Med Surg TB Chapter 33 Flashcards


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1

The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching session?

A) Family history of coronary artery disease

B) Elevated low-density lipoprotein (LDL) level

C) Greater risk associated with the patient's gender

D) Increased risk of cardiovascular disease with aging

Answer: B

2

Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes?

A) Inform the patient about a diet containing no saturated fats and minimal salt.

B) Emphasize the increased cardiac risk unless the patient makes dietary changes.

C) Help the patient modify favorite high-fat recipes by using monosaturated oils.

D) Give the patient a list of low-sodium, low-cholesterol foods to include in the diet.

Answer: C

3

The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is from acute myocardial infarction?

A) The pain increases with deep breathing.

B) The pain lasts longer than 30 minutes.

C) The pain is relieved after the patient takes nitroglycerin.

D) The pain is reproducible when the patient raises the arms.

Answer: B

4

Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina?

A) "The pain wakes me up at night."

B) "The pain is level 3 to 5 (0 to 10 scale)."

C) "The pain has gotten worse over the last week."

D) "The pain goes away after a nitroglycerine tablet."

Answer: D

5

Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat) has been effective?

A) "I can expect nausea as a side effect of nitroglycerin."

B) "I should only take nitroglycerin when I have chest pain."

C) "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."

D) "I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart."

Answer: D

6

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed?

A) "I will switch from whole milk to 1% milk."

B) "I like salmon and I will plan to eat it more often."

C) "I can have a glass of wine with dinner if I want one."

D) "I will miss being able to eat peanut butter sandwhiches."

Answer: D

7

Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing anginal episodes has been effective?

A) "Carvedilol will help my heart muscle work harder."

B) "It is important not to suddenly stop taking carvedilol."

C) "I can expect to feel short of breath when taking carvedilol."

D) "Carvedilol will increase the blood flow to my heart muscle."

Answer: B

8

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI?

A) Myoglobin

B) Homocysteine

C) C-reactive protein

D) Cardiac-specific troponin

Answer: D

9

Diltiazem (Cardizem) is prescribed for a patient with newly diagnosed Prinzmetal's (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan?

A) Reduces heart palpitations.

B) Prevents coronary artery plaque.

C) Decreases coronary artery spasms.

D) Increases contractile force of the heart.

Answer: C

10

Which data indicates to the nurse that the patient with stable angina is experiencing a side effect of metoprolol (Lopressor)?

A) Patient is restless and agitated.

B) Patient reports feeling anxious.

C) Blood pressure is 90/54 mm Hg.

D) Heart monitor shows normal sinus rhythm.

Answer: C

11

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. What data would indicate to the nurse that the drug is effective?

A) Decreased blood pressure and heart rate

B) Improvement in the strength of the distal pulses

C) Fewer complaints of having cold hands and feet

D) Participation in daily activities without chest pain

Answer: D

12

Heparin is ordered for a patient with non-ST-segment-elevation myocardial infarction (NSTEMI). How should the nurse explain the purpose of heparin to the patient?

A) "Heparin enhances platelet aggregation at the plaque site."

B) "Heparin decreases the size of the coronary artery plaque."

C) "Heparin prevents the development of new clots in the coronary arteries."

D) "Heparin dissolves clots that are blocking blood flood in the coronary arteries."

Answer: C

13

Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for a patient with a myocardial infarction (MI)?

A) Monitor heart rate.

B) Ask about chest pain.

C) Check blood pressure.

D) Observe for dysrhythmias.

Answer: B

14

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?

A) "Do you have any allergies?"

B) "Do you take aspirin daily?"

C) "What time did your pain begin?"

D) "Can you rate the pain on a 0 to 10 scale?"

Answer: C

15

A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest?

A) O2 saturation drops from 99% to 95%.

B) Heart rate increases from 66 to 98 beats/min.

C) Respiratory rate goes from 14 to 20 breaths/min.

D) Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.

Answer: B

16

The nurse is administering a thrombolytic agent to a patient with an acute myocardial infarction. What patient data indicates that the nurse should stop the drug infusion?

A) Bleeding from the gums

B) An increase in blood pressure

C) Decreased level of consciousness

D) A nonsustained episode of ventricular tachycardia

Answer: C

17

A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieves by leaning forward. Which action should the nurse take as focused follow-up on this symptom?

A) Assess both feet for pedal edema.

B) Palpate the radial pulses bilaterally.

C) Auscultate for a pericardial friction rub.

D) Check the heart monitor for dysrhythmias.

Answer: C

18

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?

A) "I will sit down before I put the nitroglycerin under my tongue."

B) "I will check my pulse rate before I take any nitroglycerin tablets."

C) "I will put the nitroglycerin patch on as soon as I get any chest pain."

D) "I will remove the nitroglycerin patch before taking sublingual nitroglycerin."

Answer: A

19

The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI). What should the nurse anticipate teaching the patient?

A) Sudden cardiac death events rarely occur.

B) Additional diagnostic testing will be required.

C) Long-term anticoagulation therapy will be needed.

D) Limiting physical activity will prevent future SCD events.

Answer: B

20

A patient with diabetes mellitus and chronic stable angina has a new order for captopril. What should the nurse teach this patient about the primary purpose of captopril?

A) Decreases the heart rate.

B) Controls blood glucose levels.

C) Prevents changes in heart muscle.

D) Reduces frequency of chest pain.

Answer: C

21

After having a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." What reply would be most appropriate for the nurse to make?"

A) "What do you think caused your chest pain?"

B) "Where are you planning to go for your vacation?"

C) "Sometimes plans need to change after a heart attack."

D) "Recovery from a heart attack takes at least a few weeks."

Answer: A

22

The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed?

A) "They will circulate my blood with a machine during surgery."

B) "I will have incisions in my leg where they will remove the vein."

C) "They will use an artery near my heart to go around the area that is blocked."

D) "I will need to take aspirin every day after the surgery to keep the graft open."

Answer: B

23

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about safely resuming sexual intercourse. Which response by the nurse is best?

A) "Most patients are able to enjoy intercourse without any complications."

B) "Sexual activity uses about as much energy as climbing two flights of stairs."

C) "The doctor will provide sexual guidelines when your heart is strong enough."

D) "Holding and cuddling are good ways to maintain intimacy after a heart attack."

Answer: B

24

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication?

A) Administer the medication at the patient's usual bedtime.

B) Have the patient take the colesevelam 1 hour before breakfast.

C) Give the patient's other medications 2 hours after colesevelam.

D) Have the patient take the dose at the same time as the prescribed aspirin.

Answer: C

25

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. What should teaching for this patient include today?

A) Typical emotional responses to AMI

B) When cardiac rehabilitation will begin

C) Pathophysiology of coronary artery disease

D) Information regarding discharge medications

Answer: B

26

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider?

A) Generalized muscle aches and pains

B) Dizziness with rapid position changes

C) Nausea when taking drugs before meals

D) Flushing and pruritus after taking the drugs

Answer: A

27

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care?

A) Tadalafil (Cialas)

B) Furosemide (Lasix)

C) Warfarin ( Coumadin)

D) Diltiazem (Cardizem)

Answer: A

28

Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider?

A) Complaints of incisional chest pain

B) Pallor and weakness of the right hand

C) Fine crackles heard at both lung bases

D) Redness on both sides of the sternal incision

Answer: B

29

The nurse is caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization. What task should the nurse delegate to a licensed practical/vocational nurse (LPN/VN)?

A) Teach the patient about postprocedure plan of care.

B) Give the scheduled aspirin and lipid-lowering medication.

C) Perform the initial assessment of the catheter insertion site.

D) Titrate the heparin infusion according to the agency protocol.

Answer: B

30

Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider?

A) Inverted P wave

B) Sinus tachycardia

C) ST-segment elevation

D) First-degree atrioventricular block

Answer: C

31

A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse?

A) Report of chest pain

B) Heart rate 102 beats/min

C) Pedal pulses 1+ bilaterally

D) Blood pressure 103/54 mm Hg

Answer: A

32

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority?

A) Anxiety

B) Acute pain

C) Stress management

D) Decreased cardiac output

Answer: D

33

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first?

A) Attach the heart monitor.

B) Obtain the blood presure.

C) Assess the peripheral pulses.

D) Auscultate breath sounds.

Answer: A

34

Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?

A) An increase in troponin levels from baseline

B) A large bruise at the patient's IV insertion site

C) No change in the patient's reported level of chest pain

D) A decrease in ST-segment elevation of the electrocardiogram

Answer: C

35

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider?

A) The troponin level is elevated.

B) The patient denies having a heart attack.

C) Bilateral crackles in the mid-lower lobes.

D) Occasional premature atrial contractions.

Answer: C

36

A patient had a non-ST-segment elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?

A) Reinforcement of teaching about the prescribed medications

B) Evaluation of the patient's response to walking in the hallway

C) Completion of the referral form for a home health nurse follow-up

D) Education of the patient about the pathophysiology of heart disease

Answer: A

37

A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one should the nurse arrange to be completed first?

A) Chest x-ray

B) Troponin level

C) Electrocardiogram

D) Insertion of a peripheral IV

Answer: C

38

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first?

A) A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain.

B) A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia).

C) A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge.

D) A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

Answer: D

39

To improve the physical activity level for a mildly obese 68-year-old patient, which action should the nurse plan to take?

A) Stress that weight loss is a major benefit of increased exercise.

B) Determine what kind of physical activities the patient usually enjoys.

C) Tell the patient that older adults should exercise for no more than 20 minutes at a time.

D) Teach the patient to include a short warm-up period at the beginning of physical activity.

Answer: B

40

Which patient at the cardiovascular clinic requires the most immediate action by the nurse?

A) Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL.

B) Patient with stable angina whose chest pain has recently increased in frequency.

C) Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL.

D) Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg.

Answer: B

41

After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider?

A) Hyperglycemia

B) Bilateral crackles

C) Q waves on ECG

D) Elevated troponin

Answer: B