Question 1

The nurse is providing teaching to a client with chronic stable angina about how to use the prescribed short-acting and long-acting nitrates. Which of the following client statements indicates that the teaching has been effective?

Accepted Answer

The client should sit down before taking the nitroglycerin to decrease cardiac workload and prevent orthostatic hypotension. Transdermal nitrates are used prophylactically rather than to treat acute pain and can be used concurrently with sublingual nitroglycerin.
Although the nurse should check blood pressure before giving nitroglycerin, clients do not need to check the pulse rate before taking nitrates.

Question 2

The nurse is developing a health teaching plan for a 60-year-old man with the following risk factors for coronary artery disease (CAD). Which of the following risk factors should the nurse focus on when teaching the client?

Accepted Answer

Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the client's LDL level. Decreases in LDL will help reduce the client's risk for developing CAD.

Question 3

The nurse is administering a fibrinolytic agent to a client with an acute myocardial infarction. Which of the following assessments should cause the nurse to stop the drug infusion?

Accepted Answer

The change in level of consciousness indicates that the client may be experiencing intracranial bleeding, a possible complication of fibrinolytic therapy. Bleeding of the gums and prolonged bleeding from IV sites are expected adverse effects of the therapy. The nurse should address these by avoiding any further injuries, but they are not an indication to stop infusion of the fibrinolytic medication. A nonsustained episode of ventricular tachycardia is a common reperfusion dysrhythmia and may indicate that the therapy is effective.

Question 4

The nurse is caring for a client who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction. Which of the following information should the nurse teach the client?

Accepted Answer

Holter monitoring is used to determine whether the client is experiencing dysrhythmias such as ventricular tachycardia during normal daily activities. SCD is likely to recur.
Heparin will not have any effect on the incidence of SCD, and SCD can occur even when the client is resting.

Question 5

Which of the following information given by a client admitted with chronic stable angina will help the nurse confirm this diagnosis?

Accepted Answer

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.

Question 6

The nurse is providing teaching to a client about use of sublingual nitroglycerin. Which of the following client statements indicates that the teaching has been effective?

Accepted Answer

The emergency medical services (EMS) system should be activated when chest pain or other symptoms are not completely relieved 5 minutes after taking one nitroglycerin.
Nitroglycerin can be taken to prevent chest pain or other symptoms from developing (e.g., before intercourse). Gastric upset is not an expected adverse effect of nitroglycerin.
Nitroglycerin does not impact the underlying pathophysiology of coronary artery atherosclerosis.

Question 7

Four days after having a myocardial infarction (MI), a client who is scheduled for discharge asks for assistance with all the daily activities, saying, "I don't understand how to care for myself." Based on this information, which of the following nursing diagnoses is appropriate?

Accepted Answer

The client data indicate ineffective health management related to lack of knowledge of disease process, and care after discharge. The other nursing diagnoses may be appropriate for some clients after an MI, but the data for this client do not support denial, activity intolerance, or social isolation.

Question 8

A client with ST segment elevation in several electrocardiographic (ECG) leads is admitted to the emergency department (ED) and diagnosed as havingan ST-segment-elevation myocardial infarction (STEMI). Which of the following questions should the nurse ask to determine whether the client is a candidate for fibrinolytic therapy?

Accepted Answer

Fibrinolytic therapy should be started within 6 hours of the onset of the myocardial infarction (MI), so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information also will be needed, but it will not be a factor in the decision about fibrinolytic therapy.

Question 9

The nurse is caring for a client with newly diagnosed Prinzmetal's (variant) angina and has a prescription for amlodipine. Which of the following information is accurate about amlodipine?

Accepted Answer

Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., amlodipine, nifedipine) are a first-line therapy for this type of angina. Platelet inhibitors, such as Aspirin, help prevent coronary artery thrombosis, and ?-blockers decrease sympathetic stimulation of the heart. Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing oxygen demand.

Question 10

Following an acute myocardial infarction, a client ambulates in the hospital hallway. When the nurse is evaluating the client's response, which of the following assessment data would indicate that the exercise level should be decreased?

Accepted Answer

A change in heart rate of more than 20 beats or more indicates that the client should stop and rest. The increases in BP and respiratory rate, and the slight decrease in oxygen saturation, are normal responses to exercise.

Question 11

The nurse is caring for a client with angina who has been prescribed nadolol. Which of the following parameters should the nurse assess to determine whether the drug is effective?

Accepted Answer

Because the medication is ordered to improve the client's angina, effectiveness is indicated if the client is able to accomplish daily activities without chest pain. Blood pressure (BP) and apical pulse rate may decrease, but these data do not indicate that the goal of decreased angina has been met. The noncardioselective ?-blockers can cause peripheral vasoconstriction, so the nurse would not expect an improvement in peripheral pulse quality or skin temperature.

Question 12

The nurse will suspect that the client with stable angina is experiencing an adverse effect of the prescribed metoprolol if which of the following findings are assessed?

Accepted Answer

Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers (e.g., amlodipine, nifedipine) are a first-line therapy for this type of angina. Platelet inhibitors, such as Aspirin, help prevent coronary artery thrombosis, and ? -blockers decrease sympathetic stimulation of the heart. Medications or activities that increase myocardial contractility will increase the incidence of angina by increasing oxygen demand.

Question 13

The nurse is caring for a client with a non-ST-segment-elevation myocardial infarction (NSTEMI) who is receiving heparin. Which of the following information explains the purpose of the heparin?

Accepted Answer

Heparin helps prevent the conversion of fibrinogen to fibrin and decreases coronary artery thrombosis. It does not change coronary artery plaque, dissolve already formed clots, or enhance platelet aggregation.

Question 14

Three days after a myocardial infarction (MI), the client develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which of the following actions should the nurse take next?

Accepted Answer

The client's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the client's symptoms.

Question 15

The nurse is providing teaching to a client about the use of atenolol in preventing anginal episodes. Which of the following client statements indicate that the teaching has been effective?

Accepted Answer

Clients who have been taking ? -blockers can develop intense and frequent angina if the medication is suddenly discontinued. Atenolol decreases myocardial contractility. Shortness of breath that occurs when taking ? -blockers for angina may be due to bronchospasm and should be reported to the health care provider. Atenolol works by decreasing myocardial oxygen demand, not by increasing blood flow to the coronary arteries.

Question 16

To assist the client with coronary artery disease (CAD) in making appropriate dietary changes, which of the following nursing interventions will be most effective?

Accepted Answer

Lifestyle changes are more likely to be successful when consideration is given to the client's values and preferences. The highest percentage of calories from fat should come from polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the client with a list alone is not likely to be successful in making dietary changes. Removing saturated fat from the diet completely is not a realistic expectation. Telling the client about the increased risk without assisting further with strategies for dietary change is unlikely to be successful.

Question 17

The nurse is caring for a client who has had severe chest pain for several hours and a diagnosis of possible acute myocardial infarction. Which of the following prescribed laboratory tests should the nurse monitor to help determine the diagnosis?

Accepted Answer

Troponin levels increase about 3-12 hours after the onset of myocardial infarction (MI). The other laboratory data are useful in determining the client's risk for developing coronary artery disease (CAD) but are not helpful in determining whether an acute MI is in progress.

Question 18

Which of the following information collected by the nurse who is admitting a client with chest pain suggests that the pain is caused by an acute myocardial infarction?

Accepted Answer

Chest pain that lasts for 20 minutes or more is characteristic of an acute myocardial infarction. Changes in pain that occur with raising the arms or with deep breathing are more typical of pericarditis or musculo-skeletal pain. Stable angina is usually relieved when the client takes nitroglycerin.

Question 19

Which of the following statements made by a client with coronary artery disease after the nurse has completed teaching about nutritional therapy for CAD indicates that further teaching is needed?

Accepted Answer

Although only 30% of the daily calories should come from fats, most of the fat should come from monosaturated fats such as are found in nuts, olive oil, and canola oil. The client can include peanut butter sandwiches as part of their diet. The other client comments indicate a good understanding of diet.

Question 20

The nurse is administering IV nitroglycerin to a client with a myocardial infarction (MI). Which of the following actions should the nurse take to evaluate the effectiveness of the medication?

Accepted Answer

The goal of IV nitroglycerin administration in MI is relief of chest pain by improving the balance between myocardial oxygen supply and demand. The nurse also will monitor heart rate and BP and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective.

Quiz 36: Nursing Management Coronary Artery Disease and Acute Coronary Syndrome