Deck 30: Nursing Care of Patients With Coronary Heart Disease

Question 1

The nurse is caring for a patient experiencing acute myocardial infarction. What electrocardiogram change should the nurse expect for this patient's health problem?

A) ST-segment elevation
B) loss of P waves
C) bradycardia
D) widening of the QRS complex

Answer 1

ST-segment elevation

Question 2

While caring for a patient admitted with chest pain, the nurse recognizes that what factor places the patient at the highest risk for heart disease?

A) overweight and carries the weight around the waist
B) mother died at age 70 of an acute myocardial infarction
C) a single mother of four young children with a low income
D) has a desk job and works long hours

Answer 2

overweight and carries the weight around the waist

Question 3

During patient teaching about cardiac risk factors, the nurse knows that which laboratory test, if abnormal, requires further instruction due to the risk for the development of coronary artery disease?

A) elevated homocysteine
B) elevated creatinine
C) elevated high density lipoprotein (HDL)
D) elevated INR

Answer 3

elevated homocysteine

Question 4

Aspirin has been prescribed for a patient following a myocardial infarction. What should the nurse include when teaching about this drug?

A) Check with your healthcare provider before taking any herbal remedies.
B) Report any itching that develops after seven days of taking the drug.
C) Take at a different time of day than warfarin (Coumadin).
D) Do not skip any scheduled appointments to have blood drawn for labs.

Question 5

The nurse is assessing a patient who is six hours postoperative from coronary artery bypass graft (CABG) surgery. The patient's heart rate is 120, blood pressure is 90/50, urine output is decreased, chest tube output is decreased, heart sounds are muffled, and peripheral pulses are diminished. What action should the nurse take first?

A) Notify the physician immediately.
B) Recheck vital signs in 15 minutes.
C) Reposition the patient.
D) Increase the intravenous fluids.

Question 6

During a follow-up appointment after a myocardial infarction, a patient states, "My friends tell me to add more garlic to my diet and start drinking red wine each evening." What response by the nurse is best?

A) "Discuss your idea with the physician to see what would benefit you."
B) "That sounds fine. See how they work."
C) "I wouldn't do that if I were you."
D) "You should also add ginkgo biloba for cardiovascular health."

Question 7

A patient recovering from cardiovascular surgery has a chest tube output of 110 mL/hr. What should the nurse do?

A) Report to the surgeon.
B) Check the hemoglobin and hematocrit.
C) Administer a blood transfusion.
D) Notify the family.
E) Strip and vent the chest tube.

Question 8

While discussing coronary heart disease risk factors with a group of factory employees, the nurse includes which options as modifiable risk factors?

A) hypertension
B) diabetes mellitus
C) obesity
D) age
E) heredity

Question 9

Fifteen hours after admission, a patient's CK-MB level is markedly increased. What should this indicate to the treatment team?

A) Cellular necrosis of myocardial tissue has occurred.
B) Lactic acid is present.
C) Thrombolytic therapy is indicated.
D) Cardiac function has returned to normal.

Question 10

The nurse is caring for a patient diagnosed with Prinzmetal or variant angina. What does the nurse realize this indicates for the patient?

A) It indicates presence of coronary artery spasm.
B) It indicates there is associated renal disease.
C) It indicates there is associated pulmonary disease.
D) It indicates the presence of a myocardial infarction.

Question 11

A patient enters the emergency department complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this patient should include which nursing actions?

A) morphine intravenously and oxygen
B) aspirin 325 mg orally
C) open heart surgery
D) heparin drip at 100 units per hour
E) Foley catheter insertion

Question 12

Coronary heart disease (CHD) is a major problem in the United States. What information on the medical history would alert the nurse to closely evaluate a patient for CHD?

A) diabetes
B) hyperlipidemia
C) positive family history
D) a premenopausal woman
E) hypotension

Question 13

During an office visit, a 55-year-old female patient asks why she has not been prescribed a daily dose of aspirin when her 56-year-old husband has been. What should the nurse explain is the most likely reason for this?

A) The benefit of aspirin in women under age 65 is not clear.
B) Aspirin is not recommended for women.
C) This must have been an oversight.
D) She has other medications that could interfere.

Question 14

What diagnostic test should the nurse anticipate as the priority for a patient admitted with chest pain to determine coronary artery status?

A) coronary angiography
B) stress electrocardiography
C) echocardiography
D) radionuclide testing

Question 15

The nurse assessing a middle-aged patient experiencing chest pain realizes that presence of what symptom would be most characteristic of an acute myocardial infarction?

A) substernal pressure type pain, radiating down the left arm
B) colic-like epigastric pain
C) sharp, well-localized unilateral chest and left arm pain
D) sharp, burning chest pain moving from place to place

Question 16

The nurse is caring for a patient recovering from fibrinolytic therapy. For which common complication should the nurse focus care for this patient?

A) bleeding
B) hypotension
C) lethargy
D) heart block

Question 17

A patient reports chest pain, nausea, and vomiting off and on for the last 4 days, which the patient interpreted as the flu. What laboratory test(s) will provide information about acute cardiac damage for this patient?

A) troponin I and T
B) red blood cells
C) CK-MB
D) homocysteine and platelets

Question 18

The nurse suspects that a patient experienced a transmural myocardial infarction. What electrocardiogram finding did the nurse use to make this clinical decision?

A) Q wave deepening
B) ST segment elevation
C) ST segment depression
D) P wave inversion

Question 19

Upon auscultating the chest of a 75-year-old patient who recently experienced a myocardial infarction (MI), the nurse hears an S₃ and lung crackles. Because of these findings, the nurse should assess for what other condition?

A) heart failure
B) extension of the MI
C) renal failure
D) liver failure

Question 20

The family of a patient who experienced a stroke after percutaneous coronary revascularization asks the nurse what caused the stroke to occur. How should the nurse respond to the family?

A) "A stroke could have been caused by clot particles from the procedure."
B) "Stroke is usually caused by ruptured plaque inside the coronary artery."
C) "Stroke is caused by heart failure."
D) "No one knows what causes strokes."

Question 21

A patient is in sinus tachycardia. Which nursing interventions are appropriate?

A) Observe the patient for effects on cardiac function.
B) Administer two tablets of acetaminophen (Tylenol) per physician prescription if an elevated temperature is present.
C) Administer normal saline 0.9% IV at the prescribed rate of 200 mL per hour if hypovolemia is suspected as the cause.
D) Give pain medications as prescribed if pain is present.
E) Give atropine per physician prescription to slow the heart rate.

Question 22

The nurse is caring for a patient with premature ventricular contractions (PVCs). What should the nurse keep in mind about this heart rhythm?

A) PVCs are insignificant in people with no history of heart disease.
B) PVCs typically have no pattern.
C) The frequency of PVCs is not associated with specific events.
D) Their incidence and significance has no relevance to the patient having had a myocardial infarction.

Question 23

Sinus bradycardia (rate 56 beats per minute) is identified in a sleeping patient on telemetry. What is the priority nursing action?

A) Awaken the patient and see how the heart rate responds.
B) Call the physician and report this dysrhythmia.
C) Check the medication administration record and see if there is a PRN medication that will improve this rhythm.
D) Call for an immediate 12-lead electrocardiogram (ECG).

Question 24

The nurse is preparing medications for a patient with hyperlipidemia. What information should the nurse consider when administering these medications?

A) Such medications include the statins, which act by lowering LDL levels.
B) These medications act by increasing the LDL levels and decreasing the HDL levels.
C) These medications do not include angiotensin-converting enzyme (ACE) inhibitors.
D) Such medications include bile acid sequestrants as first-line drugs to lower cholesterol levels.

Question 25

A nurse is performing cardiopulmonary resuscitation (CPR) on a patient who is in cardiac arrest. An automatic external defibrillator (AED) is available. What activity will allow the nurse to assess the patient's cardiac rhythm?

A) Apply adhesive patch electrodes to the chest and move away from the patient.
B) Apply standard electrocardiographic monitoring leads to the patient and observe the rhythm.
C) Hold the defibrillator paddles directly against the patient's chest.
D) Connect electrocardiographic electrodes to a telephone monitoring device and wait until the rhythm is analyzed.

Question 26

The nurse has completed teaching related to dietary management of coronary heart disease (CHD). Effective teaching is indicated by what patient statement?

A) "I can lower my trans fatty acids by switching to the soft margarines and vegetable spreads."
B) "I will watch my fiber intake so I don't get too much."
C) "Well, I'll just have to go buy some of that coconut oil to cook with."
D) "Drinking a couple of glasses of milk each day will give me better protein."

Question 27

The nurse is instructing a patient on nitroglycerin tablets prescribed to treat angina. Which statement(s) should be included in the nurse's instructions?

A) "Take a second dose if the angina is not relieved within five minutes."
B) "The drug should remain in this brown bottle since it is sensitive to light."
C) "Store this medication in your bathroom medicine cabinet so it is readily available to you."
D) "Eating or drinking will not interfere when taking the medication."
E) "Call your doctor immediately if you develop a headache when taking this drug."

Question 28

The patient has a pacemaker with one pacing spike seen on the ECG before every QRS complex. There is no change in the pacemaker rhythm over time, with rest or with activity. The nurse realizes the patient has what type of pacemaker?

A) asynchronous pacing
B) demand pacing
C) dual-chamber pacing
D) atrial single-chamber pacing

Question 29

What is the priority nursing intervention for a patient with a junctional escape rhythm?

A) Assess the patient for symptoms associated with this rhythm.
B) Contact the physician immediately for emergency orders.
C) Eliminate caffeine from the diet.
D) Prepare for a pacemaker insertion.

Question 30

The nurse is notified by the cardiac monitoring technician that a patient on continuous cardiac monitoring is having frequent alarms. When the nurse enters the patient's room, the patient is in no apparent distress, is sitting in the chair and eating. Which are appropriate nursing interventions?

A) Confirm that lead wires are properly connected.
B) Assess placement of electrodes.
C) Remove and reapply new electrodes if nonadherent.
D) Assess skin sites and move an electrode if the skin appears irritated.
E) Call for assistance.

Question 31

The nurse is caring for an adult patient who is admitted with chest pain that began four hours ago. Which test will be most specific in identifying acute heart damage?

A) troponin
B) CK
C) CK-MB
D) cholesterol

Question 32

A nurse is preparing a presentation on coronary heart disease (CHD) for a community women's club. Which statements should the nurse include in the presentation?

A) The epigastric pain and nausea experienced with a heart attack are often attributed to heartburn.
B) Common symptoms of myocardial infarction (MI) include shortness of breath and fatigue.
C) Women are more likely to have an unrecognized myocardial infarction.
D) Weakness of the legs and back often precede a heart attack.
E) The mortality rate of young women having an MI is 50 % lower than that of men.

Question 33

The nurse sees this rhythm on a patient's cardiac monitor. For which rhythm should the nurse begin care?

A) ventricular fibrillation
B) atrial flutter
C) sinus tachycardia
D) ventricular tachycardia

Question 34

The nurse is caring for a patient with ventricular tachycardia. Which care should the nurse prepare to provide to this patient?

A) immediate assessment and probable emergency intervention by the nurse
B) cardioversion, if sustained and symptomatic
C) administration of a potassium channel blocker
D) close observation for one hour prior to calling the physician
E) defibrillation to convert the rhythm in the awake patient

Question 35

The nurse is conducting teaching about risk factor management for cardiovascular disease (CVD) at a senior center. What is the most important information for the nurse to include?

A) Stop smoking.
B) Eat in moderation.
C) Exercise when able.
D) Reduce saturated fats in the diet.

Question 36

A patient is prescribed atorvastatin (Lipitor). For which adverse effect should the nurse monitor this patient?

A) liver enzyme alteration
B) blood glucose and uric acid level alteration
C) renal function alteration
D) sudden back pain and constipation

Question 37

A patient received an implantable cardioverter-defibrillator (ICD). The nurse includes what instruction during discharge teaching for this patient?

A) "If a family member is in direct contact with you when the ICD discharges, he or she may experience a shock or tingling sensation."
B) "You can activate the ICD whenever you feel a change in your heart rhythm."
C) "The batteries of the ICD won't need to be replaced if the ICD never shocks the heart."
D) "There should be no discomfort if the ICD discharges, and you probably won't notice it."

Question 38

A 52-year-old obese male patient who is admitted with elevated triglycerides and a history of smoking two packs of cigarettes a day for 20 years asks about his risk for coronary artery disease. What information should the nurse provide?

A) He is at risk for coronary artery disease.
B) He is not at risk for coronary artery disease.
C) He has nothing but nonmodifiable risk factors for coronary artery disease.
D) He has nothing but modifiable risk factors for coronary artery disease.

Question 39

A patient reports the following symptoms to the nurse: nausea, loss of appetite, blurred and double vision, green yellow halos, vomiting and "feeling uneasy." What situation should the nurse suspect?

A) digoxin toxicity
B) lidocaine toxicity
C) amiodarone toxicity
D) procainamide toxicity

Question 40

A patient asks about metabolic syndrome. How should the nurse respond to this patient?

A) "Metabolic syndrome is caused by obesity, physical inactivity, and genetic factors."
B) "This syndrome is not a concern for females unless they smoke."
C) "This problem affects only older adults over the age of 6
D) "It can be avoided by taking vitamins daily and drinking 64 fluid ounces of water a day."
E)"

Question 41

The nurse is reviewing a new prescription for propranolol (Inderal) for a patient with coronary heart disease (CHD). The nurse should call the physician and question this prescription if the patient's history includes what information?

A) asthma and chronic obstructive pulmonary disease (COPD)
B) taking antioxidants
C) taking simvastatin (Zocor)
D) bleeding disorders

Question 42

Type: MCSA Graphic A patient in the coronary care unit has the following cardiac rhythm:
What action should the nurse take when caring for this patient?

A) Prepare to defibrillate.
B) Monitor for any changes.
C) Notify the healthcare provider.
D) Administer a dose of sublingual nitroglycerin.

Question 43

A patient is experiencing supraventricular tachycardia. Which medications should the nurse prepare to administer to this patient?

A) verapamil (Calan)
B) diltiazem (Cardizem)
C) amlodipine (Norvasc)
D) propafenone (Rythmol)
E) adenosine (Adenocard)

Question 44

A patient identified as being at risk for coronary heart disease does not understand why exercise is important. What should the nurse explain to this patient?

A) Exercise decreases blood pressure.
B) Exercise increases oxygen to the heart.
C) Exercise potentiates platelet aggregation.
D) Exercise decreases the workload of the heart.
E) Exercise improves the electrical ability of the heart.

Question 45

A patient with coronary heart disease is prescribed niacin (Nicobid). What should the nurse instruct the patient about this medication?

A) Take with meals and a cold beverage.
B) Take with prescribed statin medication.
C) Keep routine appointments for blood work.
D) Report facial flushing to the healthcare provider.
E) Drink 4 ounces of alcohol if facial flushing occurs.

Question 46

A patient with a high risk for coronary heart disease is prescribed a 1750-kcal diet in which 55% of the diet is to be carbohydrates and 20% fat. How many calories should the nurse instruct the patient consume as protein each day?