Chapter 33 Coronary Artery Disease and Acute Coronary Syndrome PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter33:CoronaryArteryDiseaseandAcuteCoronarySyndrome TestBank MULTIPLECHOICE 1.Whendevelopingateachingplanfora61-year-oldmanwiththefollowingriskfactorsforcoronaryartery disease(CAD),thenurseshouldfocusonthe a.

familyhistoryofcoronaryarterydisease.

b.

increasedriskassociatedwiththepatientsgender.

c.

increasedriskofcardiovasculardiseaseaspeopleage.

d.

elevationofthepatientslow-densitylipoprotein(LDL)level.

ANS:D Becausefamilyhistory,gender,andagearenonmodifiableriskfactors,thenurseshouldfocusonthepatients LDLlevel.DecreasesinLDLwillhelpreducethepatientsriskfordevelopingCAD. DIF:CognitiveLevel:Apply(application)REF:708 TOP:NursingProcess:PlanningMSC:NCLEX:HealthPromotionandMaintenance 2.Whichnursinginterventionwillbemosteffectivewhenassistingthepatientwithcoronaryarterydisease (CAD)tomakeappropriatedietarychanges? a.

Givethepatientalistoflow-sodium,low-cholesterolfoodsthatshouldbeincludedinthediet.

b.

Emphasizetheincreasedriskforheartproblemsunlessthepatientmakesthedietarychanges.

c.

Helpthepatientmodifyfavoritehigh-fatrecipesbyusingmonosaturatedoilswhenpossible.

d.

Informthepatientthatadietcontainingnosaturatedfatandminimalsaltwillbenecessary.

ANS:C Lifestylechangesaremorelikelytobesuccessfulwhenconsiderationisgiventothepatientsvaluesand preferences.Thehighestpercentageofcaloriesfromfatshouldcomefrommonosaturatedfats.Althoughlowsodiumandlow-cholesterolfoodsareappropriate,providingthepatientwithalistaloneisnotlikelytobe successfulinmakingdietarychanges.Completelyremovingsaturatedfatfromthedietisnotarealistic expectation.Upto7%ofcaloriesinthetherapeuticlifestylechanges(TLC)dietcancomefromsaturatedfat. Tellingthepatientabouttheincreasedriskwithoutassistingfurtherwithstrategiesfordietarychangeis unlikelytobesuccessful. DIF:CognitiveLevel:Apply(application)REF:708 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 3.Whichassessmentdatacollectedbythenursewhoisadmittingapatientwithchestpainsuggestthatthe

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painiscausedbyanacutemyocardialinfarction(AMI)? a.

Thepainincreaseswithdeepbreathing.

b.

Thepainhaslastedlongerthan30minutes.

c.

Thepainisrelievedafterthepatienttakesnitroglycerin.

d.

Thepainisreproduciblewhenthepatientraisesthearms.

ANS:B Chestpainthatlastsfor20minutesormoreischaracteristicofAMI.Changesinpainthatoccurwithraising thearmsorwithdeepbreathingaremoretypicalofmusculoskeletalpainorpericarditis.Stableanginais usuallyrelievedwhenthepatienttakesnitroglycerin. DIF:CognitiveLevel:Apply(application)REF:720 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 4.Whichinformationgivenbyapatientadmittedwithchronicstableanginawillhelpthenurseconfirmthis diagnosis? a.

Thepatientstatesthatthepainwakesmeupatnight.

b.

Thepatientratesthepainatalevel3to5(0to10scale).

c.

Thepatientstatesthatthepainhasincreasedinfrequencyoverthelastweek.

d.

Thepatientstatesthatthepaingoesawaywithonesublingualnitroglycerintablet.

ANS:D Chronicstableanginaistypicallyrelievedbyrestornitroglycerinadministration.Thelevelofpainisnota consistentindicatorofthetypeofangina.Painoccurringatrestorwithincreasedfrequencyistypicalof unstableangina. DIF:CognitiveLevel:Understand(comprehension)REF:714 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 5.Afterthenursehasfinishedteachingapatientabouttheuseofsublingualnitroglycerin(Nitrostat),which patientstatementindicatesthattheteachinghasbeeneffective? a.

Icanexpectsomenauseaasasideeffectofnitroglycerin.

b.

IshouldonlytakethenitroglycerinifIstarttohavechestpain.

c.

IwillcallanambulanceifIstillhavepainaftertaking3nitroglycerin5minutesapart.

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d.

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Nitroglycerinhelpspreventaclotfromformingandblockingbloodflowtomyheart.

ANS:C Theemergencymedicalservices(EMS)systemshouldbeactivatedwhenchestpainorothersymptomsarenot completelyrelievedafter3sublingualnitroglycerintabletstaken5minutesapart.Nitroglycerincanbetakento preventchestpainorothersymptomsfromdeveloping(e.g.,beforeintercourse).Gastricupset(e.g.,nausea)is notanexpectedsideeffectofnitroglycerin.Nitroglycerindoesnotimpacttheunderlyingpathophysiologyof coronaryarteryatherosclerosis. DIF:CognitiveLevel:Apply(application)REF:715 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 6.Whichstatementmadebyapatientwithcoronaryarterydiseaseafterthenursehascompletedteaching abouttherapeuticlifestylechanges(TLC)dietindicatesthatfurtherteachingisneeded? a.

Iwillswitchfromwholemilkto1%milk.

b.

IlikesalmonandIwillplantoeatitmoreoften.

c.

IcanhaveaglassofwinewithdinnerifIwantone.

d.

Iwillmissbeingabletoeatpeanutbuttersandwiches.

ANS:D Althoughonly30%ofthedailycaloriesshouldcomefromfats,mostofthefatintheTLCdietshouldcome frommonosaturatedfatssuchasarefoundinnuts,oliveoil,andcanolaoil.Thepatientcanincludepeanut buttersandwichesaspartoftheTLCdiet.Theotherpatientcommentsindicateagoodunderstandingofthe TLCdiet. DIF:CognitiveLevel:Apply(application)REF:710 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 7.Afterthenurseteachesthepatientabouttheuseofcarvedilol(Coreg)inpreventinganginalepisodes,which statementbyapatientindicatesthattheteachinghasbeeneffective? a.

Carvedilolwillhelpmyheartmuscleworkharder.

b.

Itisimportantnottosuddenlystoptakingthecarvedilol.

c.

Icanexpecttofeelshortofbreathwhentakingcarvedilol.

d.

Carvedilolwillincreasethebloodflowtomyheartmuscle.

ANS:B Patientswhohavebeentakingb-adrenergicblockerscandevelopintenseandfrequentanginaifthemedication issuddenlydiscontinued.Carvedilol(Coreg)decreasesmyocardialcontractility.Shortnessofbreaththat

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occurswhentakingb-adrenergicblockersforanginamaybeduetobronchospasmandshouldbereportedto thehealthcareprovider.Carvedilolworksbydecreasingmyocardialoxygendemand,notbyincreasingblood flowtothecoronaryarteries. DIF:CognitiveLevel:Apply(application)REF:717 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 8.Apatientwhohashadchestpainforseveralhoursisadmittedwithadiagnosisofruleoutacutemyocardial infarction(AMI).Whichlaboratorytestshouldthenursemonitortohelpdeterminewhetherthepatienthashad anAMI? a.

Myoglobin

b.

Homocysteine

c.

C-reactiveprotein

d.

Cardiac-specifictroponin

ANS:D Troponinlevelsincreaseabout4to6hoursaftertheonsetofmyocardialinfarction(MI)andarehighly specificindicatorsforMI.Myoglobinisreleasedwithin2hoursofMI,butitlacksspecificityanditsuseis limited.Theotherlaboratorydataareusefulindeterminingthepatientsriskfordevelopingcoronaryartery disease(CAD)butarenothelpfulindeterminingwhetheranacuteMIisinprogress. DIF:CognitiveLevel:Understand(comprehension)REF:721 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 9.Diltiazem(Cardizem)isorderedforapatientwithnewlydiagnosedPrinzmetals(variant)angina.When teachingthepatient,thenursewillincludetheinformationthatdiltiazemwill a.

reduceheartpalpitations.

b.

decreasespasmofthecoronaryarteries.

c.

increasetheforceoftheheartcontractions.

d.

helppreventplaquefromforminginthecoronaryarteries.

ANS:B Prinzmetalsanginaiscausedbycoronaryarteryspasm.Calciumchannelblockers(e.g.,diltiazem,amlodipine [Norvasc])areafirst-linetherapyforthistypeofangina.Lipid-loweringdrugshelpreduceatherosclerosis (i.e.,plaqueformation),andb-adrenergicblockersdecreasesympatheticstimulationoftheheart(i.e., palpitations).Medicationsoractivitiesthatincreasemyocardialcontractilitywillincreasetheincidenceof anginabyincreasingoxygendemand. DIF:CognitiveLevel:Apply(application)REF:714

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TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 10.Thenursewillsuspectthatthepatientwithstableanginaisexperiencingasideeffectoftheprescribed metoprolol(Lopressor)ifthe a.

patientisrestlessandagitated.

b.

bloodpressureis90/54mmHg.

c.

patientcomplainsaboutfeelinganxious.

d.

cardiacmonitorshowsaheartrateof61beats/minute.

ANS:B Patientstakingb-adrenergicblockersshouldbemonitoredforhypotensionandbradycardia.Becausethisclass ofmedicationinhibitsthesympatheticnervoussystem,restlessness,agitation,hypertension,andanxietywill notbesideeffects. DIF:CognitiveLevel:Apply(application)REF:717 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 11.Nadolol(Corgard)isprescribedforapatientwithchronicstableanginaandleftventriculardysfunction.To determinewhetherthedrugiseffective,thenursewillmonitorfor a.

decreasedbloodpressureandheartrate.

b.

fewercomplaintsofhavingcoldhandsandfeet.

c.

improvementinthestrengthofthedistalpulses.

d.

theabilitytododailyactivitieswithoutchestpain.

ANS:D Becausethemedicationisorderedtoimprovethepatientsangina,effectivenessisindicatedifthepatientis abletoaccomplishdailyactivitieswithoutchestpain.Bloodpressureandheartratemaydecrease,butthese datadonotindicatethatthegoalofdecreasedanginahasbeenmet.Thenoncardioselectiveb-adrenergic blockerscancauseperipheralvasoconstriction,sothenursewouldnotexpectanimprovementindistalpulse qualityorskintemperature. DIF:CognitiveLevel:Apply(application)REF:725 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 12.HeparinisorderedforapatientwithanonST-segment-elevationmyocardialinfarction(NSTEMI).Whatis thepurposeoftheheparin? a.

Heparinenhancesplateletaggregation.

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b.

Heparindecreasescoronaryarteryplaquesize.

c.

Heparinpreventsthedevelopmentofnewclotsinthecoronaryarteries.

d.

Heparindissolvesclotsthatareblockingbloodflowinthecoronaryarteries.

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ANS:C Heparinhelpspreventtheconversionoffibrinogentofibrinanddecreasescoronaryarterythrombosis.Itdoes notchangecoronaryarteryplaque,dissolvealreadyformedclots,orenhanceplateletaggregation. DIF:CognitiveLevel:Understand(comprehension)REF:718 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 13.WhentitratingIVnitroglycerin(Tridil)forapatientwithamyocardialinfarction(MI),whichactionwill thenursetaketoevaluatetheeffectivenessofthemedication? a.

Monitorheartrate.

b.

Askaboutchestpain.

c.

Checkbloodpressure.

d.

Observefordysrhythmias.

ANS:B ThegoalofIVnitroglycerinadministrationinMIisreliefofchestpainbyimprovingthebalancebetween myocardialoxygensupplyanddemand.Thenursealsowillmonitorheartrateandbloodpressure(BP)and observefordysrhythmias,buttheseparameterswillnotindicatewhetherthemedicationiseffective. DIF:CognitiveLevel:Apply(application)REF:725 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 14.ApatientwithST-segmentelevationinthreecontiguouselectrocardiographic(ECG)leadsisadmittedto theemergencydepartment(ED)anddiagnosedashavinganST-segment-elevationmyocardialinfarction (STEMI).Whichquestionshouldthenurseasktodeterminewhetherthepatientisacandidateforthrombolytic therapy? a.

Doyouhaveanyallergies?

b.

Doyoutakeaspirinonadailybasis?

c.

Whattimedidyourchestpainbegin?

d.

Canyourateyourchestpainusinga0to10scale?

ANS:C

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Thrombolytictherapyshouldbestartedwithin6hoursoftheonsetofthemyocardialinfarction(MI),sothe timeatwhichthechestpainstartedisamajordeterminantoftheappropriatenessofthistreatment.Theother informationwillalsobeneeded,butitwillnotbeafactorinthedecisionaboutthrombolytictherapy. DIF:CognitiveLevel:Apply(application)REF:715 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 15.Followinganacutemyocardialinfarction(AMI),apatientambulatesinthehospitalhallway.Whenthe nurseisevaluatingthepatientsresponsetotheactivity,whichassessmentdatawouldindicatethattheexercise levelshouldbedecreased? a.

Bloodpressure(BP)changesfrom118/60to126/68mmHg.

b.

Oxygensaturationdropsfrom99%to95%.

c.

Heartrateincreasesfrom66to92beats/minute.

d.

Respiratoryrategoesfrom14to20breaths/minute.

ANS:C Achangeinheartrateofmorethan20beatsovertherestingheartrateindicatesthatthepatientshouldstop andrest.TheincreasesinBPandrespiratoryrate,andtheslightdecreaseinoxygensaturation,arenormal responsestoexercise. DIF:CognitiveLevel:Apply(application)REF:733 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 16.Duringtheadministrationofthethrombolyticagenttoapatientwithanacutemyocardialinfarction(AMI), thenurseshouldstopthedruginfusionifthepatientexperiences a.

bleedingfromthegums.

b.

increaseinbloodpressure.

c.

adecreaseinlevelofconsciousness.

d.

anonsustainedepisodeofventriculartachycardia.

ANS:C Thechangeinlevelofconsciousnessindicatesthatthepatientmaybeexperiencingintracranialbleeding,a possiblecomplicationofthrombolytictherapy.Somebleedingofthegumsisanexpectedsideeffectofthe therapybutnotanindicationtostopinfusionofthethrombolyticmedication.Adecreaseinbloodpressure couldindicateinternalbleeding.Anonsustainedepisodeofventriculartachycardiaisacommonreperfusion dysrhythmiaandmayindicatethatthetherapyiseffective. DIF:CognitiveLevel:Apply(application)REF:724 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity

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17.Apatientisrecoveringfromamyocardialinfarction(MI)anddevelopschestpainonday3thatincreases whentakingadeepbreathandisrelievedbyleaningforward.Whichactionshouldthenursetakenext? a.

Assessthefeetforpedaledema.

b.

Palpatetheradialpulsesbilaterally.

c.

Auscultateforapericardialfrictionrub.

d.

Checktheheartmonitorfordysrhythmias.

ANS:C Thepatientssymptomsareconsistentwiththedevelopmentofpericarditis,apossiblecomplicationofMI.The otherassessmentslistedarenotconsistentwiththedescriptionofthepatientssymptoms. DIF:CognitiveLevel:Apply(application)REF:721 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 18.Inpreparationfordischarge,thenurseteachesapatientwithchronicstableanginahowtousethe prescribedshort-actingandlong-actingnitrates.Whichpatientstatementindicatesthattheteachinghasbeen effective? a.

IwillcheckmypulseratebeforeItakeanynitroglycerintablets.

b.

IwillputthenitroglycerinpatchonassoonasIgetanychestpain.

c.

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

d.

Iwillbesuretoremovethenitroglycerinpatchbeforetakinganysublingualnitroglycerin.

ANS:C Thepatientshouldsitdownbeforetakingthenitroglycerintodecreasecardiacworkloadandprevent orthostatichypotension.Transdermalnitratesareusedprophylacticallyratherthantotreatacutepainandcan beusedconcurrentlywithsublingualnitroglycerin.Althoughthenurseshouldcheckbloodpressurebefore givingnitroglycerin,patientsdonotneedtocheckthepulseratebeforetakingnitrates. DIF:CognitiveLevel:Apply(application)REF:715 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 19.Threedaysafterexperiencingamyocardialinfarction(MI),apatientwhoisscheduledfordischargeasks forassistancewithhygieneactivities,saying,Iamtoonervoustotakecareofmyself.Basedonthis information,whichnursingdiagnosisisappropriate? a.

Ineffectivecopingrelatedtoanxiety

b.

Activityintolerancerelatedtoweakness

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

c.

DenialrelatedtolackofacceptanceoftheMI

d.

Disturbedpersonalidentityrelatedtounderstandingofillness

385

ANS:A ThepatientdataindicatethatineffectivecopingaftertheMIcausedbyanxietyabouttheimpactoftheMIisa concern.TheothernursingdiagnosesmaybeappropriateforsomepatientsafteranMI,butthedataforthis patientdonotsupportdenial,activityintolerance,ordisturbedpersonalidentity. DIF:CognitiveLevel:Apply(application)REF:729 TOP:NursingProcess:DiagnosisMSC:NCLEX:PsychosocialIntegrity 20.Whencaringforapatientwhoisrecoveringfromasuddencardiacdeath(SCD)eventandhasnoevidence ofanacutemyocardialinfarction(AMI),thenursewillanticipateteachingthepatientthat a.

suddencardiacdeatheventsrarelyreoccur.

b.