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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter27:ManagementofPatientsWithCoronaryVascularDisorders  1.

Thenurseiscaringforapatientwhohasbeendiagnosedwithanelevatedcholesterollevel.Thenurseis awarethatplaqueontheinnerlumenofarteriesiscomposedchieflyofwhat?

A)

Lipidsandfibroustissue

B)

Whitebloodcells

C)

Lipoproteins

D)

High-densitycholesterol

Ans:

A Feedback: AsT-lymphocytesandmonocytesinfiltratetoingestlipidsonthearterialwallandthendie,afibrous tissuedevelops.Thiscausesplaquestoformontheinnerlumenofarterialwalls.Theseplaquesdonot consistofwhitecells,lipoproteins,orhigh-densitycholesterol.

2.

Apatientpresentstothewalk-incliniccomplainingofintermittentchestpainonexertion,whichis eventuallyattributedtoangina.Thenurseshouldinformthepatientthatanginaismostoftenattributable towhatcause?

A)

Decreasedcardiacoutput

B)

Decreasedcardiaccontractility

C)

Infarctionofthemyocardium

D)

Coronaryarteriosclerosis

Ans:

D Feedback: Inmostcases,anginapectorisisduetoarteriosclerosis.Thediseaseisnotaresultofimpairedcardiac outputorcontractility.Infarctionmayresultfromuntreatedangina,butitisnotacauseofthedisease.

3.

Thenurseiscaringforanadultpatientwhohadsymptomsofunstableanginauponadmissiontothe hospital.Whatnursingdiagnosisunderliesthediscomfortassociatedwithangina?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Ineffectivebreathingpatternrelatedtodecreasedcardiacoutput

B)

Anxietyrelatedtofearofdeath

C)

Ineffectivecardiopulmonarytissueperfusionrelatedtocoronaryarterydisease(CAD)

D)

ImpairedskinintegrityrelatedtoCAD

Ans:

C

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Feedback: Ineffectivecardiopulmonarytissueperfusiondirectlyresultsinthesymptomsofdiscomfortassociated withangina.Anxietyandineffectivebreathingmayresultfromanginachestpain,buttheyarenotthe causes.Skinintegrityisnotimpairedbytheeffectsofangina. 4.

ThetriagenurseintheEDassessesa66-year-oldmalepatientwhopresentstotheEDwithcomplaints ofmidsternalchestpainthathaslastedforthelast5hours.IfthepatientssymptomsareduetoanMI, whatwillhavehappenedtothemyocardium?

A)

Itmayhavedevelopedanincreasedareaofinfarctionduringthetimewithouttreatment.

B)

Itwillprobablynothavemoredamagethanifhecameinimmediately.

C)

Itmayberesponsivetorestorationoftheareaofdeadcellswithpropertreatment.

D)

Ithasbeenirreparablydamaged,soimmediatetreatmentisnolongernecessary.

Ans:

A Feedback: WhenthepatientexperienceslackofoxygentomyocardiumcellsduringanMI,thesoonertreatmentis initiated,themorelikelythetreatmentwillpreventorminimizemyocardialtissuenecrosis.Delaysin treatmentequatewithincreasedmyocardialdamage.Despitethelengthoftimethesymptomshavebeen present,treatmentneedstobeinitiatedimmediatelytominimizefurtherdamage.Deadcellscannotbe restoredbyanymeans.

5.

FamilymembersbringapatienttotheEDwithpalecoolskin,suddenmidsternalchestpainunrelieved withrest,andahistoryofCAD.Howshouldthenursebestinterprettheseinitialdata?

A)

Thesymptomsindicateanginaandshouldbetreatedassuch.

B)

Thesymptomsindicateapulmonaryetiologyratherthanacardiacetiology.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Thesymptomsindicateanacutecoronaryepisodeandshouldbetreatedassuch.

D)

Treatmentshouldbedeterminedpendingtheresultsofanexercisestresstest.

Ans:

C

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Feedback: AnginaandMIhavesimilarsymptomsandareconsideredthesameprocess,butareondifferentpoints alongacontinuum.Thatthepatientssymptomsareunrelievedbyrestsuggestsanacutecoronary episoderatherthanangina.Palecoolskinandsuddenonsetareinconsistentwithapulmonaryetiology. Treatmentshouldbeinitiatedimmediatelyregardlessofdiagnosis. 6.

AnORnurseispreparingtoassistwithacoronaryarterybypassgraft(CABG).TheORnurseknows thatthevesselmostcommonlyusedassourceforaCABGiswhat?

A)

Brachialartery

B)

Brachialvein

C)

Femoralartery

D)

Greatersaphenousvein

Ans:

D Feedback: ThegreatersaphenousveinisthemostcommonlyusedgraftsiteforCABG.Therightandleftinternal mammaryarteries,radialarteries,andgastroepiploicarteryareothergraftsitesused,thoughnotas frequently.Thefemoralartery,brachialartery,andbrachialveinareneverharvested.

7.

Apatientwithanoccludedcoronaryarteryisadmittedandhasanemergencypercutaneoustransluminal coronaryangioplasty(PTCA).ThepatientisadmittedtothecardiaccriticalcareunitafterthePTCA. Forwhatcomplicationshouldthenursemostcloselymonitorthepatient?

A)

Hyperlipidemia

B)

Bleedingatinsertionsite

C)

Leftventricularhypertrophy

D)

Congestiveheartfailure

Ans:

B

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: ComplicationsofPTCAmayincludebleedingattheinsertionsite,abruptclosureoftheartery,arterial thrombosis,andperforationoftheartery.Complicationsdonotincludehyperlipidemia,leftventricular hypertrophy,orcongestiveheartfailure;eachoftheseproblemstakesanextendedtimetodevelopand noneisemergent. 8.

Thenurseiscaringforapatientwhoisscheduledforcardiacsurgery.Whatshouldthenurseincludein preoperativecare?

A)

Withthepatient,clarifythesurgicalprocedurethatwillbeperformed.

B)

Withholdthepatientsscheduledmedicationsforatleast12hourspreoperatively.

C)

Informthepatientthathealthteachingwillbeginassoonaspossibleaftersurgery.

D)

Avoiddiscussingthepatientsfearsasnottoexacerbatethem.

Ans:

A Feedback: Preoperatively,itisnecessarytoevaluatethepatientsunderstandingofthesurgicalprocedure,informed consent,andadherencetotreatmentprotocols.Teachingwouldbeginonadmissionorevenpriorto admission.Thephysicianwouldwriteorderstoalterthepatientsmedicationregimenifnecessary;this willvaryfrompatienttopatient.Fearsshouldbeaddresseddirectlyandempathically.

9.

TheORnurseisexplainingtoapatientthatcardiacsurgeryrequirestheabsenceofbloodfromthe surgicalfield.Atthesametime,itisimperativetomaintainperfusionofbodyorgansandtissues.What techniqueforachievingthesesimultaneousgoalsshouldthenursedescribe?

A)

Coronaryarterybypassgraft(CABG)

B)

Percutaneoustransluminalcoronaryangioplasty(PTCA)

C)

Atherectomy

D)

Cardiopulmonarybypass

Ans:

D Feedback: Cardiopulmonarybypassisoftenusedtocirculateandoxygenatebloodmechanicallywhilebypassing theheartandlungs.PTCA,atherectomy,andCABGareallsurgicalprocedures,noneofwhichachieves

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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thetwogoalslisted. 10. Thenursehasjustadmitteda66-year-oldpatientforcardiacsurgery.Thepatienttearfullyadmitstothe nursethatsheisafraidofdyingwhileundergoingthesurgery.Whatisthenursesbestresponse? A)

Explorethefactorsunderlyingthepatientsanxiety.

B)

Teachthepatientguidedimagerytechniques.

C)

ObtainanorderforaPRNbenzodiazepine.

D)

Describetheprocedureingreaterdetail.

Ans:

A Feedback: Anassessmentofanxietylevelsisrequiredinthepatienttoassistthepatientinidentifyingfearsand developingcopingmechanismsforthosefears.Thenursemustfurtherassessandexplorethepatients anxietybeforeprovidinginterventionssuchaseducationormedications.

11. Apatientwithanginahasbeenprescribednitroglycerin.Beforeadministeringthedrug,thenurseshould informthepatientaboutwhatpotentialadverseeffects? A)

Nervousnessorparesthesia

B)

Throbbingheadacheordizziness

C)

Drowsinessorblurredvision

D)

Tinnitusordiplopia

Ans:

B Feedback: Headacheanddizzinesscommonlyoccurwhennitroglycerinistakenatthebeginningoftherapy. Nervousness,paresthesia,drowsiness,blurredvision,tinnitus,anddiplopiadonottypicallyoccurasa resultofnitroglycerintherapy.

12. Thenurseisprovidinganeducationalworkshopaboutcoronaryarterydisease(CAD)anditsrisk factors.ThenurseexplainstoparticipantsthatCADhasmanyriskfactors,somethatcanbecontrolled andsomethatcannot.Whatriskfactorswouldthenurselistthatcanbecontrolledormodified? A)

Gender,obesity,familyhistory,andsmoking

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Inactivity,stress,gender,andsmoking

C)

Obesity,inactivity,diet,andsmoking

D)

Stress,familyhistory,andobesity

Ans:

C

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Feedback: TheriskfactorsforCADthatcanbecontrolledormodifiedincludeobesity,inactivity,diet,stress,and smoking.Genderandfamilyhistoryareriskfactorsthatcannotbecontrolled. 13. A48-year-oldmanpresentstotheEDcomplainingofseveresubsternalchestpainradiatingdownhis leftarm.Heisadmittedtothecoronarycareunit(CCU)withadiagnosisofmyocardialinfarction(MI). WhatnursingassessmentactivityisapriorityonadmissiontotheCCU? A)

BeginECGmonitoring.

B)

Obtaininformationaboutfamilyhistoryofheartdisease.

C)

Auscultatelungfields.

D)

Determineifthepatientsmokes.

Ans:

A Feedback: The12-leadECGprovidesinformationthatassistsinrulingoutordiagnosinganacuteMI.Itshouldbe obtainedwithin10minutesfromthetimeapatientreportspainorarrivesintheED.Bymonitoring serialECGchangesovertime,thelocation,evolution,andresolutionofanMIcanbeidentifiedand monitored;life-threateningarrhythmiasaretheleadingcauseofdeathinthefirsthoursafteranMI. Obtaininginformationaboutfamilyhistoryofheartdiseaseandwhetherthepatientsmokesarenot immediateprioritiesintheacutephaseofMI.Datamaybeobtainedfromfamilymemberslater.Lung fieldsareauscultatedafteroxygenationandpaincontrolneedsaremet.

14. Thepublichealthnurseisparticipatinginahealthfairandinterviewsapatientwithahistoryof hypertension,whoiscurrentlysmokingonepackofcigarettesperday.Shedeniesanyofthemost commonmanifestationsofCAD.Basedonthesedata,thenursewouldexpectthefocusesofCAD treatmentmostlikelytobewhichofthefollowing? A)

Drugtherapyandsmokingcessation

B)

Dietanddrugtherapy

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Diettherapyonly

D)

Diettherapyandsmokingcessation

Ans:

D

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Feedback: Duetotheabsenceofsymptoms,dietarytherapywouldlikelybeselectedasthefirst-linetreatmentfor possibleCAD.Drugtherapywouldbedeterminedbasedonanumberofconsiderationsanddiagnostics findings,butwouldnotbedirectlyindicated.Smokingcessationisalwaysindicated,regardlessofthe presenceorabsenceofsymptoms. 15. ThenurseisworkingwithapatientwhohadanMIandisnowactiveinrehabilitation.Thenurseshould teachthispatienttoceaseactivityifwhichofthefollowingoccurs? A)

Thepatientexperienceschestpain,palpitations,ordyspnea.

B)

Thepatientexperiencesanoticeableincreaseinheartrateduringactivity.

C)

Thepatientsoxygensaturationleveldropsbelow96%.

D)

Thepatientsrespiratoryrateexceeds30breaths/min.

Ans:

A Feedback: AnyactivityorexercisethatcausesdyspneaandchestpainshouldbestoppedinthepatientwithCAD. Heartratemustnotexceedthetargetrate,butanincreaseaboverestingrateisexpectedandis therapeutic.Inmostpatients,arespiratoryratethatexceeds30breaths/minisnotproblematic.Similarly, oxygensaturationslightlybelow96%doesnotnecessitatecessationofactivity.

16. Apatientwithcardiovasculardiseaseisbeingtreatedwithamlodipine(Norvasc),acalciumchannel blockingagent.Thetherapeuticeffectsofcalciumchannelblockersincludewhichofthefollowing? A)

Reducingtheheartsworkloadbydecreasingheartrateandmyocardialcontraction

B)

Preventingplateletaggregationandsubsequentthrombosis

C)

Reducingmyocardialoxygenconsumptionbyblockingadrenergicstimulationtotheheart

D)

Increasingtheefficiencyofmyocardialoxygenconsumption,thusdecreasingischemiaand relievingpain

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

534

A Feedback: Calciumchannelblockingagentsdecreasesinoatrialnodeautomaticityandatrioventricularnode conduction,resultinginaslowerheartrateandadecreaseinthestrengthoftheheartmusclecontraction. Theseeffectsdecreasetheworkloadoftheheart.Antiplateletandanticoagulationmedicationsare administeredtopreventplateletaggregationandsubsequentthrombosis,whichimpedesbloodflow. Beta-blockersreducemyocardialconsumptionbyblockingbeta-adrenergicsympatheticstimulationto theheart.Theresultisreducedmyocardialcontractility(forceofcontraction)tobalancethe myocardiumoxygenneedsandsupply.Nitratesreducemyocardialoxygenconsumption,which decreasesischemiaandrelievespainbydilatingtheveinsand,inhigherdoses,thearteries.

17. Thenurseisprovidingcareforapatientwithhighcholesterolandtriglyceridevalues.Inteachingthe patientabouttherapeuticlifestylechangessuchasdietandexercise,thenurserealizesthatthedesired goalforcholesterollevelsiswhichofthefollowing? A)

HighHDLvaluesandhightriglyceridevalues

B)

Absenceofdetectabletotalcholesterollevels

C)

Elevatedbloodlipids,fastingglucoselessthan100

D)

LowLDLvaluesandhighHDLvalues

Ans:

D Feedback: ThedesiredgoalforcholesterolreadingsisforapatienttohavelowLDLandhighHDLvalues.LDL exertsaharmfuleffectonthecoronaryvasculaturebecausethesmallLDLparticlescanbeeasily transportedintothevessellining.Incontrast,HDLpromotestheuseoftotalcholesterolbytransporting LDLtotheliver,whereitisexcreted.Elevatedtriglyceridesarealsoamajorriskfactorfor cardiovasculardisease.Agoalisalsotokeeptriglyceridelevelslessthan150mg/dL.Allindividuals possessdetectablelevelsoftotalcholesterol.

18. 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.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

535

A Feedback: 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.

19. ThenurseiscaringforapatientwhoisbelievedtohavejustexperiencedanMI.Thenursenotes changesintheECGofthepatient.WhatchangeonanECGmoststronglysuggeststothenursethat ischemiaisoccurring? A)

Pwaveinversion

B)

Twaveinversion

C)

QwavechangeswithnochangeinSTorTwave

D)

Pwaveenlargement

Ans:

B Feedback: T-waveinversionisanindicatorofischemicdamagetomyocardium.Typically,fewchangestoPwaves occurduringorafteranMI,whereasQ-wavechangeswithnochangeintheSTorTwaveindicatean oldMI.

20. 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

Ans:

B Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

536

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. 21. Thenurseisassessingapatientwhowasadmittedtothecriticalcareunit3hoursagofollowingcardiac surgery.Thenursesmostrecentassessmentrevealsthatthepatientsleftpedalpulsesarenotpalpable andthattherightpedalpulsesareratedat+2.Whatisthenursesbestresponse? A)
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