Med Surg Adaptive Quizzing Chapter 34

Which statement by a patient diagnosed with stable angina indicates understanding of the disease process? "Decreased oxygen level in blood is causing my chest pain." "Angina is causing an irreversible damage to cardiac muscles by cardiac ischemia." "Anginal pain is caused by increased demand for oxygen or decreased supply of oxygen." "Symptoms of angina start when the process of atherosclerosis completely occludes a coronary artery."

"Anginal pain is caused by increased demand for oxygen or decreased supply of oxygen." Explanation (pg740) Mismatch between oxygen demand of cardiac muscles and supply of oxygen leads to myocardial ischemia, which is manifested as pain. A decreased oxygenation level of blood indicates respiratory problems. Myocardial ischemia is completely reversible. The patient will start to experience symptoms of ischemia when the coronary artery is blocked by 75% or more.

What instruction should the nurse give to the patient who is predisposed to coronary artery disease (CAD)? Select all that apply. "Consume red meat." "Avoid consuming tofu." "Consume milk and eggs." "Eat peanuts and almonds." "Take a fish oil supplement."

"Eat peanuts and almonds." "Take a fish oil supplement." Explanation (pg 737) Nuts such as almonds and peanuts have monounsaturated fatty acids that are safe for a patient predisposed to coronary artery disease (CAD). Fish oil contains polyunsaturated fatty acids that are good for health. The nurse should advise the patient not to consume red meat, which contains saturated fatty acids and cholesterol. Tofu is also a healthy diet option because it contains alpha-linolenic acid, which becomes omega-3 fatty acid in the body. The patient should avoid eating milk or eggs, because they also contain saturated fatty acids and cholesterol, and increase the risk for acquiring coronary artery disease (CAD), especially in patients who are predisposed to CAD.

Which suggestion is most important for the nurse to provide to a patient with a waist circumference of 42 inches? "Check your blood pressure regularly." "Check your blood glucose levels regularly." "Consume saturated fats for health reasons." "Exercise regularly to maintain an ideal body weight."

"Exercise regularly to maintain an ideal body weight." Explanation(pg 736) The patient's waist circumference exceeds the 40-inch measurement that indicates obesity, a modifiable risk factor. The patient should be advised to exercise regularly to achieve an ideal body weight. The patient does not have high blood pressure, so it is not necessary to check it regularly; it is only advisable to eliminate other risk factors. High blood glucose levels increase the risk of developing coronary heart disease, but do not help maintain ideal body weight. The patient should be advised not to consume saturated fats, because they may lead to additional weight gain and coronary artery disease (CAD).

The patient recently diagnosed with coronary artery disease (CAD) asks the nurse: "What caused my problem?" Which response by the nurse is the most appropriate? "The heart is not able to pump effectively." "Fatty deposits on the walls of coronary arteries." "Low oxygen saturation of your blood." "Orthostatic hypotension caused this problem."

"Fatty deposits on the walls of coronary arteries." Explanation (pg 731) The major cause of CAD is atherosclerosis, which is manifested by fatty deposits on the walls of coronary arteries. Decrease in pumping action of the heart will result in congestive heart failure (CHF). Low oxygen saturation of the blood is a result of respiratory problems. Hypertension, not orthostatic hypotension, will predispose a patient to development of CAD.

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? "I will replace my nitroglycerin supply every six months." "I can take up to five tablets every three minutes for relief of my chest pain." "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." "I will take the nitroglycerin 10 minutes before a planned activity that usually causes chest pain."

"I can take up to five tablets every three minutes for relief of my chest pain." Explanation (pg743) The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after five minutes, the patient should be instructed to activate the emergency medical services (EMS) system. If symptoms are improved, repeat the nitroglycerin every five minutes for a maximum of three doses and contact EMS if symptoms have not resolved completely.

The nurse is teaching a patient with chronic stable angina on the use of nitroglycerin (NTG). Which statement made by the patient indicates effective learning? "I should dissolve the tablets in a glass of water." "I should store the medications in a light area." "I should replace the tablets in the container every 18 months." "I should take a tablet one half-hour before beginning activities."

"I should take a tablet one half-hour before beginning activities." Explanation(pg 743) Nitroglycerine is a first line treatment for patients with chronic stable angina. The patient should take nitroglycerin (NTG) before beginning any strenuous activities in order to prevent an anginal episode. The patient should keep nitroglycerin tablets away from light and heat sources to protect them from degradation. Therefore, the medication should be stored in a shady area. The patient should replace the tablets in the container every six months.

The nurse has been teaching a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates an adequate understanding? "I will add weightlifting to my exercise program." "I will change my diet to increase my intake of saturated fats." "I need to switch to smokeless tobacco instead of smoking cigarettes." "I will change my lifestyle to reduce activities that increase my stress."

"I will change my lifestyle to reduce activities that increase my stress." Explanation (pg 736) Health-promoting behaviors for those at risk for CAD include: improving physical activity such as brisk walking (three to four miles/hour for at least 30 minutes five or more times a week); reducing total fat and saturated fat intake; stopping all tobacco use, and altering patterns that are conducive to stress.

Which statement by the patient who is diagnosed recently with coronary artery disease (CAD) indicates that the patient understands dietary modifications that need to be implemented after discharge home? "I will not eat bacon or any pork products." "I will eat only fried eggs instead of boiled eggs." "I may continue to enjoy French fries with hot dogs." "I will drink no more than one glass of whole milk per day."

"I will not eat bacon or any pork products." Explanation (pg 737) Nutritional guidelines recommended for the patient with CAD include a low-cholesterol and low-fat diet; therefore, the patient has to avoid bacon and any pork products. Egg yolk is high in cholesterol and the patient with CAD has to avoid fried food. French fries are high in fat because of their preparation process. Low-fat or nonfat milk is recommended for the patient with CAD.

The nurse instructs a 68-year-old woman with hypercholesterolemia about natural lipid-lowering therapies. The nurse determines further teaching is necessary if the patient makes which statement? "Omega-3 fatty acids are helpful in reducing triglyceride levels." "I should check with my physician before I start taking any herbal products." "Herbal products do not go through as extensive testing as prescription drugs do." "I will take garlic instead of my prescription medication to reduce my cholesterol."

"I will take garlic instead of my prescription medication to reduce my cholesterol." Explanation Current evidence does not support using garlic in the treatment of elevated cholesterol. Strong evidence supports the use of omega-3 fatty acids for reduction of triglyceride levels. Many herbal products are not standardized and effects are not predictable. Patients should consult with their health care provider before starting herbal or natural therapies.

Which statement by an 84-year-old patient with coronary artery disease (CAD) indicates understanding of discharge teaching about physical activity? "I will use longer rest periods between exercise sessions." "I can stop exercising as soon as my cardiac symptoms disappear." "I should exercise outside all the time to achieve better results" "I have to exercise for longer periods of time and more vigorously compared with younger people."

"I will use longer rest periods between exercise sessions." Explanation (pg 740) Older adults have to use longer rest periods between exercise sessions because of decreased endurance and ability to tolerate stress. Older adults have decreased sweating and, therefore, shouldn't exercise in hot temperatures. Older adults have to perform low-level activity exercise for longer periods of time. Elderly adults have to change their lifestyles to accommodate a physical activity program, even though they are more prone to make such changes during hospitalization or when experiencing symptoms of CAD.

In caring for the patient with angina, the patient said, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, but the pain is gone now." What further assessment data should the nurse obtain from the patient? "What precipitated the pain?" "Has the pain changed this time?" "In what areas did you feel this pain?" "Rate the pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine."

"In what areas did you feel this pain?" Explanation Using PQRST, the assessment data not volunteered by the patient is the radiation of pain, the area the patient felt the pain, and if it radiated. The precipitating event was going to the bathroom and having a bowel movement. The quality of the pain was "like before I was admitted," although a more specific description may be helpful. Severity of the pain was the "worst chest pain ever," although an actual number may be needed. Timing is supplied by the patient describing when the pain occurred and that he had previously had this pain.

Which statement made by the student nurse indicates effective learning about microvascular angina? "It is more common in a patient with diabetic neuropathy." "It occurs at night and is triggered by the patient lying down." "It is common in women and is triggered even by daily activity." "It is commonly seen during rapid eye movement sleep in the patient."

"It is common in women and is triggered even by daily activity." Explanation (pg 752) Microvascular angina is a chest pain associated with abnormalities of the coronary microcirculation, occurring especially in women even when performing daily activities. Silent ischemia occurs in the patient with diabetic neuropathy due to the damage of nerves of the cardiovascular system. Nocturnal angina sets in when the patient lies down and is relieved upon standing or sitting. Prinzmetal's angina is very common in patients even during rapid eye movement sleep.

Which statement made by the student nurse indicates effective learning about chronic stable angina? "Nicotine stimulates catecholamine release." "Isometric exercise provides relief from angina." "Manifestations of angina occur in the late evenings." "Decreased heart rate increases myocardial oxygen demand."

"Nicotine stimulates catecholamine release." Explanation (pg 741) Chronic stable angina occurs due to insufficient blood flow in the coronary arteries due to atherosclerosis. Nicotine is a precipitating factor that provokes the angina attack, because nicotine use stimulates catecholamine release, causing vasoconstriction and increased heart rate. Isometric exercise such as lifting heavy objects promotes the onset of angina so the patient should take nitroglycerine 5 to 10 minutes before beginning activities. Manifestations of angina occur in the early mornings due to a change in the circadian rhythm patterns. Increased heart rate due to exertion reduces the time the heart spends in diastole, resulting in increased myocardial oxygen demand.

A patient is recovering from an uncomplicated myocardial infarction (MI). Which instructions will the nurse include when discussing physical activity? "Start out with 30-minute sessions." "Be sure to perform physical activity at least twice a week." "Physical activity should be regular, rhythmic, and repetitive." "Your heart rate during exercise should only go up to 30 beats over your resting heart rate."

"Physical activity should be regular, rhythmic, and repetitive." Explanation (pg 760) Physical activity should be regular, rhythmic, and repetitive, using large muscles to build up endurance (e.g., walking, cycling, swimming, rowing). Physical activity sessions should be at least 30 minutes long. Instruct the patient to begin slowly at personal tolerance (perhaps only 5 to 10 minutes) and build up to 30 minutes. Encourage the patient to perform physical activity on most days of the week. Activity intensity is determined by the patient's heart rate. If an exercise stress test has not been performed, the heart rate of the patient recovering from an MI should not exceed 20 beats/minute over the resting heart rate.

What advice should the nurse give the patient who has a blood pressure of 150/100 mm Hg? Select all that apply. "Reduce total fat intake." "Reduce salt in your diet." "Increase daily physical activity." "Ingest smaller and more frequent meals." "Reduce the amount of complex carbohydrates and fibers in diet."

"Reduce salt in your diet." "Increase daily physical activity." Explanation (pg 736) The patient's blood pressure of 150/100 mm Hg is above the normal range and is a major modifiable risk factor. The nurse should advise the patient to consume less salt to lower blood pressure and exercise daily to reduce the risk of coronary artery disease (CAD) from hypertension. If the patient has elevated serum lipids, the nurse should advise the patient to reduce total fat intake. Obese patients should eat smaller and more frequent meals. The nurse should also advise the patient to increase the amount of complex carbohydrates, fiber, and vegetable proteins in the diet for the patient who has elevated serum lipids. See Table 34-2

What should the nurse advise the patient who is on isosorbide mononitrate regarding drug administration? Select all that apply. "Take acetaminophen along with the medication." "Discontinue the medication if headache is persistent." "Avoid taking isosorbide mononitrate for eight hours at night." "Have your blood pressure measured after the initial dose." "Take the medication only when symptoms of angina appear."

"Take acetaminophen along with the medication." "Avoid taking isosorbide mononitrate for eight hours at night." "Have your blood pressure measured after the initial dose." Explanation (pg 743) The patient should be advised to take acetaminophen along with isosorbide mononitrate to avoid a headache due to the dilation of cerebral blood vessels. The patient should have blood pressure measured after the initial dose because isosorbide mononitrate causes venous dilation that may lead to a drop in blood pressure. The patient should be advised to avoid taking isosorbide mononitrate for a period of eight hours during the night to provide a nitrate-free period in order to prevent the effect of orthostatic hypotension. The patient should not be advised to discontinue the medication even if headaches persist. Isosorbide mononitrate is a long-acting nitrate used to reduce the incidence of anginal attacks and should be taken regularly, not only when angina symptoms are present.

Which statement of the student nurse indicates effective learning about Prinzmetal's angina? "The patient has to sleep in recumbent position at night." "The patient should moderately exercise the arms to relieve the pain." "The patient should take amphetamines with nitrates during an attack." "The pain in the patient is triggered while performing daily living activities."

"The patient should moderately exercise the arms to relieve the pain." Explanation (pg 742) Prinzmetal's angina occurs due to spasms in the coronary artery even when the patient is at rest. The patient may experience cyclic and short bursts of pain that are relieved upon moderate exercise of the arms. Nocturnal angina occurs when the patient is in recumbent position. The patient should not use nitrates and amphetamines together during an attack. Microvascular angina occurs even while performing daily activities due to abnormalities of the coronary microcirculation.

A patient has been classified as having stage 2 hypertension on the basis of the blood pressure recorded. The primary goal of therapy for the patient is to normalize the blood pressure. What should be the target blood pressure for this patient? 120/80 mm Hg 140/90 mm Hg 130/80 mm Hg 150/90 mm Hg

120/80 mm Hg Explanation (pg 734) The nurse's goal is to normalize the blood pressure (BP) of this patient. Therefore, the target blood pressure would be 120/80 mm Hg, which is a normal BP. If the patient has a blood pressure within 140 to 159/90 to 99 mm Hg range, then the patient has stage 1 hypertension. This can be controlled by drugs and lifestyle modifications. If the BP of the patient is within 120 to 139/80 to 89 mm Hg, then the patient has prehypertension. Lifestyle modifications are required for this patient to normalize the blood pressure. Blood pressure of 150/90 is indicative of stage 2 hypertension.

Which patient would the nurse identify being at higher risk for developing coronary artery disease (CAD)? 43-year-old nonsmoking African American male 26-year-old Hispanic male smoking one pack of cigarettes per day 49-year-old Caucasian male with blood pressure 152/92 mm Hg 72-year-old African American female with a cholesterol level of 300 mg/dL

72-year-old African American female with a cholesterol level of 300 mg/dL Explanation (pg732) Multiple risk factors increase the risk of CAD, and this patient has three risk factors: age over 55, African American ethnic background, and cholesterol level greater than 240 mg/dL. The middle-aged nonsmoking AfricanAmerican male has only two risk factors: middle age and male gender: Caucasian middle-age males are more prone to develop CAD. The Hispanic patient has only two risk factors for CAD: male gender and smoking. The middle-aged white male has only two risk factors (age and gender), because systolic blood pressure is less than 160 mm Hg.

Which patient is at greatest risk for sudden cardiac death? A 42-year-old white woman with hypertension and dyslipidemia A 52-year-old African American man with left ventricular failure A 62-year-old obese man with diabetes mellitus and high cholesterol A 72-year-old Native American woman with a family history of heart disease

A 52-year-old African American man with left ventricular failure Explanation Patients with left ventricular dysfunction (ejection fraction < 30%) and ventricular dysrhythmias after MI are at greatest risk for sudden cardiac death (SCD). Other risk factors for SCD include (1) male gender (especially African American men), (2) family history of premature atherosclerosis, (3) tobacco use, (4) diabetes mellitus, (5) hypercholesterolemia, (6) hypertension, and (7) cardiomyopathy.

Which patient is showing signs of increased low-density lipoprotein (LDL) receptors in the liver because of the therapeutic effects of lipid-lowering treatment? A patient with itching and flushing on the face A patient with pain in the joints without inflammation A patient with rashes and mild gastrointestinal disturbance A patient with weak muscles and break-down of skeletal muscles

A patient with weak muscles and break-down of skeletal muscles Explanation (pg 739) The patient with weak muscles (myopathy) and breakdown of skeletal muscles (rhabdomyolysis) is showing the adverse effects of treatment with HMG-CoA reductase inhibitors such as atorvastatin. These drugs increase the LDL receptors in the liver. The patient with pruritus and flushing on the face may be receiving niacin treatment. The patient with pain in the joints, or arthralgia, may be receiving omega-3 fatty acid treatment. The patient with rashes and mild gastrointestinal disturbances may be receiving treatment with fibric acid derivatives such as fenofibrate.

When teaching a patient about physical activity guidelines following acute coronary syndrome, the nurse recommends isotonic (static) activities. What should isotonic activities require according to the FITT (frequency, intensity, type, and time) formula? An increase in heart rate of at least 20 beats/minute over the resting heart rate A steady load on the heart and gradual increase in time and intensity A rapid increase in heart rate and blood pressure A stretching of muscles but no increase in heart rate and blood pressure

A steady load on the heart and gradual increase in time and intensity Explanation (pg 761) The FITT formula recommends isotonic activities that require a steady load on the heart, with careful attention not to increase the heart rate by more than 20 beats/minute over the resting heart rate, and that gradually increase in time and intensity. The FITT formula recommends limited isometric (dynamic) activities that rapidly increase the heart and blood pressure, but there is no FITT guideline that limits patients to stretching exercises only

The patient is being dismissed from the hospital after ACS and will be attending rehabilitation. What information does the patient need to be taught about the early recovery phase of rehabilitation? Therapeutic lifestyle changes should become lifelong habits. Physical activity is always started in the hospital and continued at home. Attention will focus on management of chest pain, anxiety, dysrhythmias, and other complications. Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring.

Activity level is gradually increased under cardiac rehabilitation team supervision and with ECG monitoring. Explanation In the early recovery phase after the patient is dismissed from the hospital, the activity level is gradually increased under supervision and with ECG monitoring. The late recovery phase includes therapeutic lifestyle changes that become lifelong habits. In the first phase of recovery, activity is dependent on the severity of the angina or MI, and attention is focused on the management of chest pain, anxiety, dysrhythmias, and other complications. With early recovery phase, the cardiac rehabilitation team may suggest that physical activity be initiated at home, but this is not always done.

The patient is being dismissed from the hospital after acute coronary syndrome and will be attending rehabilitation. What information does the patient need to be taught about the early recovery phase of rehabilitation? Therapeutic lifestyle changes should become lifelong habits. Physical activity always is started in the hospital and continued at home. Attention will focus on management of chest pain, anxiety, dysrhythmias, and other complications. Activity level is increased gradually under cardiac rehabilitation team supervision and with ECG monitoring.

Activity level is increased gradually under cardiac rehabilitation team supervision and with ECG monitoring. Explanation (pg 757) In the early recovery phase after the patient is dismissed from the hospital, the activity level is increased gradually under supervision and with ECG monitoring. The late recovery phase includes therapeutic lifestyle changes that become lifelong habits. In the first phase of recovery, activity is dependent on the severity of the angina or myocardial infarction (MI), and attention is focused on the management of chest pain, anxiety, dysrhythmias, and other complications. With early recovery phase, the cardiac rehabilitation team may suggest that physical activity be initiated at home, but this is not always done.

The patient comes to the ED with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerotic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder? Unstable angina Acute coronary syndrome (ACS) ST-segment-elevation myocardial infarction (STEMI) Non-ST-segment-elevation myocardial infarction (NSTEMI)

Acute coronary syndrome (ACS) Explanation The pain with ACS is severe, prolonged, and not easy to relieve. ACS is associated with deterioration of a once-stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation. The unstable lesion, if partially occlusive, will be manifest as unstable angina or NSTEMI. If there is total occlusion, it is manifest as a STEMI.

The patient comes to the emergency department with severe, prolonged angina that is not immediately reversible. The nurse knows that if the patient once had angina related to a stable atherosclerostic plaque and the plaque ruptures, there may be occlusion of a coronary vessel and this type of pain. How will the nurse document this situation related to pathophysiology, presentation, diagnosis, prognosis, and interventions for this disorder? Unstable angina Acute coronary syndrome (ACS) ST segment elevation myocardial infarction (STEMI) Non-ST segment elevation myocardial infarction (NSTEMI)

Acute coronary syndrome (ACS) Explanation (pg 746) The pain with ACS is severe, prolonged, and not easy to relieve. ACS is associated with deterioration of a once stable atherosclerotic plaque that ruptures, exposes the intima to blood, and stimulates platelet aggregation and local vasoconstriction with thrombus formation. The unstable lesion, if partially occlusive, will be manifest as unstable angina or NSTEMI. If there is total occlusion, it is manifest as STEMI.

For which problem is percutaneous coronary intervention (PCI) most clearly indicated? Chronic stable angina Left-sided heart failure Coronary artery disease Acute myocardial infarction

Acute myocardial infarction Explanation PCI is indicated to restore coronary perfusion in cases of myocardial infarction. Chronic stable angina and CAD are normally treated with more conservative measures initially. PCI is not relevant to the pathophysiology of heart failure, such as left-sided heart failure.

The nurse reviews the plan of care for a patient with chest pain, an oxygen saturation of 90 percent, a pulse rate of 110 beats per minute, and slight dyspnea. Which item listed on the plan should the nurse question? Advise the patient to remain on complete bed rest. Instruct the patient on how to perform relaxed breathing and imagery. Encourage the patient to exercise regularly. Encourage the patient to verbalize feelings and perceptions.

Advise the patient to remain on complete bed rest. Explanation (pg 754) Complete bed rest should be limited to reduce complications. Performing 30 minutes of exercise per day will help avoid fatigue and increase activity tolerance without rapidly increasing cardiac workload. The nurse should instruct the patient with anxiety and stress to use relaxation breathing and imagery and encourage verbalization of feelings and perceptions. This helps in providing comfort and support to the patient.

Which drug breaks up the fibrin meshwork in clots? Nadolol Alteplase Valsartan Nicardipine

Alteplase Explanation (pg 744) Alteplase is a thrombolytic agent that breaks up the fibrin meshwork in clots. Nadolol is a β adrenergic blocker that inhibits sympathetic nervous stimulation of the heart. Valsartan is an angiotensin II receptor blocker, which inhibits the binding of angiotensin II to angiotensin I receptors. Nicardipine is a calcium channel blocker that prevents calcium entry into the vascular smooth muscles and cardiac cells. (-ase) = break

The nurse is reviewing information about changes that occur during angina. Which of the following changes will the nurse review? Select all that apply. Anaerobic metabolism begins, and lactic acid accumulates during hypoxia. In ischemic conditions, cardiac cells are viable for approximately 20 minutes. The coronary artery usually is blocked 50% or more when angina episodes occur. Angina, or chest pain, is the clinical manifestation of irreversible myocardial ischemia. Demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen.

Anaerobic metabolism begins, and lactic acid accumulates during hypoxia. In ischemic conditions, cardiac cells are viable for approximately 20 minutes. Demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen. Explanation (pg 740) Anaerobic metabolism begins, and lactic acid accumulates. On the cellular level, the myocardium becomes hypoxic within the first 10 seconds of coronary occlusion. Myocardial cells are deprived of oxygen and glucose needed for aerobic metabolism and contractility. When the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, myocardial ischemia occurs. The primary reason for insufficient blood flow is narrowing of coronary arteries by atherosclerosis. For ischemia secondary to atherosclerosis to occur, the artery usually is blocked (stenosed) 75 percent or more. Angina, or chest pain, is the clinical manifestation of reversible (not irreversible) myocardial ischemia.

The nurse recognizes that which type of medication may be prescribed for a patient with an ejection fraction of 25%? Lipid lowering agent Beta-adrenergic blocker Calcium channel blocker Angiotensin-converting enzyme (ACE) inhibitor

Angiotensin-converting enzyme (ACE) inhibitor Explanation (pg 753) Angiotensin converting enzyme inhibitors improve ejection fraction, prevents ventricular remodeling, and prevents the progression of heart failure in the patient. Lipid lowering agents reduce low density cholesterol and triglyceride levels in the blood. Beta-adrenergic blockers decrease myocardial oxygen demand by reducing heart rate, blood pressure, and contractility. Calcium channel blockers are prescribed to decrease blood pressure in patients with beta blocker intolerance and Prinzmetal's angina.

A nurse is identifying obese women at risk of developing coronary artery disease in a community for health care research. What are the appropriate criteria for the selection of at-risk women? Select all that apply. Age of less than 40 years Apple-shaped obesity Pear-shaped obesity Body mass index greater than 30 kg/m2 Waist circumference more than 30 inches

Apple shaped Obesity Body mass greater than 30 kg/m2 Explanation (pg 732) Obesity is a major risk factor for the development of coronary artery diseases (CAD). Women below the age of 40 are generally premenopausal. The cardioprotective effects of estrogen make premenopausal women less susceptible for developing atherosclerosis, which can lead to CAD. Apple-shaped obesity is the type of obesity in which there is more fat deposition around the abdomen. This condition is a major risk factor for development of coronary artery disease. Obesity in women is defined as having a body mass index of 30 or greater, which is a major risk factor for development of coronary artery disease. Evidence suggests that people having fat deposition around the thigh and hip regions (pear-shaped figure) are less susceptible to develop coronary artery disease than people having fat deposition around the abdomen (apple-shaped obesity). Obesity in women is defined as having a waist circumference more than 35 inches; therefore, the criterion should be "waist circumference greater than 35 inches."

Which drug acts by direct inhibition of the clotting factor thrombin? Heparin Felodipine Enoxaparin Argatroban

Argatroban Explanation (pg 744) Argatroban is direct thrombin inhibitor, which directly inhibits the clotting factor thrombin. Heparin is an anticoagulant, which acts by preventing conversion of fibrinogen to fibrin and prothrombin to thrombin. Felodipine is a calcium channel blocker, which prevents the entry of calcium into vascular smooth muscles and myocytes. Enoxaparin is a low-molecular-weight heparin, which binds to antithrombin III and enhances its effects.

The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI)? Select all that apply. Flushing Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds

Ashen skin Diaphoresis Nausea and vomiting S3 or S4 heart sounds Explanation (pg 754) During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation. This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.

A patient reports heaviness and burning sensation in the substernal and retrosternal region. Assessment findings include a fasting blood glucose of 190 mg/dL and blood pressure of 145/90 mm Hg. The nurse recognizes that which other finding indicates sympathetic nervous system stimulation? Jugular venous distention Abnormal S3 and S4 sounds Ashen, clammy, and cool skin Shortness of breath and anxiety

Ashen, clammy, and cool skin Explanation (pg 748) A patient with heaviness and burning sensation in the substernal and retrosternal region may be having a myocardial infarction (MI) and stimulation of the sympathetic nervous system. This condition may trigger the production of catecholamines, which promote glycogen release, diaphoresis, and vasoconstriction of peripheral blood vessels. Because of this, the patient's skin may appear ashen, clammy, and cool to the touch. Jugular vein distention and abnormal S3 and S4 sounds are caused by ventricular dysfunction. Shortness of breath and anxiety may not necessarily be caused by sympathetic nervous system stimulation.

Which drug prevents platelet aggregation by inhibiting cyclooxygenase? Aspirin Heparin Abciximab Clopidogrel

Aspirin Explanation (pg 744) Aspirin produces antiplatelet activity by inhibiting cyclooxygenase, which in turn produces thromboxane A2, a potent platelet activator. Heparin prevents the conversion of fibrinogen to fibrin and prothrombin to thrombin. Abciximab prevents binding of fibrinogen to platelets, thereby blocking platelet aggregation. Clopidogrel acts by inhibiting the adenosine diphosphate receptor on the platelet cell membrane.

A nurse is caring for a patient with a myocardial infarction. The health care provider prescribes an intravenous infusion of alteplase. What is the priority nursing intervention during the administration of this medication? Assess neurologic status. Observe for bleeding gums. Apply a pressure dressing to intravenous (IV) insertion site. Monitor blood pressure for orthostatic changes.

Assess neurologic status. Explanation (pg 751) Assessment for changes in neurological status is the priority nursing intervention, because this may indicate a cerebral bleed. Gingival or bleeding gums are expected with thrombolytic therapy and are controlled by applying ice packs. Application of a pressure dressing to the IV insertion site is not done until evidence of bleeding is noted. Monitoring blood pressure for orthostatic changes is necessary with the use of short-acting nitrates.

Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication? Dehydration Paralytic ileus Atrial dysrhythmias Acute respiratory distress syndrome

Atrial dysrhythmias Explanation Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery. Although the other complications could occur, they are not common complications.

Which drugs help to prevent sudden closure of the stent used in coronary balloon angioplasty? Select all that apply. Verapamil Bivalirudin Enoxaparin Morphine sulfate Isosorbide dinitrate

Bivalirudin Enoxaparin Explanation (pg 746) A balloon angioplasty is performed in a patient with angina to dilate the coronary blood vessels. A stent is used to retain the lumen of the blood vessel dilated. Bivalirudin is used during angioplasty to prevent sudden closure of the stent. Enoxaparin is a low-molecular-weight heparin that is used to keep the blood vessel open during angioplasty. Verapamil is a calcium channel blocker that is given to a patient with beta blocker intolerance. Morphine sulfate is an analgesic and promotes vasodilation, reducing preload and myocardial oxygen consumption. Isosorbide dinitrate is the first line drug for treatment of angina.

A patient receives morphine sulfate to relieve chest pain. The nurse should monitor this patient for which complications associated with the medication? Select all that apply. Bradypnea Dysrhythmias Bradycardia Hypotension Decreased ejection fraction

Bradypnea Hypotension Explanation (pg 753) Morphine sulfate is prescribed to patients with chest pain. Morphine acts as a vasodilator; it decreases cardiac workload, contractility, and blood pressure. The nurse should monitor for signs of bradypnea and hypotension, to avoid myocardial ischemia and infarction. The nurse should monitor dysrhythmias and bradycardia in a patient receiving docusate. Morphine sulfate does not directly affect ejection fraction; indirectly, improved oxygenation will lead to more effective cardiac pumping.

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice? Baked flounder Angel food cake Baked potato with margarine Canned chicken noodle soup

Canned chicken noodle soup Explanation (pg 737) Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content. Baked flounder, angel food cake, and baked potato with margarine are all low in sodium and low in fat and would be appropriate for this diet.

Which drug may prevent or limit ventricular remodeling? Captopril Valsartan Metoprolol Nitroglycerin

Captopril Explanation (pg 744) Captopril is an angiotensin-converting enzyme (ACE) inhibitor that may prevent or limit ventricular remodeling. Valsartan is an angiotensin II receptor blocker that is used in patients who are intolerant to angiotensin-converting enzyme (ACE) inhibitor. Metoprolol is a β-adrenergic blocker that reduces heart rate, contractility, and blood pressure. Nitroglycerin is a nitrate that promotes coronary artery vasodilation.

Which drugs help optimize myocardial perfusion in chronic stable angina? Select all that apply. Aspirin Captopril Atorvastatin Propranolol Nitroglycerin

Captopril Propranolol Nitroglycerin Explanation (pg 741) Angiotensin converting enzyme inhibitors such as captopril, β-blockers such as propranolol, and nitrates such as nitroglycerin are used to optimize myocardial perfusion. Aspirin is an antiplatelet drug and atorvastatin is a lipid-lowering drug. These drugs are used in patients with angina for managing coronary artery disease.

A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that subsequently were attributed to ST segment elevation myocardial infarction (STEMI). What complication of myocardial infarction (MI) should the nurse anticipate? Unstable angina Cardiac tamponade Sudden cardiac death Cardiac dysrhythmias

Cardiac dysrhythmias Explanation (pg 748) The most common complication after MI is dysrhythmias, which are present in 80 percent of patients. Unstable angina is considered a precursor to MI rather than a complication. Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.

The nurse is teaching the family of a patient recently diagnosed with coronary artery disease (CAD). Which information on health promotion would the nurse include? Select all that apply. Consume diet low in fat and cholesterol Increase whole grains and fiber in the diet No need to limit consumption of simple sugars and alcohol Perform walking or biking at least 30 minutes four or more days per week Perform isometric exercises at least 30 minutes at least four days per week

Consume diet low in fat and cholesterol Increase whole grains and fiber in the diet Perform walking or biking at least 30 minutes four or more days per week Explanation (pg 736) Dietary modifications should include a decrease in saturated fat and cholesterol, as well as an increase in complex carbohydrates (whole grains, fruits, and vegetables) and fiber. A moderate physical activity program has to include isotonic exercises, such as walking, hiking, or jogging performed for at least 30 minutes on most week days. Consumption of alcohol and simple sugars will lead to an elevated triglyceride level. Isometric exercises, such as weight lifting, are recommended to increase muscle strength on two days per week only.

A patient with angina on sublingual nitroglycerine is not relieved after five minutes of drug administration. Which intervention by the nurse would be most appropriate in this situation? Contact the emergency medical services (EMS) immediately. Repeat the medication every 30 minutes for a maximum of three doses. Monitor for vital signs immediately and ask the patient to take rapid breaths. Instruct the patient to change positions rapidly after administration of the next dose.

Contact the emergency medical services (EMS) immediately. Explanation (pg 743) A patient with angina who is on sublingual nitroglycerine and whose condition worsens or does not resolve after administration of the medication should be referred to an emergency medical service (EMS) immediately for help. The drug should be administered to the patient every five minutes for a maximum of three doses. The nurse should take measures to reduce the severity of the condition first and then monitor vital signs. The patient may have difficulty in breathing so the nurse should not ask the patient to breathe rapidly. The nurse should advise the patient to make position changes slowly after taking the drug to prevent orthostatic hypotension.

A female patient complains of chest pain while at work. Which contributed to the patient's condition? Angina decubitus Diabetic neuropathy Raynaud's phenomenon Coronary microvascular disease

Coronary microvascular disease Explanation (pg 742) Microvascular angina occurs due to myocardial ischemia, which is associated with abnormalities of the coronary circulation and can also be triggered by daily activities. The patient with angina decubitus experiences chest pain while lying down and is usually relieved by standing or sitting. Diabetic neuropathy leads to damage of the nerves of the coronary system leading to silent ischemia. The patient with a history of Raynaud's phenomenon may experience Prinzmetal's angina.

A patient with three-vessel coronary artery disease has a random blood sugar level of 197 mg/dL. The laboratory reports show the presence of cardiac-specific troponin I (cTnI) and cardiac-specific troponin T (cTnT) markers. The nurse identifies that which intervention will benefit the patient? Placement of drug-eluting stents Coronary surgical revascularization Percutaneous coronary intervention Intraaortic balloon pump (IABP) therapy

Coronary surgical revascularization Explanation (pg 751) Coronary surgical revascularization helps restore the blood flow to the heart by replacing new blood vessels around existing blockages. This procedure is best for a patient with diabetes and three-vessel disease, because it helps improve perfusion to the myocardial muscle. A patient with confirmed myocardial infarction needs the placement of drug-eluting stents via cardiac catheterization. Percutaneous coronary intervention is a first line of treatment for a patient with definitive electrocardiogram changes and positive cardiac markers. Intraaortic balloon pump (IABP) therapy is used to treat severe left ventricular dysfunction.

A nurse is assessing a 53-year-old obese female patient who has been postmenopausal for three years. The nurse suspects that the patient may have coronary artery disease and asks the patient to test her lipid profile. What abnormality in the lipid profile would the nurse expect to find? Increased high-density lipoprotein and low-density lipoprotein levels Decreased high-density lipoprotein and low-density lipoprotein levels Decreased low-density lipoprotein and increased high-density lipoprotein levels Decreased high-density lipoproteins and increased low-density lipoprotein levels

Decreased high-density lipoproteins and increased low-density lipoprotein levels Explanation (pg 733) Following menopause, there is a significant increase in the low-density lipoprotein levels and a consequent reduction in the high-density lipoprotein levels. This occurs due to hormonal changes in the body. This makes postmenopausal women more susceptible to developing coronary artery disease. Obese postmenopausal women may have increased levels of both high-density lipoproteins and low-density lipoproteins (HDLs and LDLs). Because the patient is obese, the low-density lipoprotein (LDL) levels would be high and, because she is postmenopausal, there is a marked reduction in high-density lipoprotein levels (HDLs). Before menopause, high estrogen levels cause an increase in high-density lipoproteins and lowering of low-density lipoprotein levels. Text Reference - p. 733

A 67-year-old patient has coronary artery disease (CAD). Which question should the nurse ask to assess a need for additional teaching? When did you last have a bowel movement? Did you have any recent weight gain? Did you travel abroad within the last 12 months? Have you had pneumococcal vaccine?

Did you have any recent weight gain? Explanation (pg735) Risk for CAD increases with obesity, which is defined as a BMI more than 30 kg/m2. Constipation is not a risk factor for CAD. Traveling abroad to underdeveloped countries is a risk factor for infectious disease, but not for CAD. Pneumococcal vaccine protects the elderly patient from pneumonia, but not from CAD.

Which drugs act by decreasing the contractility of the heart? Select all that apply. Captopril Diltiazem Valsartan Carvedilol Morphine

Diltiazem Carvedilol Explanation (pg 744) Diltiazem is a calcium channel blocker that reduces the heart rate, contractility, and blood pressure. Carvedilol is a β-adrenergic blocker that also reduces the heart rate, contractility, and blood pressure. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that causes vasodilation by preventing conversion of angiotensin I to angiotensin II. Valsartan is an angiotensin II receptor blocker that causes vasodilation by inhibiting the binding of angiotensin II to angiotensin I receptors. Morphine is an opioid analgesic that acts as a vasodilator and reduces preload and myocardial oxygen consumption.

The nurse is providing teaching to a patient recovering from a myocardial infarction (MI). How should resumption of sexual activity be discussed? Delegated to the health care provider Discussed along with other physical activities Avoided because it is embarrassing to the patient Accomplished by providing the patient with written material

Discussed along with other physical activities Explanation (pg 760) Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching. It is helpful to consider sex a physical activity and to discuss or explore feelings in this area when other physical activities are discussed. The discussion of sexual activity should not be delegated to the health care provider or avoided because of embarrassment. Although providing the patient with written material is appropriate, it should not replace a verbal dialogue that can address the individual patient's questions and concerns.

A patient is admitted to the intensive care unit with a diagnosis of myocardial infarction. The patient is in stable condition. What are common medications used to treat this condition? Select all that apply. Diuretics Stool softeners Prophylactic antibiotics Dual antiplatelet therapy Intravenous (IV) nitroglycerin Low molecular weight heparin (LMWH)

Dual antiplatelet therapy Intravenous (IV) nitroglycerin Low molecular weight heparin (LMWH) Explanation (pg 744) Drug therapy for myocardial infarction includes intravenous nitroglycerin, dual antiplatelet therapy (e.g., aspirin and clopidogrel), and systemic anticoagulation with either LMWH given subcutaneously or IV UH, which are the initial drug treatments of choice for acute coronary syndrome (ACS). Oral beta-adrenergic blockers are given after day two if there are no contraindications (e.g., heart failure, heart block, hypotension). Diuretics and prophylactic antibiotics are not appropriate at this time.

A nurse is teaching a patient about strategies to prevent angina caused by coronary artery disease. The nurse tells the patient to avoid heavy meals, because they can further compromise the blood supply to the heart. What is the most likely reason for the nurse to give such advice? Eating a heavy meal can cause physical inactivity, which could precipitate angina. Eating a heavy meal would divert more blood to the gastrointestinal system. Heavy meals cause obesity and increase the susceptibility to myocardial ischemia. Heavy meals cause excessive heat production, which leads to peripheral vasodilation.

Eating a heavy meal would divert more blood to the gastrointestinal system Explanation (pg 740) The digestive system requires more blood supply for a longer period of time to digest heavy meals. Therefore blood is diverted to the gastrointestinal system, which causes reduced blood supply to the myocardium. Physical inactivity does not cause an anginal attack; angina can be precipitated by physical exertion. Eating heavy meals causes obesity in due course of time, and this increases the susceptibility of an individual to have coronary artery disease. This is not a valid reason here, because the patient already has coronary artery disease. Eating heavy meals does not cause peripheral pooling of blood.

The nurse prepares a discharge teaching plan for a 44-year-old male patient who has recently been diagnosed with coronary artery disease. Which risk factor should the nurse plan to focus on during the teaching session? Type A personality Elevated serum lipids Family cardiac history Hyperhomocysteinemia

Elevated serum lipids Explanation Dyslipidemia is one of the four major modifiable risk factors for coronary artery disease (CAD). The other major modifiable risk factors are hypertension, tobacco use, and physical inactivity. Research findings related to psychologic states (i.e., type A personality) as a risk factor for coronary artery disease have been inconsistent. Family history is a nonmodifiable risk factor. High homocysteine levels have been linked to an increased risk for CAD.

Which drug causes vasodilation by preventing conversion of angiotensin I to angiotensin II? Enalapril Losartan Amlodipine Nitroglycerine

Enalapril Explanation (pg 744) Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, resulting in vasodilation. Losartan is an angiotensin II receptor blocker that inhibits the binding of angiotensin II to angiotensin I receptors. Amlodipine is a calcium channel blocker that prevents calcium entry into the vascular smooth muscles and myocytes. Nitroglycerine is short-acting nitrate that causes peripheral vasodilation, thereby decreasing preload and afterload.

Which drug is given along with aspirin to patients with high risk for unstable angina? Heparin Warfarin Clopidogrel Eptifibatide

Eptifibatide Explanation (pg 744) Eptifibatide is used as a standard antiplatelet therapy in combination with aspirin for patients with high risk for unstable angina. Heparin is an anticoagulant, which is used for patients with angina and acute coronary syndrome. Warfarin is used as an alternative for patients who cannot use aspirin or clopidogrel. Clopidogrel is used as an alternative therapy for patients who cannot use aspirin, or it may be used in combination with aspirin.

The nurse is caring for a patient who survived sudden cardiac death (SCD) that was brought on by a lethal ventricular dysrhythmia. To reassure the patient, which tests should the nurse explain will be performed to monitor the effectiveness of drug treatment? Select all that apply. Exercise stress testing 24-hour Holter monitoring Magnetic resonance imaging Signal-averaged electrocardiogram Electrophysiologic study under fluoroscopy

Exercise stress testing 24-hour Holter monitoring Signal-averaged electrocardiogram Electrophysiologic study under fluoroscopy Explanation (pg 763) Because most SCD patients have lethal ventricular dysrhythmias associated with a high recurrence rate, they are closely monitored to assess when they are most likely to have a recurrence and to determine which drug therapies are most effective for them. This monitoring includes exercise stress testing, 24-hour Holter monitoring, signal-averaged electrocardiogram, and an electrophysiologic study done under fluoroscopy. Magnetic resonance imaging is not used to monitor for lethal dysrhythmias.

The nurse reviews the medical records of four patients with chest pain. Which patient does the nurse identify to maybe benefit from nitroprusside and intraaortic balloon pump (IABP) therapy?

Explanation (pg 749) Showing symptoms of dyspnea, pulmonary edema, and decreased cardiac output, Patient C may have papillary muscle dysfunction and is at risk for clinical deterioration. This patient must be given nitroprusside and intraaortic balloon pump (IABP) therapy to reduce the afterload on the heart. Patient A may have Dressler syndrome, which is treated by short-term corticosteroids. Patient B is exhibiting signs of acute pericarditis, which is treated by aspirin and nonsteroidal antiinflammatory agents. Patient D may have heart failure and may require intensive care.

For which antilipemic medications should the nurse question a prescription for in a patient with cirrhosis of the liver? Select all that apply. Niacin (Nicobid) Ezetimibe (Zetia) Gemfibrozil (Lopid) Atorvastatin (Lipitor) Cholestyramine (Questran)

Ezetimibe Atorvastatin Explanation (pg 739) Ezetimibe should not be used by patients with liver impairment. Adverse effects of atorvastatin, a statin drug, include liver damage and myopathy. Liver enzymes must be monitored frequently and the medication stopped if these enzymes increase. Niacin's side effects subside with time, although decreased liver function may occur with high doses. Cholestyramine is safe for long-term use.

The nurse is describing to the patient the progressive development of coronary artery disease (CAD). Place the developmental stages of CAD into their proper order. Collateral circulation: New blood circulation routes are created utilized. Fatty streaks: streaks of fat develop within the smooth muscles Fibrous plaque: collagen plaques from in the artery and blood flow is reduced Complicated lesion: trombus formation occurs

Fatty streaks: streaks of fat develop within the smooth muscle cells. Fibrous plaque: collagen plaques form in the artery and blood flow is reduced. Complicated lesion: thrombus formation occurs. Collateral circulation: New blood circulation routes are created or utilized Explanation (pg 731) The development stages of CAD are the fatty streaks stage, fibrous plaque stage, and finally, the complicated lesion stage. If the disease progresses far enough, collateral circulation increases, although this is not considered a formal developmental stage of CAD. In CAD, elevated levels of low-density lipoproteins cause the transport of cholesterol and other lipids into injured arterial intima (fatty streaks stage). Once there, the lipids and fibrous tissues form a plaque, which narrows the vessel lumen and causes a reduction of blood flow to the cardiac muscle (fibrous plaque stage). This ischemia of the cardiac muscle can lead to the development of angina (complicated lesion stage). Plaque forms in lesions in the arteries. If the blockage of coronary arteries occurs slowly over time, there is a chance of collateral circulation occurring, in which new routes of blood circulation are formed to bypass blockages.

The nurse is caring for patients who underwent coronary artery bypass graft surgery. The nurse identifies that the patients with which type of graft would be best helped by postoperative statin and antiplatelet therapies? Radial artery graft Saphenous vein graft Gastroepiploic artery graft Internal mammary artery graft

Gastroepiploic artery graft Explanation (pg 752) Coronary artery bypass graft surgery (CABG) involves the replacement of conduits that transport blood between the aorta and the coronary artery. A patient with a saphenous vein graft may develop intimal hyperplasia, which contributes to stenosis and graft occlusions. This patient should receive antiplatelet therapy and statins after surgery to improve vein graft patency. A patient with radial artery CABG should receive calcium channel blockers and long-acting nitrates to control coronary spasms. A patient with gastroepiploic artery CABG generally has a high graft patency rate; the chances of graft-related problems are very rare. A patient with CABG of the internal mammary artery has an average graft patency of more than 90 percent, even after 10 years. A patient with high graft patency rates may not require any medication to maintain the patency of the graft.

Which drug reduces triglycerides by decreasing the synthesis and secretion of very-low-density lipoproteins (VLDL)? Niacin Fluvastatin Gemfibrozil Cholestyramine

Gemfibrozil Explanation (pg 739) Gemfibrozil decreases the hepatic synthesis and secretion of VLDLs, which reduces the levels of triglycerides. Niacin inhibits the synthesis of VLDLs and low-density lipoproteins (LDL). Fluvastatin blocks the synthesis of cholesterol and increases the LDL receptors in the liver. Cholestyramine binds with the bile acids in the intestines, forming an insoluble complex. The binding results in the removal of LDL and cholesterol

A patient experienced sudden cardiac death (SCD) and survived. What should the nurse expect to be used as preventive treatment for the patient? External pacemaker An electrophysiologic study (EPS) Medications to prevent dysrhythmias Implantable cardioverter-defibrillator (ICD)

Implantable cardioverter-defibrillator (ICD) Explanation An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used but are not the best prevention of SCD.

A patient experienced sudden cardiac death (SCD) while hospitalized and survived. What should the nurse expect to be used as a preventive treatment for this patient while at home? External pacemaker An electrophysiologic study (EPS) Medications to prevent dysrhythmias Implantable cardioverter-defibrillator (ICD)

Implantable cardioverter-defibrillator (ICD) Explanation (pg 762) An ICD is the most common approach to preventing recurrence of SCD. An external pacemaker may be used in the hospital, but will not be used for the patient living daily life at home. An EPS may be done to determine if a recurrence is likely and determine the most effective medication treatment. Medications to prevent dysrhythmias are used, but are not best for prevention of SCD.

When teaching a patient about modifying risk related to serum lipid levels, what action should the nurse teach to help lower the risk of coronary artery disease? Decrease low-density and high-density lipoprotein levels. Increase low-density and high-density lipoprotein levels. Increase low-density lipoproteins and decrease high-density lipoprotein levels. Increase high-density lipoproteins and decrease low-density lipoprotein levels.

Increase high-density lipoproteins and decrease low-density lipoprotein levels. Explanation (pg 733) Low-density lipoproteins contain more cholesterol than any other lipoprotein and have an attraction to arterial walls, whereas high-density lipoproteins carry lipids away from the arteries to the liver for metabolism and prevent lipid accumulation within the arterial walls. Therefore, increasing high-density lipoprotein levels and decreasing low-density lipoprotein levels are most helpful in lowering the patient's risk of coronary artery disease. The nurse should not advise the patient to decrease high-density lipoproteins or increase low-density lipoprotein levels, because these actions would be counterproductive.

The nurse recognizes that which type of myocardial infarction (MI) may occur due to blockage of the right coronary artery? Inferior wall MI Anteroseptal MI Anterolateral MI Posterior wall MI

Inferior wall MI Explanation (pg 747) Blockage of the right coronary artery may result in an inferior wall myocardial infarction (MI) because the right coronary artery supplies blood to the inferior wall of the heart. Damage to one or more coronary arteries may result in anteroseptal and anterolateral MIs. Blockage of the left coronary artery may lead to a posterior wall MI.

The nurse assesses the right femoral artery puncture site as soon as the patient arrives after having a stent inserted into a coronary artery. The insertion site is not bleeding or discolored. What should the nurse do next to ensure the femoral artery is intact? Palpate the insertion site for induration. Assess peripheral pulses in the right leg. Inspect the patient's right side and back. Compare the color of the left and right legs.

Inspect the patient's right side and back. Explanation The best method to determine that the right femoral artery is intact after inspection of the insertion site is to logroll the patient to inspect the right side and back for retroperitoneal bleeding. The artery can be leaking and blood is drawn into the tissues by gravity. The peripheral pulses, color, and sensation of the right leg will be assessed per agency protocol.

The nurse is reviewing a plan of care for emergency treatment of a patient with chest pain. The nurse should question which item listed on the plan? Initiate supplemental oxygen. Administer emergency medications intravenously. Instruct the patient to perform breathing exercises immediately. Monitor the blood pressure and for Q and ST wave abnormalities regularly.

Instruct the patient to perform breathing exercises immediately. Explanation (pg 750) Rapid diagnosis and providing treatment to a patient with acute coronary syndrome help preserve cardiac muscle function. The initial treatment is to manage chest pain; therefore, the patient needs to rest and limit activities (including breathing exercises) for 12 to 24 hours. The nurse should make sure that the oxygen saturation stays at an acceptable level by initiating supplemental oxygen. The intravenous route for emergency medication therapy is preferred for patients with chest pain because this route is faster than oral administration. Continuous monitoring of electrocardiogram, vital signs, and pulse oximetry helps to evaluate the effectiveness of the treatments and monitor for complications.

A nurse has identified a group of people who are at risk for developing coronary artery disease. To prevent atherosclerosis, the nurse advises a reduction in salt consumption. How does salt consumption increase the risk of developing atherosclerosis? It causes hormonal imbalances It causes water retention It increases the fat levels in the body It increases homocysteine levels in the body

It causes water retention Explanation (pg 734) Salt contains sodium, which causes water retention in the body and thus hypertension. The shearing stress due to elevated blood pressure causes endothelial injury. This makes the blood vessels more susceptible to develop atherosclerosis. Hormonal changes, hyperlipidemia, and high homocysteine levels also contribute to atherosclerosis but are not caused by increased salt intake. Changes in the hormonal levels like a decrease in estrogen levels can increase the risk of atherosclerosis. Hyperlipidemia is a major predisposing factor for the development of atherosclerosis. Homocysteine contributes to atherosclerosis by damaging the inner lining of blood vessels, promoting plaque buildup, and altering the clotting mechanism to make clots more likely to occur.

A female patient who has type 1 diabetes mellitus has chronic stable angina that is controlled with rest. She states that over the past few months she has required increasing amounts of insulin. What goal should the nurse use to plan care that should help prevent cardiovascular disease progression? Exercise almost every day. Avoid saturated fat intake. Limit calories to daily limit. Keep Hgb A1C less than 7%.

Keep Hgb A1C less than 7%. Explanation If the Hgb A1C is kept below 7%, this means that the patient has had good control of her blood glucose over the past 3 months. The patient indicates that increasing amounts of insulin are being required to control her blood glucose. This patient may not be adhering to the dietary guidelines or therapeutic regimen, so teaching about how to maintain diet, exercise, and medications to maintain stable blood glucose levels will be needed to achieve this goal.

A patient with angina is prescribed a calcium channel blocker (CCB). Upon reviewing the medication history, the nurse finds that the patient is on digoxin. Which intervention by the nurse helps in ensuring safe care? Monitor for QT prolongation Monitor for increase in weight Monitor for decrease in blood pressure Monitor for increase in serum digoxin levels

Monitor for increase in serum digoxin levels Explanation (pg 745) CCB directly acts on cardiac and vascular smooth muscles and promotes smooth muscle relaxation and vasodilation of coronary and systemic arteries, thereby increasing the blood flow. The nurse should closely monitor the serum digoxin levels for toxicity because CCB potentiates the action of digoxin by increasing serum digoxin levels. QT wave prolongation should be monitored upon administration of sodium current inhibitors. Weight should be monitored in patients taking beta blockers. Long-acting nitrates such as isosorbide dinitrate and isosorbide mononitrate can cause hypotension, resulting in orthostatic hypotension.

The nurse provides a student nurse with information related to management of a patient following cardiac catheterization. Which intervention should the nurse explain is the specific responsibility of the nurse, rather than that of Unlicensed Assistive Personnel (UAP)? Asking the patient about comfort measures Recording vital signs Monitoring neurovascular changes Assisting with oral hygiene, hydration, meals, and toileting

Monitoring neurovascular changes Explanation (pg 756) The nurse is responsible for monitoring changes in neurovascular status or bleeding. All members of the health care team can address measures that will make the patient more comfortable. Unlicensed assistive personnel (UAP) take vital signs and assists with oral hygiene, hydration, meals and toileting.

A patient who has received a maximum dose of nitroglycerin continues to report chest pain. What is the next medication that the nurse should administer to the patient? Esmolol Docusate Morphine sulfate Ticagrelor

Morphine sulfate Explanation (pg 753) Morphine sulfate is the drug of choice for a patient with unrelieved chest pain even after the administration of nitroglycerin. Esmolol is a beta blocker used to slow down the heart during minimally invasive direct coronary artery bypass (MIDCAB). Docusate is a stool softener that facilitates bowel movements. Ticagrelor is used in dual antiplatelet therapy on a patient with ongoing angina and negative cardiac markers.

The nurse recognizes that which medication(s) may relieve spasms associated with radial artery coronary artery bypass surgery? Select all that apply. Captopril Carvedilol Nicardipine Tenecteplase Isosorbidedinitrate

Nicardipine Isosorbidedinitrate Explanation (pg 752) The radial artery is a thick muscular artery that is prone to spasm. A patient with coronary revascularization of the radial artery is administered long-acting nitrates and calcium channel blockers treatment. Nicardipine (a calcium channel blocker) and isosorbidedinitrate (a long acting nitrate) will help to control the spasms. Captopril, an ACE inhibitor, prevents ventricular remodeling and prevents the progression of heart failure in a patient with elevated ST-segment myocardial infarction. Carvidalol, a beta blocker, helps reduce workload on the heart. Tenecteplase stops the infarction in a patient with myocardial infarction (MI) by dissolving the thrombus and reperfusing the myocardium.

What condition might a nurse suspect in a patient who complains of a heavy, choking sensation at night while lying down or in a sitting position? Unstable angina Nocturnal angina Angina decubitus Prinzmetal's angina

Nocturnal angina Explanation (pg 742) Nocturnal angina occurs only at night but not necessarily when the patient is lying down or sleeping. Unstable angina occurs at rest or with minimal exertion, but not only at night. Angina decubitus occurs only when the patient is lying down and is relieved when the patient sits or stands. Prinzmetal's angina often occurs at rest, usually in response to spasms of a major coronary artery.

A 74-year-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which action will the nurse complete before administering sublingual nitroglycerin? Administer morphine sulfate IV. Auscultate heart and lung sounds. Obtain a 12-lead electrocardiogram (ECG). Assess for coronary artery disease risk factors.

Obtain a 12-lead electrocardiogram (ECG). Explanation If a patient has chest pain, the nurse should institute the following measures: (1) administer supplemental oxygen and position the patient in upright position unless contraindicated, (2) assess vital signs, (3) obtain a 12-lead ECG, (4) provide prompt pain relief first with a nitrate followed by an opioid analgesic if needed, and (5) auscultate heart sounds. Obtaining a 12-lead ECG during chest pain aids in the diagnosis.

After taking several types of prescribed medications, a patient with a calcified aorta continues to have an ejection fraction of 30% and recurring chest pain. Which treatment strategy does the nurse anticipate will help the patient? Off-pump coronary artery bypass Robot-assisted cardiothoracic surgery Transmyocardial laser revascularization Minimally invasive direct coronary artery bypass

Off-pump coronary artery bypass Explanation (pg 753) The off-pump coronary artery bypass (OPCAB) is a procedure to access the coronary vessels. OPCAB is useful for patients with a calcified aorta and ejection fraction of 30%. Robot-assisted cardiothoracic surgery is useful for mitral valve replacement. Transmyocardial laser revascularization will best help a patient with advanced coronary artery disease and persistent angina. Minimally invasive direct coronary artery bypass will help a patient with limited disease.

When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? Oxygen, nitroglycerin, aspirin, and morphine Oxygen, furosemide, nitroglycerin, and meperidine Aspirin, nitroprusside, dopamine, and oxygen Nitroglycerin, lorazepam, oxygen, and warfarin

Oxygen, nitroglycerin, aspirin, and morphine Explanation (pg 750) The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. Furosemide, meperidine, nitroprusside, dopamine, lorazepam, and warfarin may be used later in the patient's treatment.

The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion? Sinus tachycardia Pathologic Q wave Fibrillatory P waves Prolonged PR interval

Pathologic Q wave Explanation The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.

The nurse is caring for patients who are receiving treatment to reduce lipoproteins and cholesterol. Which findings describe a patient who would experience intensified effects when given warfarin? A. Pain in the knee joint while walking and rising with no inflammation B. Rashes on the skin, N/D, and alanine aminotransferase (ALT) level of 66u/L C. Rash, nausea, weak muscles, further weakening of skeletal muscles, and ALT level of 60u/L D. Flushing and itching below the neck, diarrhea, dyspepsia, N/V, orthostatic hypertension, and elevated homocysteine levels

Patient B - Rashes on the skin, N/D, and alanine aminotransferase (ALT) level of 66u/L Explanation (pg 739) Patient B may be on fibric acid derivative treatment such as fenofibrate, because its side effects are rashes, mild gastrointestinal disturbances, and elevated liver enzymes. Fibric acid derivatives may increase the effects of warfarin for Patient B. Patient A has pain in the knee joint with no inflammation, which is called arthralgia, a side effect of omega-3 fatty acids. Patient C has rash on the skin, gastrointestinal disturbances, and elevated liver enzymes along with myopathy and rhabdomyolysis. These are side effects of HMG-CoA reductase inhibitors such as atorvastatin. Patient D has pruritus and flushing in the upper torso with gastrointestinal disturbances, orthostatic hypotension, and elevated homocysteine levels, which are side effects of niacin.

The nurse is caring for patients on medication to lower lipid levels. For which patient is the use of penicillin contraindicated? Patient with indigestion, constipation, and bloating Patient with pain in the joints without inflammation Patient with itching below the neck and blood pressure of 80/50 mm Hg Patient with rashes and alanine aminotransferase level of 58 units per liter

Patient with indigestion, constipation, and bloating Explanation (pg 7390 Indigestion, constipation, and bloating are side effects of cholestyramine therapy, which interferes with the absorption of penicillin. Penicillin is contraindicated for the patient with these symptoms. The patient with arthralgia may be on medication with icosapent ethyl, which is an omega-3 fatty acid. The patient with pruritus and hypotension may be on medications with niacin. The patient with rashes and elevated levels of liver enzymes may be on drugs such as fenofibrate or gemfibrozil.

A patient with ventricular dysfunction receives a prescription for an angiotensin-converting (ACE) inhibitor. The nurse should monitor the patient for what side effect? Hyperactivity Persistent cough Decreased potassium levels Constipation

Persistent cough Explanation (pg 753) A nonproductive and persistent cough may occur in 5 percent to 25 percent of individuals. It may take up to two weeks or longer for coughing to subside after the ACE inhibitor is discontinued. If one ACE inhibitor causes coughing, it is likely that the others will also. Other side effects of ACE inhibitors include drowsiness (versus hyperactivity), elevated (versus decreased) blood potassium levels, and diarrhea (versus constipation).

A patient who uses nonsmoking tobacco complains of chest pain when at rest. His or her electrocardiogram (ECG) shows ST segment elevation. Which condition is the patient experiencing? Silent ischemia Angina decubitus Prinzmetal's angina Chronic stable angina

Prinzmetal's angina Explanation (pg 742) Prinzmetal's angina often occurs at rest, usually in response to spasms of a major coronary artery due to nicotine, which cause the release of catecholamines such as epinephrine and norepinephrine. When the spasms occur, the patient experiences pain and ST segment elevation. Silent ischemia refers to the ischemia that occurs in the absence of any subjective symptoms. Angina decubitus is chest pain that occurs only when the patient is lying down. Chronic stable angina does not occur at rest and is triggered by physical exertion.

Which type of angina is caused by coronary vasospasm? Unstable angina Prinzmetal's angina Microvascular angina Chronic stable angina

Prinzmetal's angina Explanation (pg. 742) Prinzmetal's angina is caused by coronary vasospasm. Unstable angina is caused by rupture of the thickened plaque. Microvascular angina is caused by myocardial ischemia secondary to microvascular disease. Chronic stable angina is caused by myocardial ischemia, which is usually secondary to coronary artery disease.

Which drug in the patient medication chart should be excluded in a patient with chronic stable angina who has a prolonged QT interval? Aspirin Heparin Captopril Ranolazine

Ranolazine Explanation (pg 745) Ranolazine is a sodium current inhibitor that further prolongs the QT interval in patients who have QT prolongation. Aspirin and heparin are safe in patients with chronic stable angina and are used to inhibit clot formation in blood vessels. Captopril is an angiotensin II converting inhibitor that reduces the risk of cardiac events by dilating the blood vessels and reducing blood pressure.

A nurse is teaching about coronary artery disease to a group of nursing students. To evaluate their understanding, the nurse asks them to explain why pain is referred to the shoulder, neck, and jaw in a case of stable angina. Prioritize the pathophysiologic events causing referred pain in stable angina. Accumulation of lactic acid in the myocardium Reduced blood supply to the myocardium Inadequate aerobic metabolism in the myocardium Transmission of pain impulses in the cardiac and upper thoracic posterior nerves Irritation of nerve fibers of the myocardial tissue

Reduced blood supply to the myocardium Explanation (pg 740) Coronary occlusion causes a reduced blood supply to the heart, thereby leading to myocardial ischemia. Because the blood supply is compromised, there is inadequate oxygen delivery to the myocardium for aerobic metabolism to take place. Anaerobic metabolism begins and leads to the accumulation of lactic acid. Lactic acid irritates the myocardial nerve fibers, and pain impulses are transmitted to the cardiac nerves and upper thoracic posterior nerve roots. This causes referred cardiac pain to the shoulder, neck, lower jaw, and arms.

The nurse observes a student nurse who is providing thrombolytic therapy to a patient three hours after the patient's report of chest pain. Which action performed by the student nurse indicates the need for the nurse to intervene? Monitors the patient for gingival bleeding Assesses the patient regularly for neurologic status changes Draws blood samples from the patient before initiation of the therapy Reduces the dose of the thrombolytic agent during episodes of chest pain

Reduces the dose of the thrombolytic agent during episodes of chest pain Explanation (pg 752) Thrombolytic therapy helps stop the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium. In order to be effective, the entire dose of a thrombolytic agent must be administered as soon as possible after the onset of symptoms. Unless contraindicated, the patient should be provided with heparin intravenously (IV) along with other thrombolytic therapy to dissolve the unstable thrombus and reduce spasms in the coronary artery. A major complication of the thrombolytic therapy is bleeding; therefore, the nurse should monitor for bleeding through the IV set and gingival bleeding. Monitoring for neurologic changes in the patient helps assess for cerebral bleeding. The nurse should draw the blood samples from the patient before initiation of the therapy to assess the baseline laboratory values.

Upon taking a lipid-lowering medication for hyperlipidemia, a patient reports muscle pain. The nurse notes the patient has elevated liver enzymes and creatine kinase levels. It is most likely that which lipid-lowering medication was taken by the patient? Niacin Simvastatin Gemfibrozil Colestipol

Simvastatin Explanation (pg 739) Muscle pain and elevated creatine kinase levels are manifestations of rhabdomyolysis. Elevated liver enzymes and rhabdomyolysis are adverse effects of statin drugs like Simvastatin. Side effects of niacin include pruritus and flushing. High doses of this drug may cause decreased liver function. Gemfibrozil is a fibric acid derivative that can cause rhabdomyolysis when given with a statin drug. Colestipol is a bile-acid sequestrant drug. This drug does not have any major adverse effects except that it lowers the absorption of drugs such as warfarin, digoxin, and thiazide diuretics. Colestipol is not related to rhabdomyolysis.

The nurse is preparing to conduct medication teaching for a patient who recently was diagnosed with coronary artery disease (CAD) and was started on new medications. Which information would be included in the teaching session? Select all that apply. Simvastatin acts by increasing lipoprotein removal. One of the most serious side effects of simvastatin is rhabdomyolysis. Ezetimibe, in combination with statins, produces greater reduction of low-density lipoprotein (LDL) levels. Ezetimibe is an example of lipid-lowering medications that are called statins. Liver enzymes have to be monitored at initiation of simvastatin and with dose increase

Simvastatin acts by increasing lipoprotein removal. One of the most serious side effects of simvastatin is rhabdomyolysis. Ezetimibe, in combination with statins, produces greater reduction of low-density lipoprotein (LDL) levels. Liver enzymes have to be monitored at initiation of simvastatin and with dose increase Explanation (pg 739) Simvastatin is a lipid-lowering agent that helps to remove LDLs from the blood by the liver, which may damage the liver. Rhabdomyolysis (breakdown of skeletal muscles) is the most serious side effect of simvastatin. Ezetimibe may be used as an addition to dietary restrictions or in combination with statins to augment their action. Simvastatin acts by restricting LDL production; this is an example of medications that are called statins. Ezetimibe acts by decreasing cholesterol absorption.

After being identified as high risk for traditional bypass surgery, a patient is scheduled for a minimally invasive direct coronary artery bypass (MIDCAB). The nurse recognizes that which steps are involved in the procedure? Select all that apply. A robot is used to replace the mitral valve. Cardiac catheterization is performed during the procedure. Small incisions are made between the ribs. A mechanical stabilizer is used on the beating heart. The heart is stopped temporarily by adenosine.

Small incisions are made between the ribs. The heart is stopped temporarily by adenosine. Explanation (pg752) Minimally invasive direct coronary artery bypass (MIDCAB) is performed on a patient with limited disease who is at a high risk for traditional bypass surgery. It involves several small incisions between the ribs to dissect the internal mammary artery (IMA) with a thoracoscope. The heart is then slowed or stopped temporarily with adenosine, which is assisted by a mechanical stabilizer to immobilize the operative site. The IMA is then sutured to the coronary artery. A robot is used to replace the mitral valve during robot-assisted cardiothoracic surgery. Transmyocardial laser revascularization involves cardiac catheterization. Mechanical stabilizers are used on a beating heart during off-pump coronary artery bypass.

The electrocardiogram (ECG) shows T wave inversion in a patient who comes to the emergency department complaining about a sharp, stabbing pain in the chest that lasted 10 minutes and occurred when lifting a heavy box at home. Which instructions given to the patient will help in managing the symptoms on reoccurrence? You should perform moderate exercise to relieve the pain. Take nitroglycerin before engaging in strenuous activities. You can engage in daily activities after taking the medication. Take nitroglycerin 30 minutes after performing strenuous activities.

Take nitroglycerin before engaging in strenuous activities. Explanation (pg 741) Ten minutes of a sharp, stabbing pain in the substernal region radiating to the neck and jaw when lifting a heavy box, and a T wave inversion in the ECG indicates that the patient is experiencing an attack of chronic stable angina. The patient should be advised to take nitroglycerin before engaging in activities, because the exertion will provoke angina and the patient may be at a risk. Patients with Prinzmetal's angina may get relief from chest pain by performing moderate exercise. The patient should wait for 30 minutes to one hour after taking the medication before engaging in daily activities. The patient should not take the nitroglycerine 30 minutes after exertion.

A patient prescribed nitroglycerin spray after reporting pain in the chest, arms, and neck region complains of persistent pain even after treatment. Which action of the patient should the nurse suspect to be the cause of the patient's condition? Taking the drug in the mornings Taking the medication through the nasal route Taking the drug even if having a tingling sensation Taking the medication 10 minutes before lifting weights

Taking the medication through the nasal route Explanation (pg 743) The patient needs to dose the medication properly to relieve symptoms. The patient should spray the medication on the tongue rather than inhale it through the nasal route. The patient may have an angina attack in the early mornings after awakening. Therefore, the patient should take the medication immediately after waking up to prevent the occurrence of attack. Upon administration of nitroglycerin, the patient should experience a tingling sensation. Otherwise, the drug may be outdated and should not be used. The patient should take the medication 5 to 10 minutes before performing an activity, such as lifting weights, that might trigger an angina attack.

Which individuals would the nurse identify as having the highest risk for CAD? A 45-year-old depressed male with a high-stress job A 60-year-old male with below normal homocysteine levels A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2

The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Explanation 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/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD.

A male patient who has coronary artery disease (CAD) has serum lipid values of LDL cholesterol 98 mg/dL and HDL cholesterol 47 mg/dL. What should the nurse include in the patient teaching? Consume a diet low in fats. Reduce total caloric intake. Increase intake of olive oil. The lipid levels are normal.

The lipid levels are normal. Explanation For men, the recommended LDL is less than 100 mg/dL, and the recommended level for HDL is greater than 40mg/dL. His normal lipid levels should be included in the patient teaching and encourage him to continue taking care of himself. Assessing his need for teaching related to diet should also be done.

Which factor leads to total occlusion of the coronary artery? Thrombus formation in the coronary artery Transport of cholesterol into the arterial intima Smooth muscle proliferation of the arterial wall Lipid-filled smooth muscle cells in the coronary artery

Thrombus formation in the coronary artery Explanation (pg 731) A thrombus may form and adhere to the wall of the coronary artery, leading to total occlusion. The transport of cholesterol into the arterial intima may lead to the formation of plaques on one portion of the artery, or in a circular fashion involving the entire lumen. Smooth muscle proliferation may lead to the thickening of the arterial wall. The earliest lesions are fatty streaks characterized by lipid-filled smooth muscle cells.

When providing nutritional counseling for patients at risk for coronary artery disease (CAD), which foods would the nurse encourage patients to include in their diet? Select all that apply. Tofu Walnuts Tuna fish Whole milk Orange juice

Tofu Walnuts Tuna fish Explanation (737) Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly. Whole milk and orange juice have no benefits for CAD.

Which type of angina increases in frequency, duration, and severity as the time progresses? Unstable angina Prinzmetal's angina Microvascular angina Chronic stable angina

Unstable angine Explanation (pg 742) Unstable angina is a chronic stable angina that increases in frequency, duration, and severity as the time progresses. Prinzmetal's angina occurs primarily at rest and is triggered by smoking and increased levels of substances, such as histamine and epinephrine. Microvascular angina is triggered by activities of daily life and exertion. Chronic stable angina is provoked by exertion and relieved by rest.

A patient who was prescribed captopril has an ejection fraction of 30%, a history of diabetes, and complains of stabbing chest pain that is relieved upon rest. At a follow-up visit, the primary care physician finds that the patient is intolerant of captopril. Which medication should be prescribed for this patient? Valsartan Tirofiban Paclitaxel Carvedilol

Valsartan Explanation 9pg 745) A patient with an ejection fraction of 30%, diabetes mellitus, and angina has a cardiovascular risk. The patient who is intolerable to angiotensin II converting enzyme inhibitors should receive an angiotensin II receptor blocker such as valsartan. Tirofiban is a glycoprotein IIb/IIIa inhibitor that is used to prevent the abrupt closure of the stents during percutaneous coronary intervention (PCI). Paclitaxel prevents the overgrowth of new intima that leads to stent restenosis. Carvedilol is a beta blocker that carries cautions for its use in a patient with diabetes, because it masks the signs of hypoglycemia.

A patient reports stabbing chest pain and shoulder pain. The nurse's assessment findings include tachycardia, a blood pressure of 160/96 mm Hg, sweating, and three to four recent episodes of vomiting. What condition does the nurse suspect the patient is experiencing? Acute pericarditis Cardiac neuropathy Acute kidney injury Ventricular dysrhythmias

Ventricular dysrhythmias Explanation (pg7480 A patient with stabbing chest pain and shoulder pain and a blood pressure of 160/96 mm Hg may be having a myocardial infarction. Myocardial infarction, resultant fluid electrolyte imbalance, and sympathetic nervous system stimulation may cause ventricular fibrillation, which may lead to fatal dysrhythmias. Acute pericarditis is an inflammation of the pericardium that results in cardiac tamponade and decreased ventricular filling and emptying. Cardiac neuropathy is common in patients with diabetes; this neuropathy causes silent ischemia and has atypical symptoms, such as dyspnea. Acute kidney injury is a complication of cardiogenic shock.

Which medication should the nurse suspect to be most beneficial to the patient who has cyclic and short bursts of pain in the chest during the day and night that are relieved after performing mild exercise? Prasugrel Sirolimus Abciximab Verapamil

Verapamil Explanation (pg 742) Cyclic and short bursts of pain in the chest during the day and night indicate Prinzmetal's angina. Calcium channel blockers such as verapamil and nitrates are useful to control this angina. Prasugrel is an antiplatelet agent used in the treatment of unstable angina. Abciximab is a glycoprotein IIb/IIIa inhibitor that helps prevent the binding of fibrinogen to platelets, thereby blocking platelet aggregation. Sirolimus is used in drug-eluting stents to prevent stent restenosis by preventing the overgrowth of new intima.

The nurse provides a list of activities that are considered to be moderate energy to a patient with acute coronary syndrome. Which activity is appropriate to be included on the list? Painting while seated Performing carpentry Walking at four miles per hour (mph) Running at seven miles per hour (mph)

Walking at four miles per hour (mph) Explanation (pg 760) Physical activity improves the physiologic functioning and psychologic well-being of a patient with acute coronary syndrome. Therefore, the nurse should encourage the patient to walk at a rate of three to four miles per hour. Painting while seated is a low-energy activity. Carpentry and running at seven miles per hour are high-energy activities for a patient with acute coronary syndrome.

A nurse is teaching a patient with coronary artery disease to decrease saturated and increase polyunsaturated dietary fat. Which major sources of polyunsaturated fats should the nurse include? Select all that apply. Walnuts Palm oil Egg yolk Margarine Sour cream

Walnuts Margarine Walnuts and margarine are major sources of polyunsaturated dietary fat. Palm oil, egg yolk, and sour cream are major sources of saturated dietary fat.

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic groups would the nurse select as the highest priority for this intervention? White male Hispanic male African American male Native American female

White Male bc white and male

A 52-year-old male patient has received a bolus dose and an infusion of alteplase (Activase) for an ST-segment elevation myocardial infarction (STEMI). To determine the effectiveness of this medication, the nurse should assess the patient for the presence of chest pain. blood in the urine or stool. tachycardia with hypotension. decreased level of consciousness.

presence of chest pain. Explanation Alteplase is a fibrinolytic that is administered to patients who have had an STEMI. If the medication is effective, the patient's chest pain will resolve because the medication dissolves the thrombus in the coronary artery and results in reperfusion of the myocardium. Bleeding is a major complication of fibrinolytic therapy. Signs of major bleeding include decreased level of consciousness, blood in the urine or stool, and increased heart rate with decreased blood pressure.