A 56-year-old individual visits his primary care provider for a routine checkup.The physical examination reveals edema, an enlarged liver (hepatomegaly), and muffled heart sounds.

Which of the following findings should the nurse be most concerned about?

Choice A rationale
Reducing the overall contractility of the heart muscle is not the primary reason for performing Coronary Artery Bypass Surgery (CABG)4. In fact, reducing the contractility of the heart muscle could potentially decrease the heart’s ability to pump blood effectively.
Choice B rationale
Reducing plaque buildup in the carotid artery is not the primary reason for performing CABG4. While plaque buildup in the carotid artery can lead to serious conditions such as stroke, CABG is specifically performed to bypass blocked coronary arteries, not carotid arteries.
Choice C rationale
Increasing the oxygen supply to the heart muscle is the primary reason for performing CABG4. When coronary arteries become blocked or narrowed due to plaque buildup, the heart muscle may not receive enough oxygen-rich blood. CABG is performed to create a new route, or bypass, around the blocked artery, which improves blood flow and oxygen supply to the heart muscle.
Choice D rationale
Increasing the myocardial workload is not the primary reason for performing CABG4. In fact, increasing the workload of the heart could potentially exacerbate heart disease and lead to complications such as heart failure.

Choice A rationale
A 59-year-old patient with unstable angina who has just returned from a percutaneous coronary intervention (PCI) should be prioritized for assessment. PCI is a procedure to open blocked or narrowed coronary arteries and can lead to complications such as re-occlusion of the artery or bleeding from the catheter insertion site. Furthermore, unstable angina is a condition that can progress to myocardial infarction if not managed effectively.
Choice B rationale
A 56-year-old patient with variant angina due to receive nifedipine (Procardia) requires monitoring, but is not the highest priority. Variant angina is a form of angina that occurs at rest, often with severe pain, but it is usually well-controlled with medications like nifedipine.
Choice C rationale
A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about discharge planned for today is a lower priority for assessment. While it’s important to address the patient’s anxiety and provide education about post-discharge care, this patient is not in immediate danger.
Choice D rationale
A 39-year-old patient with pericarditis complaining of sharp, stabbing chest pain requires assessment, but is not the highest priority. Pericarditis is inflammation of the pericardium, the sac-like covering of the heart, and while it can cause severe pain, it is not typically life- threatening.