MOC exam 2

Which statement by a patient diagnosed with chronic stable angina indicates understanding of the disease process?

"Anginal pain is caused by an increased demand or a decreased supply of oxygen."

The nurse provides medication teaching to a patient who has been prescribed sublingual (SL) nitroglycerin (NTG) tablets. Which statement made by the patient indicates the need for further education?

"I can continue taking tablets until the pain goes away, each five minutes apart."

Which statement made by the student nurse indicates effective learning about the instructions for a patient who is prescribed nitroglycerin (NTG)?

"I should instruct the patient to report changes in the pattern of pain to the health care provider."

The nurse educates a patient with stable angina regarding the administration of nitroglycerin spray. Which statement made by the patient indicates effective learning?

"I should take the medication five minutes before beginning an activity that causes angina." Rationale: Stable angina is mainly provoked due to exertion. Therefore the patient has to take the medication 5 to 10 minutes before beginning activity. The patient with stable angina should spray the medication directly on the tongue without inhaling, not on the chest. Nitroglycerin should cause a tingling sensation upon administration; otherwise, it is considered outdated.

The nurse provides information to a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates understanding of the teaching?

"I will change my lifestyle to alter patterns and decrease my stress."

Which statement made by the student nurse indicates effective learning about cardiovascular disease?

"Nicotine stimulates catecholamine release."

Which advice regarding modifiable risk factors would the nurse give to a patient who has a BP of 150/100 mm Hg? Select all that apply.

"Reduce salt in your diet." "Increase daily physical activity."

A patient states, "I have episodes of sharp and stabbing chest pain that last 10 minutes when I am restocking shelves at work." The patient is diagnosed with chronic stable angina. Which instruction would the nurse give to the patient to prevent anginal pain while at work?

"Take nitroglycerin (NTG) 5 to 10 minutes before restocking the shelves."

A patient is admitted to the hospital with chronic stable angina. Which information would the nurse teach the patient about pain associated with the diagnosis?

"The pain may last for a few minutes and stop when the precipitating factor is resolved."

A patient presents to the emergency department (ED) with chest pain. Which question would the nurse ask first?

"Where is your discomfort located?"

A nurse is assessing an athlete who has come for a routine medical checkup. The patient has a family history of heart disease. The patient asks the nurse, "Can I get heart disease too?" Which response would the nurse provide?

"You could have heart disease, especially if you don't have a healthy lifestyle."

The nurse provides medication education to a patient diagnosed with coronary artery disease (CAD) who will begin taking lipid-lowering medications. Which information would the nurse include in the teaching? Select all that apply.

- A major side effect of simvastatin is muscle weakness and pain. - With niacin, flushing of the face and neck may occur within 20 minutes of taking the drug. - Liver enzymes need to be monitored at initiation of simvastatin and with dosage increase. - Ezetimibe, in combination with statins, produces greater reduction of low-density lipoprotein (LDL) levels.

Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply.

- Hypertension - Cardiomyopathy - Coronary artery disease (CAD)

Which items in a patient's medical history are risk factors for heart failure (HF)? Select all that apply.

- Hypertension - Metabolic syndrome

The nurse is preparing a presentation related to the complications of hypertension. Which information will the nurse include? Select all that apply.

- Stroke as a result of atherosclerosis - Blurring of vision or loss of vision secondary to retinal damage

Which individuals would the nurse identify as having the highest risk for coronary artery disease (CAD)?

A 45-year-old male with depression and a high-stress job Rationale: The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m 2 depicts normal weight. The patient with two risk factors is at greatest risk for developing CAD

The nurse provides a list of health-promoting regular physical activity examples to a patient with coronary artery disease (CAD). Which activity would the nurse include on the list?

Brisk walking (3 to 4 miles per hour)

Which condition is the leading cause of death in older adults with chronic illnesses?

Coronary artery disease (CAD)

Which foods would the nurse encourage a patient with diabetes mellitus and coronary artery disease to limit intake of to help reduce the percentage of saturated fat in their diet?

Dairy products

The nurse provides care for a 54-year-old female patient who has had no menstrual periods for a year. The nurse identifies that the patient is at risk for which conditions? Select all that apply.

Depression Osteoporosis Bladder infections Coronary artery disease

Which change occurs first that makes patients susceptible to coronary artery disease?

Development of fatty streaks in the smooth muscles of the endothelium

Which intervention would the nurse plan for a patient who smokes cigarettes and is predisposed to developing coronary artery disease?

Discuss medication to help with tobacco cessation. Rationale: Smoking cessation medications, such as bupropion, can be used to prevent the withdrawal symptoms of nicotine. Even if the patient is using smokeless tobacco, the risk of developing coronary artery disease is the same. Changing to filtered cigarettes does not affect the risk of developing coronary artery disease. Changing from high-nicotine to low-nicotine cigarettes also does not affect the risk of getting coronary heart disease.

A nurse teaches a patient about strategies to prevent angina caused by coronary artery disease. The nurse tells the patient to rest for one to two hours after a heavy meal. What is the rationale for this instruction?

Eating a heavy meal would divert more blood to the gastrointestinal system.

Which risk factor for coronary artery disease is considered nonmodifiable?

Family history of heart disease

Which symptoms in a 55-year-old female patient would the nurse recognize as possibly indicating unstable angina?

Fatigue, indigestion, and shortness of breath

A patient recently diagnosed with coronary artery disease (CAD) asks the nurse: "What caused my problem?" Which cause would the nurse explain?

Fatty deposits on the walls of the coronary arteries

A nurse assesses a patient whose angiogram revealed an 80% blockage of the left circumflex artery and 70% blockage of the right coronary artery. The patient does not show any symptoms of coronary ischemia. Which reason explains this finding?

Formation of collateral circulation

A 78-year-old patient has a diagnosis of hypertension with a cholesterol level of 250 mg/dL and a fasting triglyceride level of 195 mg/dL. Which level of risk does this patient have for coronary artery disease (CAD)?

High Rationale: Increasing age is a nonmodifiable risk factor for coronary artery disease. Hypertension is the second major risk factor in CAD. The risk of CAD is associated with a serum cholesterol level greater than 200 mg/dL or a fasting triglyceride level greater than 150 mg/dL. This patient has several risk factors for CAD and is therefore considered high risk.

A patient has been diagnosed with 89% blockage in the left main coronary artery. Which statements by the patient indicate referred pain of angina? Select all that apply.

I usually get a pain in the jaw." "Moving my neck is very painful." "The pain seems to radiate through my left arm."

A patient with coronary artery disease (CAD) is being seen in an outpatient health care setting for a routine examination. The patient states, "Over the past few months, I have needed increased amounts of insulin to control my type 1 diabetes mellitus." Which goal would the nurse include in the patient's plan of care, aimed at preventing the progression of CAD?

Maintain a Hb A1C level of less than 7%.

Which type of angina occurs in the absence of significant coronary artery disease (CAD)?

Microvascular

Which condition is likely in the female patient who reports chest pain while performing daily activities and has no significant coronary atherosclerosis?

Microvascular angina

A patient with chronic stable angina asks the nurse about the origin of the pain. Which condition would the nurse explain as the cause of the pain?

Myocardial ischemia

A patient reports episodic chest pain lasting a few minutes that is provoked by exertion and relieved within 10 minutes upon resting. Which cause of the patient's symptoms would the nurse suspect?

Myocardial ischemia due to coronary artery disease

A patient with a diagnosis of unstable angina is admitted to the intensive care unit. Which drug therapies will the nurse anticipate to be prescribed? Select all that apply.

Nitrates Antiplatelet therapy Anticoagulant therapy

Which patient is at the highest risk of developing coronary artery disease (CAD)?

Patient D: 56-year-old black female with a cholesterol level of 300 mg/dL

Which type of angina occurs as a result of coronary vasospasm?

Prinzmetal's angina

The nurse provides health promotion teaching to a patient recently diagnosed with coronary artery disease (CAD). Which information would the nurse include? Select all that apply.

Reduce total fat intake. Increase complex carbohydrates in the diet. Perform moderate physical activity at least 30 minutes five days a week.

A patient has a family history of myocardial infarction (MI). Which data indicates to the nurse that the patient has additional risk factors for coronary artery disease (CAD)? Select all that apply.

Serum cholesterol level of 260 mg/dL High level of anxiety over last two years related to family issues Works over 50 hours/week in an office with little time to exercise Lives with an adult child who smokes two packs of cigarettes per day

A male patient who has coronary artery disease (CAD) has serum values of low-density lipoprotein (LDL) cholesterol 98 mg/dL, and high-density lipoprotein (HDL) cholesterol 47 mg/dL. Which information would the nurse include in patient teaching?

The lipid levels are normal.

The nurse is performing an assessment on a patient who presented to the emergency department with a report of chest pain. Which assessment data would indicate that the patient has stable angina?

The pain developed when the patient was jogging and subsided after the patient rested.

When providing nutritional counseling for patients at risk for coronary artery disease (CAD), which dietary selections should the nurse encourage to include in their meal planning? Select all that apply.

Tofu Walnuts Flaxseed

Which type of angina increases in frequency, duration, and severity over time?

Unstable angina

Which sources of polyunsaturated fat would the nurse include in a teaching plan for a patient with coronary artery disease (CAD)? Select all that apply.

Walnuts Soybeans Rationale Polyunsaturated fats are found in greatest amounts in many kinds of nuts and in foods from plants including safflower, sunflower, corn, soybean, and cottonseed oils. Palm oil, egg yolk, and sour cream are major dietary sources of saturated fat.

Which question would the nurse ask the older patient regarding risk factors for coronary artery disease (CAD)?

What is your body mass index (BMI) number? Rationale: Risk for CAD increases with obesity, which is defined as a BMI of more than 30 kg/m 2.

The community health nurse is planning health promotion teaching to prevent coronary artery disease (CAD). Which population has the highest incidence of CAD?

White male