CHAPTER 33: CORONARY
ARTERY DISEASE AND ACUTE
CORONARY SYNDROME EXAM
QUESTIONS AND VERIFIED
ANSWERS
Which patient is most likely to be in the fibrous stage of development of
coronary artery disease (CAD)?
a. Age 40, thrombus adhered to the coronary artery wall
b. Age 50, rapid onset of disease with hypercholesterolemia
c. Age 32, thickened coronary arterial walls with narrowed vessel lumen
d. Age 19, elevated low-density lipoprotein (LDL) cholesterol, lipid-filled
smooth muscle cells.
c.
The fibrous plaque stage has progressive changes that can be seen by age 30.
Collagen covers the fatty streak and forms a fibrous plaque in the artery. The
thrombus adheres to the arterial wall in the complicated lesion stage. Rapid onset of
coronary artery disease (CAD) with hypercholesterolemia may be related to familial
hypercholesterolemia, not a stage of CAD development. The fatty streak stage is the
earliest stage of atherosclerosis and can be seen by age 20.
What accurately describes the pathophysiology of CAD?
a. Partial or total occlusion of the coronary artery occurs during the stage of
raised fibrous plaque.
b. Endothelial alteration may be caused by chemical irritants such as
hyperlipidemia or by tobacco use.
c. Collateral circulation in the coronary circulation is more likely to be present
in the young patient with CAD.
d. The leading theory of atherogenesis proposes that infection and fatty
dietary intake are the basic underlying
causes of atherosclerosis.
,b.
The etiology of CAD includes atherosclerosis as the major cause. The
pathophysiology of atherosclerosis development and resulting atheromas is related
to endothelial injury and inflammation, which can be the result of tobacco use,
hyperlipidemia, hypertension, toxins, diabetes mellitus, hyperhomocysteinemia, and
infection causing a local inflammatory response in the inner lining of the vessel walls.
Partial or total occlusion occurs in the complicated lesion stage. Extra collateral
circulation occurs in the presence of chronic ischemia. Therefore it is more likely to
occur in an older patient.
While obtaining patient histories, which patient does the nurse identify as
having the highest risk for CAD?
a. A white man, age 54, who is a smoker and has a stressful lifestyle
b. A white woman, age 75, with a BP of 172/100 mm Hg and who is physically
inactive
c. An Asian woman, age 45, with a cholesterol level of 240 mg/dL and a BP of
130/74 mm Hg
d. An obese Hispanic man, age 65, with a cholesterol level of 195 mg/dL and a
BP of 128/76 mm Hg
b.
This white woman has one unmodifiable risk factor (age) and two major modifiable
risk factors (hypertension and physical inactivity). Her gender risk is as high as a
man's because she is 75 years of age. The white man has one unmodifiable risk
factor (gender), one major modifiable risk factor (smoking), and one minor modifiable
risk factor (stressful lifestyle). The Asian woman has only one major modifiable risk
factor (hyperlipidemia), and Asians in the United States have fewer myocardial
infarctions (MIs) than do whites. The Hispanic man has an unmodifiable risk factor
related to age and one major modifiable risk factor (obesity). Hispanics have slightly
lower rates of CAD than non- Hispanic whites or African Americans.
Priority Decision: While teaching women about the risks and incidence of
CAD, what should the nurse emphasize?
a. Smoking is not as significant a risk factor for CAD in women as it is in men.
b. Women seek treatment sooner than men when they have symptoms of CAD.
c. Estrogen replacement therapy in postmenopausal women decreases the
risk for CAD.
,d. CAD is the leading cause of death in women, with a higher mortality rate
after MI than in men.
d.
CAD is the number-one killer of American women, and women have a much higher
mortality rate within 1 year following MI than do men. Smoking carries specific
problems for women because smoking has been linked to a decrease in natural
estrogen levels and to early menopause, and it has been identified as the most
powerful contributor to CAD in women under the age of 50. Fewer women than men
present with classic manifestations, and women delay seeking care longer than men.
Recent research indicates that estrogen replacement does not always reduce the
risk for CAD, even though natural estrogen lowers low-density lipoprotein (LDL) and
raises high-density lipoprotein (HDL) cholesterol.
Which characteristics are associated with LDLs (select all that apply)?
a. Increases with exercise
b. Contains the most cholesterol
c. Has an affinity for arterial walls
d. Carries lipids away from arteries to liver
e. High levels correlate most closely with CAD
f. The higher the level, the lower the risk for CAD
b, c, e.
LDLs contain more cholesterol than the other lipoproteins, have an attraction for
arterial walls, and correlate most closely with increased incidence of atherosclerosis
and CAD. HDLs increase with exercise and carry lipids away from arteries to the
liver for metabolism. A high HDL level is associated with a lower risk of CAD.
Which serum lipid elevation, along with elevated LDL, is strongly associated
with CAD?
a. Apolipoproteins
b. Fasting triglycerides
c. Total serum cholesterol
d. High-density lipoprotein (HDL)
b.
Elevated fasting triglyceride levels are associated with cardiovascular disease and
diabetes. Apolipoproteins are found in varying amounts on the HDLs and activate
enzyme or receptor sites that promote removal of fat from plasma, which is
, protective. The apolipoprotein A and apolipoprotein B ratio must be done to predict
CAD. Elevated total serum cholesterol must be calculated with HDL for a ratio over
time to determine an increased risk of CAD. Elevated HDLs are associated with a
lower risk of CAD.
The laboratory tests for four patients show the following results. Which patient
should the nurse teach first about preventing CAD because the patient is at
the greatest risk for CAD even without other risk factors?
a. Total cholesterol: 152 mg/dL, triglycerides: 148 mg/dL, LDL: 148 mg/dL,
HDL: 52 mg/dL
b. Total cholesterol: 160 mg/dL, triglycerides: 102 mg/dL, LDL: 138 mg/dL,
HDL: 56 mg/dL
c. Total cholesterol: 200 mg/dL, triglycerides: 150 mg/dL, LDL: 160 mg/dL,
HDL: 48 mg/dL
d. Total cholesterol: 250 mg/dL, triglycerides: 164 mg/dL, LDL: 172 mg/dL,
HDL: 32 mg/dL
d.
All of this patient's results are abnormal. The patient in option "c" is close to being at
risk; if this patient is a woman, the HDL is too low and the other results are at or near
the cut off for being normal. The other patients' results are at acceptable levels.
The nurse is encouraging a sedentary patient with major risks for CAD to
perform physical exercise on a regular basis. In addition to decreasing the risk
factor of physical inactivity, the nurse tells the patient that exercise will also
directly contribute to reducing which risk factors?
a. Hyperlipidemia and obesity
b. Diabetes mellitus and hypertension
c. Elevated serum lipids and stressful lifestyle
d. Hypertension and elevated serum homocysteine
a.
Increased exercise without an increase in caloric intake will result in weight loss,
reducing the risk associated with obesity. Exercise increases lipid metabolism and
increases HDL, thus reducing CAD risk. Exercise may also indirectly reduce the risk
of CAD by controlling hypertension, promoting glucose metabolism in diabetes, and
reducing stress. Although research is needed to determine whether a decline in
ARTERY DISEASE AND ACUTE
CORONARY SYNDROME EXAM
QUESTIONS AND VERIFIED
ANSWERS
Which patient is most likely to be in the fibrous stage of development of
coronary artery disease (CAD)?
a. Age 40, thrombus adhered to the coronary artery wall
b. Age 50, rapid onset of disease with hypercholesterolemia
c. Age 32, thickened coronary arterial walls with narrowed vessel lumen
d. Age 19, elevated low-density lipoprotein (LDL) cholesterol, lipid-filled
smooth muscle cells.
c.
The fibrous plaque stage has progressive changes that can be seen by age 30.
Collagen covers the fatty streak and forms a fibrous plaque in the artery. The
thrombus adheres to the arterial wall in the complicated lesion stage. Rapid onset of
coronary artery disease (CAD) with hypercholesterolemia may be related to familial
hypercholesterolemia, not a stage of CAD development. The fatty streak stage is the
earliest stage of atherosclerosis and can be seen by age 20.
What accurately describes the pathophysiology of CAD?
a. Partial or total occlusion of the coronary artery occurs during the stage of
raised fibrous plaque.
b. Endothelial alteration may be caused by chemical irritants such as
hyperlipidemia or by tobacco use.
c. Collateral circulation in the coronary circulation is more likely to be present
in the young patient with CAD.
d. The leading theory of atherogenesis proposes that infection and fatty
dietary intake are the basic underlying
causes of atherosclerosis.
,b.
The etiology of CAD includes atherosclerosis as the major cause. The
pathophysiology of atherosclerosis development and resulting atheromas is related
to endothelial injury and inflammation, which can be the result of tobacco use,
hyperlipidemia, hypertension, toxins, diabetes mellitus, hyperhomocysteinemia, and
infection causing a local inflammatory response in the inner lining of the vessel walls.
Partial or total occlusion occurs in the complicated lesion stage. Extra collateral
circulation occurs in the presence of chronic ischemia. Therefore it is more likely to
occur in an older patient.
While obtaining patient histories, which patient does the nurse identify as
having the highest risk for CAD?
a. A white man, age 54, who is a smoker and has a stressful lifestyle
b. A white woman, age 75, with a BP of 172/100 mm Hg and who is physically
inactive
c. An Asian woman, age 45, with a cholesterol level of 240 mg/dL and a BP of
130/74 mm Hg
d. An obese Hispanic man, age 65, with a cholesterol level of 195 mg/dL and a
BP of 128/76 mm Hg
b.
This white woman has one unmodifiable risk factor (age) and two major modifiable
risk factors (hypertension and physical inactivity). Her gender risk is as high as a
man's because she is 75 years of age. The white man has one unmodifiable risk
factor (gender), one major modifiable risk factor (smoking), and one minor modifiable
risk factor (stressful lifestyle). The Asian woman has only one major modifiable risk
factor (hyperlipidemia), and Asians in the United States have fewer myocardial
infarctions (MIs) than do whites. The Hispanic man has an unmodifiable risk factor
related to age and one major modifiable risk factor (obesity). Hispanics have slightly
lower rates of CAD than non- Hispanic whites or African Americans.
Priority Decision: While teaching women about the risks and incidence of
CAD, what should the nurse emphasize?
a. Smoking is not as significant a risk factor for CAD in women as it is in men.
b. Women seek treatment sooner than men when they have symptoms of CAD.
c. Estrogen replacement therapy in postmenopausal women decreases the
risk for CAD.
,d. CAD is the leading cause of death in women, with a higher mortality rate
after MI than in men.
d.
CAD is the number-one killer of American women, and women have a much higher
mortality rate within 1 year following MI than do men. Smoking carries specific
problems for women because smoking has been linked to a decrease in natural
estrogen levels and to early menopause, and it has been identified as the most
powerful contributor to CAD in women under the age of 50. Fewer women than men
present with classic manifestations, and women delay seeking care longer than men.
Recent research indicates that estrogen replacement does not always reduce the
risk for CAD, even though natural estrogen lowers low-density lipoprotein (LDL) and
raises high-density lipoprotein (HDL) cholesterol.
Which characteristics are associated with LDLs (select all that apply)?
a. Increases with exercise
b. Contains the most cholesterol
c. Has an affinity for arterial walls
d. Carries lipids away from arteries to liver
e. High levels correlate most closely with CAD
f. The higher the level, the lower the risk for CAD
b, c, e.
LDLs contain more cholesterol than the other lipoproteins, have an attraction for
arterial walls, and correlate most closely with increased incidence of atherosclerosis
and CAD. HDLs increase with exercise and carry lipids away from arteries to the
liver for metabolism. A high HDL level is associated with a lower risk of CAD.
Which serum lipid elevation, along with elevated LDL, is strongly associated
with CAD?
a. Apolipoproteins
b. Fasting triglycerides
c. Total serum cholesterol
d. High-density lipoprotein (HDL)
b.
Elevated fasting triglyceride levels are associated with cardiovascular disease and
diabetes. Apolipoproteins are found in varying amounts on the HDLs and activate
enzyme or receptor sites that promote removal of fat from plasma, which is
, protective. The apolipoprotein A and apolipoprotein B ratio must be done to predict
CAD. Elevated total serum cholesterol must be calculated with HDL for a ratio over
time to determine an increased risk of CAD. Elevated HDLs are associated with a
lower risk of CAD.
The laboratory tests for four patients show the following results. Which patient
should the nurse teach first about preventing CAD because the patient is at
the greatest risk for CAD even without other risk factors?
a. Total cholesterol: 152 mg/dL, triglycerides: 148 mg/dL, LDL: 148 mg/dL,
HDL: 52 mg/dL
b. Total cholesterol: 160 mg/dL, triglycerides: 102 mg/dL, LDL: 138 mg/dL,
HDL: 56 mg/dL
c. Total cholesterol: 200 mg/dL, triglycerides: 150 mg/dL, LDL: 160 mg/dL,
HDL: 48 mg/dL
d. Total cholesterol: 250 mg/dL, triglycerides: 164 mg/dL, LDL: 172 mg/dL,
HDL: 32 mg/dL
d.
All of this patient's results are abnormal. The patient in option "c" is close to being at
risk; if this patient is a woman, the HDL is too low and the other results are at or near
the cut off for being normal. The other patients' results are at acceptable levels.
The nurse is encouraging a sedentary patient with major risks for CAD to
perform physical exercise on a regular basis. In addition to decreasing the risk
factor of physical inactivity, the nurse tells the patient that exercise will also
directly contribute to reducing which risk factors?
a. Hyperlipidemia and obesity
b. Diabetes mellitus and hypertension
c. Elevated serum lipids and stressful lifestyle
d. Hypertension and elevated serum homocysteine
a.
Increased exercise without an increase in caloric intake will result in weight loss,
reducing the risk associated with obesity. Exercise increases lipid metabolism and
increases HDL, thus reducing CAD risk. Exercise may also indirectly reduce the risk
of CAD by controlling hypertension, promoting glucose metabolism in diabetes, and
reducing stress. Although research is needed to determine whether a decline in
