Question 1

Which of the following is the earliest lesion of atherosclerosis and is characterized by lipid-filled smooth muscle cells?

Accepted Answer

The earliest lesion of atherosclerosis is the fatty streak, which is characterized by lipid-filled smooth muscle cells. Fibrous plaque and complicated lesions are later stages of atherosclerosis. C-reactive lesion is not a recognized term in the context of atherosclerosis.

Question 2

While observing the ECG monitor of a patient admitted to the ED with chest pain,the nurse suspects that the patient is having a myocardial infarction (MI)rather than angina on finding which of the following data?

Accepted Answer

A pathological Q wave on the ECG indicates that there is myocardial tissue damage and is a common finding in patients with MI. Sinus tachycardia, depressed R wave, and occasional premature ventricular contractions can also be seen in patients with angina or other cardiac conditions.

Question 3

A 45-year-old man is admitted to the ED after developing severe chest pain while raking leaves.On admission,he has midchest dullness and a normal electrocardiogram (ECG).The physician schedules the patient for cardiac catheterization with coronary angiography and possible percutaneous coronary intervention (PCI).The nurse prepares the patient for the procedure by explaining that,in his case,it is used for which of the following purposes?

Accepted Answer

Cardiac catheterization with coronary angiography and possible percutaneous coronary intervention (PCI) is used to visualize any blockages in the coronary arteries and, if necessary, to dilate an obstructed artery with the use of a small balloon. It is not typically used to determine structural defects, test for allergies to thrombolytic agents, or measure blood volume.

Question 4

The nurse administers IV nitroglycerin to a patient with an MI.In evaluating the effect of this intervention,the nurse recognizes that which of the following is an expected outcome of the administration of the medication?

Accepted Answer

IV nitroglycerin is a vasodilator that primarily affects the veins, leading to decreased preload and improved myocardial oxygen supply. Relief of pain is an expected outcome of its administration as it can decrease myocardial workload and the resulting ischemia that causes chest pain in patients with MI. Decreased heart rate, increased cardiac output, and control of cardiac dysrhythmias are not expected outcomes of nitroglycerin administration, although they may occur secondary to the medication's actions.

Question 5

The MB isoenzyme of creatine kinase (CK-MB)level is markedly elevated in a patient with chest pain 12 hours after admission.Of what would the nurse interpret this finding as being evidence?

Accepted Answer

An elevated level of CK-MB is a reliable indicator of myocardial injury, which can be seen in cellular necrosis of myocardial tissue, such as in a myocardial infarction. Therefore, the nurse would interpret this finding as evidence of cellular necrosis of myocardial tissue.

Question 6

In developing a teaching plan for the patient with angina,the nurse recognizes that teaching about the first line of drug therapy for angina will include instructions about using which of the following medications?

Accepted Answer

The answer of In developing a teaching plan for the...

Question 7

After the nurse teaches the patient about the use of atenolol (Tenormin)in preventing anginal episodes,which statement by the patient indicates that the teaching has been effective?

Accepted Answer

Option D indicates that the patient understands the importance of not abruptly stopping atenolol, which is crucial for patients taking this medication. Options A, B, and C are incorrect as atenolol does not increase heart muscle strength, may cause shortness of breath and does not improve blood flow to the coronary arteries.

Question 8

A patient admitted to the critical care unit (CCU)with an MI has a physician's orders for continuous amiodarone (Cordarone)infusion,intravenous (IV)nitroglycerin,and morphine sulphate 2 mg IV every 5 minutes until relief of pain occurs,in addition to the standard CCU protocol.The patient is having frequent,multifocal premature ventricular contractions,and he tells the nurse that the pain is worse than he has ever had and asks if he is going to die.On admission to the CCU,the nurse identifies which of the following nursing diagnoses as a priority?

Accepted Answer

Acute pain related to myocardial ischemia is the priority nursing diagnosis because the patient is experiencing severe pain, which can cause anxiety and potentially lead to complications such as increased myocardial oxygen demand and further ischemia. The other nursing diagnoses are also appropriate for a patient with an MI, but they are not the priority at this time.

Question 9

Which of the following determinants of health is true in relation to CAD in Canada?

Accepted Answer

The answer of Which of the following determinants of health...

Question 10

During assessment of a patient with chest pain,how will the nurse recognize the chest pain associated with stable angina?

Accepted Answer

Chest pain associated with stable angina is typically described as a pressure or squeezing sensation, with a predictable pattern of onset and duration. The pain may be relieved by rest or nitrates. It is not typically accompanied by cold, clammy skin or a feeling of impending doom, which are more indicative of unstable angina or a myocardial infarction. Aggravation of the pain with inspiration, coughing, or movement of the upper body is also not typical of stable angina. Residual soreness in the chest lasting for several days is also not typical of stable angina.

Question 11

While caring for a patient with an AMI,the nurse monitors the patient closely,knowing that which of the following conditions is the most common complication of MI?

Accepted Answer

Dysrhythmias are the most common complication of MI, occurring in up to 80% of patients. Pericarditis, cardiogenic shock, and congestive heart failure can all occur as complications of MI as well, but are not as common as dysrhythmias.

Question 12

In developing a teaching plan for a patient who has stable angina and is started on sublingual nitroglycerin,which one of the following would the nurse identify as an expected patient outcome?

Accepted Answer

It is expected that the patient will identify the need to seek medical attention if chest pain persists 5 minutes after taking nitroglycerin. This is because chest pain not relieved by nitroglycerin could indicate a possible heart attack or unstable angina, which requires immediate medical attention. The patient should also be instructed to take nitroglycerin as prescribed, even if chest pain is not present, to prevent the occurrence of angina attacks. The other options are incorrect as nitroglycerin is not to be taken only if chest pain develops, the side effects of nitroglycerin are not limited to gastric upset and dry mouth, and there is no need for lifelong use of nitroglycerin to prevent an MI.

Question 13

Nadolol (Corgard)is prescribed for a patient with CAD.In evaluating the effectiveness of the drug,the nurse would monitor for which of the following?

Accepted Answer

Nadolol is a beta-blocker medication that is prescribed for CAD to reduce angina symptoms related to exercise or stress. One of the main goals of treatment for CAD is to improve the patient's ability to perform daily activities without experiencing chest discomfort or shortness of breath. Therefore, the nurse would monitor the patient's exercise tolerance and ability to perform daily activities as a measure of the drug's effectiveness. Monitoring peripheral pulses, blood pressure, apical pulse rate, or complaints of cold hands and feet may be important for assessing side effects of the medication, but they are not direct indicators of CAD treatment success.

Question 14

The physician has ordered determination of CK-MB and troponin levels for a patient who has experienced chest pain and aching for the last 4 days.What does the nurse expect on reading this order?

Accepted Answer

Troponin level determination is the most reliable indicator of myocardial damage occurring several days earlier. While CK-MB enzyme levels are also used as a marker of myocardial necrosis, they may not always be specific to myocardial damage and may also be elevated in other conditions. Myoglobin levels, although sensitive, are not as specific for myocardial damage and may also be elevated in other conditions such as rhabdomyolysis. Serum cardiac markers can be inconclusive in determining myocardial injury that is several days old, hence the need for troponin level determination.

Question 15

While teaching a patient and his wife about the dietary modifications that should be made to reduce the risk of CAD,what should the nurse explain?

Accepted Answer

Fish is a good source of protein and has been shown to be beneficial in reducing the risk of CAD as it is high in omega-3 fatty acids. Red meats should be limited due to their high saturated fat content. Margarine should be limited due to its high trans fat content and butter should be avoided as it is high in saturated fat. All vegetable fats are not necessarily unsaturated as some may be hydrogenated, leading to the formation of trans fats. There is no specific recommendation for the percentage of polyunsaturated and monounsaturated fats in the diet, but it is important to choose healthy sources of fats.

Question 16

A diagnosis of acute coronary syndrome (ACS)is the admission diagnosis for a patient transferred to the CCU.The nurse knows that this diagnosis indicates that the patient has experienced which of the following?

Accepted Answer

Acute coronary syndrome (ACS) refers to a range of conditions resulting from the sudden reduction or blockage of blood flow to the heart. This can include unstable angina (UA) and myocardial infarction (MI), both of which can present with chest pain or other symptoms. Option B is not correct, as ACS does not necessarily involve resuscitation following sudden cardiac death. Option C is not specific enough, as not all severe cardiac-related chest pain is necessarily indicative of ACS. Option D is also not entirely correct, as MI can present with or without ST-segment elevation, and ACS can include UA as well as MI without ST-segment elevation.

Question 17

The nurse determines that outcomes for teaching regarding precipitating factors of angina have been met when the patient states which of the following?

Accepted Answer

Resting after a heavy meal can help prevent angina as digestion increases the heart's workload.

Question 18

When developing a health teaching plan for a 65-year-old patient with all of these risk factors for coronary artery disease (CAD),which of the following will the nurse focus on?

Accepted Answer

While all of the risk factors listed are important to consider, focusing on the patient's low activity level is the most actionable factor that can be addressed through health teaching. Encouraging the patient to increase their physical activity can have a positive impact on their overall cardiovascular health.

Question 19

To assist the patient with CAD to make the appropriate dietary changes,which of these nursing interventions will be most effective?

Accepted Answer

This intervention provides a practical way for the patient to still enjoy their favourite foods while making healthy dietary changes. Monounsaturated oils are a healthier alternative to saturated fats and can be easily substituted in many recipes. Providing a list of specific foods (B) may be too restrictive and difficult for the patient to follow long-term, while simply instructing the patient to eliminate all saturated fat and sodium (C) may be overwhelming and unrealistic. Emphasizing the increased risk of cardiac problems (D) may not provide enough guidance for the patient to make actual dietary changes.

Question 20

The nurse is admitting a patient who is complaining of chest pain to the emergency department (ED).Which information collected by the nurse suggests that the pain is caused by an acute myocardial infarction (AMI)?

Accepted Answer

Chest pain that persists for longer than 30 minutes is a common symptom of an acute myocardial infarction (AMI), also known as a heart attack. Chest pain that is worsened by arm movement (A) or deep breathing (B) may indicate a musculoskeletal or respiratory issue, respectively. The fact that the pain was relieved by nitroglycerin (C) suggests that it was caused by a cardiac issue, but this alone does not confirm an AMI.

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

Which of the following is the earliest lesion of atherosclerosis and is characterized by lipid-filled smooth muscle cells?

While observing the ECG monitor of a patient admitted to the ED with chest pain,the nurse suspects that the patient is having a myocardial infarction (MI) rather than angina on finding which of the following data?

The nurse administers IV nitroglycerin to a patient with an MI.In evaluating the effect of this intervention,the nurse recognizes that which of the following is an expected outcome of the administration of the medication?

The MB isoenzyme of creatine kinase (CK-MB) level is markedly elevated in a patient with chest pain 12 hours after admission.Of what would the nurse interpret this finding as being evidence?

In developing a teaching plan for the patient with angina,the nurse recognizes that teaching about the first line of drug therapy for angina will include instructions about using which of the following medications?

After the nurse teaches the patient about the use of atenolol (Tenormin) in preventing anginal episodes,which statement by the patient indicates that the teaching has been effective?

Which of the following determinants of health is true in relation to CAD in Canada?

During assessment of a patient with chest pain,how will the nurse recognize the chest pain associated with stable angina?

While caring for a patient with an AMI,the nurse monitors the patient closely,knowing that which of the following conditions is the most common complication of MI?

In developing a teaching plan for a patient who has stable angina and is started on sublingual nitroglycerin,which one of the following would the nurse identify as an expected patient outcome?

Nadolol (Corgard) is prescribed for a patient with CAD.In evaluating the effectiveness of the drug,the nurse would monitor for which of the following?

The physician has ordered determination of CK-MB and troponin levels for a patient who has experienced chest pain and aching for the last 4 days.What does the nurse expect on reading this order?

While teaching a patient and his wife about the dietary modifications that should be made to reduce the risk of CAD,what should the nurse explain?

A diagnosis of acute coronary syndrome (ACS) is the admission diagnosis for a patient transferred to the CCU.The nurse knows that this diagnosis indicates that the patient has experienced which of the following?

The nurse determines that outcomes for teaching regarding precipitating factors of angina have been met when the patient states which of the following?

When developing a health teaching plan for a 65-year-old patient with all of these risk factors for coronary artery disease (CAD) ,which of the following will the nurse focus on?

To assist the patient with CAD to make the appropriate dietary changes,which of these nursing interventions will be most effective?

The nurse is admitting a patient who is complaining of chest pain to the emergency department (ED) .Which information collected by the nurse suggests that the pain is caused by an acute myocardial infarction (AMI) ?