question

What is a correct understanding of an electrocardiogram (ECG)?

answer

The P wave indicates the beginning of the firing of the sinoatrial (SA) node and represents depolarization of the fibers of the atria. Normally, there should be a P wave before every QRS.

question

What does T wave represent?

answer

repolarization of the ventricles

question

What patient assessment is most likely to have a negative effect on cardiac output?

answer

An ECG indicating LV ischemia

question

Which is accurate related to factors affecting cardiac output?

answer

Contractility is increased by epinephrine or norepinephrine, which are normally released by the sympathetic nervous system, but each can be administered as a drug.

question

Preload?

answer

volume of blood in the ventricles at the end of diastole, before the next contraction. It determines the amount of stretch placed on myocardial fibers.

question

Afterload?

answer

periphearl resistance against which the LV must pump. It is affected by the size of the ventricle, wall tension, and arterial blood pressure.

question

What is auscultatory gap when measuring arterial blood pressure?

answer

the loss of sound between the systolic and diastolic blood pressures, and it occasionally is heard.

question

A patient with a tricuspid valve disorder has impaired blood flow between the?

answer

RA & RV

question

The right coronary artery (RCA) supplies blood to?

answer

the right atrium, the right ventricle, and a portion of the posterior wall of the left ventricle.

question

If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the

answer

ventricles

question

The portion of the vascular system responsible for hemostasis is the

answer

innermost lining of the arteries is the endothelium. The endothelium maintains hemostasis, promotes blood flow, and under normal conditions, inhibits blood coagulation.

question

When a person's blood pressure rises, the homeostatic mechanism that compensates for the elevation involves stimulation of?

answer

barorecpetors that inhibit the sympathetic nervous system, causing vasodilation.

question

A P wave on an ECG represents?

answer

firing of the SA node and represents depolarization of the fibers of the atria.

question

Cardiac output formula?

answer

CO = SV x HR

question

Expected CV changes in elderly patients

answer

arterial stiffening increased BP/lower HR Increased recover time from activity.

question

What are considered significant findings related to cardiac disease

answer

Attacks of shortness of breath, especially at night, that awaken the patient are associated with heart failure. History of improperly treated streptococcal sore throat can cause heart valve damage. Nocturia is a common finding with cardiovascular patients.

question

Which is the best method to document a patient's tobacco use and risk of heart disease?

answer

The most informative method is pack-years, which is the number of packs smoked per day multiplied by the number of years the patient has smoked.

question

When collecting subjective data related to the cardiovascular system, which data should be obtained from the patient

answer

smoking history, religion, number of pillow used to sleep. The health history should include assessment of tobacco use. The patient should be asked about cultural or religious beliefs that may influence management of the cardiovascular problem. Patients with heart failure may need to sleep with the head elevated on pillows or in a chair.

question

When assessing a patient, you notice a pulse deficit of 23 beats. This finding may be caused by

answer

A pulse deficit occurs if there is a difference between the apical and radial beats per minute. A pulse deficit indicates cardiac dysrhythmias.

question

When assessing the cardiovascular system of a 79-year-old patient, you expect to find

answer

Myocardial hypertrophy and the downward displacement of the heart in an older adult may result in difficulty isolating the apical pulse.

question

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What age-related change contributes to this finding?

answer

An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results.

question

Auscultation of a patient's heart reveals a murmur. This assessment finding is a result of

answer

Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.

question

While assessing the cardiovascular status of a patient, you perform auscultation. Which practice should you implement into the assessment during auscultation?

answer

palpate radial pulse while auscultating the apical.

question

Which statement is accurate regarding blood work results in assessing cardiac function?

answer

Btype natriuretic peptide (BNP) helps differentiate b/w cardiac or respiratory cause of dyspnea.

question

ejection fraction (EF)

answer

The EF is the percentage of end-diastolic blood volume that is ejected during systole. It provides information about the function of the left ventricle during systole.

question

Which nursing responsibilities are priorities when caring for a patient returning from cardiac catheterization

answer

The nursing responsibilities after cardiac catheterization include assessing the puncture site for hematoma and bleeding; assessing circulation to the extremity used for catheter insertion and peripheral pulses, color, and sensation of the extremity; and monitoring vital signs and ECG rhythm.

question

You are admitting a patient who is scheduled to undergo a cardiac catheterization. Which allergies are most important for you to assess before this procedure?

answer

iodine

question

A 59-year-old man has presented to the emergency department with chest pain. Which component of his subsequent blood work most clearly indicates a myocardial infarction (MI)?

answer

Troponin

question

What is important to teach a patient taking hydrochlorothiazide (HydroDIURIL) for hypertension?

answer

To eat bananas & oranges. Thiazide is not K sparing and can cause hypokalemia. It should be taken in the morning.

question

The patient's hypertension is being managed with enalapril (Vasotec). What finding is most important for you to follow-up?

answer

A potential side effect of angiotensin-converting enzyme (ACE) inhibitors is hyperkalemia. Salt substitutes use potassium and should not be used with ACE inhibitors; this takes priority over the other findings.

question

Which patient finding is most likely a result of long-term uncontrolled hypertension?

answer

Stroke Hypertension is a major risk factor for cerebral atherosclerosis and stroke. Even for mildly hypertensive people, the risk of stroke is four times higher than for normotensive people.

question

The patient with primary hypertension is going to take the initial dose of doxazosin (Cardura) at home. What is most important for you to teach the patient?

answer

To take drug at bedtime. The initial dose is most likely to produce a side effect. Syncope (sudden loss of consciousness) occasionally occurs 30 to 90 minutes after the initial dose. The side effects of hypotension and syncope are less likely if the drug is taken in the evening.

question

You teach a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism?

answer

HTN promotes atherosclerosis and damage to walls of arteries. Furthermore, it can decrease circulation to target organs and tissues.

question

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate?

answer

The patient should decrease intake of sodium to help control hypertension. Excessive salt intake can cause fluid retention.

question

In caring for a patient admitted with poorly controlled hypertension, you understand that which laboratory test result indicates the presence of target organ damage resulting from the primary diagnosis?

answer

Serum creatnine level of 2.6 mg/dL. This elevated level indicates damage to the kidneys.

question

normal serum creatinine level

answer

~ 0.6 to 1.3 mg/dL

question

normal serum BUN level

answer

Adult 14-21 mg/dL

question

You are caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide (HydroDIURIL) daily for the past 10 years. Which parameter indicates the optimal intended effect of this drug therapy?

answer

BP within normal range. Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect is the blood pressure.

question

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for you to make when discussing atenolol (Tenormin)?

answer

Atenolol is a β1-adrenergic blocker and antihypertensive agent that can cause orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position.

question

You are caring for a patient admitted with chronic obstructive pulmonary disorder (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol (100 mg PO), you assess the patient carefully. Which adverse effect is this patient at risk for given the health history?

answer

Bronchospasms. Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and can affect the β2-adrenergic receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.

question

You are caring for a patient with hypertension who is scheduled to receive a dose of atenolol (Tenormin). You should withhold the dose and consult the prescribing physician for which vital sign taken just before administration?

answer

Pulse of 48. Because atenolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. You should withhold the dose and consult with the prescriber for parameters regarding pulse rate limits.

question

Which blood pressure-regulating mechanisms, if defective, can result in hypertension

answer

Release of NE; secretion of prostaglandins; stimulation of sympathetic nervous system; activation of RAAS. NE is released from the sympathetic nervous system nerve endings and activates receptors located in the vascular smooth muscle. When the α-adrenergic receptors in smooth muscle of the blood vessels are stimulated by NE, vasoconstriction results. Increased sympathetic nervous system stimulation produces increased vasoconstriction and increased renin release. Increased renin levels activate the renin-angiotensin-aldosterone system, leading to elevated blood pressure. Prostaglandins secreted by the renal medulla have a vasodilator effect on the systemic circulation. This results in decreased systemic vascular resistance and lower blood pressure. If prostaglandin synthesis is altered, the blood pressure can be increased.

question

A major consideration in the management of the older adult with hypertension is to

answer

Careful technique is important in assessing blood pressure in older adults. In some older people, there is a wide gap between the first Korotkoff sound and subsequent beats, called an auscultatory gap. Failure to inflate the cuff high enough may result in seriously underestimating systolic blood pressure.

question

A patient with newly diagnosed hypertension has a blood pressure of 158/98 mm Hg after 6 months of exercise and diet modifications. Which management strategy is a priority for this patient?

answer

Staring the patient on medication. The patient has stage 1 hypertension. Lifestyle modifications will continue, but drug therapy initiation is a priority. Reduction of blood pressure will aid in the prevention of serious complications related to hypertension.

question

Which is the main difference between a hypertension emergency and hypertension urgency?

answer

Hypertensive crisis refers to a hypertension emergency or hypertension urgency. An emergency has severely elevated blood pressure with evidence of acute target organ damage, especially to the central nervous system. Urgency refers to blood pressure that is severely elevated but with no clinical evidence of target organ damage. Target organ damage is a more significant indicator than an absolute blood pressure reading.

question

Which assessment finding in a patient with hypertensive crisis is most concerning to you?

answer

New onset confusion. A hypertensive emergency often manifests as hypertensive encephalopathy, a syndrome in which a sudden rise in blood pressure is associated with severe headache, nausea, vomiting, seizures, confusion, and coma

question

What are some risk factors for coronary artery disease (CAD)?

answer

Choleserol 240+; BP of 150/92, smoking. A cholesterol level higher than 200 mg/dL is one of the four most firmly established risk factors. Hypertension (blood pressure greater than 140/90 mm Hg or greater than 130/80 mm Hg if the patient has diabetes or chronic kidney disease) is another major risk factor. Tobacco use (proportional to the number of cigarettes smoked) is major risk factor.

question

What specific diet changes are encouraged to reduce the risks associated with CAD?

answer

The American Heart Association (AHA) recommends eating tofu, other forms of soybean, canola, walnuts, and flaxseed because these products contain α-linolenic acid, which becomes omega-3 fatty acid in the body.

question

What sign or symptom is the most important for you to teach the patient who is taking gemfibrozil (Lipid) or simvastatin (Zocor)?

answer

Severe muscle aching. The risk is rhabdomyolysis. Clinical manifestations of rhabdomyolysis are increased creatinine kinase levels and muscle tenderness.

question

The patient is prescribed niacin to help reduce cholesterol. The patient tells you he does not take the medication regularly because it causes uncomfortable flushing in his face and neck. What should you teach the patient to do?

answer

Premedicating with aspirin or a nonsteroidal antiinflammatory drug (NSAID) 30 minutes before taking niacin can reduce flushing. Taking time-released niacin can also prevent flushing.

question

In teaching a patient about coronary artery disease (CAD), you explain which changes that occur in this disorder (select all that apply)?

answer

Atherosclerosis is the major cause of coronary artery disease (CAD) and is characterized by a focal deposit of cholesterol and lipids, primarily within the intimal wall of the artery. The endothelial lining of the coronary arteries becomes inflamed by unstable plaques and the oxidation of low-density lipoprotein (LDL) cholesterol. Fibrous plaque causes progressive changes in the endothelium of the arterial wall. The result is a narrowed vessel lumen and a reduction in blood flow to the myocardial tissue.

question

After teaching about ways to decrease risk factors for CAD, you recognize that additional instruction is needed when the patient says the following:

answer

"I want to add wight lifting to my exercise program" Risk factors for CAD include elevated serum lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, and elevated homocysteine levels. Weight lifting is not a cardiac-protective exercise. An example of health-promoting regular physical activity is brisk walking (3 to 4 miles/hr) for at least 30 minutes five or more times per week.

question

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease. Which ethnic group would you select as the highest priority for this intervention?

answer

The incidence of CAD and myocardial infarction is highest among white, middle-aged men

question

Which individual would you identify as having the highest risk for CAD?

answer

45 yo male w/ depression and a high stress job.

question

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, you recognize additional teaching is needed when the patient selects which food choice?

answer

Canned soup. Very high sodium content.

question

When providing nutritional counseling for patients at risk for CAD, which foods do you encourage patients to include in their diet

answer

Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly.

question

For which antilipemic medication would you question an order for a patient with cirrhosis of the liver?

answer

Atorvastatin (Lipitor), S/E include liver damage and myopathy. Liver enzymes must be monitored frequently, and the medication should be stopped if these enzyme levels increase. Liver disease is a contraindication for using atorvastatin.

question

What is a classic manifestation of chronic stable angina?

answer

Chronic, stable angina is described as pain, pressure, or an ache in the chest. It is an unpleasant feeling, often described as a constrictive, squeezing, heavy, choking, or suffocating sensation. It usually is relieved with rest or when the precipitating factor is removed. The symptoms and triggers tend to remain consistent. Angina is rarely sharp or stabbing and usually does not change with position or breathing.

question

What should you teach patients with chronic stable angina?

answer

Wear a mask when outdoors in cold weather. Blood vessels constrict in response to cold and increase the workload of the heart. Call EMS if no relief after 1 tab of nitro.

question

The patient with chronic stable angina is prescribed propranolol (Inderal). You should question the order when noticing what in the patient's history?

answer

History of asthma. Patients with asthma should avoid β-adrenergic blockers because they can contribute to bronchoconstriction and wheezing.

question

The patient is prescribed propranolol (Inderal) as part of the management of chronic stable angina. What nursing assessment should be done before the drug's administration?

answer

Apical HR. The β-adrenergic blockers are preferred drugs for the management of chronic stable angina. They reduce myocardial contractility, heart rate, and blood pressure, all which reduce the myocardial oxygen demand. They decrease morbidity and mortality in patients with coronary artery disease (CAD). Side effects include bradycardia and hypotension, and the patient should be assessed, with the drug withheld, if either value is too low.

question

A hospitalized patient with a history of chronic stable angina tells you that she is having chest pain. You base your actions on the knowledge that ischemia...

answer

will be relieved by rest, nitro or both. Chronic stable angina refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.

question

Recommended dosage when taking nitro?

answer

one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the EMS system.

question

he patient asks how Prinzmetal's angina (variant angina) is different from chronic stable angina. What is the best response?

answer

Prinzmetal's angina is not usually precipitated by increased physical demand. The strong contraction (spasm) of smooth muscle in the coronary artery results from an increase in intracellular calcium levels. It can occur in the absence of coronary artery disease (CAD). Prinzmetal's angina is more frequently seen in a patient with a history of migraine headaches and Raynaud's phenomenon, but stable angina also can occur in patients with this medical history. Nitrates and calcium channel blockers are used by patients with Prinzmetal's angina. Tobacco smoke increases myocardial oxygen demand and is an influence in both conditions.

question

The patient with Prinzmetal's angina is prescribed nitroglycerin tablets. What should you teach the patient about this drug?

answer

Nitroglycerin cannot be combined with erectile dysfunction medications because it potentiates vasodilation.

question

The patient with Prinzmetal's angina is being managed with a calcium channel blocker. The patient is also on Lanoxin (digoxin). Which statement is most important for you to follow-up?

answer

"everything now looks fuzzy" Calcium channel blockers potentiate the action of digoxin by increasing serum digoxin levels during the first week of therapy. Halo vision is a sign of digoxin toxicity.

question

The patient with acute coronary syndrome (ACS) undergoes coronary revascularization with balloon angioplasty with placement of a drug-eluting stent. The physician prescribes a glycoprotein IIb/IIIa inhibitor tirofiban (Aggrastat). What is the main rationale for administering this drug?

answer

The IIb/IIIa inhibitor prevents the abrupt closure of the stent and is initiated during the percutaneous coronary intervention and maintained for 12 hours after the procedure.

question

The patient with ACS had balloon angioplasty and a drug-eluding stent placed. What is required nursing care in the first 6 hours after the procedure

answer

Neurovascular assessments are performed in the affected leg, a IIb/IIIa inhibitor is given to prevent abrupt closure of the stented vessel, and regularly obtained vital signs help monitor cardiac function. The patient is kept on bed rest with an extended leg and a pressure dressing on the insertion site. Oxygen, if needed, usually is administered in lower concentrations by nasal cannula.

question

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for which common complication?

answer

Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days after CABG surgery.

question

What can best help to decrease the incidence of sudden cardiac death in the community?

answer

availability of AEDs. The most common cause of sudden cardiac death is the lethal dysrhythmia ventricular fibrillation, which usually occurs within the first 4 hours after the onset of pain. This lethal ventricular dysrhythmia must be treated immediately with defibrillation. Most patients with sudden cardiac death have not had an MI and have no cardiac symptoms.

question

The telemetry nurse notes eight premature ventricular contractions per minute, often with two occurring together, on the patient's electrocardiographic tracing. Why will lidocaine be administered?

answer

To prevent vfib. Premature ventricular contractions may precede ventricular tachycardia and fibrillation. These ventricular dysrhythmias are often lethal and need to be prevented. Ventricular remodeling is normal myocardium compensation after an MI. The normal cardiac tissue hypertrophies and dilates after an MI to compensate for the damaged tissue.

question

What is considered a risk factor for sudden cardiac death (SCD) without having any manifestations of an acute MI?

answer

DM. It is difficult to predict who is at risk for SCD. However, left ventricular dysfunction (ejection fraction less than 30%) and ventricular dysrhythmias after an MI have been found to be the strongest predictors. Other risk factors for SCD include male gender (especially African American men), family history of premature atherosclerosis, tobacco use, diabetes mellitus, hypercholesterolemia, hypertension, and cardiomyopathy.

question

The patient had an SCD incident caused by a lethal rhythm and now has an implantable cardioverter-defibrillator (ICD). He arrives in the emergency department today unresponsive and in ventricular fibrillation. What action should you take?

answer

If the patient is in ventricular fibrillation and unresponsive, the ICD is not working. Defibrillation is the only effective means to treat ventricular fibrillation initially, not drugs.

question

The most common finding in individuals at risk for sudden cardiac death is

answer

Left ventricular dysfunction (ejection fraction <30%) and ventricular dysrhythmias after an MI are the strongest predictors of SCD.

question

The patient presents to the emergency department with crushing chest pain. The electrocardiogram (ECG) is completed within 5 minutes and is normal. What future action is most important?

answer

Repeat the ECG. The normal progression is ischemia, injury, infarction, and resolution of the infarction. Initial ECG results can be negative, but serial ECGs may show the injury and infarction. When an initial 12-lead ECG is nondiagnostic, serial 12-lead ECGs are done every 2 to 4 hours.

question

A fibrinolytic agent is administered in the emergency department to the patient diagnosed with an acute myocardial infarction (MI). Which is the best indicator that the drug has achieved its therapeutic effect?

answer

Return of ST segment to baseline on ECG. Fibrinolytics are given to produce an open artery by lysis of the thrombus in the coronary artery. The most reliable marker that this has occurred is the return of the ST segment to baseline on the ECG. Other markers include a resolution of chest pain and an early, rapid rise of the CK-MB enzyme levels within 3 hours of therapy, because the necrotic myocardial cells release CK-MB enzymes into the circulation after perfusion is restored to the area. Reperfusion dysrhythmias are a less reliable maker. The drug is not given specifically to accomplish prolonged clotting time or to alter vital signs.

question

You are administering the prescribed fibrinolytic agent to a patient diagnosed with an acute MI. You should stop the therapy and notify the physician when observing what patient manifestation?

answer

Sudden change in LOC. Signs and symptoms of major bleeding require the therapy to be stopped. A major complication of fibrinolytic therapy is bleeding. Signs and symptoms of major bleeding include a drop in blood pressure, an increase in heart rate, a sudden change in the patient's level of consciousness, or blood in the urine or stool. Minor bleeding can be controlled by applying a pressure dressing or ice pack.

question

A patient in the emergency department with chest pain that is unrelieved by nitroglycerin is diagnosed with an acute MI. Why is IV morphine now prescribed?

answer

Morphine is given as a vasodilator to decrease the cardiac workload by lowering myocardial oxygen consumption, reducing contractility, and decreasing blood pressure and heart rate. It also helps to reduce anxiety and fear.

question

You are caring for a patient 2 days after an MI. She reports that she is experiencing chest pain. She states, "It hurts when I take a deep breath." Which action is a priority?

answer

Obtain VS and auscultage for a pericardian friction rub. Acute pericarditis is an inflammation of the visceral or parietal pericardium; it often occurs 2 to 3 days after an acute MI. Chest pain may vary from mild to severe and is aggravated by inspiration, coughing, and movement of the upper body. Sitting in a forward position often relieves the pain.

question

Your patient is recovering from an uncomplicated MI. Which rehabilitation guideline is a priority to include in your teaching?

answer

begin an exercise program that aims for at least 5 30-min sessions per week. Physical activity should be regular, rhythmic, and repetitive, using large muscles to build up endurance (e.g., walking, cycling, swimming, rowing). Physical activity sessions should be at least 30 minutes long. Instruct the patient to begin slowly at personal tolerance levels (perhaps only 5 to 10 minutes) and build up to 30 minutes.

question

You assess a patient with complaints of chest pain for which clinical manifestations associated with an MI

answer

Ashen skin, diaphoresis, nausea & vomiting, S3/S4 sounds. During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels, and the patient's skin may be ashen, cool, and clammy (not flushed). Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may produce abnormal S3 and S4 heart sounds.

question

You are providing teaching to a patient recovering from an MI. Discussion regarding resumption of sexual activity should be

answer

Discussed along w/ other activities.

question

A patient was admitted to the emergency department 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). Which complication of MI should you anticipate?

answer

The most common complication after an MI is dysrhythmias

question

You are examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion?

answer

pathologic Q wave, as often accompanies STEMI, indicates complete coronary occlusion.

question

For what is percutaneous coronary intervention (PCI) most clearly indicated?

answer

PCI is used to restore coronary perfusion in cases of MI. Chronic stable angina and CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure.

question

What is a classic sign of unstable angina and coronary artery disease (CAD) in women?

answer

fatigue (most prominent symptom), shortness of breath, indigestion, and anxiety.

question

What is the main reason a patient is instructed to take the nitroglycerin patch off for 8 hours every night?

answer

Unless there is nocturnal angina, an 8-hour nitrate-free period is suggested because tolerance to nitroglycerin-induced vasodilation can develop.

question

The patient hospitalized with unstable angina exhibits signs of anxiety. What should you ask or tell the patient?

answer

All patients with acute coronary syndrome (ACS) have anxiety. Frequently, the patient cannot verbalize the most pervasive concern: "Am I going to die?" It is helpful for you to initiate conversation by remarking that fear of dying is a common concern among most patients who have ACS

question

A patient is admitted to the coronary care unit with a diagnosis of unstable angina. Which medications do you expect the patient to receive

answer

antiplatelet therapy, beta blockers & IV nitro. Oxygen, nitroglycerin, aspirin (chewable), and morphine may be used to treat unstable angina. For patients with unstable angina with negative cardiac markers and ongoing angina, a combination of aspirin, heparin, and a glycoprotein IIb/IIIa inhibitor (e.g., eptifibatide [Integrilin]) is recommended. β-Adrenergic blockers decrease myocardial oxygen demand by reducing heart rate, blood pressure, and contractility.

question

What is a normal ankle-brachial index (ABI)

answer

0.91 to 1.30 and indicates adequate BP in the extremities. An ABI between 0.71 and 0.90 indicates mild PAD, between 0.41 and 0.70 indicates moderate PAD, and less than 0.40 indicates severe PAD.

question

most effective exercise for PAD patients

answer

Walking Supervised, treadmill exercise training improves walking performance and quality of life in PAD patients whether or not they have claudication

question

Critical limb ischemia

answer

a condition characterized by chronic ischemic rest pain lasting more than 2 weeks, arterial leg ulcers, and/or gangrene of the leg attributable to PAD. Optimal therapy is revascularization via surgery or endovascular procedure. Although palliative in nature, all patients with critical limb ischemia should have aggressive CVD risk factor modification and antiplatelet therapy to decrease the risk of a CVD event.

question

Venous Stasis

answer

when the valves are dysfunctional or the muscles of the extremities are inactive. Venous stasis occurs more frequently in people who are obese or pregnant, have chronic heart failure or atrial fibrillation, have been traveling on long trips without regular exercise, have a prolonged surgical procedure, or are immobile for long periods (e.g., spinal cord injury, fractured hip, limb paralysis).

question

You are teaching the patient about peripheral artery disease (PAD). The patient asks why the disease is so serious. You base your teaching on the knowledge that the disease

answer

PAD involves thickening of artery walls, which results in a progressive narrowing of the arteries of the upper and lower extremities.

question

While performing a nursing history, you identify several risk factors for the development of PAD.

answer

Significant risk factors for PAD include tobacco use, hyperlipidemia, elevated high-sensitivity C-reactive protein, diabetes mellitus, and uncontrolled hypertension; the most important is tobacco use.

question

The symptoms of PAD initially become apparent when blockage has reached what %?

answer

Clinical symptoms occur when vessels are 60% to 75% occluded.

question

What is the antidote for warfarin?

answer

Vitamin K

question

What are Ca channel blockers contraindicated w/?

answer

Beta blockers. You only give one or the other.

question

Surgical interventions following an MI to restore coronary perfusion?

answer

Percutaneous coronary artery intervention or CABG

question

atenolol (Tenormin)

answer

a beta blocker. Inhibits sympathetic nervous stimulation of the heart

question

Therapuetic range for INR?

answer

2-3

question

What is the antidote for heparin?

answer

Protamine sulfate

question

Priority nursing intervention for chronic venous insufficienty?

answer

Teaching patient to use compression stockings.

question

When should a pt w/ varicose veins put on stockings?

answer

In the morning while you're still laying in bed. This way, blood is not pooling, as you're laying flat and can be more effective.

question

What to do w/ phlebitis?

answer

Apply moist heat and elevate

question

A patient is admitted to the hospital with a diagnosis of AAA. Which signs and symptoms suggest that his aneurysm has ruptured?

answer

severe back pain, back or flank ecchymosis (Grey Turner's sign), and hypovolemic shock (tachycardia, hypotension, pale clammy skin, decreased urine output, altered level of consciousness, and abdominal tenderness).

question

Rest pain is a manifestation of PAD that occurs as a result of?

answer

Insufficient blood flow to meet basic metabolic requirements of the distal tissues. Rest pain occurs more often at night because cardiac output tends to drop during sleep and the limbs are at the level of the heart. Patients often try to achieve partial pain relief by dangling the leg over the side of the bed or sleeping in a chair to allow gravity to maximize blood flow.

question

Most common location of rest pain?

answer

forefoot or toes and is aggravated by limb elevation

question

intermittent claudication

answer

classic symptom of lower extremity PAD. The ischemic pain is a result of accumulation of end products of anaerobic cellular metabolism, such as lactic acid. After the patient stops exercising, the metabolites are cleared, and the pain subsides.

question

You expect the lower extremities of the patient with PAD to be

answer

thin, shiny, and taut, and hair loss occurs on the lower legs. Diminished or absent pedal, popliteal, or femoral pulses are present.

question

Which nursing diagnosis is the highest priority for a newly admitted patient with acute arterial occlusion?

answer

ineffective peripheral tissue perfusion. Acute arterial ischemia is a sudden interruption in the arterial blood supply to a tissue, organ, or extremity that can result in tissue death if left untreated.

question

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. Your initial action is to

answer

Notify physician for change in periphearl perfusion. The patient has potentially developed acute arterial ischemia (sudden interruption in the arterial blood supply to the extremity) caused by an embolism from cardiac thrombi that occurred as a complication of infective endocarditis. Clinical manifestations of acute arterial ischemia include pain, pallor, paralysis, pulselessness, paresthesia, and poikilothermia. Without immediate intervention, ischemia may progress to tissue necrosis and gangrene within a few hours. I

question

Buerger's disease and Raynaud's phenomenon have the following clinical manifestations in common:

answer

cold sensitivity, ischemic and gangrenous ulcers on fingertips, and color changes of the distal extremity (fingers or toes).

question

patient who is most likely to be at highest risk for venous thromboembolism (VTE)

answer

A 32 yo woman who smokes, takes oral contraceptives and is planning a trip to europe. Three important etiologic factors (Virchow's triad) for venous thrombosis are venous stasis, damage of the endothelium (inner lining of the vein), and hypercoagulability of the blood. The patient at risk for venous thrombosis usually has predisposing conditions for these three disorders

question

What are the probable clinical findings for a person with an acute VTE

answer

Mild to moderate calf pain and tendxerness; unilateral edema and induration of the thigh.

question

The recommended treatment for an initial VTE in an otherwise healthy person with no significant comorbidities includes

answer

Patients with confirmed VTE should receive initial treatment with Heparin LMWH, Unfractioned/UFH or fondaparinux, and warfarin for at least 5 days or until the international normalized ratio (INR) is ≥ 2.0 for 24 hours. Patients with multiple co-morbidities, complex medical issues, or a very large VTE usually are hospitalized for treatment and typically receive intravenous UFH.

question

A key aspect of teaching for a patient on anticoagulant therapy includes which instructions?

answer

monitor and report any signs of bleeding, which can be a serious complication. Patients taking warfarin also should be taught to reduce vitamin K intake and undergo routine laboratory studies of coagulation.

question

You are caring for a patient with a diagnosis of deep vein thrombosis (DVT). The patient has an order to receive 30 mg of enoxaparin (Lovenox). Which injection site should you use to administer this medication safely?

answer

Enoxaparin is a low-molecular-weight (LMW) heparin that is given as a subcutaneous injection. The preferred injection site for this medication is the right or left anterolateral abdominal wall. All subcutaneous injections should be given away from scars, lesions, or moles.

question

You are preparing to administer a scheduled 30-mg dose of enoxaparin (Lovenox) subcutaneously. What should you do to administer this medication correctly?

answer

You should gather together or "bunch up" the skin between the thumb and the forefinger before inserting the needle into the subcutaneous tissue. You should not aspirate nor rub the site after injection.

question

You are caring for a patient with a recent history of DVT. The patient now needs to undergo surgery for appendicitis. You are reviewing the laboratory results for this patient before administering an ordered dose of vitamin K. You determine that the medication is safe to give and is most needed when the international normalized ratio (INR) is

answer

2.2 Vitamin K is the antidote to warfarin (Coumadin), which the patient has most likely been taking before admission for treatment of DVT. Warfarin is an anticoagulant that impairs the ability of the blood to clot. It is necessary to give vitamin K before surgery to reduce the risk of hemorrhage. The largest value of the INR indicates the greatest impairment of clotting ability, making 2.2 the correct selection.

question

A postoperative patient asks you why the physician ordered daily administration of enoxaparin (Lovenox). Which reply is most appropriate?

answer

Enoxaparin is an anticoagulant that is used to prevent DVTs postoperatively

question

You are caring for a patient who has been receiving warfarin (Coumadin) and digoxin (Lanoxin) as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, you should diligently assess the patient for which complication early in the postoperative period until the medication is resumed?

answer

Cerebral or pulmonary emboli. Warfarin is an anticoagulant that is used to prevent thrombi from forming on the walls of the atria during atrial fibrillation. After the medication is terminated, thrombi can again form. If one or more thrombi detach from the atrial wall, they can travel from the left atrium to the brain or from the right atrium to the lungs.

question

You teach the patient that the purpose of heparin therapy for deep vein thrombosis is to

answer

Unfractionated heparin (UFH) is started to prevent thrombus enlargement and inhibit further embolization.

question

What is the safest INR value prior to surgery?

answer

~1.0, which means anticoagulation has been reversed.

question

You determine that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox) after noticing what during a routine shift assessment?

answer

Pain and swelling in the lower extremity. This can indicate development of deep vein thrombosis and therefore may signal ineffective medication therapy.

question

You are caring for a preoperative patient who has an order for vitamin K by subcutaneous injection. You should verify which laboratory study result is abnormal before administering the dose?

answer

Prothrombin time (PT). Vitamin K counteracts hypoprothrombinemia and reverses the effects of warfarin (Coumadin), decreasing the risk of bleeding. High values for the PT or INR demonstrate the need for this medication.

question

Assessment of a patient's peripheral intravenous (IV) line site reveals that phlebitis has developed over the past several hours. Which intervention should you implement first?

answer

removal of the offending IV catheter

question

A patient with varicose veins has been prescribed compression stockings. What should you teach the patient?

answer

should apply stockings in bed, before rising in the morning.

question

You are teaching a group of patients regarding measures to prevent varicose veins. Which points should you include

answer

Prevention is key. You should instruct the patient to avoid sitting or standing for long periods, maintain ideal body weight, take precautions against injury to the extremities, avoid wearing constrictive clothing, and walk daily.

question

In planning care and teaching for the patient with venous leg ulcers, you recognize that the most important intervention in healing and control of this condition is

answer

Compression is essential for chronic venous insufficiency treatment, venous ulcer healing, and prevention of ulcer recurrence. Custom-fitted, graduated compression stockings are one option for compression therapy.

question

You are caring for a newly admitted patient with vascular insufficiency. The patient has a new order for 30 mg of enoxaparin (Lovenox) given subcutaneously. What should you do to correctly administer this medication?

answer

leave the air bubble in the prefilled syringe. You should not expel the air bubble from the prefilled syringe because it should be injected to clear the needle of medication and avoid leaving medication in the needle track in the tissue.

question

What is a priority nursing intervention in the care of a patient with a diagnosis of chronic venous insufficiency (CVI)?

answer

Teaching the pt correct use of compression stockings. The patient should avoid prolonged positioning with the limb in a dependent position.

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