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Questions and Answers
A patient with a history of atherosclerosis is scheduled for a follow-up appointment. Which diagnostic test result should the nurse prioritize reviewing to assess the patient's risk of myocardial infarction (MI)?
A patient with a history of atherosclerosis is scheduled for a follow-up appointment. Which diagnostic test result should the nurse prioritize reviewing to assess the patient's risk of myocardial infarction (MI)?
- High-density lipoprotein (HDL) level
- Low-density lipoprotein (LDL) particle number (correct)
- Total cholesterol level
- Triglyceride level
A patient with angina pectoris is prescribed sublingual nitroglycerin (NTG) for acute chest pain. Which instruction should the nurse emphasize to ensure the patient uses the medication safely and effectively?
A patient with angina pectoris is prescribed sublingual nitroglycerin (NTG) for acute chest pain. Which instruction should the nurse emphasize to ensure the patient uses the medication safely and effectively?
- Avoid taking NTG if you experience a headache, as it can worsen the pain.
- If chest pain worsens after the first NTG tablet, immediately take two more tablets.
- If chest pain is not relieved after three NTG tablets taken 5 minutes apart, call 911. (correct)
- Take one NTG tablet every 15 minutes until the chest pain is relieved.
A nurse is providing discharge teaching to a patient who underwent coronary artery bypass grafting (CABG). Which statement by the patient indicates a need for further education regarding sternal precautions?
A nurse is providing discharge teaching to a patient who underwent coronary artery bypass grafting (CABG). Which statement by the patient indicates a need for further education regarding sternal precautions?
- "I should hug a pillow when I cough or move."
- "I will avoid lifting anything heavier than 5 pounds for the next few weeks."
- "I can use my arms to push myself up from a chair carefully." (correct)
- "I need to avoid raising my elbows above my shoulders."
A patient with peripheral arterial disease (PAD) reports experiencing intermittent claudication in the left calf. Which intervention should the nurse prioritize to improve the patient's tissue perfusion?
A patient with peripheral arterial disease (PAD) reports experiencing intermittent claudication in the left calf. Which intervention should the nurse prioritize to improve the patient's tissue perfusion?
A nurse assesses a patient with a history of Raynaud's disease during a cold weather season. Which assessment finding requires immediate intervention?
A nurse assesses a patient with a history of Raynaud's disease during a cold weather season. Which assessment finding requires immediate intervention?
The nurse is evaluating a patient with a diagnosis of acute coronary syndrome (ACS) who is receiving heparin. Which laboratory result requires immediate intervention?
The nurse is evaluating a patient with a diagnosis of acute coronary syndrome (ACS) who is receiving heparin. Which laboratory result requires immediate intervention?
A patient is admitted with a diagnosis of acute myocardial infarction (MI). The physician prescribes morphine sulfate for unrelieved ischemic pain. Which assessment finding would warrant withholding the morphine and contacting the physician?
A patient is admitted with a diagnosis of acute myocardial infarction (MI). The physician prescribes morphine sulfate for unrelieved ischemic pain. Which assessment finding would warrant withholding the morphine and contacting the physician?
A nurse is providing education to a patient who is newly prescribed clopidogrel (Plavix) after percutaneous coronary intervention (PCI). What statement by the patient indicates understanding of the teaching?
A nurse is providing education to a patient who is newly prescribed clopidogrel (Plavix) after percutaneous coronary intervention (PCI). What statement by the patient indicates understanding of the teaching?
A patient is scheduled for an endarterectomy. The nurse understands that the procedure involves:
A patient is scheduled for an endarterectomy. The nurse understands that the procedure involves:
A nurse is caring for a post-operative patient following an aortofemoral bypass graft. Which assessment finding should the nurse report IMMEDIATELY to the health care provider?
A nurse is caring for a post-operative patient following an aortofemoral bypass graft. Which assessment finding should the nurse report IMMEDIATELY to the health care provider?
After undergoing a percutaneous transluminal angioplasty (PTA) for treatment of peripheral arterial disease, a patient reports sudden onset of severe pain in the affected extremity. What is the nurse's priority intervention?
After undergoing a percutaneous transluminal angioplasty (PTA) for treatment of peripheral arterial disease, a patient reports sudden onset of severe pain in the affected extremity. What is the nurse's priority intervention?
A patient with a history of venous insufficiency is admitted with a venous stasis ulcer on the lower leg. Which intervention should the nurse include in the plan of care to promote healing of the ulcer?
A patient with a history of venous insufficiency is admitted with a venous stasis ulcer on the lower leg. Which intervention should the nurse include in the plan of care to promote healing of the ulcer?
A patient is prescribed warfarin (Coumadin) for long-term anticoagulation therapy following a diagnosis of atrial fibrillation. The nurse instructs the patient to maintain a consistent intake of which of the following?
A patient is prescribed warfarin (Coumadin) for long-term anticoagulation therapy following a diagnosis of atrial fibrillation. The nurse instructs the patient to maintain a consistent intake of which of the following?
A patient is receiving ezetimibe (Zetia) to manage hyperlipidemia. The nurse recognizes that the medication's primary mechanism of action is to:
A patient is receiving ezetimibe (Zetia) to manage hyperlipidemia. The nurse recognizes that the medication's primary mechanism of action is to:
A nurse is caring for a patient who is about to undergo a diagnostic angiography. What pre-procedure action is MOST important for the nurse to implement?
A nurse is caring for a patient who is about to undergo a diagnostic angiography. What pre-procedure action is MOST important for the nurse to implement?
A patient with known coronary artery disease (CAD) reports experiencing chest pain that occurs with moderate exertion and is relieved by rest. The nurse recognizes this as which type of angina?
A patient with known coronary artery disease (CAD) reports experiencing chest pain that occurs with moderate exertion and is relieved by rest. The nurse recognizes this as which type of angina?
A patient being treated for acute arterial occlusion suddenly develops increased pain, paralysis, and paresthesia in the affected limb. Which condition should the nurse suspect?
A patient being treated for acute arterial occlusion suddenly develops increased pain, paralysis, and paresthesia in the affected limb. Which condition should the nurse suspect?
A patient undergoing treatment for venous thromboembolism (VTE) is prescribed enoxaparin (Lovenox). What is the MOST important instruction the nurse should teach th patient to ensure safe administration of medication at home?
A patient undergoing treatment for venous thromboembolism (VTE) is prescribed enoxaparin (Lovenox). What is the MOST important instruction the nurse should teach th patient to ensure safe administration of medication at home?
A patient is diagnosed with Thromboangiitis Obliterans. The nurse recognizes the MOST effective intervention to prevent progressing of the disease is:
A patient is diagnosed with Thromboangiitis Obliterans. The nurse recognizes the MOST effective intervention to prevent progressing of the disease is:
A patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB) procedure. The nurse clarifies that this surgical approach involves:
A patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB) procedure. The nurse clarifies that this surgical approach involves:
A patient who has undergone angioplasty with stent placement is prescribed ticagrelor (Brilinta). The nurse understands that this medication is prescribed to:
A patient who has undergone angioplasty with stent placement is prescribed ticagrelor (Brilinta). The nurse understands that this medication is prescribed to:
A patient is being evaluated for possible peripheral vascular disease (PVD). Describe the ankle-brachial index (ABI) and what its significance is in the diagnosis of PVD.
A patient is being evaluated for possible peripheral vascular disease (PVD). Describe the ankle-brachial index (ABI) and what its significance is in the diagnosis of PVD.
A patient with an abdominal aortic aneurysm (AAA) is being medically managed. The nurse understands that a critical component of the management plan is:
A patient with an abdominal aortic aneurysm (AAA) is being medically managed. The nurse understands that a critical component of the management plan is:
What is the most critical home care instruction that the nurse should reinforce when discharging a client diagnosed with acute lymphangitis?
What is the most critical home care instruction that the nurse should reinforce when discharging a client diagnosed with acute lymphangitis?
While providing teaching to a group of patients with risk factors for cardiovascular disease, a nurse emphasizes the importance of adopting a heart-healthy lifestyle. Why?
While providing teaching to a group of patients with risk factors for cardiovascular disease, a nurse emphasizes the importance of adopting a heart-healthy lifestyle. Why?
A patient who is allergic to shellfish presents to the emergency room with a suspected acute myocardial infarction. What is the rationale for not using ionizing agents?
A patient who is allergic to shellfish presents to the emergency room with a suspected acute myocardial infarction. What is the rationale for not using ionizing agents?
The nurse is caring for a patient that is post-op from fem-pop bypass to the left lower extremity. The client asks what needs to happen so he will be able to ambulate without pain. What is the best answer?
The nurse is caring for a patient that is post-op from fem-pop bypass to the left lower extremity. The client asks what needs to happen so he will be able to ambulate without pain. What is the best answer?
Which patient statement indicates the BEST understanding of hypertension control in the setting of CAD and atherosclerosis?
Which patient statement indicates the BEST understanding of hypertension control in the setting of CAD and atherosclerosis?
Which assessment finding would lead the nurse to suspect a complication after a client suffered a Myocardial Infarction a week ago.
Which assessment finding would lead the nurse to suspect a complication after a client suffered a Myocardial Infarction a week ago.
A 60 year old client with PAD had below the knee amputation 2 days report severe pain to the left foot that is rated a 10/10. What drug schedule would you use?
A 60 year old client with PAD had below the knee amputation 2 days report severe pain to the left foot that is rated a 10/10. What drug schedule would you use?
After a thrombolytic administration for an acute Myocardial Infarction, what should the nurse look for?
After a thrombolytic administration for an acute Myocardial Infarction, what should the nurse look for?
A client arrives to the ED reporting chest pain for 4 hours. What is the first action?
A client arrives to the ED reporting chest pain for 4 hours. What is the first action?
What is the most important teaching when providing education to a client taking NTG?
What is the most important teaching when providing education to a client taking NTG?
A client with PAD is walking and reports leg pain that goes from the glutes-> calves. They immediately stop what is happening?
A client with PAD is walking and reports leg pain that goes from the glutes-> calves. They immediately stop what is happening?
What diagnostic finding must be present to label high cholesterol and hyperlipidemia.
What diagnostic finding must be present to label high cholesterol and hyperlipidemia.
After a MI there was necrosis to the myocardium where do you expect the client to complain of pain?
After a MI there was necrosis to the myocardium where do you expect the client to complain of pain?
A client is asking you what interventions may help their angina? What is the best interventions that addresses that concern?
A client is asking you what interventions may help their angina? What is the best interventions that addresses that concern?
Client has HTN that is tearful and frightened, patient is asking best preventative action? What educational action do you take?
Client has HTN that is tearful and frightened, patient is asking best preventative action? What educational action do you take?
Choose the best priority dx for Ineffective Tissue Perfursion arterial:
Choose the best priority dx for Ineffective Tissue Perfursion arterial:
Client verbalize effective self managements with health education and health promotion.
Client verbalize effective self managements with health education and health promotion.
The nurse has finished an assessment on a patient, what are important assessment findings?
The nurse has finished an assessment on a patient, what are important assessment findings?
Flashcards
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome (ACS)
A syndrome involving myocardial ischemia, including unstable angina, NSTEMI, and STEMI.
Atherosclerosis
Atherosclerosis
The formation of plaque within the arteries, leading to narrowing and reduced blood flow.
Angina Pectoris
Angina Pectoris
Chest pain due to ischemia resulting from a reduction in coronary artery blood flow and oxygen delivery to the myocardium.
Coronary Artery Disease (CAD)
Coronary Artery Disease (CAD)
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Endarterectomy
Endarterectomy
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Stenting
Stenting
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Sudden Cardiac Death
Sudden Cardiac Death
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Thromboangiitis Obliterans (Buerger Disease)
Thromboangiitis Obliterans (Buerger Disease)
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Aneurysm
Aneurysm
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Varicose Veins
Varicose Veins
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Myocardial Infarction (MI)
Myocardial Infarction (MI)
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Antiplatelets
Antiplatelets
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Nitrates
Nitrates
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Statins
Statins
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Neurovascular Checks
Neurovascular Checks
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Venous Insufficiency
Venous Insufficiency
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Vascular Bypasses and Grafts
Vascular Bypasses and Grafts
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Why are Beta Blockers Prescribed?
Why are Beta Blockers Prescribed?
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Study Notes
Key Terms
- Acute coronary syndrome is a sudden reduction of blood flow to the heart.
- Anastomosed is the surgical connection between two structures.
- An aneurysm is a bulge in a blood vessel wall.
- Angina pectoris is chest pain caused by reduced blood flow to the heart.
- Arteriosclerosis is the thickening and hardening of arterial walls.
- Atherosclerosis is plaque buildup inside arteries.
- Collateral circulation refers to new blood vessels that develop to reroute blood flow around a blockage.
- Coronary artery disease (CAD) signifies narrowed or blocked coronary arteries.
- Embolism occurs when a blood clot or other particle blocks blood flow.
- Endarterectomy is the surgical removal of plaque from an artery.
- High-density lipoprotein (HDL) carries cholesterol away from the arteries.
- Hyperlipidemia means high levels of lipids (fats) in the blood.
- Intermittent claudication is pain caused by too little blood flow during exercise.
- Ischemia is insufficient blood supply to an organ or tissue.
- Low-density lipoprotein (LDL) contributes to plaque buildup in arteries.
- Lymphangitis is inflammation of lymph vessels.
- Myocardial infarction (MI) is heart muscle damage due to lack of blood flow.
- Peripheral arterial disease (PAD) is narrowed arteries reducing blood flow to limbs.
- Plaque is a deposit of fatty material on artery walls.
- Raynaud disease causes reduced blood flow to extremities in response to cold or stress.
- Thrombosis is the formation of a blood clot inside a blood vessel.
- Varicose veins are enlarged, twisted veins.
- Venous stasis ulcers happen due to poor blood flow in veins.
NCLEX Case Study Question 1: Mr. Jones Post-CABG
- Mr. Jones, 72 years old, has a history of hypertension and hyperlipidemia.
- He underwent a quadruple coronary artery bypass graft (CABG) 3 days ago.
- Blood pressure is 100/56 mm Hg, apical pulse 115 beats/minute (irregular), respiratory rate 28 breaths/minute (shallow), temperature 99.8°F.
- Lung sounds diminished with crackles in bilateral bases.
- Chest tube drainage is 300 mL of red drainage over 1 hour.
- Pedal pulses are weak bilaterally.
- Chest and leg dressings are dry and intact.
- What is the priority nursing intervention for Mr. Jones?
- A. Increase the rate of IV fluids to improve blood pressure.
- B. Administer oxygen and notify the healthcare provider immediately.
- C. Reposition the patient to improve lung expansion.
- D. Medicate for pain to decrease cardiac workload.
- Rationale: Hypoxia and shock must be intervened to prevent further decline. Addressing airway and oxygenation are high priorities.
NCLEX Critical Thinking Question 1
- Which of Mr. Jones's postoperative findings are most concerning and require immediate action?
- A. Elevated temperature and dry dressings.
- B. Weak pedal pulses and blood pressure.
- C. Irregular apical pulse and diminished lung sounds with crackles.
- D. Excessive chest tube drainage and blood pressure.
- Rationale: Chest tube drainage indicates postoperative hemorrhage.
NCLEX Case Study Question 2: Managing Peripheral Arterial Disease (PAD)
- Mrs. Mehta, 68 years old, has severe rheumatoid arthritis.
- She is returning from physical therapy when she reports severe pain in her left groin.
- Left leg is cool and pale, nailbeds are pale with prolonged capillary refill, and pulses are absent. Right leg is warm and pink with palpable pulses.
- What is the initial nursing intervention?
- A. Apply a warm compress to the left groin to improve circulation.
- B. Elevate the left leg to reduce swelling and pain.
- C. Assess vital signs and immediately notify the healthcare provider.
- D. Administer pain medication to alleviate discomfort.
- Rationale: Early recognition and intervention of thromboembolism is critical when the limb is at highest risk.
NCLEX Critical Thinking Question 2
- Which statement from Mrs. Mehta should be addressed?
- A. "I always elevate my legs when I sit.”
- B. "I stopped smoking 10 years ago."
- C. "I take my medication every day."
- D. "I use a heating pad on my legs at night as needed for pain."
- Rationale: Peripheral vascular condition with lack of sensation cannot use heating pad due to risk of tissue damage.
NCLEX Case Study Question 3: Mrs. Sims and Atypical Angina
- Mrs. Sims, is 43 years old and has a history of midsternal chest cramping.
- Admitted to the ICU with atypical chest pain radiating to her left shoulder and arm.
- Her pain increases with activity and decreases with rest.
- Smokes 1.5 packs of cigarettes per day and is 50 pounds overweight.
- Admitted for nitroglycerin PRN for chest pain and has a normal sinus rhythm,
- One hour after admission, she reports acute midsternal pain radiating to her left neck and jaw.
- Has sinus tachycardia 108 bpm with occasional premature ventricular contractions, and her BP is 100/70.
- What is the priority nursing action for Mrs. Sims?
- A. Administer nitroglycerin sublingually as prescribed.
- B. Obtain a 12-lead ECG and cardiac enzymes.
- C. Encourage deep breathing and relaxation techniques.
- D. Assess pain levels using a pain scale of 0-10.
- Rationale: Obtaining a 12-lead ECG and cardiac enzymes is critical to rule out the possible acute M.I.
NCLEX Critical Thinking Question 3
- What education should be reinforced with Mrs. Sims and her family?
- A. Limiting caffeine intake to reduce heart rate and vasoconstriction.
- B. Recognizing the sings and symptoms of a stroke.
- C. The importance of lifestyle changes, including weight loss and programs for tobacco cessation.
- D. Contacting emergency medical services of chest pain is unrelieved after 3 doses of nitroglycerin.
- Rationale: Addressing lifestyle-related risks is required for acute M.I. and to prevent reoccurrence.
General Concepts
- Heart disease is the leading cause of adult fatalities in the U.S., occurring approximately every 36 seconds.
- Women are more likely to die or develop heart failure within 5 years after a heart attack compared to men.
Atherosclerosis
- Arteriosclerosis is age-related thickening, loss of elasticity, and calcification of arterial walls.
- Atherosclerosis involves plaque formation in arteries.
- Both may begin in childhood and worsen without symptoms into adulthood and cause coronary heart disease (CHD/CAD).
Pathophysiology
- Atherosclerosis starts with injury to the inner artery lining, causing inflammation and an immune response.
- Damage to the artery lining stimulates smooth muscle cell growth.
- Lipids, platelets, and clotting factors accumulate. The buildup of fatty deposits are known as plaque.
- Plaque develops a fibrous cap that can tear or rupture, leading to clot formation.
- Clots can block the coronary artery or break loose and lodge in smaller arteries.
- Plaque buildup narrows arteries, reducing blood flow and causing ischemia.
Etiology and Risk Factors
- Non-modifiable risk factors include age, ethnicity, gender, and genetics.
- Modifiable risk factors include diabetes, hypertension, high cholesterol, elevated LDL, high homocysteine, alcohol use, obesity, sedentary lifestyle, emotional stress, and tobacco.
Prevention
- Management of risk factors for atherosclerosis includes:
- Healthy lifestyle
- Medications
- Regular check-ups
- DASH eating plan is beneficial.
Diagnostic Tests
- Diagnostic tests for atherosclerosis consist assessing cholesterol, LDL particle number, triglycerides, arteriogram. Atherosclerosis can be assessed through cholesterol levels.
- Risk increases when total levels exceed 200 mg/dL
- Elevated LDLs and low HDLs are linked to higher CAD risk
- Elevated blood glucose can increase atherosclerosis risk,
- Radiological studies can identify narrowed or occluded vessels.
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