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

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?

A)"I will put on the nitroglycerin patch as soon as I develop any chest pain."
B)"I will check the pulse rate in my wrist just before I take any nitroglycerin."
C)"I will be sure to remove the nitroglycerin patch before using any sublingual nitroglycerin."
D)"I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."

Answer 1

"I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."

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?

A)Family history of coronary artery disease
B)Increased risk associated with the client's gender
C)High incidence of cardiovascular disease in older people
D)Elevation of the client's serum low density lipoprotein (LDL) level

Answer 2

Elevation of the client's serum low density lipoprotein (LDL) level

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?

A)Bleeding from the gums
B)Surface bleeding from the IV site
C)A decrease in level of consciousness
D)A nonsustained episode of ventricular tachycardia

Answer 3

A decrease in level of consciousness

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?

A)That sudden cardiac death events rarely reoccur
B)About the purpose of outpatient Holter monitoring
C)How to self-administer low-molecular-weight heparin
D)To limit activities after discharge to prevent future events

Question 5

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

A)The client rates the pain at a level 3-5 (0-10 scale).
B)The client states that the pain "wakes me up at night."
C)The client says that the frequency of the pain has increased over the last few weeks.
D)The client states that the pain is resolved after taking one sublingual nitroglycerin tablet.

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?

A)"I can expect indigestion as an adverse effect of nitroglycerin."
B)"I can only take the nitroglycerin if I start to have chest pain."
C)"I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin."
D)"I will help slow down the progress of the plaque formation by taking nitroglycerin."

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?

A)Ineffective health management related to insufficient knowledge
B)Activity intolerance related to physical deconditioning
C)Ineffective denial related to ineffective coping strategies
D)Social isolation related to insufficient personal resources

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?

A)"Do you take Aspirin on a daily basis?"
B)"What time did your chest pain begin?"
C)"Is there any family history of heart disease?"
D)"Can you describe the quality of your chest pain?"

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?

A)Reduce the "fight or flight" response
B)Decrease spasm of the coronary arteries
C)Increase the force of myocardial contraction
D)Help prevent clotting in the coronary arteries

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?

A)BP changes from 118/60 to 126/68 mm Hg.
B)Oxygen saturation drops from 100% to 98%.
C)Heart rate increases from 66 to 90 beats/minute.
D)Respiratory rate goes from 14 to 22 breaths/minute.

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?

A)Decreased blood pressure and apical pulse rate
B)Fewer complaints of having cold hands and feet
C)Improvement in the quality of the peripheral pulses
D)The ability to do daily activities without chest discomfort

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?

A)The client is restless and agitated.
B)The blood pressure is 190/110 mm Hg.
C)The client complains about feeling anxious.
D)The cardiac monitor shows a heart rate of 45.

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?

A)Platelet aggregation is enhanced by IV heparin infusion.
B)Heparin will dissolve the clot that is blocking blood flow to the heart.
C)Coronary artery plaque size and adherence are decreased with heparin.
D)Heparin will prevent the development of new clots in the coronary arteries.

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?

A)Palpate the radial pulses bilaterally.
B)Assess the feet for peripheral edema.
C)Auscultate for a pericardial friction rub.
D)Check the cardiac monitor for dysrhythmias.

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?

A)"It is important not to suddenly stop taking the atenolol."
B)"Atenolol will increase the strength of my heart muscle."
C)"I can expect to feel short of breath when taking atenolol."
D)"Atenolol will improve the blood flow to my 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?

A)Instruct the client that a diet containing no saturated fat and minimal sodium will be necessary.
B)Emphasize the increased risk for cardiac problems unless the client makes the dietary changes.
C)Assist the client to modify favourite high-fat recipes by using polyunsaturated oils when possible.
D)Provide the client with a list of low-sodium, low-cholesterol foods that should be included in the diet.

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?

A)Homocysteine
B)C-reactive protein
C)Cardiac-specific troponin I and troponin T
D)High-density lipoprotein (HDL) cholesterol

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?

A)The pain increases with deep breathing.
B)The pain has persisted longer than 30 minutes.
C)The pain worsens when the client raises the arms.

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?

A)"I will switch from whole milk to 1% or nonfat milk."
B)"I like fresh salmon and I will plan to eat it more often."
C)"I will miss being able to eat peanut butter sandwiches."
D)"I can have a cup of coffee with breakfast if I want one."

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?

A)Check blood pressure.
B)Monitor apical pulse rate.
C)Monitor for dysrhythmias.
D)Ask about chest discomfort.

Question 21

Which of the following information about a client who has been receiving fibrinolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?

A)No change in the client's chest pain
B)A large bruise at the client's IV insertion site
C)A decrease in ST segment elevation on the electrocardiogram (ECG)
D)An increase in cardiac enzyme levels since admission

Question 22

Which of the following electrocardiographic (ECG) change is most important for the nurse to communicate to the health care provider when caring for a client with chest pain?

A)Frequent premature atrial contractions (PACs)
B)Inverted P wave
C)Sinus tachycardia
D)ST segment elevation

Question 23

The nurse is caring for a client who has recently started taking rosuvastatin and niacin who reports all of these symptoms to the nurse. Which of the following finding is most important to communicate to the health care provider?

A)Generalized muscle aches and weakness
B)Skin flushing after taking the medications
C)Dizziness when changing positions quickly
D)Nausea when taking the drugs before eating

Question 24

The nurse is caring for a client who has had an acute myocardial infarction and the client asks the nurse about when sexual intercourse can be resumed. Which of the following responses by the nurse is best?

A)"Most clients are able to enjoy intercourse without any complications."
B)"Sexual activity uses about as much energy as climbing two flights of stairs."
C)"The doctor will discuss sexual intercourse when your heart is strong enough."
D)"Holding and cuddling are good ways to maintain intimacy after a heart attack."

Question 25

The nurse is admitting a client to the emergency department with severe chest pain and gives the following list of medications taken at home to the nurse. Which of the following medications has the most immediate implications for the client's care?

A)Sildenafil
B)Furosemide
C)Diazepam
D)Captopril

Question 26

The nurse is caring for a client who is 3 days post myocardial infarction and the client states, "I just had a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which of the following responses should the nurse make?

A)"Where are you planning to go for your vacation?"
B)"What do you think caused your chest pain episode?"
C)"Sometimes plans need to change after a heart attack."
D)"Recovery from a heart attack takes at least a few weeks."

Question 27

The nurse is caring for a client who was admitted the previous day to the coronary care unit with an acute myocardial infarction. Which of the following information should the nurse include in the teaching plan for the client?

A)Typical emotional responses to AMI
B)When client cardiac rehabilitation will begin.
C)Discharge drugs such as Aspirin and ?-blockers.
D)The pathophysiology of coronary artery disease.

Question 28

The nurse is caring for a client with acute coronary syndrome who has returned to the coronary care unit after having percutaneous coronary intervention and the nurse obtains these assessment data. Which of the following data indicate the need for immediate intervention by the nurse?

A)Pedal pulses 1+
B)Heart rate 100 beats/minute
C)Blood pressure 104/56 mm Hg
D)Chest pain level 8 on a 10-point scale

Question 29

The nurse is admitting a client with a myocardial infarction (MI) to the intensive care unit. Which of the following actions should the nurse carry out first?

A)Obtain the blood pressure.
B)Attach the cardiac monitor.
C)Assess the peripheral pulses.
D)Auscultate the breath sounds.

Question 30

The nurse obtains the following data when caring for a client who experienced an acute myocardial infarction 2 days previously. Which of the following information is most important to report to the health care provider?

A)The client denies ever having a heart attack.
B)The cardiac-specific troponin level is elevated.
C)The client has occasional premature atrial contractions (PACs).
D)Crackles are auscultated bilaterally in the mid-lower lobes.

Question 31

Which of the following causes is the most common cause for sudden cardiac death?

A)Ventricular tachycardia
B)Aortic stenosis
C)Hypertrophic cardiomyopathy
D)Angina

Question 32

Which of the following approaches to preventing a recurrence of sudden cardiac death is the most common?

A)Long-term Aspirin therapy
B)Implantable cardioverter-defibrillator
C)Administration of amiodarone
D)Continuous Holter monitoring

Question 33

The nurse is providing teaching to a client who has a prescription for transdermal nitroglycerin drug administration via reservoir. The client asks the nurse how often each day will the drug be administered. Which of the following information is the basisforthe nurse's response?

A)Every 4 hours while awake
B)Every 6 hours around the clock
C)Every 12 hours
D)Once every 24 hours

Question 34

The nurse is evaluating the outcomes of preoperative teaching with a client scheduled for a coronary artery bypass graft (CABG) using the internal mammary artery. Which of the following client statements indicates that additional teaching is needed?

A)"I will have incisions in my leg where they will remove the vein."
B)"They will circulate my blood with a machine during the surgery."
C)"I will need to take an Aspirin a day after the surgery to keep the graft open."
D)"They will use an artery near my heart to bypass the area that is obstructed."

Question 35

The nurse is admitting a client who has chest pain is to the emergency department and all the following diagnostic tests are prescribed. Which of the following tests should the nurse arrange to be completed first?

A)Electrocardiogram (ECG)
B)Computed tomography (CT) scan
C)Chest x-ray
D)Troponin level

Question 36

The nurse is caring for a client with hyperlipidemia who has a new prescription for colestipol. Which of the following nursing actions is best when giving the medication?

A)Administer the medication at the client's bedtime.
B)Have the client take this medication with an Aspirin.
C)Encourage the client to take the colestipol with a sip of water.
D)Give the client's other medications 2 hours after the colestipol.

Question 37

The nurse has just received a change-of-shift report about the following four clients. Which client should the nurse assess first?

A)38-year-old who has pericarditis and is complaining of sharp, stabbing chest pain
B)45-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge
C)51-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)
D)60-year-old with variant angina who is to receive a scheduled dose of nifedipine (Adalat)