Cardiac/Vascular Nurse Exam Secrets Study Guide (36 page)

Positive coping mechanisms

Positive coping mechanisms utilize the patient’s natural responses to crisis in order to facilitate his/her own independence and ability to make decisions and do not compromise the patient’s self-worth perceptions, mental, social or physical stability. Positive techniques reduce tension and conflict while confronting and resolving the problem in a constructive manner. The patient who is coping positively will seek out knowledge and be involved in his/her own care. He/she will grieve appropriately and adjust to changes in health, social roles and relationships and maintain a sense of hope and confidence in his/her abilities and choices.

Coping styles

An individual’s approach to coping may change based on internal and external factors. It may also change based on the situation the individual is presented with. A flexible coping style is much more effective than a rigid approach, as different situations will arise that require different modes of coping. Adaptive response to coping include lifestyle modification, enhancing knowledge and self care strategies, maintaining positive goals, adjusting to changes in relationships with family, loved ones, healthcare providers and/or co-workers, grieving over losses, dealing with role changes, adjusting to discomfort, maintaining a sense of control, maintaining hope and confronting impending death. Maladaptive responses to coping include anxiety, anger, depression, denial and dependence.

Maladaptive responses

Treatment of maladaptive responses to coping includes nonpharmacologic approaches and pharmacologic approaches. Nonpharmacologic strategies include cognitive behavioral therapy, psychotherapy, electroconvulsive therapy and/or light therapy. Pharmacologic approaches are used for cases where cognitive behavior therapy or psychotherapy is not completely effective. They are typically used in combination with these strategies. Pharmacologic approaches include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, paroxetine and fluoxetine; tricyclic antidepressants such as imipramine, nortriptyline, desipramine, amitriptyline and doxepin; benzodiazepines such as diazepam, lorazepam and oxazepam; monoamine oxidase inhibitors (MAOIs) such as phenelzine, tranylcypromine, L-deprenyl and moclobemide; and atypical antidepressants such as bupropion, mirtazapine, nefazodone, and trazodone.

Negative coping mechanisms

Negative responses do not allow the patient to adjust to the challenges he/she faces. While any of these responses may occur as part of the journey to positive action, they will not be sustained over a long period of time. If negative responses continue, they may require outside intervention and treatment to assist the patient in making positive coping and self-care decisions. Negative responses can include anxiety, depression, anger, denial, noncompliance with treatment or increased dependence on others for self-esteem and decision making abilities. Negative coping compromises the patient’s sense of independence, mental, social or physical stability. They increase tension and conflict without confronting and resolving the problem. The patient who is coping negatively will not seek out knowledge and be involved in his/her own care, and cannot adjust to changes in health, social roles and relationships while maintaining a sense of hope and confidence.

Nursing interventions to enhance coping and adaptation

Nurses and clinical practitioners need to take a proactive approach to helping patients deal with coping and providing them with more adaptive coping strategies. Assessing and following a patient’s response to illness and treatment is necessary to determine if any interventions are needed. Practicing clinicians need to make sure that there are no maladaptive responses such as anxiety, depression, or denial that need to be addressed with nonpharmacologic or pharmacologic approaches. It is necessary to provide the patient with educational material regarding their disease and treatment. Encouragement for patients to join support groups is a good approach for some patients who would like to discuss their condition with other patients. Nursing and practicing clinician interventions can be changed and revised as needed, depending on the patient’s psychosocial state.

Stress

Physiologic responses to stress include the interaction between the sympathetic nervous system, anterior and posterior pituitary gland, and adrenal gland. Physiologic responses cause the release of hormones and cytokines such as norepinephrine, epinephrine, adrenocorticotropic hormone (ACTH), vasopressin, and antidiuretic hormone. These hormones and cytokines are released during the alarm stage also known as flight or fight. Psychologic responses to stress such as palpitations may result in the use of adaptive or maladaptive coping mechanism. Psychologic responses can be treated with nonpharmacologic management and/or pharmacologic agents. Coping mechanisms are best used adaptively to address psychologic responses.

General adaptation syndrome

General adaptation syndrome is defined as the stages associated with the body’s response to a stressor. The 3 stages of general adaption syndrome include the alarm stage, stage of resistance or adaptation, and stage of exhaustion. The alarm stage is the initial response to a stressor, which is the fight or flight syndrome. The stage of resistance or adaptation is the process whereby the individual continues the fight or flight response. The stage of exhaustion is the point at which the stressor becomes dysfunctional and can lead to disease or illness.

Management techniques

Stress management techniques include autogenics, cognitive restructuring, imagery, progressive muscle relaxation, meditation, and aerobic exercise. Autogenics is a technique that involves the use of repetitive verbal phases and concentrating on sensations to lead to deep relaxation. Cognitive restructuring involves the use of the mind to alter the stress response. Imagery is another method for stress reduction. Additionally, progressive muscle relaxation reduces stress by interfering with the sympathetic nervous system. Meditation is a process that leads to deep relaxation through use of mantras and concentration. Aerobic exercise reduces anxiety and stress by increasing endorphins.

Self-monitoring techniques

Self-monitoring techniques include lifestyle modifications, reducing exposure to stressful situations, alteration of thinking, and modification to reactions. Patients should maintain a well-balanced diet, increase physical activity, get adequate sleep, apply stress management techniques and monitor blood pressure, cholesterol, and glucose levels. Reduce exposure to stressful situations by managing time and finances effectively and applying problem solving techniques to problems that arise. Patients should try to maintain a positive attitude and decrease negative thoughts. Modifying reactions to stressful situations can help reduce stress and anxiety. Applying self-monitoring techniques can help patients improve their quality of life and reduce maladaptive behaviors.

Factors that influence an individual’s perception of his/her quality of life

The factors that influence an individual’s perception of his/her quality of life include health, functional status, symptoms, and life satisfaction. The acute or chronic nature of an individual’s condition influences an individual’s perception of his/her quality of life. Health includes not only physical well-being, but also mental and social well-being. Functional status is defined as an individual’s ability to perform activities of daily living. Symptoms are an individual’s responses to his/her physical, emotional, or cognitive status. Life satisfaction is defined as an individual’s contentment with their quality of life including family, health, sexuality, spirituality, friendships, job, education, housing, standard of living, and finances.

Practice Test

1. The Health Insurance Portability and Accountability Act (HIPAA) regulates:

1. the rights of patients concerning the privacy of health information.
   
2. the transfer of patients from one facility to another.
   
3. medical trials.
   
4. workplace safety.
   

2. A patient’s pulse oximetry (SpO2) is 75%, although the patient does not appear to be in distress. A false low reading is most likely to be caused by:

1. a temperature of 100° F.
   
2. a recent transfusion.
   
3. recent exposure to carbon monoxide.
   
4. nail polish on the finger used for monitoring.
   

3. Patient goals are developed from:

a. a problem list

b. the physician’s orders.

c. the patient interview.

d. standardized goals associated with the diagnosis.

4. A 40-year old male patient complains of daytime somnolence, headache, depression, forgetfulness, weight gain, and impotence. Tests indicate hypertension and heart failure. The patient’s wife reports that her husband snores loudly with periods of breath holding. Which of the following diagnoses is most likely?

1. Narcolepsy
   
2. Insomnia
   
3. Obstructive sleep apnea
   
4. Hypothyroidism
   

5. A patient presents with pulmonary edema, tachypnea, tachycardia, hypertension, fever, and cough with frothy sanguineous sputum. What treatments are most commonly ordered initially with this clinical presentation?

a. Oxygen, nitroglycerine, loop diuretics, and morphine

b. Oxygen, thiazide diuretics, and angiotensin-converting enzyme inhibitors

c. Oxygen and thiazide diuretics

d. Oxygen, morphine, and calcium channel blockers

6. Patient-focused goal-setting should be:

a. mandated or controlled by the clinician.

b. reasonable, measurable, and achievable.

c. simple.

d. long-term rather than short-term.

7. An 86-year old patient with end-stage cardiac disease has a do-not resuscitate (DNR) order as a result of an advance directive and has been explicit about her desire to avoid life-prolonging procedures; however, when she goes into cardiac arrest, her daughter demands that the nurses perform cardiopulmonary resuscitation (CPR). In this situation, the staff should do which of the following?

a. Proceed with CPR as the patient can no longer make decisions.

b. Proceed with CPR while calling the patient’s physician to request verification of DNR order.

c. Contact the ethics committee for guidance.

d. Advise the daughter that a valid DNR order is in place and that CPR will be withheld in accordance with patient’s wishes.

8. Which test is used to determine the size, shape, and movement of cardiac structures?

a. Echocardiogram

b. Electrocardiogram

c. Chest x-ray

d. Computed tomography scan

9. A patient with ventricular tachycardia at 200 bpm and multiple premature ventricular contractions loses consciousness. What treatment is most common in this situation?

a. Antiarrhythmic medications

b. Emergency defibrillation

c. Digoxin

d. Procainamide

10. The nurse notes that a patient who has just had cardiac surgery has decreased chest tube drainage, muffled heart sounds, tachycardia, and pulsus paradoxus. The most probable cause of these symptoms is:

a. fluid overload.

b. cardiac failure.

c. cardiac tamponade.

d. infection.

11. After cardiac catheterization and removal of the sheath from the femoral artery, a manual compression device is applied and usually inflated to:

a. the patient’s current systolic pressure.

b. 20 mm Hg above the patient’s diastolic pressure.

c. 20 mm Hg below the patient’s systolic pressure.

d. 20 mm Hg above the patient’s systolic pressure.

12. Ischemia is characterized on the electrocardiogram by:

a. elevation of ST segments and elevated symmetrical T waves.

b. inverted T waves.

c. development of Q or QS waves.

d. abnormal Q waves or decreased elevation of R waves without alteration of ST and T waves.

13. The nurse enters the room of a patient who has advanced macular degeneration with loss of most central vision. The most appropriate action on the part of the nurse is:

a. speaking loudly on entering the room to alert the patient to the nurse’s presence.

b. sitting directly in front of the patient while speaking.

c. announcing his or her presence in a normal tone of voice and explaining actions and movements.

d. speaking to the patient with simple but direct vocabulary.

14. A patient complains of sharp pain in the substernal area or to the left of the sternum, which is referred to the neck, arms, and back. It occurs intermittently and suddenly and increases in intensity with inspiration, coughing, swallowing, or turning of the trunk. It is somewhat relieved by sitting upright. The most likely diagnosis is:

a. angina.

b. myocardial infarction.

c. anxiety.

d. pericarditis.