Which of the following nursing interventions are required when caring for a client who has had cardiac surgery and is at risk for ineffective tissue perfusion?

Correct Answer: B

Rationale: The correct answer is B) Ensure client avoids prolonged sitting when caring for a client who has had cardiac surgery and is at risk for ineffective tissue perfusion. Prolonged sitting can lead to decreased circulation and increased risk of blood clots, which can further compromise tissue perfusion. Encouraging the client to move frequently helps maintain adequate blood flow and prevents stasis. This intervention supports optimal tissue perfusion by promoting circulation and preventing complications. Option A) Restricting fluid intake is not appropriate in this scenario as adequate hydration is essential for maintaining blood volume and preventing complications such as dehydration. Option C) Positioning lower extremities below the level of the heart is contraindicated in clients at risk for ineffective tissue perfusion as it can further impair circulation and perfusion to the extremities. Option D) Instructing the client to avoid leg exercises is incorrect as gentle exercises can actually promote circulation and prevent complications related to immobility post-surgery. In an educational context, understanding the importance of mobility and circulation in clients post-cardiac surgery is crucial for nurses caring for these individuals. By implementing appropriate interventions such as avoiding prolonged sitting, nurses can help prevent complications and promote optimal tissue perfusion in these vulnerable patients.

Correct Answer: A

Rationale: The correct answer is A) decreases sympathetic nervous system activity. Meditation has been shown to have a calming effect on the body by reducing the activity of the sympathetic nervous system, which is responsible for the body's "fight or flight" response. This is particularly beneficial for patients recovering from a myocardial infarction (heart attack) as it helps lower heart rate, blood pressure, and overall stress levels, promoting a more stable cardiovascular system. Option B) decreases vasodilation is incorrect because meditation actually promotes vasodilation, leading to improved blood flow and decreased workload on the heart. Option C) increases the release of catecholamines is incorrect because catecholamines are stress hormones that are typically reduced with meditation, not increased. Elevated catecholamines can exacerbate cardiovascular issues. Option D) increases sympathetic nervous system activity is incorrect as meditation is known to have the opposite effect by decreasing sympathetic nervous system activity, promoting a sense of relaxation and reducing stress. Educationally, understanding the physiological effects of meditation on the body can empower healthcare professionals to recommend holistic approaches to managing cardiovascular health and overall well-being for patients. It emphasizes the importance of incorporating mind-body techniques as complementary strategies in cardiac rehabilitation programs to support patients in their recovery journey.

Correct Answer: D

Rationale: The correct answer is D) Maintain NPO status until gag reflex has returned. Following a transesophageal echocardiogram (TEE), the patient is usually under sedation and their gag reflex may be diminished. This places the patient at risk for aspiration if they were to consume food or fluids. Aspiration can lead to serious complications such as pneumonia or airway obstruction. Monitoring the ECG (option A) and pulse oximetry (option B) are important assessments, but maintaining NPO status takes precedence due to the risk of aspiration in this immediate post-procedure period. Assessing vital signs (option C) is also important, but ensuring the patient's safety by preventing aspiration is the priority immediately following a TEE. In an educational context, this question highlights the importance of understanding post-procedure care and the potential risks associated with specific procedures. It reinforces the need for critical thinking and prioritization of nursing interventions based on patient safety and potential complications.

Correct Answer: C

Rationale: A hypertensive emergency is a severe increase in blood pressure that can lead to organ damage. Option C, a sudden rise in BP accompanied by neurologic impairment, is indicative of a hypertensive emergency because it highlights the acute and severe nature of the condition that requires immediate intervention to prevent further complications such as stroke, renal failure, or myocardial infarction. Option A is incorrect because while symptoms of a stroke with elevated BP can be serious, it does not necessarily indicate a hypertensive emergency where immediate treatment is crucial. Option B describes high blood pressure levels but lacks the emphasis on the acute onset and potential organ damage seen in a hypertensive emergency. Option D describes a severe elevation of BP over days or weeks, which is more characteristic of hypertensive urgency rather than emergency. Educationally, understanding the distinction between hypertensive emergencies and urgencies is crucial for healthcare providers to appropriately triage and manage patients presenting with severe hypertension. Recognizing the signs and symptoms of a hypertensive emergency can lead to prompt intervention and prevent serious complications, underscoring the importance of clinical acumen in managing cardiovascular emergencies.

Correct Answer: B

Rationale: The correct answer is B) Captopril (Capoten). In this scenario, the patient's ejection fraction of 38% indicates reduced cardiac function and increased risk for a cardiac event. Captopril is an ACE inhibitor that helps in vasodilation, reducing afterload, and decreasing ventricular remodeling. By dilating blood vessels, captopril reduces the workload on the heart, improves cardiac output, and helps in remodeling of the ventricles. Option A) Clopidogrel (Plavix) is an antiplatelet medication and would not directly address vasodilation or ventricular remodeling in this case. Option C) Diltiazem (Cardizem) is a calcium channel blocker that primarily affects the heart's contraction and may not be as effective in reducing ventricular remodeling. Option D) Metoprolol (Lopressor) is a beta-blocker that can help in reducing heart rate and blood pressure, but it may not be the first choice for vasodilation and reducing ventricular remodeling in this specific scenario. Educationally, understanding the rationale behind selecting specific medications based on a patient's condition is crucial for nurses and healthcare providers. It is essential to comprehend the pharmacological actions of medications and their impact on the cardiovascular system to provide safe and effective care for patients with cardiac conditions. By knowing the mechanism of action of medications like Captopril in this case, healthcare professionals can make informed decisions to optimize patient outcomes and reduce the risk of cardiac events.