Ch.

12 Practice Questions Cardiovascular Alterations

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1. 1. The patient is admitted with a suspect- a. ST-segment elevation on ECG

ed acute myocardial infarction (MI). In and elevated CPK-MB or tro-
assessing the 12-lead electrocardiogram ponin levels
(ECG) changes, which findings would in-
dicate to the nurse that the patient is in
the process of an evolving Q wave my- Rationale:
ocardial infarction(MI)? ST segment elevation and ele-
vated cardiac enzymes are seen
a. ST-segment elevation on ECG and ele- in Q wave MI.
vated CPK-MB or troponin levels
b. Depressed ST-segment on ECG and
elevated total CPK
c. Depressed ST-segment on ECG and
normal cardiac enzymes
d. Q wave on ECG with normal enzymes
and troponin levels

2. 2. The nurse is assessing a patient with c. Dyspnea and crackles

left-sided heart failure. Which symptom
would the nurse expect to find? Rationale:
In left-sided heart failure, signs
a. Dependent edema and symptoms are related to pul-
b. Distended neck veins monary congestion. Dependent
c. Dyspnea and crackles edema and distended neck veins
d. Nausea and vomiting are related to right-sided heart
failure.

3. 3. A patient is admitted with an acute c. Myocardial remodeling

myocardial infarction (AMI). The nurse
knows that an angiotensin-converting Rationale:
enzymes (ACE) inhibitor should be start- Myocardial remodeling is a
ed within 24 hours to reduce the inci- process mediated by an-
dence of which process? giotensin II, aldosterone, cate-
cholamine, adenosine, and in-
a. Myocardial stunning flammatory cytokines, which
b. Hibernating myocardium causes myocyte hypertrophy
c. Myocardial remodeling and loss of contractile function
d. Tachycardia in the areas of the heart distant
from the site of infarctions. ACE
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 Ch. 12 Practice Questions Cardiovascular Alterations
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inhibitors reduce the incidence of
remodeling.

4. 4. A patient presents to the emergency a. Emergent pacemaker inser-

department (ED) with chest pain that tion
he has had for the past 2 hours. He
is nauseous and diaphoretic, and his Rationale:
skin is dusky in color. The electrocardio-
The goals of management of
gram shows ST elevation in leads II, III,
AMI are to dissolve the lesion
and aVF. Which therapeutic intervention
that is occluding the coronary
would the nurse question? artery and to increase blood
flow to the myocardium. Options
a. Emergent pacemaker insertion include emergent percutaneous
b. Emergent percutaneous coronary in- intervention, such as angioplas-
tervention ty, emergent coronary artery by-
c. Emergent thrombolytic therapy pass graft surgery, or throm-
d. Immediate coronary artery bypass bolytic therapy if the patient has
graft surgery been symptomatic for less than
6 hours. No data in this scenario
warrant insertion of a pacemak-
er.

5. 5. A patient is admitted with the diagno- c. Partial occlusion of a coronary

sis of unstable angina. The nurse knows artery with a thrombus
that the physiological mechanism pre-
sent is most likely which of the follow- Rationale:
ing? In unstable angina, some blood
continues to flow through the af-
a. Complete occlusion of a coronary fected coronary artery; however,
artery flow is diminished related to par-
b. Fatty streak within the intima of a coro- tial occlusion. The pain in unsta-
nary artery ble angina is more severe, may
c. Partial occlusion of a coronary artery occur at rest, and requires more
with a thrombus frequent nitrate therapy.
d. Vasospasm of a coronary artery

6. 6. A patient is admitted with an angina c. Nitroglycerin, oxygen, and

attack. The nurse anticipates which drug beta-blockers
regimen to be initiated?

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Rationale:
a. ACE inhibitors and diuretics Conservative intervention for the
b. Morphine sulfate and oxygen patient experiencing angina in-
c. Nitroglycerin, oxygen, and beta-block- cludes nitrates, beta-blockers,
ers and oxygen.
d. Statins, bile acid, and nicotinic acid

7. 7. A patient with coronary artery disease c. Echocardiogram

is having a cardiac evaluation to assess
for possible valvular disease. Which Rationale:
study best identifies valvular function Echocardiography is a noninva-
and measures the size of the cardiac sive, acoustic imaging procedure
chambers? and involves the use of ultra-
sound to visualize the cardiac
a. 12-lead electrocardiogram structures and the motion and
b. Cardiac catheterization function of cardiac valves and
c. Echocardiogram chambers.
d. Electrophysiology study

8. 8. A patient has elevated blood lipids. The d. Statins

nurse anticipates which classification of
drugs to be prescribed for the patient? Rationale:
The statins have been found
a. Bile acid resins to lower low-density lipoproteins
b. Nicotinic acid (LDLs) more than other types of
c. Nitroglycerin lipid-lowering drugs
d. Statins

9. 9. The patient is admitted with an acute b. Murmur

myocardial infarction (AMI). Three days
later the nurse is concerned that the pa- Rationale:
tient may have a papillary muscle rup- The presence of a new murmur
ture. Which assessment data may indi- warrants special attention, par-
cate a papillary muscle rupture? ticularly in a patient with an AMI.
A papillary muscle may have rup-
a. Gallop rhythm tured, causing the valve to close
b. Murmur incorrectly, which can be indica-
c. S1 heart sound tive of severe damage and im-
d. S3 heart sound pending complications.

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 Ch. 12 Practice Questions Cardiovascular Alterations
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10. 10. While instructing a patient on what c. Death of cardiac muscle from
occurs with a myocardial infarction, the lack of oxygen (tissue necrosis).
nurse plans to explain which process?
Rationale:
a. Coronary artery spasm. Acute myocardial infarction is
b. Decreased blood flow (ischemia). death (tissue necrosis) of the my-
c. Death of cardiac muscle from lack of ocardium that is caused by lack
oxygen (tissue necrosis). of blood supply from the occlu-
d. Sporadic decrease in oxygen to the sion of a coronary artery and its
heart (transient oxygen imbalance). branches.

11. 11. A 72-year-old woman is brought to c. Silent myocardial infarction

the ED by her family. The family states
that she's "just not herself." Her respira- Rationale:
tions are slightly labored, and her heart Some individuals may have is-
monitor shows sinus tachycardia (rate chemic episodes without know-
110 beats/min) with frequent premature ing it, thereby having a "silent" in-
ventricular contractions (PVCs). She de- farction. These can occur with no
nies any chest pain, jaw pain, back dis- presenting signs or symptoms.
comfort, or nausea. Her troponin levels Asymptomatic or nontraditional
are elevated, and her 12-lead electrocar- symptoms are more common in
diogram (ECG) shows elevated ST seg- elderly persons, in women, and
ments in leads II, III, and AVF. The nurse in diabetic patients.
knows that these symptoms are most
likely associated with which diagnosis?

a. Hypokalemia
b. Non-Q wave MI
c. Silent myocardial infarction
d. Unstable angina

12. 12. A patient presents to the ED com- a. The patient is not a candidate
plaining of severe substernal chest pres- for thrombolysis.
sure radiating to his left shoulder and
back that started about 12 hours ago. The Rationale:
patient delayed coming to the ED since To be eligible for thrombolysis,
he was hoping the pain would go away. the patient must be symptomatic
The patient's 12-lead ECG shows ST-seg- for less than 6 hours.
ment depression in the inferior leads.

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 Ch. 12 Practice Questions Cardiovascular Alterations
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Troponin and CK-MB are both elevated.
The hospital does not have the capability
for percutaneous coronary intervention.
Thrombolysis is one possible treatment.
Based on these data, the nurse under-
stands that?

a. The patient is not a candidate for

thrombolysis.
b. The patient's history makes him a
good candidate for thrombolysis.
c. Thrombolysis is appropriate for a can-
didate having a non-Q wave MI.
d. Thrombolysis should be started imme-
diately.

13. 13. The patient presents to the ED with a. Coronary artery bypass graft
severe chest discomfort. He is taken for surgery
cardiac catheterization and angiography
that shows 80% occlusion of the left Rationale:
main coronary artery. Which procedure Coronary artery bypass graft
will be most likely followed? surgery is indicated for signifi-
cant left main coronary occlusion
a. Coronary artery bypass graft surgery (>50%)
b. Intracoronary stent placement
c. Percutaneous transluminal coronary
angioplasty (PTCA)
d. Transmyocardial revascularization

14. 14. The patient is admitted with recur- c. Radiofrequency catheter abla-
rent supraventricular tachycardia that tion
the cardiologist believes to be related to
an accessory conduction pathway or a Rationale:
reentry pathway. The nurse anticipates Radiofrequency catheter abla-
which procedure to be planned for this tion is a method of interrupting
patient? a supraventricular tachycardia, a
dysrhythmia caused by a reentry
a. Implantable cardioverter-defibrillator circuit, and an abnormal conduc-
placement tion pathway.

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 Ch. 12 Practice Questions Cardiovascular Alterations
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b. Permanent pacemaker insertion
c. Radiofrequency catheter ablation
d. Temporary transvenous pacemaker
placement

15. 15. The patient presents to the ED c. contact the physician immedi-
with sudden severe sharp chest dis- ately and begin prepping the pa-
comfort radiating to his back and down tient for surgery.
both arms, as well as numbness in his
left arm. While taking the patient's vital
Rationale:
signs, the nurse notices a 30-point dis-These symptoms indicate the
crepancy in systolic blood pressure be- possibility of acute aortic dis-
tween the right and left arm. Based on section. Symptoms often mim-
these findings, the nurse should: ic those of AMI or pulmonary
embolism. Aortic dissection is a
a. contact the physician and report the surgical emergency. Signs and
cardiac enzyme results. symptoms include chest pain
b. contact the physician and prepare the and arm paresthesia.
patient for thrombolytic therapy.
c. contact the physician immediately and
begin prepping the patient for surgery.
d. give the patient aspirin and heparin.

16. 16. A patient is admitted to the emer- a. Administer thrombolytic thera-

gency department with clinical indica- py unless contraindicated
tions of an acute myocardial infarction.
Symptoms began 3 hours ago. The facil- Rationale:
ity does not have the capability for per-Medical treatment of AMI is
cutaneous coronary intervention. Given aimed at relieving pain, provid-
this scenario, what is the priority in- ing adequate oxygenation to the
tervention in the treatment and nursing myocardium, preventing platelet
management of this patient? aggregation, and restoring blood
flow to the myocardium through
a. Administer thrombolytic therapy un- thrombolytic therapy or acute
less contraindicated interventional therapy such as
b. Diurese aggressively and monitor dai- angioplasty. Since intervention-
ly weight al cardiology is not available,
c. Keep oxygen saturation levels at least thrombolytic therapy is indicat-
88% ed. Oxygen saturation should be

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 Ch. 12 Practice Questions Cardiovascular Alterations
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d. Maintain heart rate above 100 maintained at higher levels to
beats/min ensure adequate oxygenation to
the heart muscle. An elevated
heart rate increases oxygen de-
mands and should be avoided.
Diuresis is not indicated with this
scenario.

17. 17. A patient has been prescribed nitro- a. Erectile dysfunction

glycerin in the ED for chest pain. In tak-
ing the health history, the nurse will be Rationale:
sure to verify whether the patient has A history of the patient's use of
taken medications prior to admission sildenafil citrate (Viagra) or simi-
for: lar medications taken for erectile
dysfunction is necessary to know
a. Erectile dysfunction when considering NTG admin-
b. Prostate enlargement istration. These medications po-
c. Asthma tentiate the hypotensive effects
d. Peripheral vascular disease of nitrates; thus, concurrent use
is contraindicated. It is also im-
portant to determine whether the
patient has any food or drug al-
lergies.

18. 18. Which of the following cardiac di- b. Transesophageal echocardio-

agnostic tests would include monitoring gram
the gag reflex before giving the patient
anything to eat or drink? Rationale:
In transesophageal echocardio-
a. Barium swallow graphy, an ultrasound probe is
b. Transesophageal echocardiogram fitted on the end of a flexible gas-
c. MUGA scan troscope, which is inserted into
d. Stress test the posterior pharynx and ad-
vanced into the esophagus. Af-
ter the procedure, the patient is
unable to eat until the gag reflex
returns.

19.

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 Ch. 12 Practice Questions Cardiovascular Alterations
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19. A patient was admitted in terminal b. Left ventricular assist device
heart failure and is not eligible for trans- (LVAD)
plant. The family wants everything pos-
sible done to maintain life. Which proce- Rationale:
dure might be offered to the patient for LVADs are capable of partial to
this condition to increase the patient's complete circulatory support for
quality of life? short- to long-term use. At pre-
sent, the LVAD is therapy for pa-
a. Intraaortic balloon pump (IABP) tients with terminal heart failure.
b. Left ventricular assist device (LVAD) It would provide better manage-
c. Nothing, because the patient is in ter- ment than medical therapy alone.
minal heart failure The IABP is for short-term man-
d. Nothing additional; medical manage- agement of acute heart failure.
ment is the only option

20. 20. The physician orders a pharmacolog- c. Adenosine

ical stress test for a patient with activity
intolerance. The nurse would anticipate Rationale:
that the drug of choice would be If a patient is unable physical-
ly to perform the exercise, a
a. Dopamine pharmacological stress test can
b. Dobutamine be done. Adenosine is preferred
c. Adenosine over dobutamine because of its
d. Atropine short duration of action and be-
cause reversal agents are not
needed.

21. 21. The cardiologist has told the patient c. "This is an inherited condition.
and family that the diagnosis is hyper- You should give serious consid-
trophic cardiomyopathy. Later they ask eration to having family members
the nurse what the patient did wrong to screened for it."
cause this condition. The nurse explains:
RATIONALE:
a. "This is a result of a high-cholesterol Hypertrophic cardiomyopathy is
diet and poor exercise habits." a genetically inherited disease
b. "The heart has not been getting that affects the myocardial sar-
enough aerobic exercise and has devel- comere.
oped this condition. In cardiac rehabili-
tation they will work with the patient to

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 Ch. 12 Practice Questions Cardiovascular Alterations
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strengthen his heart through special ex-
ercises."
c. "This is an inherited condition. You
should give serious consideration to
having family members screened for it."
d. "This is a result of clot formation in the
blood vessels in the heart. We will need
to use medications to reduce the risk of
further clotting."

22. 22. The patient's wife is feeling over- b. "The low-cholesterol diet is
whelmed and tells the nurse that she one from which everyone can
doesn't know if she can manage to cook benefit."
different dinners for her husband and the
rest of the family to satisfy his choles- Rationale:
terol-reducing diet. The nurse tells her: Some cardiologists advocate a
reduction of the low-density
a. "It will be worth it to have him healthy, lipoprotein goal to the 50 to 70
won't it?" mg/dL range for everyone, not
b. "The low-cholesterol diet is one from only those with a known cardio-
which everyone can benefit." vascular disease.
c. "As long as you change at least a few
things in the diet, it will be okay."
d. "You can go on the diet with him, and
then just let the children eat whatever
they want."

23. 23. Percutaneous coronary intervention d. Left main coronary artery

is contraindicated for patients with le-
sions in which coronary artery? RATIONALE:
Stenosis of the left mainstem
a. Right coronary artery artery is considered unaccept-
b. Left coronary artery able for percutaneous interven-
c. Circumflex tion.
d. Left main coronary artery

24. 24. Which comment by the patient indi- b. "The pain in my chest gets
cates a good understanding of her diag- worse each time it happens. I
nosis of coronary heart disease? think that there is more damage

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 Ch. 12 Practice Questions Cardiovascular Alterations
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to my heart vessels as time goes
a. "I had a heart attack because I work on."
too hard and it puts too much strain on
my heart." RATIONALE:
b. "The pain in my chest gets worse each Coronary heart disease is a pro-
time it happens. I think that there is more gressive atherosclerotic disorder
damage to my heart vessels as time goes of the coronary arteries that re-
on." sults in narrowing or complete
c. "If I change my diet and exercise more, occlusion.
I should get over this and be healthy."
d. "What kind of pills can you give me
to get me over this and back to my
lifestyle?"

25. 25. The patient has undergone open b. Atrial fibrillation or flutter
chest surgery for coronary artery bypass
grafting. One of the nurse's responsibil- RATIONALE:
ities is to monitor the patient for which Atrial fibrillation and flutter are
common postoperative dysrhythmia? dysrhythmias common after car-
diac surgery.
a. Second degree heart block
b. Atrial fibrillation or flutter
c. Ventricular ectopy
d. Premature junctional contractions

26. 26. An essential aspect of teaching that b. compliance with diuretic thera-
may prevent recurrence of heart failure py.
is:
RATIONALE:
a. notifying the physician if a 2-lb weight Reduction or cessation of diuret-
gain occurs in 24 hours. ics usually results in sodium and
b. compliance with diuretic therapy. water retention, which may pre-
c. taking nitroglycerin if chest pain oc- cipitate heart failure.
curs.
d. assessment of an apical pulse.

27. 27. The patient's wife asks the nurse c. "The best outcome will be if
if the angioplasty will remove all the 20% to 50% of the diameter of
buildup in the vessel walls so that the the vessel can be restored. Your

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 Ch. 12 Practice Questions Cardiovascular Alterations
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patient will be healthy again. The nurse husband will need to diet and ex-
explains: ercise carefully to avoid further
cardiac risk."
a. "The operation will remove all of the
plaque, and if your husband exercises RATIONALE:
and diets he will be free of cardiac prob- A successful angioplasty proce-
lems." dure is one in which the steno-
b. "The surgery will remove all the sis is reduced to less than 50%
buildup, but it will reaccumulate and he of the vessel lumen diameter, al-
will probably need this surgery again this though most clinicians aim for
time next year." less than 20% final diameter
c. "The best outcome will be if 20% to stenosis.
50% of the diameter of the vessel can be
restored. Your husband will need to diet
and exercise carefully to avoid further
cardiac risk."
d. "The surgeon will only be able to get
5% to 10% of the plaque, but this will
bring about marked relief of your hus-
band's symptoms."

28. 28. The patient's wife is confused about b. "The stent is inserted to en-
the scheduling of a stent insertion. She hance the results of the angio-
says that she thought the angioplasty plasty, by helping to keep the
was surgery to fix her husband's heart vessel open and prevent it from
problem. The nurse explains to her: closing again."

a. "The angioplasty was a failure, and so RATIONALE:

this procedure has to be done to fix the Stents are inserted to optimize
heart vessel." the results of other treatments for
b. "The stent is inserted to enhance the acute vessel closure (percuta-
results of the angioplasty, by helping to neous transluminal coronary an-
keep the vessel open and prevent it from gioplasty, atherectomy, fibrinolyt-
closing again." ics) and to prevent restenosis.
c. "This procedure is being done instead
of using clot-dissolving medication to
help keep the heart vessel open."
d. "The stent will remove any clots that

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 Ch. 12 Practice Questions Cardiovascular Alterations
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are in the vessel and protect the heart
muscle from damage."

29. 29. The nurse is providing care to a pa- a. "My back is killing me!"
tient on fibrinolytic therapy. Which state-
ment from the patient warrants further RATIONALE:
assessment and intervention by the crit-The nurse must continually mon-
ical care nurse? itor for clinical manifestations of
bleeding. Mild gingival bleeding
a. "My back is killing me!" and oozing around venipuncture
b. "There is blood on my toothbrush!" sites are common and not a
c. "Look at the bruises on my arms!" cause for concern. Severe low-
d. "My arm is bleeding where my IV is!" er back pain and ecchymoses
are suggestive of retroperitoneal
bleeding. If serious bleeding oc-
curs, all fibrinolytic heparin ther-
apies must be discontinued, and
volume expanders or coagula-
tion factors, or both, are admin-
istered.

30. MULTIPLE RESPONSE a. Dobutamine

b. Intraaortic balloon pump
1. The patient has been in chronic heart c. Nesiritide (Natrecor)
failure for the past 10 years. He has
been treated with beta-blockers and an- RATIONALE:
giotensin-converting enzyme inhibitors This patient is showing signs and
as well as diuretics. His symptoms have symptoms of an acute exacer-
recently worsened, and he presents to bation of heart failure. Dobut-
the ED with severe shortness of breath amine and nesiritide are med-
and crackles throughout his lung fields. ications administered for acute
His respirations are labored and arteri- short-term management; me-
al blood gases show that he is at risk chanical assist with an intraaortic
for respiratory failure. Which of the fol- balloon pump also may be war-
lowing therapies may be used for acute, ranted.
short-term management of the patient?
(Select all that apply).

a. Dobutamine

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 Ch. 12 Practice Questions Cardiovascular Alterations
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b. Intraaortic balloon pump
c. Nesiritide (Natrecor)
d. Ventricular assist device

31. MULTIPLE RESPONSE a. Administration of morphine

b. Administration of nitroglycerin
2. Identify the priority interventions for (NTG)
managing symptoms of an acute my- d. Oxygen therapy
ocardial infarction (AMI) in the ED. (Se-
lect all that apply). RATIONALE:
The initial pain of AMI is treat-
a. Administration of morphine ed with morphine sulfate admin-
b. Administration of nitroglycerin (NTG) istered intravenously. NTG may
c. Dopamine infusion be given to reduce the ischemic
d. Oxygen therapy pain of AMI. NTG increases coro-
nary perfusion because of its
vasodilatory effects. Oxygen ad-
ministration is important for as-
sisting the myocardial tissue to
continue its pumping activity and
for repairing the damaged tissue
around the site of the infarct.

32. MULTIPLE RESPONSE a. Dysrhythmias are common oc-

currences.
3. Which statements are true regarding c. Midsternal chest pain is a com-
the symptoms of an AMI? (Select all that mon presenting symptom.
apply.) d. Some patients are asympto-
matic.
a. Dysrhythmias are common occur-
rences. RATIONALE:
b. Men have more atypical symptoms Chest pain is a common present-
than women. ing symptom in AMI. Dysrhyth-
c. Midsternal chest pain is a common mias are commonly seen in AMI.
presenting symptom. Some individuals may have is-
d. Some patients are asymptomatic. chemic episodes without know-
ing it, thereby having a "silent"
infarction. Women are more like-
ly to have atypical signs and

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symptoms, such as shortness
of breath, nausea and vomiting,
and back or jaw pain.

33. MULTIPLE RESPONSE c. Non-Q wave

d. Q wave
4. Acute myocardial infarction (AMI) can
be classified as which of the following? RATIONALE:
(Select all that apply.) AMI can be classified as Q wave
or non-Q wave.
a. Angina
b. Nonischemic
c. Non-Q wave
d. Q wave

34. MULTIPLE RESPONSE a. Cardiac dysrhythmias

b. Heart failure
5. A patient is admitted with an acute my- c. Pericarditis
ocardial infarction (AMI). The nurse mon- d. Ventricular rupture
itors for which potential complications?
(Select all that apply.) RATIONALE:
All are potential complications of
a. Cardiac dysrhythmias AMI.
b. Heart failure
c. Pericarditis
d. Ventricular rupture

35. MULTIPLE RESPONSE a. "Pain can occur anywhere in

the chest, neck, arms, or back.
6. The patient's husband tells the nurse, Don't hesitate to call the emer-
"We didn't think she was having a heart gency medical services if you
attack because the pain was in her neck think it's a heart attack."
and back." The nurse explains: (Select all b. "For many people chest pain
that apply.) from a heart attack occurs in the
center of the chest, behind the
a. "Pain can occur anywhere in the chest, breastbone."
neck, arms, or back. Don't hesitate to call c. "The sooner the patient can
the emergency medical services if you get medical help, the less dam-
think it's a heart attack." age is likely to occur in case of a

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 Ch. 12 Practice Questions Cardiovascular Alterations
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b. "For many people chest pain from a heart attack."
heart attack occurs in the center of the
chest, behind the breastbone." RATIONALE:
c. "The sooner the patient can get med- Angina may occur anywhere in
ical help, the less damage is likely to the chest, neck, arms, or back,
occur in case of a heart attack." but the most commonly de-
d. "You need to make sure it's a heart scribed is pain or pressure be-
attack before you call the emergency re- hind the sternum. The pain often
sponse personnel." radiates to the left arm but can
also radiate down both arms and
to the back, the shoulder, the jaw,
and/or the neck.

36. MULTIPLE RESPONSE a. Jugular venous distention

b. Peripheral edema
7. Which clinical manifestations are in-
dicative of right ventricular failure? (Se- RATIONALE:
lect all that apply.) Rationale: Jugular venous dis-
tention, liver tenderness, he-
a. Jugular venous distention patomegaly, and peripheral ede-
b. Peripheral edema ma are signs of right ventricular
c. Crackles audible in the lungs failure.
d. Weak peripheral pulses

37. MULTIPLE RESPONSE b. Assess pedal pulses on the

involved limb every 15 minutes
8. Which nursing interventions would be for 2 hours
appropriate after angioplasty? (Select all c. Monitor the vascular hemosta-
that apply.) tic device for signs of bleeding
d. Instruct the patient bend
a. Elevate the head of the bed by 45 de- his/her knee every 15 minutes
grees for 6 hours while the sheath is in place
b. Assess pedal pulses on the involved
limb every 15 minutes for 2 hours RATIONALE:
c. Monitor the vascular hemostatic de- The head of the bed must not
vice for signs of bleeding be elevated more than 30 de-
d. Instruct the patient bend his/her knee grees, and the patient should be
every 15 minutes while the sheath is in instructed to keep the affected
place leg straight. Bed rest is 6 to 8

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hours in duration, unless a vas-
cular hemostatic device is used.
The nurse observes the patient
for bleeding or swelling at the
puncture site and frequently as-
sesses adequacy of circulation
to the involved extremity.

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