CAD Flashcards
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.
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 low-sodium 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.
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.
A 58-year-old female with a family history of CAD is being seen for her annual physical exam. Fasting lab test results include: Total cholesterol 198; LDL cholesterol 120; HDL cholesterol 58; Triglycerides 148; Blood sugar 102; and C-reactive protein (CRP) 4.2. The health care provider informs the client that she will be started on a statin medication and aspirin. The client asks the nurse why she needs to take these medications. Which is the best response by the nurse?
a. “The labs indicate severe hyperlipidemia and the medications will lower your LDL, along with a low-fat diet.”
b. “The triglycerides are elevated and will not return to normal without these medications.”
c. “The CRP is elevated indicating inflammation seen in cardiovascular disease, which can be lowered by the medications ordered.”
d. “The medications are not indicated since your lab values are all normal.”
ANS: C
CRP is a marker of inflammation and is elevated in the presence of cardiovascular disease. The high sensitivity CRP (hs-CRP) is the blood test for greater accuracy in measuring the CRP to evaluate cardiovascular risk. The family history, post-menopausal age, LDL above optimum levels and elevated CRP place the client at risk of CAD. Statin medications can decrease LDL, whereas statins and aspirin can reduce CRP and decrease the risk of MI and stroke.
If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by:
a. Explaining how the old behavior leads to poor health
b. Withholding praise until the new behavior is well established
c. Rewarding the client whenever the acceptable behavior is performed
d. Instilling mild fear into the client to extinguish the behavior
ANS: C.
A basic principle of behavior modification is that behavior that is learned and continued is behavior that has been rewarded. Other reinforcement techniques have not been found to be as effective as reward.
When providing nutritional counseling for patients at risk for coronary artery disease (CAD), which foods would the nurse encourage patients to include in their diet? Select all that apply. 1 Tofu 2 Walnuts 3 Tuna fish 4 Whole milk 5 Orange juice
ANS. 1,2,3
Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly. Whole milk and orange juice have no benefits for CAD.
The nurse has been teaching a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates an adequate understanding?
1”I will add weightlifting to my exercise program.”
2”I will change my diet to increase my intake of saturated fats.”
3”I need to switch to smokeless tobacco instead of smoking cigarettes.”
4”I will change my lifestyle to reduce activities that increase my stress.”
ANS: 4
Health-promoting behaviors for those at risk for CAD include: improving physical activity such as brisk walking (three to four miles/hour for at least 30 minutes five or more times a week); reducing total fat and saturated fat intake; stopping all tobacco use, and altering patterns that are conducive to stress.
Which patient would the nurse identify being at higher risk for developing coronary artery disease (CAD)?
1 43-year-old nonsmoking African American male
2 26-year-old Hispanic male smoking one pack of cigarettes per day
3 49-year-old Caucasian male with blood pressure 152/92 mm Hg
4 72-year-old African American female with a cholesterol level of 300 mg/dL
ANS: 4
Multiple risk factors increase the risk of CAD, and this patient has three risk factors: age over 55, African American ethnic background, and cholesterol level greater than 240 mg/dL. The middle-aged nonsmoking AfricanAmerican male has only two risk factors: middle age and male gender: Caucasian middle-age males are more prone to develop CAD. The Hispanic patient has only two risk factors for CAD: male gender and smoking. The middle-aged white male has only two risk factors (age and gender), because systolic blood pressure is less than 160 mm Hg.
When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice? 1 Baked flounder 2 Angel food cake 3 Baked potato with margarine 4 Canned chicken noodle soup
ANS: 4
Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content. Baked flounder, angel food cake, and baked potato with margarine are all low in sodium and low in fat and would be appropriate for this diet.
A patient returns to the unit after having a stent inserted into the coronary artery. What should the nurse do first to assess patency of the femoral artery?
1 Palpate the insertion site for induration
2 Assess peripheral pulses in the right leg
3 Inspect the patient’s right side and back
4Compare the color of the left and right legs
ANS: B
The first action the nurse should take is to assess peripheral pulses in the right leg. If a pulse is absent, the artery is not patent, meaning there is minimal or no blood flow to the artery. Inspecting the patient’s right side and back can be used to assess an intact artery, but the blood may take a long time to pool into the tissues. Palpating the insertion site for induration and comparing the color of the legs does is not the best method to assess patency of the artery.
The nurse is teaching the family of a patient recently diagnosed with coronary artery disease (CAD). Which information on health promotion would the nurse include? Select all that apply.
1 Consume diet low in fat and cholesterol
2 Increase whole grains and fiber in the diet
3 No need to limit consumption of simple sugars and alcohol
4 Perform walking or biking at least 30 minutes four or more days per week
5 Perform isometric exercises at least 30 minutes at least four days per week
ANS: 1,2,3
Dietary modifications should include a decrease in saturated fat and cholesterol, as well as an increase in complex carbohydrates (whole grains, fruits, and vegetables) and fiber. A moderate physical activity program has to include isotonic exercises, such as walking, hiking, or jogging performed for at least 30 minutes on most week days. Consumption of alcohol and simple sugars will lead to an elevated triglyceride level. Isometric exercises, such as weight lifting, are recommended to increase muscle strength on two days per week only.
A nurse is identifying obese women at risk of developing coronary artery disease in a community for health care research. What are the appropriate criteria for the selection of at-risk women? Select all that apply.
1 Age of less than 40 years
2 Apple-shaped obesity
3 Pear-shaped obesity
4 Body mass index greater than 30 kg/m2
5 Waist circumference more than 30 inches
ANS: 2,4
Obesity is a major risk factor for the development of coronary artery diseases (CAD). Women below the age of 40 are generally premenopausal. The cardioprotective effects of estrogen make premenopausal women less susceptible for developing atherosclerosis, which can lead to CAD. Apple-shaped obesity is the type of obesity in which there is more fat deposition around the abdomen. This condition is a major risk factor for development of coronary artery disease. Obesity in women is defined as having a body mass index of 30 or greater, which is a major risk factor for development of coronary artery disease. Evidence suggests that people having fat deposition around the thigh and hip regions (pear-shaped figure) are less susceptible to develop coronary artery disease than people having fat deposition around the abdomen (apple-shaped obesity). Obesity in women is defined as having a waist circumference more than 35 inches; therefore, the criterion should be “waist circumference greater than 35 inches.”
What advice should the nurse give the patient who has a blood pressure of 150/100 mm Hg? Select all that apply.
1. “Reduce total fat intake.”
2. “Reduce salt in your diet.”
3. “Increase daily physical activity.”
4 .”Ingest smaller and more frequent meals.”
5. “Reduce the amount of complex carbohydrates and fibers in diet.”
ANS. 2,3
The patient’s blood pressure of 150/100 mm Hg is above the normal range and is a major modifiable risk factor. The nurse should advise the patient to consume less salt to lower blood pressure and exercise daily to reduce the risk of coronary artery disease (CAD) from hypertension. If the patient has elevated serum lipids, the nurse should advise the patient to reduce total fat intake. Obese patients should eat smaller and more frequent meals. The nurse should also advise the patient to increase the amount of complex carbohydrates, fiber, and vegetable proteins in the diet for the patient who has elevated serum lipids.
A nurse is teaching a patient with coronary artery disease to decrease saturated and increase polyunsaturated dietary fat. Which major sources of polyunsaturated fats should the nurse include? Select all that apply. 1 Walnuts 2 Palm oil 3 Egg yolk 4 Margarine 5 Sour cream
ANS: 1, 4
Walnuts and margarine are major sources of polyunsaturated dietary fat. Palm oil, egg yolk, and sour cream are major sources of saturated dietary fat.
In assessing a patients major risk factors for heart disease, which would the nurse want to include when taking a history?
a. Family history, hypertension, stress, and age
b. Personality type, high cholesterol, diabetes, and smoking
c. Smoking, hypertension, obesity, diabetes, and high cholesterol
d. Alcohol consumption, obesity, diabetes, stress, and high cholesterol
ANS: C
To assess for major risk factors of coronary artery disease, the nurse should collect data regarding elevated serum cholesterol, elevated blood pressure, blood glucose levels above 100 mg/dL or known diabetes mellitus, obesity, any length of hormone replacement therapy for post menopausal women, cigarette smoking, and low activity level.
Heart disease in women is manifested by a variety of subtle signs. Which sign is typically seen in women?
a. Fainting
b. Chest pain
c. Dizziness
d. Fatigue
ANS. D
Women frequently experience fatigue with heart disease. Many women do not even experience chest pain. Fainting and dizziness are not typical signs of heart disease in women.
he nurse reading admission data on a patient recognizes information that puts the patient at risk for coronary artery disease (CAD). Which characteristic place the patient at risk? (Select all that apply.)
a. 38-year-old African American
b. Low-density lipoprotein (LDL) 120, high-density lipoprotein (HDL) 68
c. Taking oral birth control pills
d. Nonsmoker for 10 years
e. Diagnosed with diabetes 2 years ago
ANS: A, C, E
African Americans have an ethnic tendency to CAD. Taking birth control pills and diabetes are both risk factors for CAD. The lipid values are extremely healthy, as is the smoking cessation.
The community health nurse assesses clients at a health fair. Which statement assists the nurse to identify modifiable risk factors in clients with coronary artery disease?
a. Would you please state your full name and birth date?
b. Have you ever had an exercise tolerance stress test?
c. In what activities do you participate on a daily basis?
d. Does anyone in your family have a history of heart disease?
ANS: C
Modifiable risk factors can be altered or controlled. Cigarette smoking and a sedentary lifestyle are examples of behaviors that are modifiable. Nonmodifiable factors are personal elements that cannot be altered or controlled (e.g., age, gender, family history). A stress test would not provide any information about risk factors.
