Deck 32: Caring for the Patient With Coronary Artery Disorders

Question 1

Fifteen hours after admission, a patient's CK-MB level is markedly increased. What does 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.

Answer 1

Cellular necrosis of myocardial tissue has occurred.

Question 2

A patient is recovering from an acute myocardial infarction. The nurse realizes that the final extent of cardiac damage depends on which factor?

A) Reperfusion of the ischemic zone
B) Patient's ethnicity
C) Patient's gender
D) Development of heart block

Answer 2

Reperfusion of the ischemic zone

Question 3

Which laboratory test result would the nurse evaluate as indicating increased risk of coronary artery disease CAD)?

A) Elevated homocysteine
B) Elevated creatinine
C) Elevated high-density lipoprotein HDL)
D) Elevated INR

Answer 3

Elevated homocysteine

Question 4

The nurse, caring for a patient diagnosed with Prinzmetal's or variant angina, realizes this is a serious type of chest pain. Why is this so?

A) It indicates the 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 5

A patient who is recovering from cardiovascular surgery is demonstrating chest tube output of greater than 100 mL per hour. Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Report to the surgeon.
B) Check the hemoglobin and hematocrit.
C) Administer a blood transfusion.
D) Notify the family.
E) Connect pacemaker wires.

Question 6

A patient enters the emergency department complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this patient includes which nursing actions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Morphine intravenously and oxygen
B) Aspirin 325 mg orally
C) Preparation for open heart surgery
D) Heparin drip at 100 units per hour
E) Foley catheter insertion

Question 7

Following a transmural myocardial infarction, which ECG change stays with the patient for life?

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

Question 8

The nurse, assessing a middle-aged patient experiencing chest pain, realizes that which symptoms would be most suggestive 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 9

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

A) Troponin I and T
B) Red blood cells
C) CPK-MB
D) Homocysteine and platelets

Question 10

An otherwise healthy patient admitted with chest pain is scheduled for diagnostic testing. The nurse anticipates that the results of which test will provide the best information about the patient's coronary artery status?

A) Coronary angiography
B) Stress electrocardiography
C) Echocardiography
D) Nuclear persantine dipyridamole) stress test

Question 11

The nurse is assessing a patient who is 6 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 12

The nurse, caring for a patient with myocardial damage, would expect which change on the ECG tracing?

A) ST segment elevation
B) Loss of P waves
C) Bradycardia
D) Widening of the QRS complex

Question 13

The nurse is teaching a patient about coronary artery bypass surgery via the left internal mammary artery. Which information is essential for the patient to understand?

A) "You must still reduce or modify cardiac risk factors."
B) "This surgery prolongs life an average of 2 years."
C) "You have only a minimal chance of functional improvement, even with this surgery."
D) "This surgery will cure your atherosclerosis."

Question 14

Nursing care of the patient after thrombolytic therapy focuses on the assessment of which common complication?

A) Bleeding
B) Reperfusion chest pain
C) Lethargy
D) Heart block

Question 15

A patient, recovering from coronary artery bypass graft CABG) surgery, tells the nurse that it feels good to be cured of heart disease. Which are appropriate responses by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "The surgery only relieves the symptoms; it does not cure the disease."
B) "You must continue to modify your cardiac risk factors."
C) "You are correct; your heart is now normal."
D) "You should avoid exercise for at least 6 months after this surgery."
E) "There no need to monitor your fat intake any longer."

Question 16

The family of a patient who experienced a stroke after CABG surgery asks the nurse what caused the stroke. What is the nurse's best response?

A) "Stroke is usually caused by a blood clot that breaks loose and travels to the brain."
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 17

When 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 would assess for which other condition?

A) Heart failure
B) Extension of the MI
C) Renal failure
D) Liver failure

Question 18

Which finding from the social and history assessment of a patient admitted for chest pain would the nurse evaluate as carrying the highest risk for heart disease?

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

Question 19

The nurse is discussing coronary heart disease risk factors with a group of factory employees. Which risk factors would the nurse identify as modifiable? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Hypertension
B) Diabetes mellitus
C) Obesity
D) Age
E) Heredity

Question 20

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

A) Watch for signs of bleeding, such as bruising.
B) Report any itching that develops after 7 days of taking the drug.
C) Take aspirin as a substitute for clopidrogrel Plavix).
D) Do not skip any scheduled appointments to have blood drawn for labs.

Question 21

The nurse would suspect conversion of a patient's stable angina to unstable angina if the patient reports angina lasting over _______ minutes at rest.

Question 22

Two days after having coronary bypass grafting, a patient develops atrial fibrillation. The patient is tolerating the rhythm. What is the nurse's initial action?

A) Have the patient cough.
B) Do an electrocardiogram ECG).
C) Increase the patient's IV rate.
D) Notify the health care provider.

Question 23

A patient is about to have a balloon angioplasty. The nurse would evaluate that the patient does not understand the procedure when the patient makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "They may put in a stent to help keep my artery open."
B) "I expect to be up walking in the hall an hour after the procedure."
C) "If they put a stent in, I will have to come back to have it removed in about 3 months."
D) "I may feel a hot flush during this procedure."
E) "My family should be prepared for this procedure to take several hours."

Question 24

A patient is being discharged after having balloon angioplasty. Which teaching should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "Take aspirin for any minor discomfort at the procedure site."
B) "Call the hospital immediately if there is any bright red bleeding from the procedure site."
C) "Because the access site is in your groin, you should avoid bending over or straining for at least 48 hours."
D) "You may shower or bathe as usual."
E) "Keep a pressure dressing over the site for 24 hours and then replace it with a light dressing for the next 24 hours."

Question 25

A patient asks the nurse about metabolic syndrome. Which is the most accurate answer for the nurse to provide?

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) "Metabolic syndrome can be avoided by taking vitamins daily and drinking 64 fluid ounces of water a day."
E)"

Question 26

A patient's electrocardiogram ECG) reveals evidence of a myocardial infarction MI), although this event is not recorded in the patient's history. The nurse teaches the patient that silent ischemia and silent MI are more common in which people? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Women
B) African Americans
C) People with diabetes
D) People in high-stress occupations.
E) People younger than 45

Question 27

After a percutaneous coronary intervention PCI), a patient develops a pseudoaneurysm. The nurse would anticipate conservative management if testing proves the pseudoaneurysm to be less than ______ centimeters in diameter as long as the patient is asymptomatic.

Question 28

A patient who is prescribed atorvastatin Lipitor) should be monitored for which condition?

A) Liver enzyme alteration
B) Blood glucose and uric acid level alteration
C) Renal function alteration
D) Sudden back pain and constipation

Question 29

A patient's activity is progressing after an acute myocardial infarction AMI). The nurse would determine that the patient is deconditioned if getting up in a chair decreases systolic blood pressure by _______ mmHg or more.

Question 30

The nurse would recommend closer evaluation for coronary artery disease CAD) to a patient with which history? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Diabetes
B) Hyperlipidemia
C) Positive family history
D) Increased C-reactive protein level
E) hypotension

Question 31

A patient was admitted this morning for an elective percutaneous coronary intervention. The nurse would alert the health care provider if the patient makes which statement?

A) "My blood sugar was high yesterday, so I took my metformin as prescribed last night."
B) "I have not had anything to eat or drink since midnight last night."
C) "I am eager to get this procedure over with so I can go to my grandson's baseball game next week."
D) "I did not sleep well last night."

Question 32

The nurse considers which information when planning care for a patient with left anterior descending LAD) artery occlusion?

A) An occlusion in the LAD often results in death.
B) The patient may have atrial dysrhythmias.
C) Occlusion of this vessel will result in an inferior wall MI.
D) Occlusion of this vessel damages the aorta.

Question 33

The nurse is reviewing a new prescription for propranolol Inderal) for a patient with coronary artery disease CAD). The nurse would call the physician and question this prescription if the patient has which history?

A) History of asthma
B) Also taking antioxidants
C) Also taking simvastatin Zocor)
D) History of bleeding disorders

Question 34

A patient is scheduled for cardiac catheterization this morning. Which information should the nurse communicate to the treatment team? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The night nurse reports the patient was confused and combative throughout the night.
B) The patient's potassium is 4.1 mEq/L.
C) The patient's serum creatinine is 1.6 mg/dL this morning.
D) The patient's previous S₃ heart sound is not audible this morning.
E) The patient required intravenous morphine sulfate for pain control on one occasion during the night.