While evaluating a patient diagnosed with angina, the patient asks, “What causes this pain in my heart?” What is the nurse’s BEST response?

Choice A rationale:

Venous thromboembolism (VTE) is a blood clot that forms in a vein, usually in the legs. It can be a serious condition, as the clot can break loose and travel to the lungs, causing a pulmonary embolism (PE).

Crossing the legs at the knees can impede blood flow in the veins of the legs, increasing the risk of VTE. This is because it compresses the veins, slowing the flow of blood and making it more likely for clots to form.

The patient's statement that they will make sure not to cross their legs when resting in bed demonstrates that they understand this important risk factor for VTE and are taking steps to prevent it.

Choice B rationale:

While keeping pillows under the knees can help to improve circulation, it is not a specific measure to prevent VTE. It is more important to avoid crossing the legs and to engage in regular movement and activity to promote blood flow.

Choice C rationale:

Compression stockings can help to reduce the risk of VTE by compressing the veins in the legs and promoting blood flow. However, they should be worn as instructed by a healthcare professional, and not only if the patient experiences pain in their calves. Pain in the calves can be a symptom of VTE, so it is important to seek medical attention if it occurs.

Choice D rationale:

Bed rest is actually a risk factor for VTE, as it can lead to decreased blood flow in the legs. It is important to get up and move around as soon as possible after surgery, even if it is just for short periods of time. This will help to promote blood flow and reduce the risk of VTE.

Choice A rationale:

Increased afterload refers to the resistance against which the heart must pump to eject blood into the aorta. While increased afterload can contribute to chest pain in certain conditions like aortic stenosis, it's not the primary cause of angina.

Angina is typically triggered by exertion or emotional stress, which increase myocardial oxygen demand. Increased afterload doesn't directly cause this imbalance in oxygen supply and demand, making it less likely to be the primary driver of angina pain.

Choice B rationale:

Inadequate myocardial oxygenation is a key concept in understanding angina, but it's not the most precise answer to the patient's question about the cause of their pain.

It's important to explain the underlying reason for the inadequate oxygenation, which is coronary artery disease.

Choice C rationale:

Coronary artery disease (CAD) is the most common cause of angina. It's characterized by narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart muscle.

When the heart's demand for oxygen exceeds the supply available through the narrowed arteries, it experiences ischemia (lack of oxygen), leading to the characteristic chest pain of angina.

This explanation directly addresses the patient's question about the cause of their pain, linking the symptom to the underlying disease process. Choice D rationale:

Increased preload refers to the amount of blood filling the ventricles before they contract. While increased preload can contribute to heart failure and pulmonary edema, it's not typically a direct cause of angina.