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

Question 1

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

A) Fatty streak
B) Fibrous plaque
C) C-reactive lesion
D) Complication lesion

Answer 1

Fatty streak

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?

A) Sinus tachycardia
B) Depressed R wave
C) Pathological Q wave
D) Occasional premature ventricular contractions

Answer 2

Pathological Q wave

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?

A) To determine whether the walls or chambers of the patient's heart have any structural defects
B) To determine whether any obstructions are present in his coronary arteries and to test for an allergy to thrombolytic agents
C) To measure the amount of blood being pumped from his heart with each contraction to determine whether the heart is damaged
D) To visualize any blockages in the coronary arteries and,if necessary,to dilate an obstructed artery with the use of a small balloon

Answer 3

To visualize any blockages in the coronary arteries and,if necessary,to dilate an obstructed artery with the use of a small balloon

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?

A) Relief of pain
B) Decreased heart rate
C) Increased cardiac output
D) Control of cardiac dysrhythmias

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?

A) Lactic acidosis
B) A need for thrombolytic therapy
C) Deterioration of cardiac function
D) 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?

A) One aspirin a day
B) Transdermal nitrates
C) Lovastatin (Mevacor)
D) Metoprolol (Lopressor)

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?

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

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?

A) Acute pain related to myocardial ischemia
B) Anxiety related to perceived threat of death
C) Decreased cardiac output related to cardiogenic shock
D) Activity intolerance related to decreased cardiac output

Question 9

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

A) Native-born Canadians have better cardiovascular health than immigrants to Canada.
B) Immigrants from South Asia have a very high risk for cardiovascular disease.
C) Asian Indians experience lower rates of cardiovascular disease,regardless of where they live.
D) Chinese immigrants have a very low rate of cardiovascular disease.

Question 10

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

A) It is severe,persistent,and unrelieved by rest.
B) Cold,clammy skin accompanied by a feeling of doom.
C) It is aggravated by inspiration,coughing,and movement of the upper body.
D) It is accompanied by a residual soreness in the chest,which lasts for several days.

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?

A) Pericarditis
B) Dysrhythmias
C) Cardiogenic shock
D) Congestive heart failure

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?

A) States nitroglycerin is to be taken only if chest pain develops
B) Lists the side effects of nitroglycerin as gastric upset and dry mouth
C) Identifies the need to seek medical attention if chest pain persists 5 minutes after taking nitroglycerin
D) Identifies the need for lifelong use of nitroglycerin to prevent the development of 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?

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

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?

A) Myoglobin levels will also have to be determined to confirm myocardial damage.
B) CK-MB enzyme levels will be the most reliable indicator of any myocardial necrosis that has occurred.
C) Any serum cardiac marker will be inconclusive in determining myocardial injury that is several days old.
D) The presence of myocardial damage occurring several days earlier can be validated best by the 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?

A) Margarine can be used in any amount,but butter should be avoided.
B) Fish is preferable to red meats as sources of protein.
C) All vegetable fats are unsaturated and are preferable to meat and dairy fats.
D) Polyunsaturated and monounsaturated fats should be restricted to 50% of the total daily calories.

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?

A) Unstable angina (UA)or an MI
B) Resuscitation following sudden cardiac death
C) Onset of any severe cardiac-related chest pain
D) MI accompanied by 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?

A) "I will stop my sexual activities."
B) "I will rest for 1 to 2 hours after a heavy meal."
C) "I will take my medication before doing my daily walk."
D) "I will limit my coffee intake,but I may substitute regular cola products."

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?

A) A family history of heart disease
B) Increased risk associated with the patient's ethnicity
C) A high incidence of cardiovascular disease in older people
D) A low activity level reported by the patient

Question 19

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

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

A) The pain worsens when the patient raises the arms.
B) The pain increases with deep breathing.
C) The pain is relieved after the patient takes nitroglycerin.
D) The pain has persisted longer than 30 minutes.

Question 21

A patient who has recently started taking rosuvastatin (Crestor)and niacin (Nicobid)reports all the following symptoms to the nurse.Which one is most important to communicate to the physician?

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

Question 22

For which of the following patient conditions is the use of garlic as a complementary therapy to help lower blood pressure contraindicated?

A) Pre-existing hypertension
B) Diabetes
C) Obesity
D) Osteoarthritis

Question 23

A patient who has chest pain is admitted to the ED,and the following diagnostic tests are ordered.Which one will the nurse arrange to be completed first?

A) Chest X-ray
B) Troponin level
C) Computed tomography scan
D) ECG

Question 24

When caring for a patient who has survived a sudden cardiac death event and has no evidence of an AMI,what will the nurse anticipate teaching the patient?

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

Question 25

Three weeks after his hospitalization for an AMI,a patient returns to the cardiac centre for follow-up.When the nurse asks about his sleep patterns,the patient tells the nurse that he sleeps fine but that his wife moved into the spare bedroom to sleep when he returned home.He states,"I guess we will never have sex again after this." What is the best response to the patient?

A) "Sexual intercourse will be too strenuous on your heart,but closeness and intimacy can be maintained with holding and cuddling."
B) "You should discuss your questions about your sexual activity with your doctor because the activity it requires is a medical concern."
C) "Sexual activity can be resumed whenever you and your wife feel like it.Most sexual response is emotional rather than physical."
D) "Sexual activity can be gradually resumed like other forms of activity.A good comparison of energy expenditure is climbing two flights of stairs."

Question 26

Three days after an MI,the patient develops chest pain that radiates to the back and left arm and is relieved by sitting in a forward position.On auscultation of the patient's chest,what would the nurse expect to hear?

A) Distant heart sounds
B) S₃ or S₄ heart sounds
C) A pericardial friction rub
D) A loud holosystolic apical murmur

Question 27

Which of the following is the mechanism of action of aspirin that is commonly prescribed for patients that have had acute coronary syndrome?

A) Inhibits platelet aggregation
B) Promotes coronary artery vasodilation
C) Promotes peripheral vasodilation
D) Inhibits cyclooxygenase

Question 28

The nurse evaluates the outcomes of preoperative teaching with a patient scheduled for a coronary artery bypass graft using the internal mammary artery.Which of the following statements by the patient helps the nurse identify that additional teaching is needed?

A) "I will need to take an aspirin a day after the surgery to keep the graft open."
B) "I will have incisions in my leg where they removed the vein."
C) "They will stop my heart and circulate my blood with a machine during the surgery."
D) "They will cut between my ribs and use a scope to attach a different artery to the artery that is blocked in my heart."

Question 29

During early assessment of the patient with an MI,the nurse is aware that which of the following diagnostic tests is the most important to determine the extent and treatment of an MI?

A) Serial ECGs
B) A chest X-ray
C) Treadmill exercising
D) Serum cardiac markers

Question 30

In preparing a patient for discharge from the hospital following an MI,which of the following statements by the patient indicates to the nurse that further instruction is needed?

A) "Exercise will increase the efficiency of my heart."
B) "I can control several risk factors of CAD just by exercising."
C) "My heart will be as good as new when I finish a cardiac rehabilitation program."
D) "I should do more exercises that move my joints than exercises that require static force."

Question 31

A patient who is being admitted to the ED with severe chest pain gives the nurse the following list of medications taken at home.Which medication has the most immediate implications for the patient's care?

A) Captopril (Capoten)
B) Furosemide (Lasix)
C) Sildenafil (Viagra)
D) Diazepam (Valium)

Question 32

During the initial stages of hospitalization for an MI,the patient has been in denial,stating "I just had a little chest pain." What is the most appropriate intervention for the nurse to plan for the patient at this time?

A) Have the patient's family encourage him to talk about his plans for the future.
B) Allow the patient to use denial as a coping mechanism until he asks questions about his condition.
C) Implement reality orientation by reminding the patient several times a day that he has had major cardiac damage.
D) Begin teaching the patient about the anatomy and physiology of the heart so that he can understand what has happened to him.

Question 33

Which of the following signs would the patient experience when the nurse evaluates that fibrinolytic therapy has not been successful in restoring perfusion to the myocardium?

A) Continuing chest pain
B) Dyspnea and tachycardia
C) A marked,rapid rise in the CK enzyme
D) An increase in premature ventricular contractions

Question 34

A patient has had an elevated temperature of 38.2°C for 3 days since experiencing an MI.What does the nurse understand that this fever indicates?

A) A normal response to the necrotic tissue of infarction
B) A need for concern only if a leukocytosis is also present
C) Beginning congestive heart failure from increased myocardial oxygen demand
D) Developing pericarditis as a complication of myocardial necrosis

Question 35

Which of the following is a mnemonic to assist the nurse in obtaining thorough information from a patient who has chest pain?

A) ABCDEF
B) PAIN
C) PQRST
D) AQSP

Question 36

For a patient who was admitted the previous day to the CCU with an AMI,the nurse will anticipate teaching the patient about which one of the following?

A) The pathophysiology of CAD
B) When patient cardiac rehabilitation will begin
C) Home-discharge drugs such as aspirin and b-blockers
D) Typical emotional responses to MI

Question 37

Which of the following is an absolute contraindication for the use of fibrinolytic therapy?

A) Diabetes
B) Pregnancy
C) Intercranial neoplasm
D) Laser eye surgery

Question 38

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

A) A 38-year-old patient who has pericarditis and is complaining of sharp,stabbing chest pain
B) A 45-year-old patient who had an MI 4 days ago and is anxious about the planned discharge
C) A 51-year-old patient who has just returned to the unit after a coronary arteriogram and PCI
D) A 60-year-old patient who is due for a scheduled dose of atenolol 25 mg orally

Question 39

Fibrinolytic therapy is prescribed for a 64-year-old patient with an STEMI.During the administration of the fibrinolytic agent,the nurse recognizes that the therapy should be stopped when the patient experiences which of the following signs?

A) Bleeding from the gums
B) Surface bleeding from the IV site
C) A sudden decrease in the level of consciousness
D) Premature ventricular contractions and ventricular tachycardia