The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to:
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Solution
Assess the extent of arterial blockage
Cardiac catheterization is done in clients with angina primarily to assess the extent and severity of the coronary artery blockage, A decision about medical management, angioplasty, or coronary artery bypass surgery will be based on the catheterization results.
Which of the following symptoms should the nurse teach the client with unstable angina to report immediately to her physician?
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Solution
A change in the pattern of her pain
The client should report a change in the pattern of chest pain. It may indicate increasing severity of CAD.
During the previous few months, a 56-year-old woman felt brief twinges of chest pain while working in her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up appointment, she is discouraged because she is experiencing pain with increasing frequency. She states that she is visiting an invalid friend twice a week and now cannot walk up the second flight of steps to the friend’s apartment without pain. Which of the following measures that the nurse could suggest would most likely help the client deal with this problem?
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Solution
Take a nitroglycerin tablet before climbing the stairs.
Nitroglycerin may be used prophylactically before stressful physical activities such as stair climbing to help the client remain pain-free.
Option A: Visiting her friend early in the day would have no impact on decreasing pain episodes.
Option B: Resting before or after an activity is not as likely to help prevent an activity-related pain episode.
Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of:
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Solution
Cerebrovascular accident
Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, hypertension may go undetected. CVA’s can be related to long-term hypertension.
Option B and D: Liver or pulmonary disease is generally not associated with hypertension.
Option C: Myocardial infarction is generally related to coronary artery disease.
The most important long-term goal for a client with hypertension would be to:
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Solution
Make a commitment to long-term therapy
Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.
When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:
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Solution
Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.
The nurse receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following?
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Solution
Myocardial infarction
Detection of myoglobin is one diagnostic tool to determine whether myocardial damage has occurred. Myoglobin is generally detected about one hour after a heart attack is experienced and peaks within four (4) to six (6) hours after infarction (Remember, less than 90 mg/L is normal).
A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse’s next action would be to:
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Solution
Start an intravenous line
Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces.
Options A, C, and D: Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.
When interpreting an ECG, the nurse would keep in mind which of the following about the P wave? Select all that apply.
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Solution
Answer: 1, 3, 5
In a client who has had an ECG, the P wave represents the activation of the electrical impulse in the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11 seconds or less in duration and 2.5 mm or more in height.
When administered a thrombolytic drug to the client experiencing an MI, the nurse explains to him that the purpose of this drug is to:
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Solution
Dissolve clots he may have
Thrombolytic drugs are administered within the first 6 hours after onset of an MI to lyse clots and reduce the extent of myocardial damage.