
chest pain did take three nitroglycerin
Nitroglycerin SL
tablets. Although the pain has lessened,
the client states, "They did not work all
that well." The client shows the nurse the
nitroglycerin bottle; the prescription was
filled 12 months ago. The nurse antici-
pates which order by the physician?
Which discharge instruction for self-care
should the nurse provide to a client who
Monitor the site for bleeding or
has undergone a percutaneous translu-
hematoma
minal coronary angioplasty (PTCA) pro-
cedure?
The nurse is caring for a client who
was admitted to the telemetry unit with
a diagnosis of "rule/out acute MI." The
Creatinine kinase-myoglobin (CK-MB)
client's chest pain began 3 hours earli-
level
er. Which laboratory test would be most
helpful in confirming the diagnosis of a
current MI?
The nurse is administering a calcium
channel blocker to a patient who has
Decreases the sinoatrial node auto-
symptomatic sinus tachycardia at a rate
maticity
of 132 bpm. What is the anticipated ac-
tion of the drug for this patient?
An older adult is postoperative day one,
following a coronary artery bypass graft
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(CABG). The client's family members
express concern to the nurse that the
client is uncharacteristically confused. Assess for factors that may be causing
After reporting this change in status to the client's delirium
the health care provider, what additional
action should the nurse take?
A client is receiving anticoagulant thera-
py. What question will the nurse ask the What color is your urine
client to detect any signs of bleeding?
A client is admitted to the emergency
department with chest pain and doesn't
respond to nitroglycerin. The health care
team obtains an electrocardiogram and
administers I.V. morphine. The health
Within 6 hours
care provider also considers adminis-
tering alteplase. This thrombolytic agent
must be administered how soon after
onset of myocardial infarction (MI) symp-
toms?
The nurse is caring for a client ex-
periencing an acute MI (STEMI). The
nurse anticipates the physician will pre-
What time did your chest pain start today
scribe alteplase. Before administering
this medication, which question is most
important for the nurse to ask the client?
A middle-aged client presents to the
ED reporting severe chest discomfort. Chest discomfort not relieved by rest or
Which finding is most indicative of a pos- nitroglycerin
sible myocardial infarction (MI)?
The nurse is assessing a client with se-
vere angina pectoris and electrocardio-
gram changes in the emergency room. Troponin
What is the most important cardiac
marker for the client?
The nurse is assessing a client with sus-
Pericardial friction rub
pected post-pericardiotomy syndrome

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after cardiac surgery. What manifesta-
tion will alert the nurse to this syndrome?
A nurse is teaching a client who receives
Lie down or sit in a chair for 5 to 10
nitrates for the relief of chest pain. Which
minutes after taking the drug.
instruction should the nurse emphasize?
The nurse knows that women and the
elderly are at greater risk for a fatal my-
Vague symptoms
ocardial event. Which factor is the prima-
ry contributor of this cause?
To be effective, percutaneous translumi-
nal coronary angioplasty (PTCA) must
be performed within what time frame,
60 minutes
beginning with arrival at the emergency
department after diagnosis of myocar-
dial infarction (MI)?
The nurse is teaching a client with sus-
pected acute myocardial infarction about
serial isoenzyme testing. When is it best 4-6 hours after pain
to have isoenzyme creatinine kinase of
myocardial muscle (CK-MB) tested?
The nurse is explaining the cause of
angina pain to a client. What will the A lack of oxygen in the heart muscle cells
nurse say most directly caused the pain?
When the postcardiac surgery client
demonstrates restlessness, nausea,
weakness, and peaked T waves, the Hyperkalemia
nurse reviews the client's serum elec-
trolytes, anticipating which abnormality?
Which is a diagnostic marker for inflam-
mation of vascular endothelium
The nurse is reviewing the results of a
total cholesterol level for a client who has
been taking simvastatin. Which results 160-190 mg/dL
display the effectiveness of the medica-
tion

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The nurse reviews laboratory tests for
cardiac biomarkers for a client suspect-
Myoglobin
ed of suffering an MI. What is the earliest
marker of an MI?
A client comes to the health care
provider's office for a follow-up visit 4
weeks after suffering a myocardial in-
"Client walks 4 miles in 1 hour every day"
farction (MI). Which evaluation state-
ment suggests that the client needs
more instruction?
A nurse is caring for a client in the car-
diovascular intensive care unit following
a coronary artery bypass graft. Which central venous pressure reading of 1
clinical finding requires immediate inter-
vention by the nurse?
A client has a blockage in the proxi-
mal portion of a coronary artery and
decides to undergo percutaneous trans-
Ticagrelor
luminal coronary angioplasty (PTCA).
What medication will the nurse expect to
administer during the procedure?
A client with chronic arterial occlusive
disease undergoes percutaneous trans-
luminal coronary angioplasty (PTCA) for
mechanical dilation of the right femoral Aspirin or clopidogrel
artery. After the procedure, the client will
be prescribed long-term administration
of which drug?
A client asks the nurse how long to wait
after taking nitroglycerin before experi-
5 minutes
encing pain relief. What is the best an-
swer by the nurse?
A client with a myocardial infarction (MI)
develops pulmonary crackles and dys-
pnea. A chest X-ray shows evidence of Anterior
pulmonary edema. What type of MI did
this client have?
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The nurse is caring for a client with Ray-
naud's disease. What is an important in- Avoid situations that contribute to is-
struction for a client who is diagnosed chemic episodes
with this disease to prevent an attack?
A client reports chest pain and heavy
breathing when exercising or when
Assess chest pain and administer pre-
stressed. Which is a priority nursing in-
scribed drugs and oxygen
tervention for the client diagnosed with
coronary artery disease?
A client is scheduled for a percuta-
neous transluminal coronary angioplas-
ty (PTCA) immediately following con-
firmed diagnosis of acute myocardial in- "Tell me what concerns you most"
farction. The client is overtly anxious and
crying. Which response by the nurse is
most appropriate?
When a client who has been diagnosed
with angina pectoris reports experienc-
ing chest pain more frequently, even at
rest, that the period of pain is longer, Unstabel
and that it takes less stress for the pain
to occur, the nurse recognizes that the
client is describing which type of angina?
A nurse is reevaluating a client receiv-
ing IV fibrinolytic therapy. Which finding
Altered level of consciousness
requires immediate intervention by the
nurse?
A patient with coronary artery disease
(CAD) is having a cardiac catheteriza-
The patient has at least a 70% occlusion
tion. What indicator is present for the
of a major coronary artery.
patient to have a coronary artery bypass
graft (CABG)?
A patient in the recovery room after car-
diac surgery begins to have extremity
Potassium
paresthesia, peaked T waves, and men-
tal confusion. What type of electrolyte

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imbalance does the nurse suspect this
patient is having?
A nurse is caring for a client who is
exhibiting signs and symptoms charac-
teristic of a myocardial infarction (MI). Assess the client's level of pain and ad-
Which statement describes priorities the minister prescribed analgesics.
nurse should establish while performing
the physical assessment?
When the nurse notes that, after car-
diac surgery, the client demonstrates
low urine output (less than 25 mL/h)
Inadequate fluid volume
with high specific gravity (greater than
1.025), the nurse suspects which condi-
tion
The nurse is caring for a client following
a coronary artery bypass graft (CABG).
The nurse notes persistent oozing of
bloody drainage from various puncture
Protamine sulfate
sites. The nurse anticipates that the
physician will order which medication to
neutralize the unfractionated heparin the
client received?

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