While the cardiac-vascular nurse preceptor is orienting a graduate nurse on the telemetry unit, a patient experiences cardiac arrest. Which action by the preceptor, during the emergency cardiac care procedure, facilitates the graduate nurse's competence and professional development?

Correct Answer: D

Rationale: In this scenario, option D is the most appropriate choice for facilitating the graduate nurse's competence and professional development during an emergency cardiac arrest. By involving the graduate nurse in the resuscitation process through assigning a basic task, the preceptor is providing an opportunity for hands-on learning, skill development, and real-time application of knowledge. This active participation helps the graduate nurse build confidence, improve critical thinking abilities, and gain valuable experience in emergency situations, which are essential aspects of professional growth in cardiovascular nursing. Option A, asking the graduate nurse to review the policy and procedure, though important, may not be the most effective action during an actual cardiac arrest where immediate intervention is crucial. Option B, assigning the nurse to comfort the family, is also important but does not directly contribute to the nurse's clinical skills development in this critical situation. Option C, directing the nurse to attempt IV access, may be beyond the scope of the graduate nurse's current competency level and could potentially delay necessary interventions during the cardiac arrest. In an educational context, hands-on experience and active participation in real clinical scenarios are paramount for nursing skill development. By involving the graduate nurse in the resuscitation process, the preceptor is fostering a supportive learning environment that promotes confidence, competence, and professional growth in cardiovascular nursing practice.

Correct Answer: D

Rationale: In the context of measuring blood pressure, the correct technique is crucial for obtaining accurate readings. Option D, which states to take readings at least two times at least 1 minute apart, is the correct choice. This is because blood pressure can fluctuate due to various factors such as stress, activity, or time of day. Taking multiple readings helps to account for these fluctuations and provides a more reliable average value. Option A, which suggests always taking the BP in both arms, is incorrect because it is not necessary for routine blood pressure measurement. Typically, healthcare providers measure BP in one arm unless there is a specific medical reason to check both arms. Option B, positioning the patient supine for all readings, is also incorrect. While this position may be used in certain clinical scenarios, such as assessing orthostatic changes, it is not the standard position for routine blood pressure measurements. Option C, placing the cuff loosely around the upper arm, is incorrect as well. The cuff should be snug but not too tight to ensure an accurate reading. A loose cuff can lead to falsely low readings. Educationally, understanding the correct technique for blood pressure measurements is essential for healthcare providers, especially for those seeking certifications like the ANCC Cardiovascular Certification. Proper technique ensures accurate results, which are crucial for diagnosing and managing cardiovascular conditions. By following standardized procedures, healthcare professionals can provide optimal care for their patients.

Correct Answer: D

Rationale: The correct answer is D) impairs perfusion of the coronary arteries. In the context of tachycardia caused by sympathetic response to ischemic pain, an increased heart rate leads to higher oxygen demand by the myocardium. This increased demand for oxygen is detrimental in cases of ischemia because it can exacerbate the imbalance between oxygen supply and demand, further compromising the perfusion of the coronary arteries. Impaired perfusion of the coronary arteries can worsen the ischemic condition, potentially leading to myocardial infarction or other serious cardiac events. Option A) increases cardiac output is incorrect because while tachycardia does increase heart rate, it does not necessarily improve cardiac output efficiency, especially in the context of ischemia where oxygen demand is already high. Option B) causes reflex hypotension is incorrect because tachycardia, by itself, is more likely to cause hypertension rather than hypotension due to increased sympathetic activity and vasoconstriction. Option C) may lead to atrial dysrhythmias is incorrect because while tachycardia can predispose individuals to various arrhythmias, the primary concern in the context of ischemic pain is the increased oxygen demand and impaired coronary perfusion. Understanding the relationship between sympathetic response, tachycardia, oxygen demand, and coronary perfusion is crucial in managing patients with cardiac conditions, especially in scenarios involving ischemia. By grasping these concepts, healthcare providers can better assess and intervene in cases of acute coronary syndromes to prevent serious complications like myocardial infarction.

Correct Answer: C

Rationale: In explaining to the patient that the internal mammary artery will be detached from the chest wall and attached to a coronary artery distal to the stenosis during CABG surgery (Option C), the nurse is providing accurate information about the procedure. This is the correct answer because using the internal mammary artery as a graft has shown better long-term patency rates compared to synthetic grafts or saphenous veins. Option A is incorrect because a synthetic graft is typically used to bypass the obstruction, not as a tube for blood flow. Option B is incorrect as resecting the coronary artery is not a standard practice in CABG surgery. Option D is incorrect because reversed segments of a saphenous artery are typically used as grafts, but not from the aorta. For educational context, it is important for nurses to understand the rationale behind using specific grafts in CABG surgery to provide accurate and clear information to patients. This knowledge helps in patient education, informed consent, and post-operative care management. Understanding the advantages and disadvantages of different graft options is crucial for optimal patient outcomes.

Correct Answer: A

Rationale: Unstable angina is a type of chest pain that occurs at rest due to reduced blood flow to the heart. The correct answer is A) Chest pain at rest. This is because unstable angina is characterized by chest pain that is unpredictable, occurs at rest, and can be a sign of an impending heart attack. Option B) Chest pain during exertion typically describes stable angina, where chest pain is triggered by physical activity or stress, but it is relieved by rest. Option C) Chest pain relieved by nitroglycerin is more indicative of stable angina, where nitroglycerin can alleviate chest pain associated with coronary artery disease. It is crucial for healthcare professionals, especially those specializing in cardiovascular care, to understand the differences between stable and unstable angina as the management and urgency of treatment differ significantly. Recognizing the symptoms of unstable angina promptly is vital for providing appropriate care and preventing adverse cardiac events.