Lewis Ch 33: Coronary Artery Disease and Acute Coronary Syndrome

Question 1

The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching session?

a. Family history of coronary artery disease
b. Elevated low-density lipoprotein (LDL) level
c. Greater risk associated with the patient’s gender
d. Increased risk of cardiovascular disease with aging

Answer 1

ANS: B
Because family history, gender, and age are nonmodifiable risk factors, the nurse should focus on the patient’s LDL level. Decreases in LDL will help reduce the patient’s risk for developing CAD.

Question 2

Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes?

a. Inform the patient about a diet containing no saturated fat and minimal salt.
b. Emphasize the increased cardiac risk unless the patient makes dietary changes.
c. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet.

Answer 2

ANS: C
Lifestyle changes are more likely to be successful when consideration is given to the patient’s values and preferences. The highest percentage of calories from fat should come from monounsaturated or polyunsaturated 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 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.

Question 3

The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is from an acute myocardial infarction?

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

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.

Question 4

Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina?

a. “The pain wakes me up at night.”
b. “The pain is level 3 to 5 (0 to 10 scale).”
c. “The pain has gotten worse over the last week.”
d. “The pain goes away after a nitroglycerin tablet.”

Answer 4

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.

Question 5

Which patient statement indicates that the nurse’s teaching about sublingual nitroglycerin (Nitrostat) has been effective?

a. “I can expect nausea as a side effect of nitroglycerin.”
b. “I should only take nitroglycerin when I have chest pain.”
c. “Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.”
d. “I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes
apart. ”

Answer 5

ANS: D
The emergency response system (ERS) should be activated when chest pain or other symptoms are not completely relieved after three 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.

Question 6

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the 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

ANS: D
Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should come from monounsaturated 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.

Question 7

Which patient statement indicates that the nurse’s teaching about carvedilol (Coreg) for preventing anginal episodes 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

ANS: B
Patients who have been taking -adrenergic blockers can develop intense and frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases myocardial contractility. Shortness of breath that occurs when taking -adrenergic blockers for angina may be due to bronchospasm and should be reported to the health care provider. Carvedilol works by decreasing myocardial O2 demand, not by increasing blood flow to the coronary arteries.

Question 8

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AUMI). Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI?

a. Myoglobin
b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin

Answer 8

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 patient’s risk for developing coronary artery disease but are not helpful in determining whether an acute MI is in progress.

Question 9

Diltiazem (Cardizem) is prescribed for a patient with newly diagnosed Prinzmetal’s (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan?

a. Reduces heart palpitations.
b. Prevents coronary artery plaque.
c. Decreases coronary artery spasms.
d. Increases contractile force of the heart.

Answer 9

ANS: C
Prinzmetal’s 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 -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 O2 demand.

Question 10

Which data indicates to the nurse that the patient with stable angina is experiencing a side effect of metoprolol (Lopressor)?

a. Patient is restless and agitated.
b. Patient reports feeling anxious.
c. Blood pressure is 90/54 mm Hg.
d. Heart monitor shows normal sinus rhythm.

Answer 10

ANS: C 
Patients taking -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. Normal sinus rhythm is a normal and expected heart rhythm.

Question 11

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. What data would indicate to the nurse that the drug is effective?

a. Decreased blood pressure and heart rate
b. Improvement in the strength of the distal pulses
c. Fewer complaints of having cold hands and feet
d. Participation in daily activities without chest pain

Answer 11

ANS: D
Because the drug is ordered to improve the patient’s 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 -adrenergic blockers can cause peripheral vasoconstriction, so the nurse would not expect an improvement in distal pulse quality or skin temperature.

Question 12

Heparin is ordered for a patient with a non–ST-segment-elevation myocardial infarction (NSTEMI). How should the nurse explain the purpose of the heparin to the patient?

a. “Heparin enhances platelet aggregation at the plaque site.”
b. “Heparin decreases the size of the coronary artery plaque.”
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

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.

Question 13

Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for a patient with a myocardial infarction (MI)?

a. Monitor heart rate.
b. Ask about chest pain.
c. Check blood pressure.
d. Observe for dysrhythmias.

Answer 13

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 will also monitor heart rate and blood pressure and observe for dysrhythmias, but these parameters will not indicate whether the medication is effective.

Question 14

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department 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 daily?”
c. “What time did your pain begin?”
d. “Can you rate the pain on a 0 to 10 scale?”

Answer 14

ANS: C
Thrombolytic therapy should be started within 6 hours of the onset of the myocardial infarction, so the time at which the chest pain started is a major determinant of the appropriateness of this treatment. The other information is not a factor in the decision about thrombolytic therapy.

Question 15

A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest?

a. O2 saturation drops from 99% to 95%.
b. Heart rate increases from 66 to 98 beats/min.
c. Respiratory rate goes from 14 to 20 breaths/min.
d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.

Answer 15

ANS: B
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 O2 saturation, are normal responses to exercise.

Question 16

The nurse is administering a thrombolytic agent to a patient with an acute myocardial infarction. What patient data indicates that the nurse should stop the drug infusion?

a. Bleeding from the gums
b. An increase in blood pressure
c. Decreased level of consciousness
d. A nonsustained episode of ventricular tachycardia

Answer 16

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.

Question 17

A patient recovering from a myocardial infarction (MI) 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 as focused follow-up on this symptom?

a. Assess both 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

ANS: C
The patient’s 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 patient’s symptoms.

Question 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 sit down before I put the nitroglycerin under my tongue.”
b. “I will check my pulse rate before I take any nitroglycerin tablets.”
c. “I will put the nitroglycerin patch on as soon as I get any chest pain.”
d. “I will remove the nitroglycerin patch before taking sublingual nitroglycerin.”

Answer 18

ANS: A
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.

Question 19

The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI). What should the nurse anticipate teaching the patient?

a. Sudden cardiac death events rarely reoccur.
b. Additional diagnostic testing will be required.
c. Long-term anticoagulation therapy will be needed.
d. Limiting physical activity will prevent future SCD events.

Answer 19

ANS: B 
Diagnostic testing (e.g., stress test, Holter monitor, electrophysiologic studies, cardiac catheterization) is used to determine the possible cause of the SCD and treatment options. SCD is likely to recur. Anticoagulation therapy will not have any effect on the incidence of SCD, and SCD can occur even when the patient is resting.

Question 20

A patient with diabetes mellitus and chronic stable angina has a new order for captopril. What should the nurse teach this patient about the primary purpose of captopril?

a. Decreases the heart rate.
b. Controls blood glucose levels.
c. Prevents changes in heart muscle.
d. Reduces the frequency of chest pain.

Answer 20

ANS: C
The purpose for angiotensin-converting enzyme (ACE) inhibitors in patients with chronic stable angina who are at high risk for a cardiac event is to decrease ventricular remodeling. ACE inhibitors do not directly impact angina frequency, blood glucose, or heart rate.

Question 21

After having a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, “It was just a little chest pain. As soon as I get out of here, I’m 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

ANS: A
When the patient is experiencing denial, the nurse should assist the patient in testing reality until the patient has progressed beyond this step of the emotional adjustment to MI. Asking the patient about vacation plans reinforces the patient’s plan, which is not appropriate in the immediate post-MI period. Reminding the patient in denial about the MI is likely to make the patient angry and lead to distrust of the nursing staff.

Question 22

The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed?

a. “They will circulate my blood with a machine during surgery.”
b. “I will have 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 aspirin every day after the surgery to keep the graft open.”

Answer 22

ANS: B
When the internal mammary artery is used, there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective.

Question 23

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about safely resuming sexual intercourse. 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

ANS: B
Sexual activity places about as much physical stress on the cardiovascular system as moderate-energy activities, such as climbing two flights of stairs. The other responses are general statements that may be accurate, but do not provide useful guidelines for judging the physical safety of the activity.

Question 24

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication?

a. Administer the medication at the patient’s usual bedtime.
b. Have the patient take the colesevelam 1 hour before breakfast.
c. Give the patient’s other medications 2 hours after colesevelam.
d. Have the patient take the dose at the same time as the prescribed aspirin.

Answer 24

ANS: C
The bile acid sequestrants interfere with the absorption of many other drugs and giving other medications at the same time should be avoided. Taking an aspirin concurrently with the colesevelam may increase the incidence of gastrointestinal side effects such as heartburn. For maximum effect, colesevelam should be administered with meals.

Question 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. What should teaching for this patient include today?

a. Typical emotional responses to AMI
b. When cardiac rehabilitation will begin
c. Pathophysiology of coronary artery disease
d. Information regarding discharge medications

Answer 25

ANS: B
Early after an AMI, the patient will want to know when resumption of usual activities can be expected. At this time, the patient’s anxiety level or denial will interfere with good understanding of complex information such as the pathophysiology of coronary artery disease. Teaching about discharge medications should be done closer to discharge. The nurse should support the patient by decreasing anxiety rather than discussing the typical emotional responses to myocardial infarction.

Question 26

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider?

a. Generalized muscle aches and pains
b. Dizziness with rapid position changes
c. Nausea when taking the drugs before meals
d. Flushing and pruritus after taking the drugs

Answer 26

ANS: A
Muscle aches and pains may indicate myopathy and rhabdomyolysis, which have caused acute kidney injury and death in some patients who have taken the statin medications. These symptoms indicate that the pravastatin may need to be discontinued. The other symptoms are common side effects when taking niacin, and although the nurse should follow-up with the health care provider, they do not indicate that a change in medication is needed.

Question 27

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient’s care?

a. Tadalafil (Cialas)
b. Furosemide (Lasix)
c. Warfarin (Coumadin)
d. Diltiazem (Cardizem)

Answer 27

ANS: A
The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using tadalafil because of the risk of severe hypotension caused by vasodilation. The other home medications should be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient’s treatment.

Question 28

Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse 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

ANS: B
The changes in the right hand indicate compromised blood flow, which requires immediate evaluation and actions, such as prescribed calcium channel blockers or surgery. The other changes are expected or require nursing interventions.

Question 29

The nurse is caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization. What task should the nurse delegate to a licensed practical/vocational nurse (LPN/VN)?

a. Teach the patient about the postprocedure plan of care.
b. Give the scheduled aspirin and lipid-lowering medication.
c. Perform the initial assessment of the catheter insertion site.
d. Titrate the heparin infusion according to the agency protocol.

Answer 29

ANS: B
Administration of oral medications is within the scope of practice for LPNs/VNs. The initial assessment of the patient, patient teaching, and titration of IV anticoagulant medications should be done by the registered nurse (RN).

Question 30

Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider?

a. Inverted P wave
b. Sinus tachycardia
c. ST-segment elevation
d. First-degree atrioventricular block

Answer 30

ANS: C
The patient is likely to be experiencing an ST-segment-elevation myocardial infarction. Immediate therapy with percutaneous coronary intervention or thrombolytic medication is indicated to minimize myocardial damage. The other ECG changes may also suggest a need for therapy but not as rapidly.

Question 31

A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse?

a. Report of chest pain
b. Heart rate 102 beats/min
c. Pedal pulses 1+ bilaterally
d. Blood pressure 103/54 mm Hg

Answer 31

ANS: C
The patient’s chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse.

Question 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 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority?

a. Anxiety
b. Acute pain
c. Stress management
d. Decreased cardiac output

Answer 32

ANS: D
The hypotension and tachycardia indicate decreased cardiac output and shock from the damaged myocardium. This will result in decreased perfusion to all vital organs (e.g., brain, kidney, heart) and is a priority.

Question 33

When admitting a patient with a non–ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first?

a. Attach the heart monitor.
b. Obtain the blood pressure.
c. Assess the peripheral pulses.
d. Auscultate the breath sounds.

Answer 33

ANS: A
Because dysrhythmias are the most common complication of myocardial infarction (MI), the first action should be to place the patient on a heart monitor. The other actions are also important and should be accomplished as quickly as possible.

Question 34

Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider?

a. An increase in troponin levels from baseline
b. A large bruise at the patient’s IV insertion site
c. No change in the patient’s reported level of chest pain
d. A decrease in ST-segment elevation on the electrocardiogram

Answer 34

ANS: C
Continued chest pain suggests that the thrombolytic therapy is not effective and that other interventions such as percutaneous coronary intervention may be needed. Bruising is a possible side effect of thrombolytic therapy, but it is not an indication that therapy should be discontinued. The decrease of the ST-segment elevation indicates that thrombolysis is occurring, and perfusion is returning to the injured myocardium. An increase in troponin levels is expected with reperfusion and is related to the washout of cardiac biomarkers into the circulation as the blocked vessel is opened.

Question 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 having a heart attack.
c. Bilateral crackles in the mid-lower lobes.
d. Occasional premature atrial contractions (PACs).

Answer 35

ANS: C
The crackles indicate that the patient may be developing heart failure, a possible complication of myocardial infarction (MI). The health care provider may need to order medications such as diuretics or angiotensin-converting enzyme inhibitors for the patient. Elevation in troponin level at this time is expected. PACs are not life-threatening dysrhythmias. Denial is a common response in the immediate period after the MI.

Question 36

A patient had a non–ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?

a. Reinforcement of teaching about the prescribed medications
b. Evaluation of the patient’s response to walking in the hallway
c. Completion of the referral form for a home health nurse follow-up
d. Education of the patient about the pathophysiology of heart disease

Answer 36

ANS: A
LPN/VN education and scope of practice include reinforcing education that has previously been done by the RN. Evaluating the patient’s response to exercise after a NSTEMI requires more education and should be done by the RN. Teaching and discharge planning and referral are skills that require RN education and scope of practice.

Question 37

A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. 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

ANS: C
The priority for the patient is to determine whether an acute myocardial infarction (AMI) is
occurring so that the appropriate therapy can begin as quickly as possible. ECG changes occur USNT O
very rapidly after coronary artery occlusion, and an ECG should be obtained as soon as possible. Troponin levels will increase after about 3 hours. Data from the chest x-ray may impact the patient’s care but are not helpful in determining whether the patient is experiencing a myocardial infarction. Peripheral access will be needed but not before the ECG

Question 38

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

Answer 38

ANS: D
After PCI, the patient is at risk for hemorrhage from the arterial access site. The nurse should assess the patient’s blood pressure, pulses, and the access site immediately. The other patients should also be assessed as quickly as possible, but assessment of this patient has the highest priority.

Question 39

To improve the physical activity level for a mildly obese 68-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

ANS: B
Because patients are more likely to continue physical activities that they already enjoy, the nurse will plan to ask the patient about preferred activities. The goal for older adults is 30 minutes of moderate activity on most days. Older adults should plan for a longer warm-up period. Benefits of exercises, such as improved activity tolerance, should be emphasized rather than aiming for significant weight loss in older mildly obese adults.

Question 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

ANS: B
The history of more frequent chest pain suggests that the patient may have unstable angina, which is part of the acute coronary syndrome spectrum. This will require rapid implementation of actions such as cardiac catheterization and possible percutaneous coronary intervention. The data about the other patients suggest that their conditions are more stable.

Question 41

The nurse reviews information shown in the accompanying figure from the medical records of a 43-year-old patient. 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. Cardiac risk associated with previous tobacco use

Answer 41

ANS: C
The patient has an elevated low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol, which will increase the risk of coronary artery disease. The patient’s waist circumference and body mass index indicate an appropriate body weight. The risk for coronary artery disease a year after quitting smoking is the same as a nonsmoker. The patient’s occupation indicates that daily activity is at the levels suggested by national guidelines.

Question 42

After reviewing a patient’s 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. Hyperglycemia
b. Bilateral crackles
c. Q waves on ECG
d. Elevated troponin

Answer 42

ANS: B
Pulmonary congestion suggests that the patient may be developing heart failure, a complication of myocardial infarction (MI). Hyperglycemia is common after MI because of the inflammatory process that occurs with tissue necrosis. Troponin levels will be elevated for several days after MI. Q waves often develop with ST-segment-elevation MI.