A patient who underwent a percutaneous, transluminal coronary angioplasty four weeks ago has a subsequent ejection fraction of 30%. The patient returns for a follow-up visit. Examination reveals lungs that are clear on auscultation and slight pedal edema. The patient's medications are digoxin (Lanoxin), furosemide (Lasix), enalapril maleate (Vasotec), and aspirin. The patient reports a 5 lb (2.27 kg) weight gain over the past two days. The cardiac-vascular nurse's initial action is to:

Correct Answer: B

Rationale: The correct initial action for the cardiac-vascular nurse in this scenario is option B: inquire about the patient's medication compliance. This is the most appropriate step because the patient has presented with signs of fluid retention (pedal edema, weight gain) and a decreased ejection fraction, indicating potential heart failure exacerbation. By assessing the patient's medication compliance, the nurse can determine if the prescribed medications (digoxin, furosemide, enalapril) are being taken as directed, as non-compliance could lead to worsening heart failure symptoms. Option A is incorrect because simply documenting the weight and waiting until the next session could delay necessary interventions if the patient's condition is deteriorating. Option C is not the initial action as the nurse should first gather more information before involving the physician. Option D is also not the priority as reviewing the nuclear scan is not as immediate as assessing medication compliance in this situation. From an educational perspective, this question highlights the importance of medication adherence in managing heart failure and the need for timely assessment and intervention in patients showing signs of decompensation. It emphasizes the role of nurses in monitoring patients' conditions and taking appropriate actions to prevent further complications.

Correct Answer: B

Rationale: In hypertension, the most common cause of organ damage is related to atherosclerotic changes in vessels that supply the organs. This is the correct answer (B) because hypertension leads to increased pressure within the blood vessels, causing them to undergo structural changes like thickening and hardening of the arterial walls. These changes can lead to atherosclerosis, where plaques build up and narrow the blood vessels, reducing blood flow to organs and tissues. Option A is incorrect because while increased fluid pressure against organ tissue can contribute to damage, it is not the primary mechanism in hypertension-related organ damage. Option C is incorrect as erosion and thinning of blood vessels from constant pressure is not the main pathophysiological process seen in hypertension. Option D is also incorrect as increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces is not the primary cause of organ damage in hypertension. From an educational perspective, understanding the link between hypertension and atherosclerosis is crucial for healthcare professionals to effectively manage and prevent complications in patients with high blood pressure. Knowing how hypertension impacts the vascular system and organ health is essential for providing comprehensive care and educating patients on risk factors and lifestyle modifications to mitigate these effects.

Correct Answer: B

Rationale: The correct answer is B) Fasting triglycerides. Elevated fasting triglycerides, along with elevated LDL cholesterol, are strongly associated with coronary artery disease (CAD). Triglycerides are a type of fat found in the blood that can contribute to the buildup of plaque in the arteries, leading to a higher risk of CAD. Option A) Apolipoproteins play a role in lipid metabolism but are not specifically associated with CAD risk like triglycerides. Option C) Total serum cholesterol includes both LDL and HDL cholesterol levels, so it is not specific enough to determine the risk of CAD. Option D) High-density lipoprotein (HDL) is known as "good" cholesterol and is actually associated with a lower risk of CAD, as it helps remove LDL cholesterol from the bloodstream. Educationally, understanding the role of different lipid profiles in cardiovascular health is crucial for healthcare professionals to assess and manage CAD risk in patients. By recognizing the significance of fasting triglycerides in conjunction with LDL levels, clinicians can make informed decisions regarding preventive measures and treatments to reduce the risk of CAD and its complications.

Correct Answer: C

Rationale: In the context of a myocardial infarction (MI), the correct answer is C) Use continuous cardiac monitoring. This is because the most common complication of MI is cardiac arrhythmias, such as ventricular tachycardia or ventricular fibrillation. Continuous cardiac monitoring allows for early detection of any abnormal heart rhythms, enabling prompt intervention and treatment to prevent further complications like sudden cardiac arrest. Option A) Measure hourly urine output is not directly related to the most common complication of MI. While monitoring urine output is important for assessing renal function and fluid balance, it is not the primary concern when dealing with complications of MI. Option B) Auscultate the chest for crackles is more indicative of heart failure or pulmonary edema, which can be a complication of MI but is not the most common one. While crackles may be present in some cases of MI, they are not specific to detecting arrhythmias, which are the primary concern. Option D) Take vital signs every 2 hours for the first 8 hours is a general monitoring practice but may not provide real-time information about cardiac rhythm abnormalities. Vital signs are important for overall assessment, but continuous cardiac monitoring is specifically designed to monitor the heart's electrical activity continuously, making it the most appropriate choice in this scenario. From an educational perspective, understanding the rationale behind the correct answer not only helps in answering exam questions correctly but also reinforces the importance of specific monitoring techniques in managing patients with MI. It emphasizes the critical role of continuous cardiac monitoring in early detection and intervention, ultimately improving patient outcomes and safety.

Correct Answer: B

Rationale: In counseling a patient about sexual activity following a myocardial infarction (MI), the nurse should choose option B: Discuss sexual activity while teaching about other physical activities. This option is correct because it acknowledges the importance of addressing the topic of sexual activity as part of the overall conversation about physical activity after an MI. Option A is incorrect because waiting for the patient to ask about resuming sexual activity may result in the topic not being addressed at all, leading to potential misunderstandings or concerns for the patient. Option C is also incorrect as it places the responsibility on the healthcare provider to initiate the discussion about sexual activity, when it is within the scope of nursing practice to provide this guidance. Option D is incorrect because while impotence can be a long-term complication following an MI, it is not appropriate to assume this outcome for all patients and to present it as a common certainty. In an educational context, it is crucial for healthcare providers, including nurses, to address the topic of sexual activity following an MI as it is an important aspect of a patient's quality of life and recovery. By integrating this discussion into the overall education about physical activity and lifestyle changes post-MI, nurses can provide comprehensive support to patients in their recovery journey. This approach helps normalize the conversation around sexual health and encourages open communication between patients and healthcare providers.