A client is admitted for observation following complaints of intermittent chest pain while mowing the grass. The pain persisted for an hour following the activity. All cardiac labs, electrocardiogram, and radiologic studies were normal and the client was provided nitroglycerin for a new diagnosis of angina pectoris. Discharge education includes information that angina is most often attributable to what cause?
Coronary arteriosclerosis
Decreased workload of the heart
Atrial septal defect
Infarction of the myocardium
The Correct Answer is A
A. Coronary arteriosclerosis: The narrowing and hardening of the coronary arteries restrict the flow of oxygenated blood to the myocardium. When physical activity increases the heart's oxygen demand, the restricted vessels cannot provide adequate supply, resulting in ischemic pain known as angina. This is the primary underlying cause of most cases of chronic stable angina.
B. Decreased workload of the heart: A reduction in cardiac workload would actually decrease the likelihood of experiencing angina. Angina is triggered when the workload exceeds the available oxygen supply, such as during physical exertion or stress. Management of angina focuses on reducing this workload through rest and medications like beta-blockers.
C. Atrial septal defect: This congenital heart defect involves an opening in the wall between the atria, which primarily causes shunting of blood. While it can lead to long-term complications like pulmonary hypertension, it is not the most common cause of typical angina pectoris in adults. Angina is almost always a result of obstructive coronary artery disease.
D. Infarction of the myocardium: Myocardial infarction refers to actual tissue death due to a complete and prolonged lack of blood flow. Angina is a warning sign of ischemia without cell death, which is why the client's cardiac labs and EKG remained normal. Infarction represents a permanent injury, whereas angina is a transient episode of oxygen mismatch.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
A. Diltiazem: This calcium channel blocker reduces blood pressure and slows the heart rate, both of which can contribute to orthostatic hypotension. In a 70-year-old patient, the baroreceptor reflex is less efficient, making them more susceptible to syncopal episodes during position changes. Lowering systemic vascular resistance too much can result in an acute drop in cerebral perfusion.
B. Carbidopa/levodopa: This medication is primarily used to treat Parkinson's disease and, while it can cause some hypotension, it is not a primary cardiovascular agent. Its impact on blood pressure is generally less profound than that of diuretics or dedicated antihypertensives. It is less likely than the other choices to be the primary driver of a blood pressure of 88/48.
C. Hydrochlorothiazide: Diuretics reduce the total intravascular volume by promoting the excretion of sodium and water. A decrease in blood volume directly lowers the blood pressure and can lead to dehydration-related syncope. This medication is a very common cause of orthostatic dizziness and falls in the geriatric population.
D. Metoprolol: As a beta-blocker, metoprolol reduces cardiac output and inhibits the compensatory tachycardia usually seen when standing. This prevents the body from quickly adjusting the blood pressure during postural changes, leading to the reported dizziness. The combination of reduced heart rate and reduced force of contraction contributes to the hypotensive state.
E. aspirin: Aspirin is an antiplatelet agent used for the prevention of cardiovascular events and does not have a direct effect on blood pressure. It does not cause vasodilation, volume depletion, or changes in heart rate that would lead to syncope. Its primary side effects are related to gastrointestinal irritation and bleeding risks rather than hemodynamics.
Correct Answer is B
Explanation
A. Encourage the client to drink fluids and then give the medication: While increasing fluid intake can help raise blood pressure if the cause is dehydration, it does not justify giving an antihypertensive to a hypotensive patient. Administering lisinopril will further lower the pressure regardless of fluid status. The priority is to avoid exacerbating the existing hypotension.
B. Hold the dose and notify the healthcare provider: A blood pressure of 88/56 is significantly below the normal therapeutic range and indicates that the patient cannot tolerate further antihypertensive therapy. Giving the lisinopril could lead to profound hypotension, syncope, or decreased organ perfusion. The nurse must withhold the drug and seek medical guidance for dose adjustment.
C. Give half the dose and recheck the blood pressure in 30 minutes: Nurses are not authorized to alter the prescribed dose of a medication or provide a partial dose without a specific physician order. Even a half-dose of an ACE inhibitor could be dangerous for a client whose pressure is already below 90 mmHg systolic. Clinical judgment requires stopping the medication entirely until the patient is stable.
D. Document the finding and give the drug as usual: Giving the drug as usual despite a blood pressure of 88/56 is a medication error that ignores critical assessment data. This action directly endangers the patient and violates basic safety protocols for administering cardiovascular medications. Documentation of the vital signs must be followed by an appropriate clinical action, which is withholding the dose.
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