A nurse is caring for a 60-year-old male client who reports chest pain in the emergency department.

Exhibits

The nurse is preparing the client for the cardiac catheterization. Which of the following actions should the nurse take? (Select all that apply.)

Witness the client’s signature on the informed consent form

Inform the client of the risks of the procedure

Obtain the client’s vital signs

Confirm the client’s allergies

Mark the surgical site

Answer and Explanation

Correct Answer : A,C,D

Choice A rationale: Witness the client’s signature on the informed consent form

Before undergoing a cardiac catheterization, the client must provide informed consent, which includes understanding the nature of the procedure, its risks, and potential complications. The nurse's role is to witness the signature, ensuring the client has signed willingly and understands what was discussed by the provider.

Choice B rationale: Inform the client of the risks of the procedure

While education is an essential part of nursing care, informing the client of the risks falls under the responsibility of the primary health care provider. Nurses can reinforce information, but the initial discussion about risks must come from the provider.

Choice C rationale: Obtain the client’s vital signs

Monitoring vital signs before the procedure is essential to establish a baseline. Since this client has tachycardia, elevated blood pressure, and possible myocardial infarction, ensuring stable parameters before catheterization is critical for assessing procedural risks.

Choice D rationale: Confirm the client’s allergies

Confirming allergies is crucial because contrast dye is often used during cardiac catheterization. Allergic reactions to iodine-based contrast agents can be severe. Ensuring there are no contrast dye or medication allergies before the procedure helps prevent complications.

Choice E rationale: Mark the surgical site

Cardiac catheterization is a non-surgical procedure, performed through a vascular access site, typically the femoral or radial artery. Site marking is unnecessary for this procedure, as it is not an open surgery requiring clear identification of an incision site.

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Correct Answer is ["B","C"]

Explanation

Choice A rationale

Limiting exercise to 10 minutes, 2 days per week is insufficient for cardiovascular health. Current recommendations generally advise at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities at least two days a week, to reduce the risk of heart disease.

Choice B rationale

Monitoring blood pressure is a crucial preventative measure for heart disease. Hypertension is a major risk factor for cardiovascular diseases, including coronary artery disease, stroke, and heart failure. Regular blood pressure monitoring allows for early detection and management of elevated blood pressure, reducing the risk of these complications. A normal blood pressure is typically considered to be less than 120/80 mmHg.

Choice C rationale

Losing weight if necessary is an important recommendation for preventing heart disease. Obesity and being overweight are significant risk factors for hypertension, dyslipidemia, type 2 diabetes, and sleep apnea, all of which increase the risk of heart disease. Achieving and maintaining a healthy weight through diet and exercise can significantly reduce cardiovascular risk.

Choice D rationale

Eating a diet high in saturated fats increases the risk of heart disease. Saturated fats can raise low-density lipoprotein (LDL) cholesterol levels, which contribute to the formation of atherosclerotic plaques in the arteries, increasing the risk of coronary artery disease and stroke. Dietary guidelines recommend limiting saturated fat intake.

Choice E rationale

Maintaining the current cholesterol level may not be a preventative measure if the current cholesterol level is elevated. High levels of LDL cholesterol are a major risk factor for heart disease. Preventative measures often include lifestyle modifications and, if necessary, medication to lower elevated cholesterol levels to reduce cardiovascular risk. Normal total cholesterol is generally less than 200 mg/dL, LDL cholesterol less than 100 mg/dL, and HDL cholesterol greater than 60 mg/dL.

A. A client who has coronary artery disease and chronic obstructive pulmonary disease. B. A client who has coronary artery disease and Bell's palsy. C. A client who has coronary artery disease and chronic diverticulitis. D. A client who has coronary artery disease and chronic allergies.

Correct Answer is A

Explanation

Choice A rationale

Chronic obstructive pulmonary disease (COPD) significantly increases the risk of postoperative complications following coronary artery bypass graft (CABG) surgery due to impaired respiratory function. COPD is characterized by airflow limitation and inflammation, which can lead to difficulties with ventilation and oxygenation after surgery. Patients with COPD have reduced lung capacity and increased mucus production, making them more susceptible to atelectasis, pneumonia, and prolonged intubation. These pulmonary complications can further strain the cardiovascular system and increase the risk of mortality and morbidity following CABG.

Choice B rationale

Bell's palsy, a temporary facial nerve paralysis, does not directly impact the cardiovascular or respiratory systems in a way that would significantly increase the risk of complications following CABG. While it can cause discomfort and functional limitations, it does not have a direct pathophysiological link to increased surgical risks associated with CABG. The primary concerns after CABG relate to cardiac function, bleeding, infection, and respiratory compromise, none of which are directly exacerbated by Bell's palsy.

Choice C rationale

Chronic diverticulitis, an inflammatory condition of the colon, primarily affects the gastrointestinal system. While it can cause pain, inflammation, and potential for infection, it does not directly increase the risks associated with CABG surgery. The physiological stressors of CABG mainly involve the cardiovascular and respiratory systems. Although systemic inflammation can have indirect effects, chronic diverticulitis is not a primary risk factor for complications following this specific cardiac surgery compared to a respiratory condition like COPD.

Choice D rationale

Chronic allergies, while causing inflammation and potential respiratory symptoms like asthma in some cases, do not inherently pose as high a risk for complications following CABG as COPD. Allergic reactions during or after surgery can occur, but well-managed allergies are less likely to lead to severe postoperative pulmonary or cardiovascular complications compared to the chronic and progressive lung damage seen in COPD. The primary risks in CABG are related to the heart and lungs, making a pre-existing chronic lung condition a major concern.

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A nurse is caring for a 60-year-old male client who reports chest pain in the emergency department. Exhibits The nurse is preparing the client for the cardiac catheterization. Which of the following actions should the nurse take? (Select all that apply.)

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A nurse is caring for a 60-year-old male client who reports chest pain in the emergency department.

Exhibits

The nurse is preparing the client for the cardiac catheterization. Which of the following actions should the nurse take? (Select all that apply.)