Chapter 34: Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome 9th Edition

Question 1

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

Answer 1

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

Question 2

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.

Answer 2

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

Question 3

3. 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.

Answer 3

b. The pain has lasted longer than 30 minutes.

Question 4

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.

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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.

Answer 6

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

Question 7

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.

Answer 7

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

Question 8

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

Answer 8

d. Cardiac-specific troponin

Question 9

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.

Answer 9

b. decrease spasm of the coronary arteries.

Question 10

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.

Answer 10

b. blood pressure is 90/54 mm Hg.

Question 11

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.

Answer 11

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

Question 12

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.
    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.

Answer 12

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

Question 13

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.

Answer 13

b. Ask about chest pain.

Question 14

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?

Answer 14

c. What time did your chest pain begin?

Question 15

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.

Answer 15

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

Question 16

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.

Answer 16

c. a decrease in level of consciousness.

Question 17

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.

Answer 17

c. Auscultate for a pericardial friction rub.

Question 18

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.

Answer 18

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

Question 19

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
    c. Denial related to lack of acceptance of the MI
    d. Disturbed personal identity related to understanding of illness

Answer 19

a. Ineffective coping related to anxiety

Question 20

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. 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.

Answer 20

b. additional diagnostic testing will be required.

Question 21

21. 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.

Answer 21

a. What do you think caused your chest pain?

Question 22

22. 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.

Answer 22

b. I will have small incisions in my leg where they will remove the vein.

Question 23

23. 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.

Answer 23

b. Sexual activity uses about as much energy as climbing two flights of stairs.

Question 24

24. 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.

Answer 24

d. Give the patients other medications 2 hours after the colesevelam.

Question 25

25. The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Teaching for this patient would include
    a. when cardiac rehabilitation will begin.
    b. the typical emotional responses to AMI.
    c. information regarding discharge medications.
    d. the pathophysiology of coronary artery disease.

Answer 25

a. when cardiac rehabilitation will begin.

Question 26

26. A patient who has recently started taking pravastatin (Pravachol) and niacin (Nicobid) reports the following symptoms to the nurse. Which is most important to communicate to the health care provider?
    a. Generalized muscle aches and pains
    b. Dizziness when changing positions quickly
    c. Nausea when taking the drugs before eating
    d. Flushing and pruritus after taking the medications

Answer 26

a. Generalized muscle aches and pains

Question 27

27. A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of medications to the nurse. Which medication has the most immediate implications for the patients care?
    a. Sildenafil (Viagra)
    b. Furosemide (Lasix)
    c. Captopril (Capoten)
    d. Warfarin (Coumadin)

Answer 27

a. Sildenafil (Viagra)

Question 28

28. Which assessment finding by the nurse caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the health care provider?
    a. Complaints of incisional chest pain
    b. Pallor and weakness of the right hand
    c. Fine crackles heard at both lung bases
    d. Redness on both sides of the sternal incision

Answer 28

b. Pallor and weakness of the right hand

Question 29

29. When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing intervention should the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
    a. Give the scheduled aspirin and lipid-lowering medication.
    b. Perform the initial assessment of the catheter insertion site.
    c. Teach the patient about the usual postprocedure plan of care.
    d. Titrate the heparin infusion according to the agency protocol.

Answer 29

a. Give the scheduled aspirin and lipid-lowering medication.

Question 30

30. Which electrocardiographic (ECG) change is most important for the nurse to report to the health care provider when caring for a patient with chest pain?
    a. Inverted P wave
    b. Sinus tachycardia
    c. ST-segment elevation
    d. First-degree atrioventricular block

Answer 30

c. ST-segment elevation

Question 31

31. When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having angioplasty with stent placement, the nurse obtains the following assessment data. Which data indicate the need for immediate action by the nurse?
    a. Heart rate 102 beats/min
    b. Pedal pulses 1+ bilaterally
    c. Blood pressure 103/54 mm Hg
    d. Chest pain level 7 on a 0 to 10 point scale

Answer 31

d. Chest pain level 7 on a 0 to 10 point scale

Question 32

32. A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 and heart rate is 123. Based on this information, which nursing diagnosis is a priority for the patient?
    a. Acute pain related to myocardial infarction
    b. Anxiety related to perceived threat of death
    c. Stress overload related to acute change in health
    d. Decreased cardiac output related to cardiogenic shock

Answer 32

c. Stress overload related to acute change in health

Question 33

33. When admitting a patient with a nonST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first?
    a. Obtain the blood pressure.
    b. Attach the cardiac monitor.
    c. Assess the peripheral pulses.
    d. Auscultate the breath sounds.

Answer 33

b. Attach the cardiac monitor.

Question 34

34. Which information about a patient who has been receiving thrombolytic therapy for an acute myocardial infarction (AMI) is most important for the nurse to communicate to the health care provider?
    a. No change in the patients chest pain
    b. An increase in troponin levels from baseline
    c. A large bruise at the patients IV insertion site
    d. A decrease in ST-segment elevation on the electrocardiogram

Answer 34

a. No change in the patients chest pain

Question 35

35. The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider?
    a. The troponin level is elevated.
    b. The patient denies ever having a heart attack.
    c. Bilateral crackles are auscultated in the mid-lower lobes.
    d. The patient has occasional premature atrial contractions (PACs)

Answer 35

c. Bilateral crackles are auscultated in the mid-lower lobes.

Question 36

36. A patient had a nonST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention included in the plan of care is most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
    a. Evaluation of the patients response to walking in the hallway
    b. Completion of the referral form for a home health nurse follow-up
    c. Education of the patient about the pathophysiology of heart disease
    d. Reinforcement of teaching about the purpose of prescribed medications

Answer 36

d. Reinforcement of teaching about the purpose of prescribed medications

Question 37

37. A patient who has chest pain is admitted to the emergency department (ED) and all of the following are ordered. Which one should the nurse arrange to be completed first?
    a. Chest x-ray
    b. Troponin level
    c. Electrocardiogram (ECG)
    d. Insertion of a peripheral IV

Answer 37

c. Electrocardiogram (ECG)

Question 38

38. After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
    a. 39-year-old with pericarditis who is complaining of sharp, stabbing chest pain
    b. 56-year-old with variant angina who is to receive a dose of nifedipine (Procardia)
    c. 65-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge
    d. 59-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)

Answer 38

d. 59-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI)

Question 39

39. To improve the physical activity level for a mildly obese 71-year-old patient, which action should the nurse plan to take?
    a. Stress that weight loss is a major benefit of increased exercise.
    b. Determine what kind of physical activities the patient usually enjoys.
    c. Tell the patient that older adults should exercise for no more than 20 minutes at a time.
    d. Teach the patient to include a short warm-up period at the beginning of physical activity

Answer 39

b. Determine what kind of physical activities the patient usually enjoys.

Question 40

40. Which patient at the cardiovascular clinic requires the most immediate action by the nurse?
    a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL
    b. Patient with stable angina whose chest pain has recently increased in frequency
    c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL
    d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg

Answer 40

b. Patient with stable angina whose chest pain has recently increased in frequency

Question 41

41. A patient with diabetes mellitus and chronic stable angina has a new order for captopril (Capoten). The nurse should teach the patient that the primary purpose of captopril is to
    a. lower heart rate.
    b. control blood glucose levels.
    c. prevent changes in heart muscle.
    d. reduce the frequency of chest pain.

Answer 41

c. prevent changes in heart muscle.

Question 42

42. After reviewing information shown in the accompanying figure from the medical records of a 43-year-old, which risk factor modification for coronary artery disease should the nurse include in patient teaching?
    a. Importance of daily physical activity
    b. Effect of weight loss on blood pressure
    c. Dietary changes to improve lipid levels
    d. Ongoing cardiac risk associated with history of tobacco use

Answer 42

c. Dietary changes to improve lipid levels

Question 43

43. After reviewing a patients history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider?
    a. Q waves on ECG
    b. Elevated troponin levels
    c. Fever and hyperglycemia
    d. Tachypnea and crackles in lungs

Answer 43

d. Tachypnea and crackles in lungs