Blood Work
A patient is on Coumadin therapy. The nurse will educate the patient to avoid a diet high in this
What is Vitamin K?
Potentially life-threatening complication of an infection
What is Sepsis?
The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?
A) The client's apical pulse is 64
B) The client's calcium level is elevated
C) The client's telemetry shows occasional PVCs
D) The client's blood pressure is 90/62
D) The client's blood pressure is 90/62
Rational: The client's blood pressure is low, and a calcium channel blocker could cause the blood pressure to bottom out.
Which of the following conditions most commonly results in CAD?
A) DM
B) MI
C) Atherosclerosis
D) Renal failure
C) Atherosclerosis
Rationale: Atherosclerosis, or plaque formation, is the leading cause of CAD. DM is a risk factor for CAD but isn't the most common cause. Renal failure doesn't cause CAD, but the two conditions are related. Myocardial infarction is commonly a result of CAD.
A patient was admitted with signs of angina related to ACS. The nurse anticipates and order of this treatment
What is MONA?
MONA stands for morphine, oxygen, nitroglycerin, and aspirin. It is the standard initial treatment approach for patients presenting with chest pain due to suspected myocardial ischemia.
A patient is receiving continuous IV Heparin. In order for this medication to have a therapeutic effect on the patient, the PTT should be?
A) 0.5-2.5 times the normal value range
B) 2-3 times the normal value range
C) 1.5-2.5 times the normal value range
D) 1-3.5 times the normal value range
C) 1.5-2.5 times the normal value range
Rational: An PTT should be 1.5-2.5 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the PTT is too low, blood clots can form. If the PTT is too high, bleeding can occur.
Which newly admitted client does the nurse consider to be at highest risk for development of sepsis?
A) 75-year-old man with hypertension and early Alzheimer's disease
B) 68-year-old woman 2 days postoperative from bowel surgery
C) 80-year-old community-dwelling man with no other health problems undergoing cataract surgery
D) 54-year-old woman with moderate asthma and severe degenerative joint disease of the right knee
B) 68-year-old woman 2 days postoperative from bowel surgery
Rationale: The 68-year-old woman has several risk factors. First she is an older adult, and immune function decreases with age. The greatest risk factor is that she has just had bowel surgery. Not only does major surgery further reduce the immune response, the bowel cannot be "sterilized" for surgery. Therefore the usual bacteria of the bowel have the chance to escape the site and enter the bloodstream when the bowel is disrupted.
Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction?
A) Midepigastric pain and pyrosis
B) Diaphoresis and cool clammy skin
C) Intermittent claudication and palor
D) Jugular vein distention and dependent edema
B) Diaphoresis and cool clammy skin
Rational: Diaphoresis is a systemic reaction to the MI. The body vasoconstricts to shunt blood from the periphery to the trunk of the body; this in turn, leads to cold, clammy skin
List 3 modifiable risk factors for CAD
Smoking
Poor Diet
Physical Inactivity
Excess Alcohol Consumption
High Stress Level
High Blood Pressure
Elevated LDL
Low HDL
The client with unstable angina has received education about the acute coronary syndrome. Which of the following indicates that he understood the teaching?
A) "This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year."
B) "Angina is just a temporary interruption of blood flow to my heart."
C) "I need to tell my wife I've had a heart attack."
D) "Because this was temporary, I will not need to take any medications for my heart."
A) "This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year."
Rationale: Among people who have unstable angina, 10% to 30% have a myocardial infarction (MI) within 1 year. Although angina pain is temporary, it reflects underlying coronary artery disease (CAD), which requires attention, including lifestyle modifications. Unstable angina reflects tissue ischemia, but infarction represents tissue necrosis. Clients with underlying CAD may need medications such as aspirin (ASA), lipid-lowering agents, antianginals, or antihypertensives.
A cardiac enzyme that the nurse should expect to be elevated first in a client diagnosed with a myocardial infarction
What is Troponin?
An inflammatory state affecting the whole body
What is SIRS?
Which population is at a higher risk for dying from a myocardial infarction?
A) Caucasian Males
B) Hispanic Females
C) Asian Males
D) African American Females
D) African American Females
Rational: African American Females are 35% more likely to die from CAD than any other population. This population has significantly higher rates of HTN, and it occurs at a younger age. The higher risk of death from an MI is also attributed to a delay in seeking emergency care - an average of 11 hours
Blood flow is regulated by baroreceptors in this artery
What is the Aorta?
The client with unstable angina has received education about the acute coronary syndrome. Which of the following indicates that he understood the teaching?
A) "This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year."
B) "Angina is just a temporary interruption of blood flow to my heart."
C) "I need to tell my wife I've had a heart attack."
D) "Because this was temporary, I will not need to take any medications for my heart."
A) "This is a big warning, I must modify my lifestyle or risk having a heart attack in the next year."
Rationale: Among people who have unstable angina, 10% to 30% have a myocardial infarction (MI) within 1 year. Although angina pain is temporary, it reflects underlying coronary artery disease (CAD), which requires attention, including lifestyle modifications. Unstable angina reflects tissue ischemia, but infarction represents tissue necrosis. Clients with underlying CAD may need medications such as aspirin (ASA), lipid-lowering agents, antianginals, or antihypertensives.
A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure what information is gathered correctly before initiating the drip?
A) Vital signs
B) Weight
C) PT/INR level
D) EKG
B) Weight
Rational: The nurse would want to make sure the documented weight of the patient is current and accurate. This medication is weight-based. Therefore, for proper dosing to be administered, a correct weight should be used.
A patient is treated in the emergency department (ED) for shock of unknown etiology. The patient is noticeably SOB and AAOx3. The first action by the nurse should be to
A) administer oxygen.
B) attach a cardiac monitor.
C) obtain the blood pressure.
D) check the level of consciousness.
A) administer oxygen.
Rational: The initial actions of the nurse are focused on the ABCs—airway, breathing, circulation—and administration of oxygen should be done first. The other actions should be accomplished as rapidly as possible after oxygen administration.
One hour post-MI is the greatest risk of this lethal arrhythmia
What is ventricular fibrillation?
CAD can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause________, a local state in which the cells are temporarily deprived of blood supply.
A. Infarction
B. Ischemia
C. Necrosis
D. Inflammation
B) Ischemia is a local state in which the cells are temporarily deprived of blood supply
Which of the following cardiovascular effects of aging should the nurse anticipate when providing care for older adults (select all that apply)?
A) Arterial stiffening
B) Increased blood pressure
C) Increased maximal heart rate
D) Decreased maximal heart rate
E) Increased recovery time from activity
A, B, D, E
Rationale: Well-documented cardiovascular effects of the aging process include arterial stiffening, possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age.
If PTT is 6x above normal range, the nurse would administer this to offset the effects of anticoagulant medication
What is Protamine Sulfate?
A clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in 2 or more organs or organ systems that is induced by a variety of acute insults, including sepsis.
What is MODS?
The client diagnosed with a myocardial infarction asks the nurse, "why do I have to rest and take it easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response?
A) "Your heart is damaged and needs about 4 to 6 weeks to heal"
B) "There is necrotic myocardial tissue that puts you at risk for dysrhythmias"
C) "Your doctor has ordered bedrest. Therefore, you must stay in bed."
D) "Just because your chest doesn't hurt anymore doesn't mean you are out of danger"
A) "Your heart is damaged and needs about 4 to 6 weeks to heal"
Rational: The heart tissue is dead, stress or activity may cause heart failure, and it does take about 6-8 weeks for scar tissue to form
Medical treatment of coronary artery disease includes which of the following procedures?
A) Percutaneous transluminal coronary angioplasty
B) Oral medication administration
C) Cardiac catheterization
D) Coronary artery bypass surgery
B) Oral medication administration
Rationale: Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catheterization isn't a treatment but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical
A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure?
A) Glipizide
B) Metformin
C) Repaglinide
D) Regular insulin
B) Metformin
Rational: Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before and 48 hours after cardiac catheterization.