Coronary Artery Disease
While caring for a patient with angina, the nurse plans interventions that decrease myocardial oxygen demand and promote coronary blood flow. Appropriate interventions are those that primarily prevent.
a. Coronary Artery Spasms
b. An increase in heart rate
c. A decreased blood volume
d. Disruption of circadian rhythms
b. An increase in heart rate
A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. Which of the following will you include in your discharge teaching about this medication?
Answer: D. This patient needs to be educated to check their glucose levels regularly because this medication can mask the typical signs and symptoms of hypoglycemia. This is very important since the patient is diabetic.
A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply:*
The answers are C, D, E, and G. High cholesterol, diabetes mellitus, uncontrolled hypertension, and smoking are risk factors for peripheral arterial disease (PAD). Pregnancy, being female, varicose veins are risk factors for peripheral venous disease.
The patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario’s description?*
The answer is A. These findings are associated with a venous ulcer.
You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them?*
The answer is B. The most common cause of a myocardial infarction is CORONARY ARTERY DISEASE...not coronary spasm which is uncommon.
Which coronary artery provides blood to the left atrium and left ventricle:
True or False: ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin II to Angiotensin I which causes vasodilation.
Answer: False. ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin I to Angiotensin II (not Angiotensin II to Angiotensin I as stated in the question) which causes vasodilation.
Your patient is diagnosed with Buerger's Disease (thromboangiitis obliterans). The nurse will make it priority to educate the patient about implementing?*
The answer is C. The most common cause of Buerger's Disease (thromboangiities obliterans) is tobacco usage (smoking). Buerger's Disease occurs when the blood vessels of the hands and feet become inflamed and clots form. The clots will block blood flow. The nurse should make it priority to educate the patient on smoking cessation.
Your patient has returned from a peripheral artery bypass for the treatment of peripheral arterial disease. The nurse will make it PRIORITY to?*
The answer is B. A peripheral artery bypass is performed to treat severe cases of PAD. The surgeon will "bypass" the blockage in the lower extremity and have blood flow re-routed around the blockage. This will provide blood flow back to the lower extremity. It is PRIORITY that the nurse assesses and grades the lower extremity pulses bilaterally frequently. If the pulses diminish or become absent the nurse should notify the physician immediately.
A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from?*
The answer is D. A complication of a myocardial infarction is PERICARDITIS, especially 24-36 hours post MI. This is because of neutrophils being present at the site which causes inflammation. The patient's signs and symptoms are classic pericarditis.
A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix. What important information will you include in the patient's teaching? Select-all-that-apply:
Answers: A and D. Patients on Plavix should let their doctor know that they are taking Plavix because it should be discontinued 5 to 7 days before a surgical procedure due to increased risk of bleeding. Also, option D represents signs and symptoms of Thrombotic Thrombocytopenic Purpura a clotting disorder where clots form in the vessels of the body which is a complication of Plavix.
You're providing education to a patient who will be undergoing a heart catheterization. Which statement by the patient requires you to re-educate the patient about this procedure?
Answers: A. The femoral or radial artery is used during a heart cath...not the brachial.
patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition? Select all that apply:*
The answers are A and C. Raynaud's Disease occurs when vasospasm of peripheral arteries occurs. It mainly affects the fingers and toes (it can also affect the ears/nose). It is triggered by exposure to cold or during stress. It can be prevented by keeping the toes, fingers, ears, and nose warm and avoid stress. Medications can also be used as well that help prevent vasospasm.
A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease? Select all that apply:*
The answers are B and C. The patient with peripheral VENOUS disease should elevate the lower extremities ABOVE heart level (this helps return blood to the heart and decrease swelling/pain), avoid crossing the legs (or the knee-flexed position) because this impedes blood flow, and limit long periods of standing and sitting (this limits blood return to the heart and increases swelling). In addition, the application of compression stockings is very beneficial in peripheral venous disease because it helps blood return to the heart and prevents the stasis of blood in the lower extremities.
After a myocardial infraction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue?*
The answer is C.
A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next?*
Answer: B. If a patient's chest pain is not relieved with 3 doses of Nitroglycerin, taken 5 minutes apart, they should call 911 immediately. The patient should never exceed more than 3 doses of Nitroglycerin or take 2 doses at one time.
A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:
Answer: C. Stable angina occurs during activities but goes away when the patient rests. Variant and Prinzmetal angina are the same and occur at rest during cycles. Unstable angina is chest pain felt during rest and is more severe.
The MOST common cause of peripheral arterial disease is?*
The answer is C. Atherosclerosis is the most common cause of PAD (peripheral arterial disease). This is the collection of fatty plaques on the artery wall. This blocks blood flow.
Your patient has severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks:*
The answer is D. In severe PAD, if the lower extremities are elevated they will turn pale (pallor). However, if they are in the dependent position (dangling) they will appear rubor (red and warm…this occurs due to inflammation of the vessels).
24-36 hours after a myocardial infarction _____________ congregate at the site during the inflammation phase.*
The answer is A.
A patient taking Zocor is reporting muscle pain. You are evaluating the patient’s lab work and note that which of the following findings could cause muscle pain?*
Answer: B. Zocor (a statin medication used for lowering cholesterol) can cause increased CPK levels which will lead to a patient experiencing muscle pain. Therefore, CPK levels must be monitored while a patient is taking this medication.
A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction?
Answer: D This is a common finding on an EKG when a patient is having a myocardial infraction due to muscle damage.
True or False: Peripheral venous disease can occur due to narrowing of the valves in the veins of the lower extremities.*
The answer is FALSE. Peripheral venous disease can occur due to overstretched valves of the veins (NOT narrowed) in the lower extremities. In addition, it can occur when the veins become damaged.
Your patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient’s symptoms, the nurse will position the lower extremities in the?*
The answer is C. Based on the signs and symptoms in the scenario above, the patient is experiencing peripheral VENOUS disease. The blood is stagnant (or static) in the lower extremities and can’t flow back to the heart. Therefore, the patient is experiencing dull and achy sensations along with edema and brownish pigmentation. The nurse should place the patient’s lower extremities in the elevated position above the heart to help facilitate blood return to the heart and alleviate the pain.
A patient is complaining of chest pain. You obtain a 12-lead EKG and see ST elevation in leads II, III, AVF. What area of the heart does this represent?*
The answer is D