Nurs 2000 Ch 35 Critical care of pt's w/Acute
coronary syndromes Questions with Complete
Solutions
1. Which findings would the nurse expect when assessing a client with
chronic stable angina? Select all that apply.
A. Chest discomfort that occurs in a pattern that is familiar to the client
B. Chest discomfort that occurs with moderate to prolonged exertion
C. Frequency, duration, and intensity of symptoms remain the same over
several months
D. Results in moderate limitation of activity
E. Usually treated with rest and nitroglycerin (NTG)
F. Pain lasts less than 15 minutes Correct Answer-1. A, B, C, E, F All of
these characteristics describe chronic stable angina, except that this
condition results in only slight limitation of activity (not moderate).
2. Which essential points would the nurse include when teaching a client
with angina about nitroglycerin tablets? Select all that apply.
A. If one tablet does not relieve the chest pain after 5 minutes, put two
pills under your tongue.
B. Keep your nitroglycerin pills with you at all times.
C. The prescription should last about 7 to 8 months before a refill is
needed.
D. You can tell the tablets are active when you feel a tingling after
placing one under your tongue.
E. Keep the tablets in a glass, light-resistant container.
,F. If no immediate pain relief occurs, just wait because the drug will
eventually take effect Correct Answer-2. B, D, E
Teach the client to carry NTG at all times. Keep the tablets in a glass,
light-resistant container because the drug degrades quickly in light,
moisture, and in plastic. The drug should be replaced every 3 to 5
months before it loses its potency or stops producing a tingling sensation
when placed under the tongue. Management of chest pain at home
includes: keep fresh nitroglycerin available for immediate use; at the
first indication of chest discomfort, cease activity and sit or lie down;
place one nitroglycerin tablet under your tongue, allowing the tablet to
dissolve; wait 5 minutes for relief; if no relief results, call 911 for
transportation to a health care facility; while waiting for emergency
medical services (EMS), repeat the nitroglycerin and wait 5 more
minutes; if there is no relief, repeat and wait 5 more minutes. Be sure to
carry a medical identification card or wear a bracelet or necklace that
identifies a history of heart problems.
3. A client with chronic stable angina now has chest pressure, cool and
clammy skin, blood pressure 150/90 mm Hg, heart rate 100 beats/min,
and respiratory rate 32 breaths/min. What are the priorities of
collaborative care for this client? Select all that apply.
A. Maintain NPO status.
B. Relieve chest pain.
C. Improve coronary artery perfusion.
D. Draw troponin blood samples.
E. Improve myocardial oxygenation.
F. Relieve nausea. Correct Answer-3. B, C, D, E
, This client has experienced a change from chronic stable angina to
symptoms that may indicate acute coronary syndrome. The purpose of
collaborative care is to decrease pain, decrease myocardial oxygen
demand, and increase perfusion (myocardial oxygen supply). Emergency
care of the client with chest discomfort includes: assess airway,
breathing, and circulation (ABCs); defibrillate as needed; provide
continuous ECG monitoring; obtain the client's description of pain or
discomfort; obtain the client's vital signs (blood pressure, pulse,
respiration); assess/provide vascular access; consult chest pain protocol
or notify the cardiac health care provider or Rapid Response Team for
specific intervention; obtain a 12-lead ECG within 10 minutes of report
of chest pain; provide pain relief medication and aspirin (non-enteric
coated) as prescribed; administer supplemental oxygen therapy to
maintain an oxygen saturation > 90%; remain calm and stay with the
client if possible; assess the client's vital signs and intensity of pain 5
minutes after administration of medication; remedicate with prescribed
drugs (if vital signs remain stable) and check the client every 5 minutes;
and notify the cardiac health care provider if vital signs deteriorate.
Troponin levels would be sent to the laboratory to check for possible MI.
4. Which statement by a client indicates to the nurse correct
understanding of resuming sexual activity in the presence of angina?
A. "When I can climb two flights of stairs, it is safe to resume sexual
activity."
B. "It is best to resume sexual activity in the evening before I go to
sleep."
C. "If I am unable to walk at least a mile, it is unsafe for me to resume
sexual activity."
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