Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome

A patient who is being admitted to the emergency department with severe chest pain gives the following list of medications taken at home to the nurse. Which of the medications has the most immediate implications for the patients care? a. sildenafil (Viagra) b. furosemide (Lasix) c. diazepam (Valium) d. captopril (Capoten)

A

A patient who has chest pain is admitted to the emergency department (ED), and all the following diagnostic tests are ordered. Which one will the nurse arrange to be completed first? a. Electrocardiogram (ECG) b. Computed tomography (CT) scan c. Chest x-ray d. Troponin level

A

Four days after having a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with all the daily 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. Social isolation related to lack of support system

A

When evaluating the outcomes of preoperative teaching with a patient scheduled for a coronary artery bypass graft (CABG) using the internal mammary artery, the nurse determines that additional teaching is needed when the patient says, a. I will have incisions in my leg where they will remove the vein. b. They will circulate my blood with a machine during the surgery. c. I will need to take an aspirin a day after the surgery to keep the graft open. d. They will use an artery near my heart to bypass the area that is obstructed.

A

When developing a health teaching plan for a 60-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. high incidence of cardiovascular disease in older people. d. elevation of the patients serum low density lipoprotein (LDL) level.

D

A few days after experiencing a myocardial infarction (MI), 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 response should the nurse make? a. Where are you planning to go for your vacation? b. What do you think caused your chest pain episode? c. Sometimes plans need to change after a heart attack. d. Recovery from a heart attack takes at least a few weeks.

B

Which information given by a patient admitted with chronic stable angina will help the nurse confirm this diagnosis? a. The patient rates the pain at a level 3 to 5 (0 to 10 scale). b. The patient states that the pain wakes me up at night. c. The patient says that the frequency of the pain has increased over the last few weeks. d. The patient states that the pain is resolved after taking one sublingual nitroglycerin tablet.

D

A patient who has had 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 discuss sexual intercourse when your heart is strong enough. d. Holding and cuddling are good ways to maintain intimacy after a heart attack.

B

A patient with ST segment elevation in several 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 fibrinolytic therapy? a. Do you take aspirin on a daily basis? b. What time did your chest pain begin? c. Is there any family history of heart disease? d. Can you describe the quality of your chest pain?

B

Amlodipine (Norvasc) is ordered for a patient with newly diagnosed Prinzmetals (variant) angina. When teaching the patient, the nurse will include the information that amlodipine will a. reduce the fight or flight response. b. decrease spasm of the coronary arteries. c. increase the force of myocardial contraction. d. help prevent clotting in the coronary arteries.

B

A patient who has had severe chest pain for several hours is admitted with a diagnosis of possible acute myocardial infarction (AMI). Which of these ordered laboratory tests should the nurse monitor to help determine whether the patient has had an AMI? a. Homocysteine b. C-reactive protein c. Cardiac-specific troponin I and troponin T d. High-density lipoprotein (HDL) cholesterol

C

Three days after a myocardial infarction (MI), the patient develops chest pain that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take next? a. Palpate the radial pulses bilaterally. b. Assess the feet for peripheral edema. c. Auscultate for a pericardial friction rub. d. Check the cardiac monitor for dysrhythmias.

C

. Which of these nursing interventions included in the plan of care for a patient who had an acute myocardial infarction (AMI) 3 days ago is most appropriate for the RN to delegate to an experienced LPN/LVN? a. Evaluating the patients response to ambulation in the hallway b. Completing the documentation for a home health nurse referral c. Educating the patient about the pathophysiology of heart disease d. Reinforcing teaching about the purpose of prescribed medications

D

When caring for a patient with acute coronary syndrome who has returned to the coronary care unit after having balloon angioplasty, the nurse obtains the following assessment data. Which data indicate the need for immediate intervention by the nurse? a. Pedal pulses 1+ b. Heart rate 100 beats/min c. Blood pressure 104/56 mm Hg d. Chest pain level 8 on a 10-point scale

D

After the nurse teaches the patient about the use of atenolol (Tenormin) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? a. It is important not to suddenly stop taking the atenolol. b. Atenolol will increase the strength of my heart muscle. c. I can expect to feel short of breath when taking atenolol. d. Atenolol will improve the blood flow to my coronary arteries.

A

Which information about a patient who has been receiving fibrinolytic 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. A large bruise at the patients IV insertion site c. A decrease in ST segment elevation on the electrocardiogram (ECG) d. An increase in cardiac enzyme levels since admission

A

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

A

For a patient who has been admitted the previous day to the coronary care unit with an acute myocardial infarction (AMI), the nurse will anticipate teaching about a. typical emotional responses to AMI. b. when patient cardiac rehabilitation will begin. c. discharge drugs such as aspirin and b-blockers. d. the pathophysiology of coronary artery disease.

B

When admitting a patient with a myocardial infarction (MI) to the intensive care unit, which action should the nurse carry out first? a. Obtain the blood pressure. b. Attach the cardiac monitor. c. Assess the peripheral pulses. d. Auscultate the breath sounds.

B

When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient a. that sudden cardiac death events rarely reoccur. b. about the purpose of outpatient Holter monitoring. c. how to self-administer low-molecular-weight heparin. d. to limit activities after discharge to prevent future events.

B

Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)? a. The pain increases with deep breathing. b. The pain has persisted longer than 30 minutes. c. The pain worsens when the patient raises the arms. d. The pain is relieved after the patient takes nitroglycerin.

B

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 110. Based on this information, which nursing diagnosis is a priority for the patient? a. Acute pain related to myocardial ischemia b. Anxiety related to perceived threat of death c. Decreased cardiac output related to cardiogenic shock d. Activity intolerance related to decreased cardiac output

C

After the nurse has finished teaching a patient about use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? a. I can expect indigestion as a side effect of nitroglycerin. b. I can only take the nitroglycerin if I start to have chest pain. c. I will call an ambulance if I still have pain 5 minutes after taking the nitroglycerin. d. I will help slow down the progress of the plaque formation by taking nitroglycerin.

C

During the administration of the fibrinolytic 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. surface bleeding from the IV site. c. a decrease in level of consciousness. d. a nonsustained episode of ventricular tachycardia.

C

Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patients response, which of these assessment data would indicate that the exercise level should be decreased? a. BP changes from 118/60 to 126/68 mm Hg. b. Oxygen saturation drops from 100% to 98%. c. Heart rate increases from 66 to 90 beats/minute. d. Respiratory rate goes from 14 to 22 breaths/minute.

C

The nurse has just received change-of-shift report about the following four patients. Which patient should the nurse assess first? a. 38-year-old who has pericarditis and is complaining of sharp, stabbing chest pain b. 45-year-old who had a myocardial infarction (MI) 4 days ago and is anxious about the planned discharge c. 51-year-old with unstable angina who has just returned to the unit after having a percutaneous coronary intervention (PCI) d. 60-year-old with variant angina who is to receive a scheduled dose of nifedipine (Procardia)

C

To assist the patient with coronary artery disease (CAD) in making appropriate dietary changes, which of these nursing interventions will be most effective? a. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary. b. Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes. c. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible. d. Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet.

C

Which assessment finding by the nurse who is caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the physician? a. Complaints of incisional chest pain b. Crackles audible at both lung bases c. Pallor and weakness of the right hand d. Redness on either side of the chest incision

C

Which of these statements 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% or nonfat milk. b. I like fresh salmon and I will plan to eat it more often. c. I will miss being able to eat peanut butter sandwiches. d. I can have a cup of coffee with breakfast if I want one.

C

A patient with a nonST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin? a. Platelet aggregation is enhanced by IV heparin infusion. b. Heparin will dissolve the clot that is blocking blood flow to the heart. c. Coronary artery plaque size and adherence are decreased with heparin. d. Heparin will prevent the development of new clots in the coronary arteries.

D

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when giving the medication? a. Administer the medication at the patients bedtime. b. Have the patient take this medication with an aspirin. c. Encourage the patient to take the colesevelam with a sip of water. d. Give the patients other medications 2 hours after the colesevelam.

D

After the nurse teaches a patient with chronic stable angina about how to use the prescribed short-acting and long-acting nitrates, which statement by the patient indicates that the teaching has been effective? a. I will put on the nitroglycerin patch as soon as I develop any chest pain. b. I will check the pulse rate in my wrist just before I take any nitroglycerin. c. I will be sure to remove the nitroglycerin patch before using any sublingual nitroglycerin. d. I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.

D

Nadolol (Corgard) is prescribed for a patient with angina. To determine whether the drug is effective, the nurse will monitor for a. decreased blood pressure and apical pulse rate. b. fewer complaints of having cold hands and feet. c. improvement in the quality of the peripheral pulses. d. the ability to do daily activities without chest discomfort.

D

The nurse obtains the following data when caring for a patient who experienced an acute myocardial infarction (AMI) 2 days previously. Which information is most important to report to the health care provider? a. The patient denies ever having a heart attack. b. The cardiac-specific troponin level is elevated. c. The patient has occasional premature atrial contractions (PACs). d. Crackles are auscultated bilaterally in the mid-lower lobes.

D

The nurse will suspect that the patient with stable angina is experiencing a side effect of the prescribed metoprolol (Lopressor) if a. the patient is restless and agitated. b. the blood pressure is 190/110 mm Hg. c. the patient complains about feeling anxious. d. the cardiac monitor shows a heart rate of 45.

D

When administering IV nitroglycerin (Tridil) to a patient with a myocardial infarction (MI), which action will the nurse take to evaluate the effectiveness of the medication? a. Check blood pressure. b. Monitor apical pulse rate. c. Monitor for dysrhythmias. d. Ask about chest discomfort.

D

When caring for a patient who has just arrived on the medical-surgical unit after having cardiac catheterization, which nursing action should the nurse delegate to an LPN/LVN? a. Perform the initial assessment of the catheter insertion site. b. Teach the patient about the usual postprocedure plan of care. c. Check the rate on the infusion pump used to administer heparin. d. Administer the scheduled aspirin and lipid-lowering medication.

D

Which electrocardiographic (ECG) change is most important for the nurse to communicate to the health care provider when caring for a patient with chest pain? a. Frequent premature atrial contractions (PACs) b. Inverted P wave c. Sinus tachycardia d. ST segment elevation

D