Nursing Elites

1. A patient is considering options to manage his/her coronary artery disease. The nurse explains a coronary artery bypass graft procedure will:

• A. Cure the patient's coronary artery disease.
• B. Replace the leaking valve in the heart.
• C. Connect grafts to aorta to improve blood flow.
• D. Place a permanent pacemaker on the heart muscle.

Correct answer: C

Rationale: The correct answer is C. A coronary artery bypass graft procedure involves connecting grafts to the aorta to improve blood flow to the heart muscle by bypassing blocked or narrowed coronary arteries. This procedure does not cure coronary artery disease but helps improve blood supply to the heart. Choices A, B, and D are incorrect because a bypass graft procedure does not cure the underlying disease, replace heart valves, or involve the placement of a pacemaker.

2. The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

• A. Aspirin
• B. Heparin
• C. Warfarin
• D. Erythropoietin

Correct answer: B

Rationale: The correct answer is B: Heparin. An activated partial thromboplastin time (aPTT) level of 28 seconds indicates a prolonged time, which is associated with heparin administration. Heparin is an anticoagulant medication that affects the intrinsic pathway of the coagulation cascade, leading to an increased aPTT. Aspirin (choice A) affects platelet aggregation and does not directly impact aPTT. Warfarin (choice C) affects the extrinsic pathway of the coagulation cascade and is monitored using the international normalized ratio (INR), not aPTT. Erythropoietin (choice D) is not related to coagulation parameters.

3. Which statement by a patient indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?

• A. Home oxygen therapy is frequently used to decrease sickling.
• B. There are no effective medications that can help prevent sickling.
• C. Routine continuous dosage narcotics are prescribed to prevent a crisis.
• D. Risk for a crisis is decreased by having an annual influenza vaccination.

Correct answer: D

Rationale: Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered.

4. When providing care for a patient with sickle cell crisis, what is important for the nurse to do?

• A. Monitor the patient's intake of oral and IV fluids
• B. Evaluate the effectiveness of opioid analgesics
• C. Encourage the patient to ambulate as much as tolerated
• D. Educate the patient about high-protein, high-calorie foods

Correct answer: B

Rationale: The correct answer is to evaluate the effectiveness of opioid analgesics. In sickle cell crisis, pain is the most common symptom and is usually managed with large doses of continuous opioids. Monitoring fluid intake (Choice A) is important, but limiting fluids may not be necessary. Encouraging ambulation (Choice C) is generally good but may not be the priority during a sickle cell crisis. Educating the patient about nutrition (Choice D) is important for overall health but may not be the immediate focus during a crisis.

5. The nurse is caring for a patient post-coronary artery bypass graft procedure who is on a nitroglycerin intravenous drip. The nurse understands the importance of nitroglycerin with this procedure as:

• A. Decreasing myocardial oxygen supply.
• B. Increasing preload.
• C. Decreasing cardiac output.
• D. Decreasing afterload.

Correct answer: D

Rationale: Nitroglycerin is a vasodilator that works by decreasing afterload, which is the pressure the heart must work against to eject blood during systole. By reducing afterload, nitroglycerin helps the heart pump more effectively and decreases the workload on the heart. This results in improved cardiac output and decreased myocardial oxygen demand. Choices A, B, and C are incorrect because nitroglycerin does not decrease myocardial oxygen supply, increase preload, or decrease cardiac output.

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