Coronary Artery Disease and Acute Coronary Syndrome Lewis: Medical-Surgical Nursing latest Edition

Coronary Artery Disease and Acute Coronary Syndrome Lewis: Medical-Surgical Nursing, 10th Edition 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. ANS: B Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient’s LDL level. Decreases in LDL will help reduce the patient’s risk for developing CAD. DIF: Cognitive Level: Apply (application) REF: 703 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance 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. ANS: B Lifestyle changes are more likely to be successful when consideration is given to the patient’s values and preferences. The highest percentage of calories from fat should come from monounsaturated or polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the patient with a list alone is not likely to be successful in making dietary changes. Completely removing saturated fat from the diet is not a realistic expectation. Up to 7% of calories in the therapeutic lifestyle changes diet can come from saturated fat. Telling the patient about the increased risk without assisting further with strategies for dietary change is unlikely to be successful. DIF: Cognitive Level: Analyze (analysis) REF: 705 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 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. ANS: B Chest pain that lasts for 20 minutes or more is characteristic of AMI. Changes in pain that occur with raising the arms or with deep breathing are more typical of musculoskeletal pain or pericarditis. Stable angina is usually relieved when the patient takes nitroglycerin. DIF: Cognitive Level: Apply (application) REF: 720 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 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.” ANS: D Chronic stable angina is typically relieved by rest or nitroglycerin administration. The level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or with increased frequency is typical of unstable angina. DIF: Cognitive Level: Understand (comprehension) REF: 712 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 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.” ANS: D The emergency response system (ERS) should be activated when chest pain or other symptoms are not completely relieved after three sublingual nitroglycerin tablets taken 5 minutes apart. Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse). Gastric upset (e.g., nausea) is not an expected side effect of nitroglycerin. Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis. DIF: Cognitive Level: Apply (application) REF: 716 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 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.” ANS: D Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should come from monounsaturated fats such as are found in nuts, olive oil, and canola oil. The patient can include peanut butter sandwiches as part of the TLC diet. The other patient comments indicate a good understanding of the TLC diet. DIF: Cognitive Level: Apply (application) REF: 709 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 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.” ANS: B Patients who have been taking b-adrenergic blockers can develop intense and frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases myocardial contractility. Shortness of breath that occurs when taking b-adrenergic blockers for angina may be due to bronchospasm and should be reported to the health care provider. Carvedilol works by decreasing myocardial O2 demand, not by increasing blood flow to the coronary arteries. DIF: Cognitive Level: Apply (application) REF: 715 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 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 ANS: D Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI) and are highly specific indicators for MI. Myoglobin is released within 2 hours of MI, but it lacks specificity and its use is limited. The other laboratory data are useful in determining the patient’s risk for developing coronary artery disease but are not helpful in determining whether an acute MI is in progress. DIF: Cognitive Level: Understand (comprehension) REF: 722 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 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. ANS: C Prinzmetal’s angina is caused by coronary artery spasm. Calcium channel blockers (e.g., diltiazem, amlodipine [Norvasc]) are a first-line therapy for this type of angina. Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), and b-adrenergic blockers decrease sympathetic stimulation of the heart (i.e., palpitations). Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing O2 demand. DIF: Cognitive Level: Apply (application) REF: 713 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 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. ANS: B Patients taking b-adrenergic blockers should be monitored for hypotension and bradycardia. Because this class of medication inhibits the sympathetic nervous system, restlessness, agitation, hypertension, and anxiety will not be side effects. Normal sinus rhythm is a normal and expected heart rhythm. DIF: Cognitive Level: Apply (application) REF: 715 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 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. ANS: D