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NUR251 - Medical Surgical III > Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome pt. ii > Flashcards

Chapter 37: Coronary Artery Disease and Acute Coronary Syndrome pt. ii Flashcards

CAD, Angina

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USMLE® Step 1 flashcards
1
Q

A nurse is educating a patient on modifiable risk factors for coronary artery disease (CAD). Which of the following factors should the nurse emphasize? Select all that apply.

A. Tobacco use
B. Hyperlipidemia
C. Age
D. Hypertension
E. Family history of CAD

A

A. Tobacco use
B. Hyperlipidemia
D. Hypertension

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2
Q

A patient with elevated lipoprotein(a) levels asks about the significance of this finding. Which of the following statements by the nurse is correct?

A. “High lipoprotein(a) levels do not affect coronary artery health.”

B. “Lipoprotein(a) contributes to atherosclerosis by promoting plaque buildup.”

C. “Elevated lipoprotein(a) is unrelated to blood clot formation.”

D. “Lipoprotein(a) levels are not used for CAD risk assessment in high-risk patients.”

A

B. “Lipoprotein(a) contributes to atherosclerosis by promoting plaque buildup.”

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3
Q

Which of the following findings would indicate the earliest stage of atherosclerosis?

A. Fatty streak
B. Complicated lesion
C. Fibrous plaque
D. Collagen formation

A

A. Fatty streak

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4
Q

When explaining the role of C-reactive protein (CRP) in coronary artery disease, the nurse would correctly state that elevated CRP levels indicate:

A. A high risk of a cardiac arrhythmia.
B. Systemic inflammation that may contribute to CAD.
C. Increased HDL cholesterol levels.
D. An acute myocardial infarction is currently occurring.

A

B. Systemic inflammation that may contribute to CAD.

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5
Q

The nurse is discussing factors that can cause endothelial injury in patients with CAD. Which of the following should the nurse include in her teaching? (Select all that apply)

A. Diabetes
B. Hypertension
C. Obesity
D. Tobacco use
E. Low HDL cholesterol

A

A. Diabetes
B. Hypertension
D. Tobacco use

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6
Q

Which statement correctly describes the role of the endothelium in coronary arteries in healthy individuals?

A. It promotes clotting under normal conditions.

B. It naturally accumulates lipid deposits with age.

C. It thickens in response to LDL cholesterol.

D. It prevents platelet adhesion and leukocyte activation.

A

D. It prevents platelet adhesion and leukocyte activation.

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7
Q

In the fibrous plaque stage of atherosclerosis, which event occurs?

A. Lipid-filled smooth muscle cells accumulate.

B. Fatty deposits form a complicated lesion.

C. The endothelium thickens in response to platelets and LDLs.

D. Collagen forms a cap over fatty deposits, narrowing the arterial lumen.

A

D. Collagen forms a cap over fatty deposits, narrowing the arterial lumen.

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8
Q

A nurse is teaching a community group about coronary artery disease prevention. Which statement by a participant indicates a need for further teaching?

A. “High levels of homocysteine can damage blood vessel linings.”

B. “Only older adults need to worry about CAD.”

C. “Hypertension is a risk factor for CAD.”

D. “Lowering LDL cholesterol can slow disease progression.”

A

B. “Only older adults need to worry about CAD.”

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9
Q

The development of a complicated lesion in atherosclerosis includes which of the following characteristics?

A. It is the earliest stage of atherosclerosis.
B. It involves lipid-filled smooth muscle cells.
C. It can lead to plaque rupture and thrombus formation.
D. It occurs exclusively in peripheral arteries.

A

C. It can lead to plaque rupture and thrombus formation.

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10
Q

Which patient would benefit most from the measurement of lipoprotein(a) and homocysteine levels?

A. A young adult with no family history of heart disease
B. An adult at low risk for CAD with controlled blood pressure
C. A patient with an intermediate or high suspicion of CAD
D. An individual with high HDL cholesterol levels

A

C. A patient with an intermediate or high suspicion of CAD

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11
Q

Which statement accurately describes the progression of a complicated lesion in atherosclerosis?

A. It occurs when lipid deposits form the initial fatty streak.

B. It results in fibrous plaque development without further complications.

C. It involves plaque rupture and thrombus formation due to platelet aggregation.

D. It solely leads to collateral circulation growth.

A

C. It involves plaque rupture and thrombus formation due to platelet aggregation.

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12
Q

What contributes to the growth of collateral circulation in coronary arteries? (Select all that apply)

A. Acute coronary occlusion
B. Inherited predisposition for angiogenesis
C. Chronic ischemia
D. Sudden coronary artery spasm
E. Regular aerobic exercise

A

B. Inherited predisposition for angiogenesis
C. Chronic ischemia

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13
Q

The nurse is caring for a patient with a newly diagnosed complicated lesion in a coronary artery. What is the primary concern for this patient?

A. Development of stable plaque with minimal symptoms
B. Decreased blood pressure due to collateral circulation
C. Risk of total artery occlusion due to thrombus formation
D. Chronic ischemia leading to vessel dilation

A

C. Risk of total artery occlusion due to thrombus formation

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14
Q

A patient with a history of CAD is found to have an extensive collateral circulation network. What is the most likely explanation for this finding?

A. The patient has experienced a recent myocardial infarction.

B. The patient has chronic ischemia that allowed gradual collateral vessel growth.

C. The patient’s coronary arteries are completely occluded without warning.

D. The patient has only acute, short-term ischemic events.

A

B. The patient has chronic ischemia that allowed gradual collateral vessel growth.

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15
Q

Which of the following statements about glycoprotein IIb/IIIa receptors in complicated lesions is correct?

A. They inhibit platelet adhesion and thrombus formation.
B. They are activated when exposed platelets attempt to heal a ruptured plaque.
C. Their activation decreases the risk of arterial occlusion.
D. They are unrelated to fibrinogen binding and platelet aggregation.

A

B. They are activated when exposed platelets attempt to heal a ruptured plaque.

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16
Q

The nurse is teaching a patient about factors that influence the formation of complicated lesions. Which of the following should the nurse include as key contributors? (Select all that apply)

A. Inflammation and plaque instability
B. Presence of stable arterial plaque
C. Sudden coronary spasm
D. Continued platelet aggregation
E. Gradual buildup of fatty streaks

A

A. Inflammation and plaque instability
D. Continued platelet aggregation

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17
Q

Which patient would be at greatest risk for inadequate collateral circulation development in CAD?

A. A patient experiencing a slow, chronic arterial blockage

B. A patient with acute severe coronary spasm

C. A patient with long-term, mild hypertension

D. A patient undergoing gradual lifestyle changes to reduce risk factors

A

B. A patient with acute severe coronary spasm

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18
Q

Which of the following is considered a major risk factor for coronary artery disease (CAD)?

A. High serum LDL levels

B. Low serum HDL levels

C. High serum albumin levels

D. Low serum triglyceride levels

A

A. High serum LDL levels

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19
Q

HDL cholesterol is referred to as “good cholesterol” because it primarily functions to:

A. Deposit cholesterol on arterial walls

B. Transport cholesterol to arteries for use

C. Carry lipids away from arteries for metabolism

D. Increase triglyceride levels

A

C. Carry lipids away from arteries for metabolism

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20
Q

The risk for CAD increases with all of the following serum lipid levels EXCEPT:

A. Total serum cholesterol >200 mg/dL
B. LDL cholesterol >130 mg/dL
C. HDL cholesterol >50 mg/dL in women
D. Triglycerides >150 mg/dL

A

C. HDL cholesterol >50 mg/dL in women

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21
Q

Premenopausal women typically have higher levels of HDL due to the influence of:

A. Estrogen
B. Testosterone
C. Progesterone
D. Insulin

A

A. Estrogen

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22
Q

Hypertension contributes to the risk of CAD primarily by:

A. Increasing the elasticity of arterial walls
B. Enhancing HDL metabolism
C. Causing endothelial injury and promoting atherosclerosis
D. Reducing blood flow resistance

A

C. Causing endothelial injury and promoting atherosclerosis

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23
Q

A BMI greater than 30 kg/m2 and waist circumference over 40 inches for men is considered a risk factor for CAD because:

A. It increases LDL and triglyceride levels

B. It is linked with reduced physical activity

C. It lowers HDL levels more effectively than other factors

D. It decreases insulin resistance

A

A. It increases LDL and triglyceride levels

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24
Q

Nicotine exposure increases the risk of CAD by:

A. Decreasing peripheral vasoconstriction
B. Reducing LDL levels
C. Increasing catecholamine release and heart workload
D. Enhancing oxygen transport to the myocardium

A

C. Increasing catecholamine release and heart workload

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25
Q

Which factor contributes to the development of CAD by promoting endothelial dysfunction and changes in lipid metabolism?

A. Diabetes mellitus
B. Low triglyceride levels
C. High HDL levels
D. Increased estrogen levels

A

A. Diabetes mellitus

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26
Q

Physical inactivity raises the risk of CAD because it leads to:

A. Reduced triglyceride production

B. Increased HDL synthesis

C. Decreased risk of thrombus formation

D. Lower lipid metabolism efficiency

A

D. Lower lipid metabolism efficiency

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27
Q

A modifiable risk factor for CAD that involves catecholamine release, elevated BP, and vessel inflammation is:

A. Low serum HDL levels

B. Smoking tobacco

C. High LDL cholesterol

D. Chronic renal disease

A

B. Smoking tobacco

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28
Q

Obesity often coexists with other CAD risk factors, including:

A. Decreased triglyceride levels

B. Low insulin resistance

C. Hypertension and high LDL levels

D. Increased heart rate and vasodilation

A

C. Hypertension and high LDL levels

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29
Q

Which of the following contributes to endothelial injury and increased myocardial oxygen demand, worsening CAD risk?

A. Sympathetic nervous system stimulation

B. Low catecholamine release

C. Decreased blood glucose levels

D. Increased HDL cholesterol

A

A. Sympathetic nervous system stimulation

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30
Q

The use of illegal drugs, such as cocaine, can lead to CAD-related issues by:

A. Reducing myocardial oxygen demand
B. Inducing coronary artery spasms
C. Increasing hemoglobin sites for oxygen transport
D. Enhancing HDL transport

A

B. Inducing coronary artery spasms

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31
Q

Patients exposed to secondhand tobacco smoke:

A. Have a CAD risk decrease of 25% to 30%
B. Show a reduction in LDL levels
C. Face an increased CAD risk by 25% to 30%
D. Are not affected by smoke exposure

A

C. Face an increased CAD risk by 25% to 30%

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32
Q

What is the primary goal of managing coronary artery disease (CAD) risk factors?

A) To eliminate all modifiable risk factors

B) To slow disease progression through lifestyle and treatment interventions

C) To focus on the treatment of non-modifiable risk factors only

D) To emphasize pharmaceutical treatment as the first line of defense

A

B) To slow disease progression through lifestyle and treatment interventions

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33
Q

When assessing for coronary artery disease, which patient history is most relevant?

A) Presence of cardiovascular symptoms only

B) Physical activity level only

C) Current employment status only

D) Eating habits, family history, and stress factors

A

D) Eating habits, family history, and stress factors

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34
Q

Which statement about managing high-risk persons for CAD is accurate?

A) Non-modifiable risk factors cannot influence CAD risk at all.

B) Patients should be encouraged to change all risk factors simultaneously.

C) Non-modifiable factors should be balanced by controlling modifiable risks.

D) Modifiable factors are less significant than genetic predisposition.

A

C) Non-modifiable factors should be balanced by controlling modifiable risks.

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35
Q

What is the best initial approach for a patient who is hesitant to change lifestyle habits that increase CAD risk?

A) Encourage immediate, drastic changes in all risk factors.

B) Identify personal values and set realistic goals for change.

C) Avoid discussing lifestyle changes until symptoms appear.

D) Focus solely on drug therapy for the patient

A

B) Identify personal values and set realistic goals for change.

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36
Q

A patient with multiple CAD risk factors is highly motivated to improve health. What should be the primary focus of teaching?

A) Avoiding tobacco and alcohol use

B) Starting multiple lifestyle changes simultaneously

C) Knowing how to reduce CAD risk factors

D) Limiting physical activity to reduce stress

A

C) Knowing how to reduce CAD risk factors

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37
Q

What key factor should be considered when discussing CAD risk reduction with a patient reluctant to change?

A) The severity of their symptoms

B) The patient’s personal values and motivations

C) Immediate implementation of drug therapy

D) Only focusing on exercise habits

A

B) The patient’s personal values and motivations

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38
Q

What is a common barrier for patients in reducing CAD risk factors?

A) A lack of understanding about prescribed drugs

B) Over-motivation to change lifestyle habits

C) Misconceptions about CAD and lifestyle change impact

D) Insufficient access to environmental pollutants

A

C) Misconceptions about CAD and lifestyle change impact

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39
Q

What is the primary purpose of following the FITT formula when creating a physical activity program for CAD prevention?

A) To maximize exercise benefits through structured parameters
B) To limit exercise to only one type
C) To reduce overall daily physical activity
D) To ensure only high-intensity workouts are done

A

A) To maximize exercise benefits through structured parameters

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40
Q

Which of the following best describes moderate aerobic activity recommended for CAD prevention?

A) Weightlifting twice weekly

B) Sedentary stretching exercises

C) Vigorous jogging for 10 minutes per week

D) 150 minutes per week of brisk walking, biking, or recreational swimming

A

D) 150 minutes per week of brisk walking, biking, or recreational swimming

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41
Q

How does regular weight training benefit individuals at risk for metabolic syndrome and CAD?

A) Increases LDL cholesterol levels

B) Helps reduce muscle strength

C) Improves muscle strength and addresses metabolic syndrome

D) Decreases aerobic capacity

A

C) Improves muscle strength and addresses metabolic syndrome

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42
Q

Which dietary approach is recommended to lower LDL cholesterol levels and reduce CAD risk?

A) Increase intake of red meat and egg yolks

B) Reduce intake of complex carbohydrates and fiber

C) Eliminate all types of fat from the diet

D) Focus on monounsaturated and polyunsaturated fats while reducing saturated fats

A

D) Focus on monounsaturated and polyunsaturated fats while reducing saturated fats

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43
Q

Why is the consumption of fatty fish, such as salmon, recommended twice weekly for individuals at risk of CAD?

A) To significantly raise LDL cholesterol levels

B) To provide a rich source of omega-3 fatty acids that reduce triglycerides

C) To reduce protein intake

D) To increase saturated fat consumption

A

B) To provide a rich source of omega-3 fatty acids that reduce triglycerides

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44
Q

For patients with high serum triglyceride levels, what dietary change should be prioritized?

A) Eliminate or reduce alcohol and simple sugar intake

B) Focus solely on increasing fiber

C) Increase intake of alcohol and simple sugars

D) Add more saturated fats to the diet

A

A) Eliminate or reduce alcohol and simple sugar intake

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45
Q

What effect does increasing daily physical activity have on cardiovascular health?

A) Increases systolic blood pressure

B) Contributes to weight gain

C) Reduces systolic blood pressure and aids in weight management

D) Decreases HDL cholesterol levels

A

C) Reduces systolic blood pressure and aids in weight management

46
Q

What is the primary mechanism by which statin drugs lower LDL cholesterol levels?

A) Increasing cholesterol synthesis in the liver

B) Inhibiting the synthesis of cholesterol and increasing hepatic LDL receptors

C) Reducing the conversion of cholesterol to bile acids

D) Selectively inhibiting dietary cholesterol absorption

A

B) Inhibiting the synthesis of cholesterol and increasing hepatic LDL receptors

47
Q

When should a complete lipid profile be initiated for screening purposes according to the guidelines provided?

A) At age 20, with testing every 5 years unless risk factors suggest more frequent testing

B) At age 30, and every year thereafter

C) Only for patients over age 50

D) For patients with CAD risk factors only

A

A) At age 20, with testing every 5 years unless risk factors suggest more frequent testing

48
Q

Which of the following describes a primary preventive approach to starting statin therapy for adults aged 40 to 75 years without known CAD?

A) Automatically starting high-dose statin therapy

B) Evaluating a 10-year cardiovascular risk before initiating therapy

C) Ignoring risk factor assessment

D) Only prescribing statins to patients over 75 years old

A

B) Evaluating a 10-year cardiovascular risk before initiating therapy

49
Q

In patients at very high risk for CAD, what is the recommended target LDL level?

A) Less than 130 mg/dL
B) Less than 100 mg/dL
C) Less than 150 mg/dL
D) Less than 70 mg/dL

A

D) Less than 70 mg/dL

50
Q

What should be monitored when using bempedoic acid (Nexletol) due to its potential adverse effects?

A) Uric acid levels and tendon integrity

B) Platelet levels

C) Blood glucose levels

D) Hemoglobin concentration

A

A) Uric acid levels and tendon integrity

51
Q

Why must caution be taken when combining fibric acid derivatives with statins?

A) Increased risk of liver failure
B) Reduced LDL cholesterol-lowering effect
C) Heightened risk for myopathy
D) Lack of impact on triglycerides

A

C) Heightened risk for myopathy

52
Q

Which of the following statements accurately describes PCSK9 inhibitors?

A) They decrease triglyceride synthesis in the liver

B) They selectively inhibit cholesterol absorption from the intestines

C) They increase the number of hepatic receptors for LDL clearance

D) They are used as first-line therapy for hyperlipidemia

A

C) They increase the number of hepatic receptors for LDL clearance

53
Q

How should other medications be taken in relation to bile-acid sequestrants to minimize drug absorption interference?

A) Taken immediately after the bile-acid sequestrant

B) 30 minutes before taking the bile-acid sequestrant

C) 1 hour before or 3-4 hours after taking the bile-acid sequestrant

D) Only at night

A

C) 1 hour before or 3-4 hours after taking the bile-acid sequestrant

54
Q

In patients with moderate risk of CAD and a 10-year risk of less than 10%, what is the recommended LDL target level?

A) Less than 70 mg/dL
B) Less than 100 mg/dL
C) Less than 130 mg/dL
D) Less than 160 mg/dL

A

B) Less than 100 mg/dL

55
Q

Ezetimibe (Zetia) works to decrease cholesterol by which primary mechanism?

A) Increasing bile acid synthesis

B) Inhibiting the synthesis of cholesterol in the liver

C) Selectively inhibiting dietary and biliary cholesterol absorption

D) Enhancing LDL receptor production

A

C) Selectively inhibiting dietary and biliary cholesterol absorption

56
Q

What is a key consideration when prescribing low-dose aspirin for primary prevention of CAD in adults aged 40 to 59 years?

A) It should be used in all adults regardless of CAD risk

B) It should only be used in those without any risk of bleeding

C) It should not be used due to the risk of GI bleeding

D) It should always be combined with high-dose statins

A

B) It should only be used in those without any risk of bleeding

57
Q

In which of the following cases should low-dose aspirin not be initiated for primary prevention of CAD?

A) Adults over age 60 without known CAD

B) Adults aged 50 with a moderate risk of CAD and no bleeding risk

C) Adults aged 45 with a high risk of CAD and a bleeding history

D) Adults aged 40 who have significant family history of CAD

A

A) Adults over age 60 without known CAD

58
Q

What is the primary cause of chronic stable angina?

A) Emotional stress alone

B) High levels of physical activity without rest

C) Significant narrowing of one or more coronary arteries due to atherosclerosis

D) Rapid changes in body position

A

C) Significant narrowing of one or more coronary arteries due to atherosclerosis

59
Q

Which symptom description is most consistent with chronic stable angina?

A) Sharp, localized chest pain worsened by deep breaths

B) Pressure or tightness in the chest that radiates to the jaw or arm, often provoked by physical activity

C) Pain that increases with changes in body position

D) Persistent pain that does not subside with rest

A

B) Pressure or tightness in the chest that radiates to the jaw or arm, often provoked by physical activity

60
Q

In which scenario should chronic stable angina be suspected?

A) Chest discomfort occurring predictably with exertion and relieved by rest

B) Sudden onset chest pain with syncope and arrhythmia

C) Persistent pain lasting hours that does not respond to rest

D) Pain that occurs solely at night without exertion

A

A) Chest discomfort occurring predictably with exertion and relieved by rest

61
Q

Which of the following ECG changes would you expect in a patient with chronic stable angina during ischemic episodes?

A) ST-segment depression and/or T wave inversion in two contiguous leads

B) ST-segment elevation in two contiguous leads

C) Q waves appearing in all leads

D) No changes observed in any leads

A

A) ST-segment depression and/or T wave inversion in two contiguous leads

62
Q

What is a common management strategy for chronic stable angina that occurs predictably upon awakening?

A) Avoiding morning medications

B) Exercising immediately upon awakening

C) Scheduling medications to achieve peak effects at the time angina is likely to occur

D) Delaying all activities until midday

A

C) Scheduling medications to achieve peak effects at the time angina is likely to occur

63
Q

Which of the following best describes silent ischemia?

A) Chest pain that occurs without ECG changes

B) Ischemia that occurs without subjective symptoms but with detectable ECG changes

C) Chronic stable angina exacerbated by exercise

D) Painful episodes of angina occurring only during the night

A

B) Ischemia that occurs without subjective symptoms but with detectable ECG changes

64
Q

Which patient population has a higher prevalence of silent ischemia?

A) Patients with hypertension

B) Patients with normal cholesterol levels

C) Patients under age 40

D) Patients with diabetes due to diabetic neuropathy

A

D) Patients with diabetes due to diabetic neuropathy

65
Q

Which of the following is a common characteristic of Prinzmetal’s angina?

a) Occurs with increased physical demand

b) Associated with CAD only

c) Occurs at rest without increased physical demand

d) Always occurs during exercise

A

c) Occurs at rest without increased physical demand

66
Q

Which of the following is a risk factor for developing Prinzmetal’s angina?

a) Diabetes
b) History of migraine headaches
c) High cholesterol
d) Family history of CAD

A

b) History of migraine headaches

Rationale: Risk factors for Prinzmetal’s angina include a history of migraine headaches, Raynaud’s phenomenon, and heavy smoking.

67
Q

What is a common precipitating factor for coronary artery spasm in Prinzmetal’s angina?

a) High-protein diet

b) Aerobic exercise

c) Alcohol consumption

d) Low blood pressure

A

c) Alcohol consumption

68
Q

Which of the following medications is used in the treatment of Prinzmetal’s angina?

a) Beta blockers
b) Calcium channel blockers
c) Diuretics
d) ACE inhibitors

A

b) Calcium channel blockers

69
Q

In which patient population is coronary spasm more common?

a) African Americans
b) Whites
c) Asians
d) Hispanics

A

c) Asians

70
Q

What characterizes microvascular angina in terms of coronary artery disease (CAD) and coronary spasm

a) Significant CAD and coronary spasm are always present
b) Chest pain occurs with significant CAD
c) Chest pain occurs without significant CAD or coronary spasm of a major coronary artery
d) Chest pain occurs only during rest

A

c) Chest pain occurs without significant CAD or coronary spasm of a major coronary artery

71
Q

Which population is more commonly affected by microvascular angina?

a) Men
b) Children
c) Women
d) Elderly

A

c) Women

72
Q

How is chest pain in microvascular angina typically brought on?

a) During physical exertion
b) At rest
c) During sleep
d) After eating

A

a) During physical exertion

73
Q

What is the usual finding in cardiac catheterization for patients with microvascular angina?

a) Obstructive coronary disease in major coronary arteries
b) Significant coronary artery spasm
c) Complete blockage of major coronary arteries
d) No obstructive coronary disease in major coronary arteries

A

d) No obstructive coronary disease in major coronary arteries

74
Q

What is the goal of treatment for a patient admitted with angina?

a) Increase physical activity
b) Decrease O2 demand and/or increase O2 supply
c) Provide nutritional support
d) Administer antibiotics

A

b) Decrease O2 demand and/or increase O2 supply

75
Q

Which of the following is NOT an overall goal for a patient who presents with angina?

a) Pain relief
b) Preservation of heart muscle if an MI is suspected
c) Enhanced academic performance
d) Effective coping with illness-associated anxiety

A

c) Enhanced academic performance

76
Q

What position should a patient with chest pain be placed in, unless contraindicated?

a) Upright
b) Prone
c) Supine
d) Latera

A

a) Upright

77
Q

Which of the following measures should be taken first to provide prompt pain relief for a patient with chest pain?

a) Administer oral acetaminophen
b) Apply ice to the chest
c) Provide SL or IV NTG
d) Offer a sedative

A

c) Provide SL or IV NTG

78
Q

What might a new systolic murmur heard during an angina attack indicate?

a) Normal heart function
b) Ischemia of a papillary muscle of the mitral valve
c) Improved cardiac output
d) Dehydration

A

b) Ischemia of a papillary muscle of the mitral valve

79
Q

Which diagnostic test should be obtained to evaluate a patient with chest pain?

a) Blood glucose test
b) Abdominal ultrasound
c) Pulmonary function test
d) 12-lead ECG

A

d) 12-lead ECG

80
Q

Which of the following symptoms might indicate the patient is experiencing pain during an angina attack?

a) Low heart rate and calm demeanor
b) High HR, respiratory rate, or BP; restlessness; clutching the chest or bed linens
c) Normal ECG and relaxed posture
d) Low respiratory rate and quiet demeanor

A

b) High HR, respiratory rate, or BP; restlessness; clutching the chest or bed linens

81
Q

How should the nurse approach the patient to help reduce anxiety during an angina attack?

a) Use a calm approach and provide support and reassurance
b) Avoid any interaction to prevent overstimulation
c) Use a firm and authoritative tone
d) Ignore the patient’s anxiety

A

a) Use a calm approach and provide support and reassurance

82
Q

What should be emphasized in patient teaching to slow the progression of CAD?

a) Increasing calorie intake

b) Risk factor modification

c) Limiting physical activity

d) Avoiding all medications

A

b) Risk factor modification

83
Q

Why is maintaining ideal body weight important for patients with angina?

a) To reduce medication dependence
b) To decrease the heart’s workload
c) To improve mental health
d) To eliminate the need for exercise

A

b) To decrease the heart’s workload

84
Q

What type of diet should be taught to patients with angina and their caregivers?

a) Low in salt and saturated fats
b) High in saturated fats
c) High in sugar
d) Low in fiber

A

a) Low in salt and saturated fats

85
Q

What should patients be taught to avoid to prevent angina attacks?

a) Regular physical activity
b) Reading books
c) Exposure to extremes of weather and eating large, heavy meals
d) Drinking water

A

c) Exposure to extremes of weather and eating large, heavy meals

86
Q

What is the primary goal of drug therapy for chronic stable angina?

a) Increase weight gain

b) Reduce angina symptoms and the risk of MI and death

c) Enhance physical stamina

d) Reduce the frequency of headaches

A

b) Reduce angina symptoms and the risk of MI and death

87
Q

Which of the following is a short-acting nitroglycerin preparation used for an acute episode of angina?

a) Isosorbide dinitrate (Isordil)
b) Transdermal NTG patch
c) SL NTG tablet
d) Calcium channel blocker

A

c) SL NTG tablet

88
Q

How often should SL nitroglycerin tablets be replaced to ensure potency?

a) Every month
b) Every 3 months
c) Every 6 months
d) Every year

A

c) Every 6 months

89
Q

What should a patient do if angina symptoms are unchanged or worse after 5 minutes of taking SL NTG?

a) Take another medication
b) Rest and wait for relief
c) Drink a glass of water
d) Contact the emergency response system (e.g., 911)

A

d) Contact the emergency response system (e.g., 911)

90
Q

What side effect is common with all nitrates and requires monitoring?

a) Hyperglycemia
b) Orthostatic hypotension
c) Hyperthermia
d) Tachycardia

A

b) Orthostatic hypotension

91
Q

Why is a 10- to 14-hour nitrate-free period scheduled for patients on long-acting nitrates?

a) To prevent nitrate tolerance
b) To increase medication absorption
c) To enhance physical performance
d) To reduce gastrointestinal side effects

A

a) To prevent nitrate tolerance

92
Q

Which medication is used as an ACE inhibitor for patients with chronic stable angina?

a) Amlodipine
b) Metoprolol succinate
c) Lisinopril
d) Ranolazine

A

c) Lisinopril

93
Q

What is a common side effect of β-blockers?

a) Hyperactivity
b) Insomnia
c) Increased appetite
d) Bradycardia

A

d) Bradycardia

94
Q

Which patient population should avoid β-blockers due to contraindications?

a) Patients with diabetes
b) Patients with severe bradycardia
c) Patients with hyperthyroidism
d) Patients with hypertension

A

b) Patients with severe bradycardia

95
Q

When are calcium channel blockers used to treat angina?

a) When β-blockers are contraindicated or not well tolerated

b) When nitrates are effective

c) When there is no need for medication

d) When treating bacterial infections

A

a) When β-blockers are contraindicated or not well tolerated

96
Q

What is a primary side effect of taking calcium channel blockers, such as verapamil?

a) Hyperactivity
b) Increased energy
c) Weight loss
d) Severe constipation

A

d) Severe constipation

97
Q

What should be monitored when starting nondihydropyridines calcium channel blockers?

a) Blood glucose levels
b) Serum digoxin levels
c) Kidney function
d) Liver enzymes

A

b) Serum digoxin levels

98
Q

Why is ranolazine (Ranexa) used in treating chronic angina?

a) It increases blood pressure
b) It prolongs QT interval
c) It treats chronic angina in patients who have not responded to other medications
d) It causes weight gain

A

c) It treats chronic angina in patients who have not responded to other medications

99
Q

Which patients are recommended for CABG surgery

a) Patients with well-managed CAD
b) Patients with no history of cardiovascular disease
c) Patients with mild angina symptoms
d) Patients with left main coronary artery or 3-vessel disease

A

d) Patients with left main coronary artery or 3-vessel disease

100
Q

Which vein or artery is commonly used for bypass grafts in CABG surgery?

a) Radial artery
b) Femoral vein
c) Brachial artery
d) Carotid artery

A

a) Radial artery

101
Q

What does traditional CABG surgery require?

a) Minimally invasive technique
b) Sternotomy and cardiopulmonary bypass (CPB)
c) Local anesthesia
d) No hospital stay

A

b) Sternotomy and cardiopulmonary bypass (CPB)

102
Q

Why is the left internal mammary artery (LIMA) commonly used for bypass grafts?

a) It has a shorter patency rate
b) It is less prone to infection
c) It provides blood to the largest part of the heart muscle
d) It requires no surgical intervention

A

c) It provides blood to the largest part of the heart muscle

103
Q

What is a disadvantage of using the saphenous vein for bypass grafts?

a) High patency rates
b) Prone to spasm
c) No need for anticoagulation therapy
d) Risk of diffuse intimal hyperplasia

A

d) Risk of diffuse intimal hyperplasia

104
Q

Which procedure is used for patients with advanced CAD who are not candidates for conventional CABG surgery?

a) Balloon angioplasty
b) Transmyocardial laser revascularization
c) PCI
d) Stress echocardiogram

A

b) Transmyocardial laser revascularization

105
Q

What is the advantage of totally endoscopic coronary artery bypass (TECAB)?

a) No need for anesthesia
b) Shorter recovery times and less risk of sternal wound infection
c) High blood loss and more pain
d) Long hospital stay

A

b) Shorter recovery times and less risk of sternal wound infection

106
Q

What is the initial postoperative care setting for a patient after CABG surgery?

a) General ward
b) Step-down unit
c) Intensive care unit (ICU)
d) Outpatient clinic

A

c) Intensive care unit (ICU)

107
Q

Which of the following is a major complication related to the use of cardiopulmonary bypass (CPB) after CABG surgery?

a) Hypothermia
b) Hyperglycemia
c) Hypertension
d) Hyperkalemia

A

a) Hypothermia

108
Q

What is a common postoperative dysrhythmia after CABG surgery?

a) Ventricular fibrillation
b) Atrial fibrillation (AF)
c) Bradycardia
d) Tachycardia

A

b) Atrial fibrillation (AF)

109
Q

Why should β-blockers be started at least 24 hours before CABG surgery?

a) To prevent fluid retention
b) To enhance wound healing
c) To increase blood pressure
d) To reduce the incidence of atrial fibrillation (AF)

A

d) To reduce the incidence of atrial fibrillation (AF)

110
Q

What is the purpose of placing inflatable BP cuffs around the legs in enhanced external counterpulsation (EECP)?

a) To reduce muscle cramps
b) To improve coronary perfusion and LV diastolic filling
c) To increase blood glucose levels
d) To prevent infections

A

b) To improve coronary perfusion and LV diastolic filling

111
Q

Which patients are contraindicated for Enhanced External Counter Pulsation (EECP) therapy?

a) Patients with decompensated heart failure (HF)
b) Patients with well-controlled hypertension
c) Patients with a history of smoking
d) Patients with high cholesterol

A

a) Patients with decompensated heart failure (HF)

NUR251 - Medical Surgical III (6 decks)

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