The nurse is caring for a client three hours after percutaneous coronary intervention (PCI) with stent placement. The client now complains of 5/10 chest pain. The client is visibly diaphoretic and anxious. The ECG shows ST segment elevations. The vital signs are as follows: BP: 156/82, HR: 110, RR: 20, T: 98.6, and Sp02: 94% on 2L nasal canula. The nurse anticipates which intervention in this situation?

Fluid bolus and IV heparin

A medical prescription for a stat chest x-ray

Coronary artery bypass (CABG) surgery if there is no improvement in 12 hours

Repeat PCI with thrombectomy or angioplasty

Answer and Explanation

The Correct Answer is D

A) Fluid bolus and IV heparin:
A fluid bolus and IV heparin may be used in certain cardiovascular conditions, such as hypotension or in the setting of acute coronary syndrome (ACS) to prevent clot formation. However, in this case, the client is experiencing chest pain with ST segment elevations, a sign of ongoing ischemia, which suggests that the problem may be related to inadequate blood flow to the heart. Fluid boluses could exacerbate the condition if the heart's function is compromised, and IV heparin alone would not address the root cause of the ischemia. Hence, this is not the most appropriate intervention at this time.

B) A medical prescription for a stat chest x-ray:
A chest x-ray would not be immediately indicated in this scenario. The client's symptoms of chest pain, diaphoresis, and ST segment elevations on the ECG are indicative of myocardial ischemia or infarction, not a respiratory or structural lung issue that would be visualized on an x-ray. The priority here is to address the myocardial ischemia, which could be due to a clot or reocclusion in the coronary artery. A stat chest x-ray would not address the underlying cardiac issue, so this is not the best choice.

C) Coronary artery bypass (CABG) surgery if there is no improvement in 12 hours:
While CABG is an option for clients with severe coronary artery disease, it is generally considered when PCI is not successful or when there are multiple blockages that cannot be stented. In this situation, since the client has just undergone PCI and is now experiencing signs of reocclusion (e.g., chest pain, ST segment elevations), a repeat PCI with thrombectomy or angioplasty is more appropriate and urgent. Waiting 12 hours would delay treatment and risk further myocardial damage. CABG would not be the first intervention after a failed PCI within hours of the procedure.

D) Repeat PCI with thrombectomy or angioplasty:
This is the most appropriate intervention. The client's symptoms (chest pain, diaphoresis, and ST segment elevations) are suggestive of reocclusion of the stented artery, a complication that can occur after PCI. Reocclusion can cause further myocardial ischemia and infarction. A repeat PCI with thrombectomy or angioplasty would aim to reopen the blocked artery and restore blood flow to the myocardium, which is the immediate priority in this situation. This intervention can help resolve the ischemia and prevent further damage to the heart muscle.

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Correct Answer is D

Explanation

A. Resume smoking initially to help manage stress and anxiety:
Smoking is a significant risk factor for cardiovascular disease and can worsen the prognosis after coronary artery bypass graft (CABG) surgery. Smoking increases the risk of coronary artery disease and impairs healing after surgery. Therefore, advising the client to resume smoking, even temporarily, is unsafe and completely contrary to health recommendations for post-CABG care. Smoking cessation should be emphasized as a key part of the recovery process.

B. Consume a high-fat diet to promote weight gain and energy:
A high-fat diet is not recommended for individuals with coronary artery disease, especially after CABG surgery. Consuming a diet high in saturated fats and cholesterol can lead to further plaque buildup in the coronary arteries, increasing the risk of atherosclerosis and cardiac events. After CABG, patients are typically encouraged to follow a heart-healthy diet that is low in saturated fat, high in fiber, and rich in fruits, vegetables, and lean proteins to support overall heart health and recovery.

C. Avoid physical activity and rest as much as possible:
While rest is essential immediately following surgery, complete avoidance of physical activity is not advisable long-term. In fact, early and gradual physical activity is a key component of rehabilitation after CABG surgery. A sedentary lifestyle can increase the risk of complications such as blood clots, muscle weakness, and weight gain, while physical activity helps improve circulation, heart function, and overall recovery. The nurse should encourage the client to gradually resume physical activity according to the guidance of their healthcare provider, often starting with light walking and progressing as tolerated.

D. Continue taking all prescribed medications as directed: Following coronary artery bypass graft (CABG) surgery, it is essential for the client to continue taking all prescribed medications, including antiplatelets, statins, beta-blockers, and any other medications ordered by the healthcare provider. These medications play a critical role in preventing blood clots, controlling blood pressure, reducing cholesterol levels, and preventing future cardiac events. Stopping or altering medications without consulting a healthcare provider could increase the risk of complications or recurrent cardiac events.

A. sublingual nitroglycerin each day to prevent chest pain." B. clopidergrol to prevent clots from forming." C. atorvastatin at bedtime to reduce my cholesterol levels." D. metoprolo! to decrease my heart's need for oxygen."

Correct Answer is A

Explanation

A. Sublingual nitroglycerin each day to prevent chest pain:
The statement about taking sublingual nitroglycerin daily is incorrect. Sublingual nitroglycerin is prescribed as needed for acute chest pain (angina) or for relieving chest discomfort associated with myocardial infarction (MI). It is not intended for daily use as a preventive measure. The client should be educated to use sublingual nitroglycerin only when experiencing chest pain, and if the pain persists or worsens, they should seek immediate medical help. Daily or routine use of nitroglycerin should be avoided unless specifically instructed by a healthcare provider. The client should also be educated about other preventive measures like long-acting nitrates if needed for chest pain prevention.

Explanation of other options:

B. Clopidogrel to prevent clots from forming:
This statement is correct. Clopidogrel (Plavix) is an antiplatelet medication commonly prescribed after a myocardial infarction to help prevent the formation of blood clots, which can reduce the risk of future cardiovascular events such as stroke or further heart attacks. It works by inhibiting platelets from clumping together, which is crucial in the post-MI period.

C. Atorvastatin at bedtime to reduce my cholesterol levels:
This statement is correct. Atorvastatin is a statin medication that is used to lower cholesterol levels, particularly LDL cholesterol (the "bad" cholesterol), which contributes to atherosclerosis and increases the risk of further heart problems. Statins are often prescribed after a myocardial infarction to help reduce the risk of future events. Taking atorvastatin at bedtime is also a common recommendation because cholesterol synthesis is higher during the night.

D. Metoprolol to decrease my heart's need for oxygen:
This statement is correct. Metoprolol is a beta-blocker that reduces the heart rate and blood pressure, which in turn lowers the heart's oxygen demand. After a myocardial infarction, beta-blockers like metoprolol are commonly prescribed to prevent further heart damage, reduce ischemia, and decrease the likelihood of arrhythmias. They help in the management of heart failure as well by improving the heart's efficiency.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who is being discharged following coronary artery bypass graft surgery. Discharge instructions would include:

Correct Answer is D

Explanation

The nurse prepares discharge instructions for the client diagnosed with a myocardial infarction. Which client statement indicates a need for further education? "I will take:

Correct Answer is A

Explanation

Which of the following assessment findings in a client who is receiving atenolol for angina would be a cause for the nurse to hold the medication and contact the provider?

The nurse is caring for a client receiving mechanical ventilation. The nurse hears the low-pressure alarm sound. After checking the client and ventilator, the nurse cannot determine the source of the alarm. What should the nurse do next?

A client comes to the emergency Department with chest pain and the nurse suspects a myocardial infarction. Which questions) should the nurse ask the client about the pain in the initial assessment? (SELECT ALL THAT APPLY)

The physician orders 500 mg PO of medication. The Medication is supplied as a suspension 125 mg/5mL. How many mL will the nurse administer for one dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

The nurse is caring for a client diagnosed with acute respiratory distress syndrome (ARDS) who requires mechanical ventilation. A client problem of decreased cardiac output from the positive pressure ventilator has been identified. What should the nurse include in the plan of care? Assess:

The nurse is caring for a client diagnosed with acute respiratory failure as a result of right middle and lower lobe pneumonia. To optimize ventilation and secretion removal the nurse should position the client:

The nursing is caring for a client in the Intensive Care Unit on a ventilator. Which intervention(s) should the nurse implement? (SELECT ALL THAT APPLY)