Med Surg 2 Exam 2 Practice Questions & Answers | Latest Update | Graded A+

Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome 1. The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching sessionx? a. Family history of coronary artery disease b. Elevated low-density lipoprotein (LDL) level c. Greater risk associated with the patient’s gender d. Increased risk of cardiovascular disease with aging ANS: B RN should focus on the pt’s LDL level. ↓ LDL will help ↓ the pt’s risk for developing CAD. 2. Which nursing intervention is likely to be most effective when assisting the pt w/ CAD to make appropriate dietary ∆? a. Inform the patient about a diet containing no saturated fat and minimal salt. b. Emphasize the increased cardiac risk unless the patient makes dietary changes. c. Help the patient modify favorite high-fat recipes by using monounsaturated oils. d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet. ANS: C 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. 3. The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is from an acute MI? 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 4. Which info from a pt helps the nurse confirm the previous dx 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 5. Which pt statement indicates that the RN’s teaching about subling nitroglycerin (Nitrostat) 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 have pain after taking 3 nitroglycerin 5 minutes apart.” ANS: D 6. Which statement made by a pt w/ CAD after the nurse has completed teaching about the thx 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 7. Which pt statement indicates that the nurse’s teaching about carvedilol (Coreg) for preventing anginal episodes 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 Can develop intense and frequent angina if the medication is suddenly DC’d 8. A pt who has had chest pain for several hours is admitted with a diagnosis of rule out AMI. Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI? a. Myoglobin b. Homocysteine c. C-reactive protein d. Cardiac-specific troponin ANS: D Troponin levels ↑about 4-6 hrs 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. 9. Diltiazem (Cardizem) is Rx for a pt w/ newly dx Prinzmetal’s (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan? a. Reduces heart palpitations. b. Prevents coronary artery plaque.