You are the charge nurse of the coronary care step-down unit. Which patient is best to assign to an RN who has floated for the day from the general medical-surgical unit?
A patient receiving IV furosemide (Lasix) to treat acute left ventricular failure.
A patient requiring discharge teaching about coronary artery stenting prior to going home today.
A patient just transferred from the radiology department after a coronary angioplasty.
A patient just admitted with unstable angina who has orders for a heparin infusion and aspirin.
The Correct Answer is A
A. A patient receiving IV furosemide (Lasix) to treat acute left ventricular failure: This patient is relatively stable, with a predictable medication regimen and clearly defined monitoring parameters, such as intake/output, daily weights, blood pressure, and electrolyte levels. The RN would be familiar with IV diuretics, fluid management, and basic cardiac assessments.
B. A patient requiring discharge teaching about coronary artery stenting prior to going home today: Discharge teaching for coronary interventions requires specialized knowledge of antiplatelet therapy, lifestyle modifications, and potential complications. A floating RN may not be fully equipped to provide in-depth education or answer detailed cardiac-specific questions.
C. A patient just transferred from the radiology department after a coronary angioplasty: This patient is considered high acuity due to potential post-procedural complications such as bleeding at the access site, arrhythmias, or acute vessel closure. Assigning this patient to a floated RN unfamiliar with post-PCI monitoring would pose safety risks.
D. A patient just admitted with unstable angina who has orders for a heparin infusion and aspirin: This patient is unstable and at high risk for acute coronary events. Heparin infusion requires careful titration, frequent lab monitoring (aPTT or anti-Xa), and rapid recognition of bleeding or ischemic complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. determine whether any obstructions are present in his coronary arteries and test for an allergy to thrombolytic agents: Cardiac catheterization with angiography is used to identify coronary artery blockages, but it does not involve testing for allergies to thrombolytic agents. Allergy testing is performed separately if needed; combining these purposes is inaccurate.
B. determine whether there are any structural defects in the walls or chambers of his heart: While cardiac catheterization can provide some information about intracardiac pressures and chamber function, identifying structural defects is more accurately accomplished with echocardiography. Coronary angiography primarily focuses on the patency of the coronary arteries.
C. measure the amount of blood being pumped from his heart with each contraction to determine whether there is heart damage: Cardiac output can be indirectly assessed during catheterization, but the main purpose in this context is not measuring pumping efficiency or myocardial damage. Enzyme studies and imaging are better suited for assessing heart damage.
D. visualize any blockages in the coronary arteries and, if necessary, dilate an obstructed artery with the use of a small balloon: Coronary angiography allows direct visualization of coronary artery patency. If a blockage is detected, PCI can be performed immediately using a balloon to dilate the artery and restore blood flow. This is the primary purpose of the procedure in acute chest pain and suspected coronary artery disease.
Correct Answer is B
Explanation
A. all of these: Anticoagulants do not convert atrial fibrillation to normal sinus rhythm, nor do they directly control the ventricular rate. Their role is specific to preventing thromboembolic events, so selecting “all of these” would be inaccurate in this context.
B. reduce thromboembolic complications: Anticoagulants are prescribed in atrial fibrillation to prevent clot formation in the atria, particularly the left atrial appendage. Atrial fibrillation causes stasis of blood, which significantly increases the risk of stroke or systemic embolism. The medication’s primary purpose is prophylactic, reducing morbidity and mortality from thromboembolic events.
C. convert the rhythm to a normal sinus rhythm: Rhythm conversion requires antiarrhythmic medications or electrical cardioversion, not anticoagulants. While anticoagulants may be continued before and after cardioversion to reduce stroke risk, they do not restore sinus rhythm on their own.
D. control the ventricular response: Ventricular rate control is achieved with beta-blockers, calcium channel blockers, or digoxin. Anticoagulants have no effect on heart rate or AV nodal conduction, so they do not address the rapid ventricular response seen in atrial fibrillation.
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