Deck 30: Nursing Care of Patients with Coronary Heart Disease

Question 1

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 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.

Answer 1

It indicates presence of coronary artery spasm.

Question 2

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

A)Check with your healthcare provider before taking any herbal remedies.
B)Report any itching that develops after seven days of taking the drug.
C)Take at a different time of day than warfarin (Coumadin).
D)Do not skip any scheduled appointments to have blood drawn for labs.

Answer 2

Check with your healthcare provider before taking any herbal remedies.

Question 3

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

Answer 3

Q wave deepening

Question 4

Fifteen hours after admission, a patient's CPK-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.

Question 5

The nurse, assessing a middle-aged patient experiencing chest pain, realizes that presence of which symptoms would be most characteristic 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 6

Nursing care of the patient after thrombolytic therapy focuses on the assessment of which finding that is the most common complication?

A)bleeding
B)reperfusion chest pain
C)lethargy
D)heart block

Question 7

The nurse, caring for a patient admitted with chest pain, realizes that which factor places the patient at the highest risk for heart disease?

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

Question 8

During patient teaching about cardiac risk factors, the nurse knows that which laboratory test, if abnormal, requires further instruction due to the risk for the development of coronary artery disease?

A)elevated homocysteine
B)elevated creatinine
C)elevated high density lipoprotein (HDL)
D)elevated INR

Question 9

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? Select all that apply. Select all that apply.

A)morphine intravenously and oxygen
B)aspirin 325 mg orally
C)open heart surgery
D)heparin drip at 100 units per hour
E)Foley catheter insertion

Question 10

The nurse is assessing a patient who is six 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 be taken by the nurse first?

A)Notify the physician immediately.
B)Recheck vital signs in 15 minutes.
C)Reposition the patient.
D)Increase the intravenous fluids.

Question 11

During a follow-up appointment after a myocardial infarction, a patient states, "My friends tell me to add more garlic to my diet and start drinking red wine each evening." Which response by the nurse is best?

A)"Discuss your idea with the physician to see what would benefit you."
B)"That sounds fine.See how they work."
C)"I wouldn't do that if I were you."
D)"You should also add ginkgo biloba for cardiovascular health."

Question 12

The nurse, caring for a patient recovering from an acute myocardial infarction, realizes that the final extent of cardiac damage is dependent upon which factor?

A)reperfusion of the ischemic zone
B)patient's ethnicity
C)patient's gender
D)development of heart block

Question 13

Which diagnostic test would the nurse anticipate as priority for a patient admitted with chest pain to determine coronary heart disease status?

A)coronary angiography
B)stress electrocardiography
C)echocardiography
D)radionuclide testing

Question 14

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)bradycardia.
E)widening of the QRS complex

Question 15

Upon ascultating 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 16

The nurse, discussing coronary heart disease risk factors with a group of factory employees, would include which option(s) as modifiable risk factors? Select all that apply.

A)hypertension
B)diabetes mellitus
C)obesity
D)age
E)heredity

Question 17

During an office visit, a 55-year-old female patient asks why she has not been prescribed a daily dose of aspirin. Her 56-year-old husband has been advised by the physician to take a daily aspirin. What can the nurse explain is the most likely reason for this?

A)The benefit of aspirin in women under age 65 is not clear.
B)Aspirin is not recommended for women.
C)This must have been an oversight.
D)She has other medications that could interfere

Question 18

The nurse is teaching a patient about coronary artery bypass surgery. Which statement, included in this teaching, is essential for the patient to understand?

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

Question 19

A patient, recovering from coronary artery bypass graft (CABG) surgery, tells the nurse that it feels good to be cured of heart disease. Which of the following is the most appropriate response for the nurse to make? 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 not ever exercise again."
E)"There no need to monitor your fat intake any longer."

Question 20

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 21

A 52-year-old obese male patient who is admitted with elevated triglycerides and a history of smoking two packs of cigarettes a day for 20 years asks about his risk for coronary artery disease. What information should the nurse provide?

A)He is at risk for coronary artery disease.
B)He is not at risk for coronary artery disease.
C)He possesses all nonmodifiable risk factors for coronary artery disease that cannot be overcome.
D)He possesses all modifiable risk factors for coronary artery disease that can be overcome.

Question 22

The family of a patient who experienced a stroke after CABG surgery asks the nurse what caused the stroke to occur. The nurse's best response would be which of the following?

A)"Stroke is usually caused by a blood clot that brakes 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 23

Identify the following ECG rhythm. 11ea992e_0a2c_b99e_9f38_79acc3bb2d0a

A)ventricular fibrillation
B)atrial flutter
C)sinus tachycardia
D)ventricular tachycardia

Question 24

A nurse is conducting teaching about risk factor management for cardiovascular disease (CVD) at a senior center. What is the most important information for the nurse to include?

A)Stop smoking.
B)Eat in moderation.
C)Exercise when able.
D)Reduce saturated fats in the diet.

Question 25

The patient has a pacemaker with one pacing spike seen on the ECG before every QRS complex. There is no change in the pacemaker rhythm over time, with rest or with activity. The nurse realizes that this means that this which type of pacemaker?

A)asynchronous pacing
B)demand pacing
C)dual-chamber pacing
D)atrial single-chamber pacing

Question 26

The nurse is assessing a patient who is currently experiencing chest pain. The patient has a previous diagnosis of chest pain but now reports an increase in the frequency and duration. Appropriate nursing care for this type of chest pain includes which nursing intervention?

A)aspirin 325 mg PO per day per physician prescription
B)bed rest with bathroom privileges
C)aluminum hydroxide (Maalox) 5 mL PO PRN per physician prescription
D)atropine (Atropair) 0.4 mg IVP PRN per physician prescription

Question 27

What information does the nurse consider when administering medication to treat hyperlipidemia?

A)Such medications include the statins, which act by lowering LDL levels.
B)These medications act by increasing the LDL levels and decreasing the HDL levels.
C)These medications do not include angiotensin-converting enzyme (ACE) inhibitors.
D)Such medications include bile acid sequestrants as first-line drugs to lower cholesterol levels.

Question 28

Which of the following should the nurse do to assist a patient recovering from cardiovascular surgery who is demonstrating chest tube output of greater than 100 mL per hours? Select all that apply. Select all that apply.

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

Question 29

The nurse is notified by the cardiac monitoring technician that a patient on continuous cardiac monitoring is having frequent alarms. When the nurse enters the patient's room, the patient is in no apparent distress, is sitting in the chair and eating. Which are appropriate nursing interventions? Select all that apply.

A)Confirm that lead wires are properly connected.
B)Assess placement of electrodes.
C)Remove and reapply new electrodes if nonadherent.
D)Assess skin sites and move an electrode if the skin appears irritated.
E)Call for assistance.

Question 30

The term pacemaker noncapture requires which nursing action(s)? Select all that apply.

A)Contact the physician and describe what is noted on the ECG strip.
B)Assess the patient to determine response to the pacemaker noncapture.
C)Document the event by printing the ECG strip and placing it on the patient's record.
D)Ask the patient to ambulate to increase cardiac output.
E)Administer nitroglycerin sublingual one dose stat according to physician prescription.

Question 31

Which is the priority nursing intervention for a patient with a junctional escape rhythm?

A)Assess the patient for symptoms associated with this rhythm.
B)Contact the physician immediately for emergency orders.
C)Eliminate caffeine from the diet.
D)Prepare for a pacemaker insertion.

Question 32

The nurse is instructing a patient on nitroglycerin tablets prescribed to treat angina. Which statement(s) should be included in the nurse's instructions? Select all that apply. Select all that apply.

A)"Take a second dose if the angina is not relieved within five minutes."
B)"The drug should remain in this brown bottle since it is sensitive to light."
C)"Store this medication in your bathroom medicine cabinet so it is readily available to you."
D)"Eating or drinking will not interfere when taking the medication."
E)"Call your doctor immediately if you develop a headache when taking this drug."

Question 33

The nurse realizes that the patient in the critical care area with ventricular tachycardia will require which action? Select all that apply.

A)immediate assessment and probable emergency intervention by the nurse
B)cardioversion, if sustained and symptomatic
C)probable administration of a potassium channel blocker
D)close observation for one hour prior to calling the physician
E)defibrillation to convert the rhythm in the awake patient

Question 34

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

A)liver enzyme alteration
B)blood glucose and uric acid level alteration
C)renal function alteration
D)sudden back pain and constipation

Question 35

Coronary heart disease (CHD) is a major problem in the United States. Patients with which history may require closer evaluation for CHD? Select all that apply.

A)diabetes
B)hyperlipidemia
C)positive family history
D)a premenopausal woman
E)hypotension

Question 36

The nurse completed teaching related to dietary management of coronary heart disease (CHD). Effective teaching would be indicated by which patient statement?

A)"I can lower my trans fatty acids by switching to the soft margarines and vegetable spreads."
B)"I will watch my fiber intake so I don't get too much."
C)"Well, I'll just have to go buy some of that coconut oil to cook with."
D)"Drinking a couple of glasses of milk each day will give me better protein."

Question 37

Sinus bradycardia (rate 56 beats per minute) is identified in a sleeping patient on telemetry. Which is the priority nursing action?

A)Awaken the patient and see how the heart rate responds.
B)Call the physician and report this dysrhythmia.
C)Check the medication administration record and see if there is a PRN medication that will improve this rhythm.
D)Call for an immediate 12-lead electrocardiogram (ECG).

Question 38

The nurse is caring for an adult patient who is admitted with chest pain that began four hours ago. Which test will be most specific in identifying acute heart damage?

A)troponin
B)CPK
C)CK-MB
D)cholesterol

Question 39

A patient is in sinus tachycardia. Which nursing interventions are appropriate? Select all that apply.

A)Observe the patient for effects on cardiac function.
B)Administer two tablets of acetaminophen (Tylenol) per physician prescription if an elevated temperature is present.
C)Administer normal saline 0.9% IV at the prescribed rate of 200 mL per hour if hypovolemia is suspected as the cause.
D)Give pain medications as prescribed if pain is present.
E)Give atropine per physician prescription to slow the heart rate.

Question 40

The nurse is caring for a patient who develops atrial fibrillation with a heart rate above 100 beats per minute. Place the following nursing actions in sequence from the highest priority to the lowest priority. Click and drag the options below to move them up or down.

A)Assess the patient for comfort level and vital signs.
B)Check the patency of an intermittent IV.
C)Check the patient's chart for lab results from today's tests.
D)Call the physician to report the dysrhythmia.

Question 41

A nurse is performing cardiopulmonary resuscitation (CPR) on a patient who is in cardiac arrest. An automatic external defibrillator (AED) is available. Which activity will allow the nurse to assess the patient's cardiac rhythm?

A)Apply adhesive patch electrodes to the chest and move away from the patient.
B)Apply standard electrocardiographic monitoring leads to the patient and observe the rhythm.
C)Hold the defibrillator paddles directly against the patient's chest.
D)Connect electrocardiographic electrodes to a telephone monitoring device and wait until the rhythm is analyzed.

Question 42

A patient received an implantable cardioverter-defibrillator (ICD). The nurse would include which instruction during discharge teaching for this patient?

A)"If a family member is in direct contact with you when the ICD discharges, he or she may experience a shock or tingling sensation."
B)"You can activate the ICD whenever you feel a change in your heart rhythm."
C)"The batteries of the ICD won't need to be replaced if the ICD never shocks the heart."
D)"There should be no discomfort if the ICD discharges and you probably won't notice it."

Question 43

A patient reports the following symptoms to the nurse: nausea, loss of appetite, blurred and double vision, green yellow halos, vomiting and "feeling uneasy."." What situation should the nurse suspect?

A)digoxin toxicity
B)lidocaine toxicity
C)amiodarone toxicity
D)procainamide toxicity

Question 44

A patient is having elective synchronized cardioversion. Place the following steps of the procedure in the correct order. Click and drag the options below to move them up or down.

A)Verify patency of IV access.
B)Administer sedative per physician prescription.
C)Set cardioverter to "synchronize" mode.
D)Place conductive pads on the patient's chest.
E)Charge the cardioverter to the selected energy level.Remove oxygen.
F)Personnel step away from the bed prior to delivery of the electrical shock.

Question 45

Angina that is characterized as atypical, occurs unpredictably and often at night and is associated with coronary artery spasm would be labeled as which type of angina?

A)Prinzmetal's (variant) angina
B)stable angina
C)unstable angina
D)ischemic angina

Question 46

Premature ventricular contractions (PVCs) are best characterized by which statement?

A)They are insignificant in people with no history of heart disease.
B)PVCs typically have no pattern.
C)The frequency of PVCs is not associated with specific events.
D)Their incidence and significance has no relevance to the patient having had a myocardial infarction.

Question 47

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

A)has a history of asthma and chronic obstructive pulmonary disease (COPD)
B)is also taking antioxidants
C)is also taking simvastatin (Zocor)
D)has a history of bleeding disorders

Question 48

A nurse is preparing a presentation on coronary heart disease (CHD) for a community women's club. Which statement(s) should the nurse include in the presentation? Select all that apply.

A)Epigastric pain and nausea are often experienced with a heart attack but attributed to heartburn.
B)Common symptoms of myocardial infarction (MI) include shortness of breath and fatigue.
C)Women are more likely to have an unrecognized myocardial infarction.
D)Weakness of the legs and back often precede a heart attack.
E)The mortality rate of young women having an MI is 50 % lower than that of men.