Chapter 34: Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome 9th Edition 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
d. elevation of the patients low-density lipoprotein (LDL) level
- 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.
c. Help the patient modify favorite high-fat recipes by using monosaturated oils when possible.
- Which assessment data collected by the nurse who is admitting a patient with chest pain suggest that the 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.
b. The pain has lasted longer than 30 minutes.
- 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.
d. The patient states that the pain goes away with one sublingual nitroglycerin tablet.
- 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.
d. Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.
c. I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart.
- 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.
d. I will miss being able to eat peanut butter sandwiches.
- 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.
b. It is important not to suddenly stop taking the carvedilol.
- 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
d. Cardiac-specific troponin
- 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.
b. decrease spasm of the coronary arteries.
- 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.
b. blood pressure is 90/54 mm Hg.
- 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.
d. the ability to do daily activities without chest pain.
- 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.
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.
c. Heparin prevents the development of new clots in the coronary arteries.
- 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.
b. Ask about chest pain.
- 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?
c. What time did your chest pain begin?
- 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.
c. Heart rate increases from 66 to 92 beats/minute.
- 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.
c. a decrease in level of consciousness.
- 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.
c. Auscultate for a pericardial friction rub.
- 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.
c. I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.
- 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
c. Denial related to lack of acceptance of the MI
d. Disturbed personal identity related to understanding of illness
a. Ineffective coping related to anxiety
- 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. additional diagnostic testing will be required.
c. long-term anticoagulation therapy will be needed.
d. limited physical activity after discharge will be needed to prevent future events.
b. additional diagnostic testing will be required.
- A few days after experiencing a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, I just had a little chest pain. As soon as I get out of here, Im going for my vacation as planned. Which reply would be most appropriate for the nurse to make?
a. What do you think caused your chest pain?
b. Where are you planning to go for your vacation?
c. Sometimes plans need to change after a heart attack.
d. Recovery from a heart attack takes at least a few weeks.
a. What do you think caused your chest pain?
- When evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says which of the following?
a. They will circulate my blood with a machine during the surgery.
b. I will have small incisions in my leg where they will remove the vein.
c. They will use an artery near my heart to go around the area that is blocked.
d. I will need to take an aspirin every day after the surgery to keep the graft open.
b. I will have small incisions in my leg where they will remove the vein.
- A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about when sexual intercourse can be resumed. Which response by the nurse is best?
a. Most patients are able to enjoy intercourse without any complications.
b. Sexual activity uses about as much energy as climbing two flights of stairs.
c. The doctor will provide sexual guidelines when your heart is strong enough.
d. Holding and cuddling are good ways to maintain intimacy after a heart attack.
b. Sexual activity uses about as much energy as climbing two flights of stairs.
- A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is most appropriate when giving the medication?
a. Have the patient take this medication with an aspirin.
b. Administer the medication at the patients usual bedtime.
c. Have the patient take the colesevelam with a sip of water.
d. Give the patients other medications 2 hours after the colesevelam.
d. Give the patients other medications 2 hours after the colesevelam.