Cardiovascular Nursing: Identifying and Managing Complications, Exams of Nursing

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Cardio - NCLEX Saunders Cardiovascular Disorders

(Pacemaker, CAD to Pulmonary Edema) Questions with

Answers

The nurse in a medical unit is caring for a client with heart failure. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles, and the nurse suspects pulmonary edema. The nurse immediately notifies the registered nurse and expects which interventions to be prescribed? Select all that apply.

1. Administering oxygen
2. Inserting a Foley catheter
3. Administering furosemide (Lasix)
4. Administering morphine sulfate intravenously
5. Transporting the client to the coronary care unit
6. Placing the client in a low-Fowler's side-lying position - Correct Answer 1. Administering oxygen
7. Inserting a Foley catheter
8. Administering furosemide (Lasix)
9. Administering morphine sulfate intravenously Pulmonary edema is a life-threatening event that can result from severe heart failure. In pulmonary edema the left ventricle fails to eject sufficient blood, and pressure increases in the lungs because of the accumulated blood. Oxygen is always prescribed, and the client is placed in a high-Fowler's position to ease the work of breathing. Furosemide, a rapid- acting diuretic, will eliminate accumulated fluid. A Foley catheter is inserted to accurately measure output. Intravenously administered morphine sulfate reduces venous return (preload), decreases anxiety, and reduces the work of breathing. Transporting the client to the coronary care unit is not a priority intervention. In fact, this may not be necessary at all if the client's response to treatment is successful.

The nurse is assisting in caring for the client immediately after insertion of a permanent demand pacemaker via the right subclavian vein. The nurse prevents dislodgement of the pacing catheter by implementing which intervention? A. Limiting movement and abduction of the left arm B. Limiting movement and abduction of the right arm C. Assisting the client to get out of bed and ambulate with a walker D. Having the physical therapist do active range of motion to the right arm - Correct Answer B. Limiting movement and abduction of the right arm In the first several hours after insertion of either a permanent or temporary pacemaker, the most common complication is pacing electrode dislodgment. The nurse helps prevent this complication by limiting the client's activities. A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. The nurse listens to breath sounds, expecting to hear which breath sounds bilaterally? A. Rhonchi B. Crackles C. Wheezes D. Diminished breath sounds - Correct Answer B. Crackles Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Wheezes, rhonchi, and diminished breath sounds are not associated with pulmonary edema The nurse is collecting data on a client with a diagnosis of right-sided heart failure. The nurse should expect to note which specific characteristic of this condition? A. Dyspnea B. Hacking cough

C. Dependent edema D. Crackles on lung auscultation - Correct Answer C. Dependent edema Right-sided heart failure is characterized by signs of systemic congestion that occur as a result of right ventricular failure, fluid retention, and pressure buildup in the venous system. Edema develops in the lower legs and ascends to the thighs and abdominal wall. Other characteristics include jugular (neck vein) congestion, enlarged liver and spleen, anorexia and nausea, distended abdomen, swollen hands and fingers, polyuria at night, and weight gain. Left-sided heart failure produces pulmonary signs. These include dyspnea, crackles on lung auscultation, and a hacking cough. A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often in the morning. On further data collection, the nurse notes that the pain occurs in the absence of precipitating factors. How should the nurse best describe this type of anginal pain? A. Stable angina B. Variant angina C. Unstable angina D. Nonanginal pain - Correct Answer B. Variant angina Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often in the morning. Stable angina is induced by exercise and relieved by rest or nitroglycerin tablets. Unstable angina occurs at lower and lower levels of activity or at rest, is less predictable, and is often a precursor of myocardial infarction. The data in the question is characteristic of a type of angina pain, and therefore, nonanginal pain is incorrect. An emergency department client who complains of slightly improved but unrelieved chest pain for 2 days is reluctant to take a nitroglycerin sublingual tablet offered by the nurse. The client states, "I don't need that—my dad takes that for his heart. There's nothing wrong with my heart." Which description best describes the client's response? A. Angry

B. Denial C. Phobic D. Obsessive-compulsive - Correct Answer B. Denial Denial is the most common reaction when a client has a myocardial infarction or anginal pain. No angry behavior was identified in the question. Phobias and obsessive-compulsive disorders are mental health diagnoses. An ambulatory clinic nurse is interviewing a client who is complaining of flulike symptoms. The client suddenly develops chest pain. Which question best assists the nurse to discriminate pain caused by a noncardiac problem? A. "Can you describe the pain to me?" B. "Have you ever had this pain before?" C. "Does the pain get worse when you breathe in?" D. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?" - Correct Answer C. "Does the pain get worse when you breathe in?" Chest pain is assessed using the standard pain assessment parameters, (characteristics, location, intensity, duration, precipitating and alleviating factors, and associated symptoms). Describing the pain, asking if it has occurred in the past, and rating the pain using a pain scale may or may not help determine the origin of pain. Pain of pleuropulmonary origin usually worsens on inspiration. A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit with cardiac monitoring via telemetry. The nurse assisting in caring for the client expects to note which type of activity prescribed? A. Strict bed rest for 24 hours B. Bathroom privileges and self-care activities C. Unrestricted activities because the client is monitored

D. Unsupervised hallway ambulation with distances less than 200 feet - Correct Answer B. Bathroom privileges and self-care activities Upon transfer from the coronary care unit, the client is allowed self-care activities and bathroom privileges. Supervised ambulation in the hall for brief distances is encouraged, with distances gradually increased (50, 100, 200 feet). A hospitalized client with a history of angina pectoris is ambulating in the corridor. The client suddenly complains of severe substernal chest pain. The nurse should take which action first? A. Check the client's vital signs. B. Assist the client to sit or lie down. C. Administer sublingual nitroglycerin. D. Apply nasal oxygen at a rate of 2 L/min. - Correct Answer B. Assist the client to sit or lie down. Chest pain is caused by an imbalance between myocardial oxygen supply and demand. During episodes of pain, the nurse first limits the client's activity and assists the client to a position of comfort, checks the vital signs, administers oxygen and medication according to protocol, and obtains a 12 - lead electrocardiogram. A client brings the following medications to the clinic for a yearly physical. The nurse realizes which medication has been prescribed to treat heart failure? A. Digoxin (Lanoxin) B. Warfarin (Coumadin) C. Amiodarone (Cordarone) D. Potassium chloride (K-Dur) - Correct Answer A. Digoxin (Lanoxin) Digoxin strengthens the heartbeat and decreases the heart rate. It is used in the treatment of heart failure. Potassium chloride increases the potassium level. Although digoxin does

lower the potassium level, potassium chloride is not specifically administered for heart failure. Warfarin and amiodarone do not treat heart failure. A student nurse is assigned to assist in caring for a client with acute pulmonary edema who is receiving digoxin (Lanoxin) and heparin therapy. The nursing instructor reviews the plan of care formulated by the student and tells the student that which intervention is unsafe? A. Restricting the client's potassium intake B. Encouraging the client to rest after meals C. Administering the heparin with a 25 - gauge needle D. Holding the digoxin for a heart rate less than 60 beats per minute - Correct Answer A. Restricting the client's potassium intake Clients with acute pulmonary edema are on a sodium-restricted diet, not potassium restricted. Restricting potassium makes the client more prone to digoxin toxicity. Digoxin should be held and the health care provider notified when the client's heart rate is less than 60 beats per minute, unless otherwise prescribed. Heparin should be administered with a 25 - or 27 - gauge needle to reduce tissue trauma. Resting after meals decreases the demands placed on the heart and should be encouraged. For a client diagnosed with pulmonary edema, the nurse establishes a goal to have the client participate in activities that reduce cardiac workload. Which client activities will contribute to achieving this goal? A. Elevating the legs when in bed B. Sleeping in the supine position C. Using a bedside commode for stools D. Seasoning beef with a meat tenderizer - Correct Answer C. Using a bedside commode for stools Using a bedside commode decreases the work of getting to the bathroom or struggling to use the bedpan. Elevating the client's legs would increase venous return to the heart and result in an increase in cardiac workload. The supine position can increase respiratory

effort and decrease oxygenation, which increases cardiac workload. Meat tenderizers are high in sodium. Sodium contributes to hypertension, which increases cardiac workload. The nurse is caring for a client who is developing pulmonary edema. The client exhibits respiratory distress, but the blood pressure is unchanged from the client's baseline. As an immediate action before help arrives, the nurse should perform which action? A. Suction the client vigorously. B. Place the client in high-Fowler's position. C. Begin assembling medications that are anticipated to be given. D. Call the respiratory therapy department to request a ventilator. - Correct Answer B. Place the client in high-Fowler's position. The client in pulmonary edema is placed in high-Fowler's position if the blood pressure is adequate. Vigorous suctioning may deplete the client of vital oxygen at a time when the respiratory system is compromised. Assembling medications is useful but not critical to the immediate well-being of the client. The client may or may not need mechanical ventilation. The nurse has reinforced home care instructions to a client who had a permanent pacemaker inserted. Which educational outcome has the greatest impact on the client's long-term cardiac health? A. Knowledge of when it is safe to resume sexual activity B. The ability to take an accurate pulse in either the wrist or neck C. An understanding of the importance of proper microwave oven usage D. An understanding of why vigorous arm and shoulder movement must be avoided initially - Correct Answer B. The ability to take an accurate pulse in either the wrist or neck Clients with permanent pacemakers must be able to accurately take their pulse in the wrist and/or neck. The client needs to identify any variation in the pulse rate or rhythm and immediately report the variation to the health care provider. Clients can safely operate microwave ovens, radios, electric blankets, lawn mowers, leaf blowers, and cars (proper grounding must be ensured if the client is to operate electrical items). Sexual activity is not resumed until 6 weeks after surgery. The arms and shoulders should not be moved

vigorously for 6 weeks after insertion. The remaining options do not have the same impact on long-term cardiac health as does the correct option. The nurse is caring for a client who has been admitted to the hospital with a diagnosis of angina pectoris. The client is receiving oxygen via nasal cannula at 2 L. The client asks the nurse why the oxygen is necessary. The nurse bases the response on which information? A. Oxygen assists in calming the client. B. Oxygen prevents the development of any thrombus formation. C. Deficient oxygenation to heart cells results in angina pectoris pain. D. Oxygen dilates the blood vessels, supplying more nutrients to the heart muscle. - Correct Answer C. Deficient oxygenation to heart cells results in angina pectoris pain. The pain associated with angina is derived from ischemic myocardial cells. The pain is often associated with activity that places more oxygen demand on heart muscle. Supplemental oxygen helps meet the added demands on the heart muscle. Oxygen does not dilate blood vessels, prevent thrombus formation, or directly calm the client. The licensed practical nurse (LPN) is assisting in caring for a client with a diagnosis of myocardial infarction (MI). The client is experiencing chest pain that is unrelieved by the administration of nitroglycerin. The registered nurse administers morphine sulfate to the client as prescribed by the health care provider. Following administration of the morphine sulfate, the LPN plans to monitor which indicator(s)? A. Mental status B. Urinary output C. Respirations and blood pressure D. Temperature and blood pressure - Correct Answer C. Respirations and blood pressure Morphine sulfate is an opioid analgesic that may be administered to relieve pain in a client who experienced an MI. Although monitoring mental status is a component of the nurse's assessment, it is not the priority following administration of morphine sulfate. The nurse should monitor the client's respirations and blood pressure. Signs of morphine toxicity include respiratory depression and hypotension. Urinary output is unrelated to the

administration of this medication. Monitoring the temperature is also not associated with the use of this medication. The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting the client in completing the diet menu. Which beverage does the nurse instruct the client to select from the menu? A. Tea B. Cola C. Coffee D. Lemonade - Correct Answer D. Lemonade A client with a diagnosis of MI should not consume caffeinated beverages. Caffeinated products can produce a vasoconstrictive effect, leading to further cardiac ischemia. Coffee, tea, and cola all contain caffeine and need to be avoided in the client with MI. The nurse is collecting data on a client with a diagnosis of angina pectoris who takes nitroglycerin for chest pain. During the admission, the client reports chest pain. The nurse immediately asks the client which question? A. "Are you having any nausea?" B. "Where is the pain located?" C. "Are you allergic to any medications?" D. "Do you have your nitroglycerin with you?" - Correct Answer B. "Where is the pain located?" If a client complains of chest pain, the initial assessment question is to ask the client about the pain intensity, precipitating factors, location, radiation, and quality. Although options 1, 3, and 4 may be components of the assessment, these would not be the initial assessment questions in this situation. The nurse has reinforced dietary instructions to a client with coronary artery disease. Which statement by the client indicates an understanding of the dietary instructions?

A. "I need to substitute eggs and milk for meat." B. "I will eliminate all cholesterol and fat from my diet." C. "I should routinely use polyunsaturated oils in my diet." D. "I need to seriously consider becoming a strict vegetarian." - Correct Answer C. "I should routinely use polyunsaturated oils in my diet." The client with coronary artery disease should avoid foods high in saturated fat and cholesterol such as eggs, whole milk, and red meat. These foods contribute to increases in low-density lipoproteins. The use of polyunsaturated oils is recommended to control hyperlipidemia. It is not necessary to eliminate all cholesterol and fat from the diet. It is not necessary to become a strict vegetarian. A client with a history of angina pectoris tells the nurse that chest pain usually occurs after going up two flights of stairs or after walking four blocks. The nurse interprets that the client is experiencing which type of angina? A. Stable B. Variant C. Unstable D. Intractable - Correct Answer A. Stable Stable angina, also known as exertional angina, is triggered by a predictable amount of effort or emotion. Unstable angina is triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time. Variant angina is triggered by coronary artery spasm; the attacks are of longer duration than classic angina and tend to occur early in the day and at rest. Intractable angina is chronic and incapacitating, and is refractory to medical therapy. The nurse is teaching the client with angina pectoris about disease management and lifestyle changes that are necessary in order to control disease progression. Which statement by the client indicates a need for further teaching? A. "I will avoid using table salt with meals."

B. "It is best to exercise once a week for an hour." C. "I will take nitroglycerin whenever chest discomfort begins." D. "I will use muscle relaxation to cope with stressful situations." - Correct Answer B. "It is best to exercise once a week for an hour." Exercise is most effective when done at least 3 times a week for 20 to 30 minutes to reach a target heart rate. Other healthy habits include limiting salt and fat in the diet and using stress management techniques. The client also should be taught to take nitroglycerin before any activity that causes pain, and to take the medication at the first sign of chest discomfort. The nurse is working with a client who has been diagnosed with Prinzmetal's (variant) angina. The nurse plans to reinforce which information about this type of angina when teaching the client? A. Prinzmetal's angina is effectively managed by beta-blocking agents. B. Prinzmetal's angina improves with a low-sodium, high-potassium diet. C. Prinzmetal's angina has the same risk factors as stable and unstable angina. D. Prinzmetal's angina is generally treated with calcium channel blocking agents. - Correct Answer D. Prinzmetal's angina is generally treated with calcium channel blocking agents. Prinzmetal's angina results from spasm of the coronary arteries and is generally treated with calcium channel blocking agents. The risk factors are unknown, and this type of angina is relatively unresponsive to nitrates. Beta-blockers are contraindicated because they may actually worsen the spasm. Diet therapy is not specifically indicated although a healthy diet consuming foods low in fat and sodium is advocated in cardiac disease. The nurse working in a long-term care facility is collecting data from a client experiencing chest pain. The nurse should interpret that the pain is likely a result of myocardial infarction (MI) if which observation is made by the nurse? A. The client is not experiencing nausea or vomiting. B. The pain is described as substernal and radiating to the left arm.

C. The pain has not been unrelieved by rest and nitroglycerin tablets. D. The client says the pain began while trying to open a stuck dresser drawer. - Correct Answer C. The pain has not been unrelieved by rest and nitroglycerin tablets. The pain of angina may radiate to the left shoulder, arm, neck, or jaw. It is often precipitated by exertion or stress, has few associated symptoms, and is relieved by rest and nitroglycerin. The pain of MI may also radiate to the left arm, shoulder, jaw, and neck. It typically begins spontaneously, lasts longer than 30 minutes, and is frequently accompanied by associated symptoms (such as nausea, vomiting, dyspnea, diaphoresis, anxiety). The pain of MI is not relieved by rest and nitroglycerin and requires opioid analgesics, such as morphine sulfate, for relief. The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to the client to try to motivate the client to quit smoking? A. "Since the damage has already been done, it will be all right to cut down a little at a time." B. "None of the cardiovascular effects are reversible, but quitting might prevent lung cancer." C. "If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year." D. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years." - Correct Answer D. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years." The risks to the cardiovascular system from smoking are noncumulative and are not permanent. Three to 4 years after cessation, a client's cardiovascular risk is comparable to that of a person who never smoked. Therefore, options A, B, and C are incorrect. A client with heart failure is scheduled to be discharged to home with digoxin (Lanoxin) and furosemide (Lasix) as ongoing prescribed medications. The nurse teaches the client to report which sign/symptom that indicates the medications are not producing the intended effect? A. Decrease in pedal edema

B. High urine output during the day C. Weight gain of 2 to 3 pounds in a few days D. Cough accompanied by other signs of respiratory infection - Correct Answer C. Weight gain of 2 to 3 pounds in a few days Clients with heart failure should immediately report weight gain, loss of appetite, shortness of breath with activity, edema, persistent cough, and nocturia. An increase in daytime voiding is expected while on diuretic therapy (Lasix). A cough as a result of respiratory infection does not necessarily indicate that heart failure is exacerbating. A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving if which breath sounds are noted? A. Rhonchi B. Wheezes C. Crackles in the lung bases D. Crackles throughout the lung fields - Correct Answer C. Crackles in the lung bases Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy pink-tinged sputum. Auscultation of the lungs reveals crackles throughout the lung fields. As the client's condition improves, the amount of fluid in the alveoli decreases and may be detected by crackles in the bases. (Clear lung sounds would indicate full resolution of the episode.) Wheezes and rhonchi are not associated with pulmonary edema. A client in pulmonary edema has a prescription to receive morphine sulfate intravenously. The licensed practical nurse assisting in caring for the client determines that the client experienced an intended effect of the medication if which is noted? A. Increased pulse rate B. Relief of apprehension C. Decreased urine output

D. Increased blood pressure - Correct Answer B. Relief of apprehension Morphine sulfate reduces anxiety and dyspnea in the client with pulmonary edema. It also promotes peripheral vasodilation and causes blood to pool in the periphery. It decreases pulmonary capillary pressures, which reduces fluid migration into the alveoli. The client receiving morphine sulfate is monitored for signs and symptoms of respiratory depression and extreme drops in blood pressure, especially when administered intravenously. Options 1, 3, and 4 are unrelated to the action of morphine sulfate. The nurse is providing discharge teaching for a post-myocardial infarction (MI) client who will be taking 1 baby aspirin a day. The nurse determines that the client understands the use of this medication if the client makes which statement? A. "I will take this medication every day." B. "I will take this medication every other day." C. "I will take this medication until I feel better." D. "I will take this medication only when I have pain." - Correct Answer A. "I will take this medication every day." A single daily dose of 1 baby aspirin (low-dose aspirin) may be a component of the standard treatment regimen for the client after an MI. Aspirin helps prevent clotting and may prevent a thrombosis that could cause a second MI. If the client cannot tolerate aspirin, then another antiplatelet medication may be prescribed. The other three options are unacceptable because the benefit comes in taking the medication on a daily basis. The nurse determines that a client with coronary artery disease (CAD) needs further teaching about disease management if the client makes which statement? A. "I will watch my weight gain." B. "I will avoid walking for exercise." C. "I will monitor my cholesterol intake." D. "I will follow a low-fat, low-salt diet." - Correct Answer B. "I will avoid walking for exercise."

Lack of physical exercise contributes to the development of coronary artery disease, and engaging in a regular program of exercise helps retard progression of atherosclerosis by lowering cholesterol levels and developing collateral circulation to heart tissue. Walking should be encouraged for 30 minutes a day. Watching weight gain, monitoring cholesterol and following a low-fat, low-salt diet are accurate statements An older client with ischemic heart disease has experienced an episode of dizziness and shortness of breath. The nurse reviews the plan of care and notices documentation of decreased cardiac output, dyspnea, and syncopal episodes. The nurse plans to take which important action? A. Monitor oxygen saturation levels. B. Place the client on a cardiac monitor. C. Measure blood pressure every 4 hours. D. Check capillary refill at least once per shift. - Correct Answer B. Place the client on a cardiac monitor. The client with decreased cardiac output should be placed on continuous cardiac monitoring so myocardial perfusion and presence of dysrhythmias can be most accurately assessed. Other cardiovascular data should be collected at least every 2 hours initially. The nurse is planning adaptations needed for activities of daily living for a client with cardiac disease. The nurse should incorporate which instruction in discussion with the client? A. Increase fluids to 3000 mL per day to promote renal perfusion. B. Consume 1 to 2 oz of liquor each night to promote vasodilation. C. Try to engage in vigorous activity to strengthen cardiac reserve. D. Take in adequate daily fiber to prevent straining during a bowel movement. - Correct Answer D. Take in adequate daily fiber to prevent straining during a bowel movement. Standard instructions for a client with cardiac disease include, among others, lifestyle changes such as decreasing alcohol intake, avoiding activities that increase the demands

on the heart, instituting a bowel regimen program to prevent straining and constipation, and maintaining fluid and electrolyte balance. Increasing fluids to 3000 mL could lead to increased blood volume and an increased workload on the heart in the client with cardiac disease. An adult client just admitted to the hospital with heart failure also has a history of diabetes mellitus. The nurse calls the health care provider to verify a prescription for which medication that the client was taking before admission? A. NPH insulin B. Regular insulin C. Chlorpropamide D. Acarbose (Precose) - Correct Answer C. Chlorpropamide Chlorpropamide is an oral hypoglycemic agent that exerts an antidiuretic effect and should be administered cautiously or avoided in the client with cardiac impairment or fluid retention. It is a first-generation sulfonylurea. Insulin does not cause or aggravate fluid retention. Acarbose is a miscellaneous oral hypoglycemic agent. The nurse is caring for a client with coronary artery disease, and a topical nitrate is prescribed for the client. Why is acetaminophen (Tylenol) usually prescribed to be taken before the administration of the topical nitrate A. Headache is a common side effect of nitrates. B. Fever usually accompanies coronary artery disease. C. Acetaminophen potentiates the therapeutic effects of nitrates. D. Acetaminophen does not interfere with platelet action as acetylsalicylic acid (aspirin) does. - Correct Answer A. Headache is a common side effect of nitrates. Headache occurs as a side effect of nitrates. Acetaminophen may be given before nitrates to prevent headaches or to minimize the discomfort from the headaches. Option 2 is incorrect. Options 3 and 4 are unrelated to the data in the question.

The nurse is reinforcing dietary instructions to a client with heart failure (HF). The nurse determines that the client understands the instructions if the client states that which food item will be avoided? A. Catsup B. Sherbet C. Cooked cereal D. Leafy green vegetables - Correct Answer A. Catsup Catsup is high in sodium. Leafy green vegetables, cooked cereal, and sherbet all are low in sodium. Clients with heart failure should monitor sodium intake. The nurse is assisting a hospitalized client who is newly diagnosed with coronary artery disease (CAD) to make appropriate selections from the dietary menu. The nurse encourages the client to select which meal? A. Sausage, pancakes, and toast B. Broccoli, buttered rice, and grilled chicken C. Hamburger, baked apples, and avocado salad D. Fresh strawberries, steamed vegetables, and baked fish - Correct Answer D. Fresh strawberries, steamed vegetables, and baked fish Diets high in saturated fats raise the serum lipid level, which, in turn, raises the blood cholesterol. Over time, high blood cholesterol levels lead to the development of atherosclerosis and diseases such as coronary artery disease. A diet that is low in saturated fats is helpful in reducing the progression of atherosclerosis. Meats and dairy products tend to be higher in fat than other food groups. A client with known coronary artery disease (CAD) begins to experience chest pain while getting out of bed. The nurse should take which action? A. Get a prescription for pain medication. B. Have the client stop and lie back down in bed.

C. Report the complaint to the health care provider. D. Have the client continue to get out of bed and into a chair. - Correct Answer B. Have the client stop and lie back down in bed. The pain associated with coronary artery disease is called angina pectoris, and it occurs because of myocardial tissue ischemia from insufficient blood flow to the heart. The nurse should first have the client stop the activity and lie back down to decrease the workload and oxygen demand on the heart. Options 1 and 3 can be done after ensuring that the client is resting. The pain medication that is likely to be prescribed is nitroglycerin, which is a coronary vasodilator. Option 4 is contraindicated and will worsen the pain and possibly lead to myocardial infarction. The nurse is setting up the bedside unit for a client being admitted to the nursing unit from the emergency department with a diagnosis of coronary artery disease (CAD). The nurse should place highest priority on making sure that which is available at the bedside? A. Bedside commode B. Rolling shower chair C. Oxygen tubing and flowmeter D. Twelve-lead electrocardiogram (ECG) machine - Correct Answer C. Oxygen tubing and flowmeter CAD causes obstruction to blood flow through one or more major coronary arteries, cutting off oxygen and nutrients to the cardiac cells, and resulting in chest pain. Providing oxygen to the client is important to help decrease pain and prevent its recurrence. A bedside commode and ECG machine may be helpful but are not the priority. A rolling shower chair has no value for this client because the client should be able to walk and shower if pain free and an activity prescription allows it. The nurse determines that a client with coronary artery disease (CAD) understands disease management if the client makes which statement? A. "I will walk for one-half hour daily." B. "As long as I exercise I can eat anything I wish."

C. "My weight has nothing to do with this disease." D. "It doesn't matter if my father had high cholesterol." - Correct Answer A. "I will walk for one-half hour daily." Lack of physical exercise contributes to the development of CAD, and engaging in a regular program of exercise helps retard progression of atherosclerosis by lowering cholesterol levels and developing collateral circulation to heart tissue. Options 2 and 4 are incorrect because obesity and a diet high in fat can contribute to CAD. Option 4 is incorrect because genetic factors also contribute to CAD. A client has just completed an information session about measures to minimize the progression of coronary artery disease (CAD). Which statement indicates an initial understanding of lifestyle alterations? A. I should take daily medication for life. B. I should eat a diet that is low in fat and cholesterol. C. I should continue to smoke to keep the metabolic rate high. D. I should begin to exercise if diet is not sufficient to achieve weight loss. - Correct Answer B. I should eat a diet that is low in fat and cholesterol. A diet that is low in fat and cholesterol helps slow the progression of CAD. This must be accompanied by regular exercise and cessation of smoking. If these measures are effective, the client may not need daily medication. The nurse is collecting data on a client who was just admitted to the hospital with a diagnosis of coronary artery disease (CAD). The client reveals having been under a great deal of stress recently. Which should the nurse do next? A. Ask whether the client wants to see a psychiatrist. B. Explore with the client the sources of stress in life. C. Reassure the client that everybody seems stressed these days. D. Ask the client to write down a list of stressors to be evaluated at a later time. - Correct Answer B. Explore with the client the sources of stress in life.

The nurse should encourage the client to explore and verbalize stressors. Later, the nurse can teach the client strategies for coping with stress, such as the basic relaxation techniques of deep breathing, progressive muscle relaxation, and visualization. Option 1 could be construed as excessive or insulting and puts the client's feelings on hold. Option 3 ignores the client's concerns. Option 4 places further data collection of this area on hold. A client with a diagnosis of myocardial infarction has a new activity prescription allowing the client to have bathroom privileges. As the client stands and begins to walk, the client begins to complain of chest pain. The nurse should take which action? A. Assist the client to get back into bed. B. Report the chest pain episode to the health care provider. C. Tell the client to stand still, and take the client's blood pressure. D. Give a nitroglycerin (Nitrostat) tablet, and assist the client to the bathroom. - Correct Answer A. Assist the client to get back into bed. The client is assisted back to bed to put the client at rest. The nurse can then measure vital signs and administer nitroglycerin that is prescribed for as-needed (PRN) use. The nurse should then report the chest pain episode to the health care provider. The nurse should not continue to assist the client into the bathroom because it places the client in danger because of continued myocardial oxygen demands. A client being seen in the emergency department for complaints of chest pain confides in the nurse about regular use of cocaine as a recreational drug. The nurse takes which important action in delivering holistic nursing care to this client? A. Reports the client to the police for illegal drug use B. Explains to the client the damage that cocaine does to the heart C. Tells the client it is imperative to stop before myocardial infarction occurs D. Teaches about the effects of cocaine on the heart and offers referral for further help - Correct Answer D. Teaches about the effects of cocaine on the heart and offers referral for further help

To provide the most holistic care, the nurse should meet the information needs of the client about the effects of cocaine on the heart and offer referral for further help with this possible addiction. Option 1 is partially correct but does not meet the holistic needs of the client. Option 2 is not indicated and breaches the client's right to confidentiality. Option 3 is incorrect because it "preaches" to the client. The nurse is reinforcing instructions to a client with angina pectoris about measures to reduce recurrence of chest pain. The nurse should stress to the client the importance of taking which measure? A. Saving all chores for the end of the day B. Avoiding exposure to either very hot or very cold weather C. Eating large meals to reduce the work of the gastrointestinal tract D. Keeping items stored above shoulder level to encourage exercise - Correct Answer B. Avoiding exposure to either very hot or very cold weather The client should avoid extreme hot or cold temperatures to avoid placing undue stress on the cardiovascular system. The client should space activities throughout the day rather than save them for the end of the day when the client is more fatigued. The client should eat smaller meals so less blood flow is diverted for the work of digestion. Exercise is important, but the client should keep most items stored at heart level, to prevent straining and increased intrathoracic pressure, which can decrease cardiac output. The nurse is planning measures to decrease the incidence of chest pain for a client with angina pectoris. The nurse should do which intervention to effectively accomplish this goal? A. Provide a quiet and low-stimulus environment. B. Encourage the family to come visit very frequently. C. Encourage the client to call friends and relatives each day. D. Recommend that the client watch TV as a constant diversion. - Correct Answer A. Provide a quiet and low-stimulus environment.

Chest pain can be minimized by a quiet, low-stimulus environment, which reduces factors that trigger chest pain, such as emotional excitement. Each of the incorrect options increases the amount of client stimulation, which increases the risk of an anginal episode. A client in a long-term care facility who has a history of angina pectoris wants to go for a short walk outside with a family member. It is a sunny but chilly December day. The nurse should perform which intervention to care for this client in a holistic manner? A. Tell the client that this is not allowed. B. Tell the family member not to take the client outdoors. C. Give the client a cup of hot coffee before going outside. D. Instruct the family member to dress the client warmly before going outside. - Correct Answer D. Instruct the family member to dress the client warmly before going outside. The nurse should meet both the physiological and psychosocial needs of the client in a holistic manner by asking the family member to be sure that the client is dressed warmly before going outside. Option 4 is correct because dressing the client warmly will decrease the chance of vasoconstriction, which may lead to an angina attack. Options 1 and 2 ignore the psychosocial needs. Option 3 is detrimental to physiological needs because, in addition to the cold weather, caffeine places an additional burden on the heart. A client admitted to the hospital with a diagnosis of myocardial infarction (MI) tells the nurse that the pain likely resulted from the fried chicken sandwich that the client had for lunch. The nurse's response is based on which fact? A. Most people love high-fat diets. B. Denial is a common occurrence early after MI. C. The client probably wants to belittle the opinion of the staff. D. The client is not motivated to learn about heart disease at this time. - Correct Answer B. Denial is a common occurrence early after MI. An early initial coping response following MI is denial. The nurse uses this knowledge of this common response in planning care for the client. Option 1 is an opinion and not based

on information in the question. There is no evidence in the question to support options 3 and 4. The nurse is preparing to provide a therapeutic environment for a client who recently had a myocardial infarction (MI). Which are characteristics of a therapeutic environment? A. No stimulus, no stress B. Low stimulus, low stress C. High stimulus, low stress D. Moderate stimulus, low stress - Correct Answer B. Low stimulus, low stress An environment that is low stimulus and low stress is needed to decrease anxiety and metabolic demands for the client after MI. Nursing care is directed at promoting rest and assisting with activities of daily living. Option 1 cannot be provided, and options 3 and 4 are too high in stimulus to be therapeutic. A client who experienced a myocardial infarction (MI) tells the nurse that he is fearful about not being able to return to a normal life. Which action by the nurse is therapeutic at this time? A. Tell the client that his fears are not rational. B. Tell the client that his life has not changed. C. Explore the specific concerns with the client. D. Tell the client to talk it out with the significant other. - Correct Answer C. Explore the specific concerns with the client. The therapeutic action by the nurse is one that gathers more data. This then allows the nurse to formulate the appropriate response. Each of the incorrect options is nontherapeutic because they place the client's feelings on hold and do not address them. A client complaining of chest pain has an as-needed (PRN) prescription for sublingual nitroglycerin (Nitrostat). Before administering the medication to the client, the nurse should first check which?

A. Blood pressure B. Cardiac rhythm C. Respiratory rate D. Peripheral pulses - Correct Answer A. Blood pressure Assessing the blood pressure is a priority before administering nitroglycerin to determine the vasodilating effect of the medication and to monitor for a drop in blood pressure. Cardiac rhythm and respiratory rate are also important to assess after checking the blood pressure. Peripheral pulses do not need to be checked before administering this medication. A client with infective endocarditis is at risk for heart failure. The nurse monitors the client for which signs and symptoms of heart failure? A. Lung crackles, peripheral edema, and weight gain B. Confusion, decreasing level of consciousness, and aphasia C. Respiratory distress, chest pain, and the use of accessory muscles D. Flank pain with radiation to the groin, accompanied by hematuria - Correct Answer A. Lung crackles, peripheral edema, and weight gain The client with infective endocarditis may experience both left- and right-sided heart failure, and thus the nurse monitors the client for both pulmonary and peripheral symptoms, such as lung crackles, peripheral edema, and weight gain. Options 2 and 4 relate to disorders of the brain and kidney, respectively. Option 3 contains symptoms that occur with pulmonary embolism, which is not related to the subject of the question. A client with coronary artery disease has selected guided imagery to help cope with psychological stress. Which statement by the client indicates understanding of this stress reduction measure? A. "This will help only if I play music at the same time." B. "This will work for me only if I am alone in a quiet area."

C. "I need to do this only when I lie down in case I fall asleep." D. "The best thing about this is that I can use it anywhere, anytime." - Correct Answer D. "The best thing about this is that I can use it anywhere, anytime." Guided imagery involves the client's creation of an image in the mind, concentrating on the image, and gradually become less aware of the offending stimulus. It does not require any adjuncts and does not need to be done in a quiet area only, although some clients may use other relaxation techniques or play music with it. A client, who is 36 hours post-myocardial infarction, has ambulated for the first time. The nurse determines that the client best tolerated the activity if which observation is made? A. The skin is cool but slightly diaphoretic. B. Dyspnea is noted only at the end of the exercise. C. The preactivity pulse rate is 86 beats per minute; the postactivity pulse rate is 94 beats per minute. D. The preactivity blood pressure (BP) is 140/84 mm Hg; the postactivity BP is 110/72 mm Hg. - Correct Answer C. The preactivity pulse rate is 86 beats per minute; the postactivity pulse rate is 94 beats per minute. The nurse checks vital signs and the level of fatigue with each activity. The client is not tolerating the activity if systolic BP drops more than 20 mm Hg, pulse rate increases more than 20 beats per minute, or if the client experiences dyspnea or chest pain. In addition, a significant drop in BP can indicate orthostatic hypotension, which is an abnormal condition. Cool, diaphoretic skin is a sign of some degree of cardiovascular compromise. The nurse is planning a dietary menu for a client with heart failure being treated with digoxin (Lanoxin) and furosemide (Lasix). Which would be the best dinner choice from the daily menu? A. Beef ravioli, spinach soufflé, and Italian bread B. Baked pollock, mashed potatoes, and carrot-raisin salad C. Roasted chicken breast, brown rice, and stewed tomatoes