CAD ch 33

Question 1

When developing a teaching plan for a 61-yr-old patient with multiple risk factors for coronary artery disease (CAD), the nurse should focus primarily on the

a. family history of coronary artery disease.
b. elevated low-density lipoprotein (LDL) level.
c. increased risk associated with the patient’s gender.
d. increased risk of cardiovascular disease as people age.

Answer 1

B

Question 2

Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes?

a. Inform the patient about a diet containing no saturated fat and minimal salt.
b. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
c. Emphasize the increased risk for heart problems unless the patient makes the dietary changes.
d. Give the patient a list of low-sodium, low-cholesterol foods that should be included in the diet.

Answer 2

B

Question 3

The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is caused by an acute myocardial infarction (AMI)?

a. The pain increases with deep breathing.
b. The pain has lasted longer than 30 minutes.
c. The pain is relieved after the patient takes nitroglycerin.
d. The pain is reproducible when the patient raises the arms.

Answer 3

B

Question 4

Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina?

a. “The pain wakes me up at night.”
b. “The pain is level 3 to 5 (0 to 10 scale).”
c. “The pain has gotten worse over the last week.”
d. “The pain goes away after a nitroglycerin tablet.”

Answer 4

D

Question 5

After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective?

a. “I can expect nausea as a side effect of nitroglycerin.”
b. “I should only take nitroglycerin when I have chest pain.”
c. “Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.”
d. “I will call an ambulance if I still have pain after taking three nitroglycerin 5 minutes apart.”

Answer 5

D

Question 6

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed?

a. “I will switch from whole milk to 1% milk.”
b. “I like salmon and I will plan to eat it more often.”
c. “I can have a glass of wine with dinner if I want one.”
d. “I will miss being able to eat peanut butter sandwiches.”

Answer 6

D

Question 7

After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective?

a. “Carvedilol will help my heart muscle work harder.”
b. “It is important not to suddenly stop taking the carvedilol.”
c. “I can expect to feel short of breath when taking carvedilol.”
d. “Carvedilol will increase the blood flow to my heart muscle.”

Answer 7

B

Question 8

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test should the nurse monitor to best determine whether the patient has had an AMI?

a. Myoglobin c. C-reactive protein
b. Homocysteine d. Cardiac-specific troponin

Answer 8

D

Question 9

Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal’s (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will

a. reduce heart palpitations.
b. prevent coronary artery plaque.
c. decrease coronary artery spasms.
d. increase contractile force of the heart.

Answer 9

C

Question 10

The nurse suspects that the patient with stable angina is experiencing a side effect of the prescribed drug metoprolol (Lopressor) if the

a. patient is restless and agitated.
b. blood pressure is 90/54 mm Hg.
c. patient complains about feeling anxious.
d. heart monitor shows normal sinus rhythm.

Answer 10

B

Question 11

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for

a. decreased blood pressure and heart rate.
b. fewer complaints of having cold hands and feet.
c. improvement in the strength of the distal pulses.
d. participation in daily activities without chest pain.

Answer 11

D

Question 12

Heparin is ordered for a patient with a non–ST-segment-elevation myocardial infarction (NSTEMI). What is the purpose of the heparin?

a. Heparin enhances platelet aggregation at the plaque site.
b. Heparin decreases the size of the coronary artery plaque.
c. Heparin prevents the development of new clots in the coronary arteries.
d. Heparin dissolves clots that are blocking blood flow in the coronary arteries.

Answer 12

C

Question 13

When titrating IV nitroglycerin for a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the drug?

a. Monitor heart rate. c. Check blood pressure.
b. Ask about chest pain. d. Observe for dysrhythmias.

Answer 13

B

Question 14

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction. Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?

a. “Do you have any allergies?”
b. “Do you take aspirin on a daily basis?”
c. “What time did your chest pain begin?”
d. “Can you rate your chest pain using a 0 to 10 scale?”

Answer 14

C

Question 15

After an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse evaluates the patient’s response to the activity, which data would indicate that the exercise level should be decreased?

a. O2 saturation drops from 99% to 95%.
b. Heart rate increases from 66 to 98 beats/min.
c. Respiratory rate goes from 14 to 20 breaths/min.
d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.

Answer 15

B

Question 16

During the administration of the thrombolytic agent to a patient with an acute myocardial infarction, the nurse should stop the drug infusion if the patient experiences

a. bleeding from the gums.
b. increase in blood pressure.
c. a decrease in level of consciousness.
d. a nonsustained episode of ventricular tachycardia.

Answer 16

C

Question 17

A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take as focused follow-up on this symptom?

a. Assess the feet for pedal edema.
b. Palpate the radial pulses bilaterally.
c. Auscultate for a pericardial friction rub.
d. Check the heart monitor for dysrhythmias.

Answer 17

C

Question 18

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective?

a. “I will check my pulse rate before I take any nitroglycerin tablets.”
b. “I will put the nitroglycerin patch on as soon as I get any chest pain.”
c. “I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.”
d. “I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin.”

Answer 18

C

Question 19

Three days after experiencing a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with hygiene activities, saying, “I am too nervous about my heart to be alone while I get washed up.” Based on this information, which nursing diagnosis is appropriate?

a. Activity intolerance related to weakness
b. Anxiety related to change in health status
c. Denial related to lack of acceptance of the MI
d. Altered body image related to cardiac disease

Answer 19

B

Question 20

When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient that

a. sudden cardiac death events rarely reoccur.
b. additional diagnostic testing will be required.
c. long-term anticoagulation therapy will be needed.
d. limiting physical activity will prevent future SCD events.

Answer 20

B

Question 21

A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, “It was just a little chest pain. As soon as I get out of here, I’m going for my vacation as planned.” Which reply would be most appropriate for the nurse to make?

a. “What do you think caused your chest pain?”
b. “Where are you planning to go for your vacation?”
c. “Sometimes plans need to change after a heart attack.”
d. “Recovery from a heart attack takes at least a few weeks.”

Answer 21

A

Question 22

When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says which of the following?

a. “They will circulate my blood with a machine during surgery.”
b. “I will have incisions in my leg where they will remove the vein.”
c. “They will use an artery near my heart to go around the area that is blocked.”
d. “I will need to take an aspirin every day after the surgery to keep the graft open.”

Answer 22

B

Question 23

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse when sexual intercourse can be resumed. Which response by the nurse is best?

a. “Most patients are able to enjoy intercourse without any complications.”
b. “Sexual activity uses about as much energy as climbing two flights of stairs.”
c. “The doctor will provide sexual guidelines when your heart is strong enough.”
d. “Holding and cuddling are good ways to maintain intimacy after a heart attack.”

Answer 23

B

Question 24

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication?

a. Administer the medication at the patient’s usual bedtime.
b. Have the patient take the colesevelam 1 hour before breakfast.
c. Give the patient’s other medications 2 hours after colesevelam.
d. Have the patient take the dose at the same time as the prescribed aspirin.

Answer 24

C

Question 25

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Teaching for this patient would include a. when cardiac rehabilitation will begin. b. the typical emotional responses to AMI. c. information regarding discharge medications. d. the pathophysiology of coronary artery disease.

Answer 25

A

Question 26

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Dizziness with rapid position changes c. Nausea when taking the drugs before meals d. Flushing and pruritus after taking the drugs

Answer 26

A

Question 27

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient’s care? a. captopril c. furosemide (Lasix) b. sildenafil (Viagra) d. warfarin (Coumadin)

Answer 27

B

Question 28

Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision

Answer 28

B

Question 29

When caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Give the scheduled aspirin and lipid-lowering medication. b. Perform the initial assessment of the catheter insertion site. c. Teach the patient about the usual postprocedure plan of care. d. Titrate the heparin infusion according to the agency protocol.

Answer 29

A

Question 30

Which electrocardiographic (ECG) change is most important for the nurse to report to the health care provider when caring for a patient with chest pain? a. Inverted P wave c. ST-segment elevation b. Sinus tachycardia d. First-degree atrioventricular block

Answer 30

C

Question 31

31. When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse? a. Heart rate 102 beats/min c. Report of severe chest pain b. Pedal pulses 1+ bilaterally d. Blood pressure 103/54 mm Hg

Answer 31

C

Question 32

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which nursing diagnosis is a priority for the patient? a. Acute pain related to myocardial infarction b. Anxiety related to perceived threat of death c. Stress overload related to acute change in health d. Decreased cardiac output related to cardiogenic shock

Answer 32

D

Question 33

When admitting a patient with a non–ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? a. Attach the heart monitor. c. Assess the peripheral pulses. b. Obtain the blood pressure. d. Auscultate the breath sounds.

Answer 33

A

Question 34

Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? a. An increase in troponin levels from baseline b. A large bruise at the patient’s IV insertion site c. No change in the patient’s reported level of chest pain d. A decrease in ST-segment elevation on the electrocardiogram

Answer 34

C

Question 35

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? a. The troponin level is elevated. b. The patient denies having a heart attack. c. Bilateral crackles in the mid-lower lobes. d. Occasional premature atrial contractions (PACs).

Answer 35

C

Question 36

A patient had a non–ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Evaluation of the patient’s response to walking in the hallway b. Completion of the referral form for a home health nurse follow-up c. Education of the patient about the pathophysiology of heart disease d. Reinforcement of teaching about the purpose of prescribed medications

Answer 36

D

Question 37

A patient who has chest pain is admitted to the emergency department (ED), and all of the following are ordered. Which one should the nurse arrange to be completed first? a. Chest x-ray c. Electrocardiogram (ECG) b. Troponin level d. Insertion of a peripheral IV

Answer 37

C

Question 38

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? a. A 39-yr-old patient with pericarditis who is complaining of sharp, stabbing chest pain b. A 56-yr-old patient with variant angina who is scheduled to receive nifedipine (Procardia) c. A 65-yr-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today’s planned discharge d. A 59-yr-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI)

Answer 38

D

Question 39

To improve the physical activity level for a mildly obese 71-yr-old patient, which action should the nurse plan to take? a. Stress that weight loss is a major benefit of increased exercise. b. Determine what kind of physical activities the patient usually enjoys. c. Tell the patient that older adults should exercise for no more than 20 minutes at a time. d. Teach the patient to include a short warm-up period at the beginning of physical activity.

Answer 39

B

Question 40

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL b. Patient with stable angina whose chest pain has recently increased in frequency c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

Answer 40

B

Question 41

A patient with diabetes mellitus and chronic stable angina has a new order for captopril . The nurse should teach the patient that the primary purpose of captopril is to a. decrease the heart rate. c. prevent changes in heart muscle. b. control blood glucose levels. d. reduce the frequency of chest pain.

Answer 41

C

Question 42

After reviewing information shown in the accompanying figure from the medical records of a 43-yr-old patient, which risk factor modification for coronary artery disease should the nurse include in patient teaching? a. Importance of daily physical activity b. Effect of weight loss on blood pressure c. Dietary changes to improve lipid levels d. Cardiac risk associated with previous tobacco use

Answer 42

C

Question 43

After reviewing a patient’s history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? a. Hyperglycemia c. Q waves on ECG b. Bilateral crackles d. Elevated troponin

Answer 43

B