A patient who is in the 10th week of outpatient cardiac rehabilitation continues to exhibit symptoms of depression. When developing a discharge plan, the cardiac-vascular nurse includes:

Correct Answer: A

Rationale: The correct answer is option A) a referral for counseling and possible medication. Rationale: In this scenario, the patient is exhibiting symptoms of depression despite being in the 10th week of outpatient cardiac rehabilitation. Depression is a serious condition that can impact the patient's overall well-being and recovery process. By including a referral for counseling and possible medication in the discharge plan, the cardiac-vascular nurse is addressing the mental health aspect of the patient's care. Option B) suggesting a trial of herbal remedies is not the best course of action for managing depression in this case. Herbal remedies do not have the same level of evidence-based support as counseling and medication in treating clinical depression. Option C) proposing alternative therapies like yoga and massage may offer some benefits in reducing stress and promoting relaxation, but they are not sufficient treatments for clinical depression. Patients with depression often require more structured interventions. Option D) providing comprehensive information about the patient's cardiac status may be important for reducing anxiety, but it does not directly address the patient's symptoms of depression. Mental health support is crucial in managing depression alongside cardiac rehabilitation. Educational Context: It is essential for healthcare providers, including nurses, to recognize and address the mental health needs of patients undergoing cardiac rehabilitation. Depression is a common comorbidity in patients with cardiovascular conditions and can impact their outcomes. Integrating mental health support into the care plan can improve the patient's overall well-being and quality of life. Collaborating with mental health professionals and considering evidence-based interventions like counseling and medication is crucial in providing holistic care to these patients.

Correct Answer: C

Rationale: Secondary hypertension is differentiated from primary hypertension by having a specific identifiable cause, such as renal disease, that can often be treated by medicine or surgery. This is the correct answer because secondary hypertension is caused by an underlying medical condition or medication, whereas primary hypertension has no identifiable cause and is often related to lifestyle factors. Option A is incorrect because the onset of secondary hypertension can vary and is not necessarily more gradual than primary hypertension. Option B is incorrect because secondary hypertension can cause target organ damage similar to primary hypertension. Option D is incorrect because age-related changes in blood pressure regulatory mechanisms do not specifically define secondary hypertension. Educationally, understanding the distinction between primary and secondary hypertension is crucial for healthcare professionals to accurately diagnose and treat patients. Recognizing the underlying cause of hypertension is essential for developing an effective treatment plan and preventing further complications. This knowledge helps in providing personalized care and improving patient outcomes.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A, a white man, age 54, who is a smoker and has a stressful lifestyle. This patient has the highest risk for Coronary Artery Disease (CAD) due to multiple risk factors. Smoking is a significant risk factor for CAD as it damages the blood vessels, increases heart rate, and reduces oxygen delivery. Additionally, stress can contribute to hypertension and other cardiovascular issues. Option B is less likely as age is a significant risk factor for CAD, but the combination of smoking and stress in option A poses a higher risk. Option C, although having high cholesterol, lacks other significant risk factors like smoking and stress. Option D, despite being obese, does not have as many risk factors as option A. Educationally, this question highlights the importance of recognizing multiple risk factors in assessing CAD risk. It reinforces the need to consider lifestyle choices, age, and other health indicators when evaluating cardiovascular risk in patients. Understanding these risk factors can guide nurses in providing targeted interventions and preventive care to reduce the likelihood of CAD development.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) He reports he has had no relief of the pain with rest or position change. This is indicative of myocardial infarction (MI) because chest pain associated with an MI typically does not improve with rest or position change. This is a key characteristic of cardiac-related chest pain. Option A) He has pale, cool, clammy skin can be indicative of shock, which can occur with various medical conditions, not just MI. It is not specific to MI. Option B) He reports nausea and vomited once at home can be seen in a variety of conditions, including gastrointestinal issues, food poisoning, or viral illnesses. While nausea can be present in some cases of MI, it is not specific enough to solely suspect an MI. Option C) He says he is anxious and has a feeling of impending doom can be a symptom of anxiety or panic attacks, which can mimic symptoms of MI. While anxiety can sometimes accompany an MI, it is not a definitive indicator on its own. Educationally, it is important for nurses and healthcare providers to recognize the key signs and symptoms of an MI to ensure timely and appropriate intervention. Understanding the specific characteristics of chest pain associated with an MI can aid in prompt diagnosis and treatment, ultimately improving patient outcomes.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Golfing. This choice aligns with the patient outcome of being able to tolerate moderate-energy activities post-MI. Golfing involves a combination of walking, swinging, and standing, which represents a moderate level of physical exertion suitable for a patient recovering from a myocardial infarction. It allows for gradual reintegration of physical activity without placing excessive strain on the cardiovascular system. Option B) Walking at 5 mph is a high-intensity activity that may be too strenuous for a patient recently discharged after a heart attack. Option C) Cycling at 13 mph and Option D) Mowing the lawn by hand are also activities that require higher levels of energy expenditure and may not be appropriate for a patient recovering from an MI. Educationally, understanding the appropriate level of physical activity after a myocardial infarction is critical for healthcare providers to ensure the safe and effective recovery of their patients. By setting realistic and achievable goals, such as being able to tolerate activities like golfing, healthcare teams can support patients in their post-MI rehabilitation journey while minimizing the risk of complications.