Ch 33 Acute Coronary Syndrome, Coronary Artery Disease

The client with a STEMI should be transferred to the cath lab for a cardiac catherization within what timeframe? 30 minutes 90 minutes 12 hours 72 hours

90 minutes

The nurse should educate the client on which of the following side effects of Nitroglycerin? High blood pressure Dizziness Increasing pain levels Decreasing headache

Dizziness

Which statement made by the student nurse indicates effective learning about cardiovascular disease? 1 "Nicotine stimulates catecholamine release." 2 "Isometric exercise provides relief from angina." 3 "Manifestations of angina often occur in the late evenings." 4 "Decreased heart rate increases myocardial oxygen demand."

1 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; the patient should take nitroglycerin 5 to 10 minutes before beginning activities that are known to cause angina. 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.

During the 48 hours after a myocardial infarction (MI), a nurse should assign the highest priority to monitoring the patient for what complication? 1 Dysrhythmias 2 Anxiety and fear 3 Metabolic acidosis 4 Medication side effects

1 The nurse must be most alert for dysrhythmias, which may signal another MI or impending complications. The nurse should also be alert for increased anxiety, which may cause pain and lead to a secondary infarction. Anxiety and fear are highly likely but secondary in importance to monitoring the patient for dysrhythmias. Metabolic acidosis and reactions to new medications are not likely but should still be included as part of overall assessment of the patient.

A patient with a history of unstable angina reports a sudden onset of retrosternal chest heaviness and tightness, fatigue, shortness of breath, and nausea. What actions should the nurse take? Select all that apply. 1 Obtain a 12-lead ECG. 2 Administer sublingual nitroglycerin. 3 Place the patient in a supine position. 4 Apply high-flow oxygen by face mask. 5 Auscultate for a pericardial friction rub.

1 Obtain a 12-lead ECG. 2 Administer sublingual nitroglycerin. Initial management of the patient with chest pain includes the following: Obtain a 12-lead ECG and start continuous ECG monitoring. Position the patient in an upright, not supine, position unless contraindicated, and initiate oxygen by nasal cannula (not high-flow by face mask) to keep oxygen saturation above 93%. Establish an intravenous (IV) route to provide an access for emergency drug therapy. Give sublingual nitroglycerin and aspirin (chewable). Morphine sulfate is given for pain unrelieved by nitroglycerin (NTG). Auscultating for a pericardial friction rub is not an appropriate action.

The nurse provides discharge teaching to a patient who is newly diagnosed with coronary artery disease (CAD). Which statement made by the patient indicates understanding of the dietary modifications that need to be implemented after discharge home? 1 "I will not eat bacon or any pork products." 2 "I will eat only fried eggs instead of boiled eggs." 3 "I may continue to enjoy French fries with hot dogs." 4 "I will drink no more than one glass of whole milk per day."

1 "I will not eat bacon or any pork products." 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 is caring for a patient who survived sudden cardiac death (SCD) that was caused by a lethal ventricular dysrhythmia. The nurse anticipates that which tests will be prescribed to monitor the effectiveness of drug treatment? Select all that apply. 1 Exercise stress testing 2 24-hour Holter monitoring 3 Magnetic resonance imaging (MRI) 4 Signal-averaged electrocardiogram (ECG) 5 Electrophysiologic study (EPS) under fluoroscopy

1,2,4,5 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 provides medication teaching to a patient who has been prescribed sublingual nitroglycerin tablets. Which statement made by the patient indicates the need for further education? 1 "When I put the tablet under my tongue, I should feel a tingling sensation." 2 "I can take as many tablets as needed until the pain goes away, each five minutes apart." 3 "I will need to be careful when I stand up because nitroglycerin can cause dizziness." 4 "If chest pain occurs, I will stop what I'm doing and place one tablet under my tongue."

2 The recommended dose for a patient who has been prescribed nitroglycerin (NTG) is one tablet taken sublingually or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should repeat NTG every 5 minutes for a maximum of three doses and contact emergency response system if symptoms have not resolved completely. Tell the patient to place an NTG tablet under the tongue and allow it to dissolve. NTG should cause a tingling sensation when administered; otherwise it may be expired and ineffective. Warn the patient that a headache, dizziness, or flushing may occur. Caution the patient to change positions slowly after NTG use because orthostatic hypotension may occur.

The nurse provides information about thrombolytic therapy to a group of student nurses. Which statement made by a student nurse indicates the need for further teaching? 1 "A symptom of major bleeding with thrombolytic therapy is an increase in heart rate." 2 "Significant facial trauma within the past 3 months is a relative contraindication." 3 "The goal is to give the thrombolytic within 30 minutes of the patient's arrival to the emergency department." 4 "The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the ECG."

2 "Significant facial trauma within the past 3 months is a relative contraindication." Significant closed-head or facial trauma within the past 3 months is an absolute contraindication due to increased risk of bleeding; the benefit does not outweigh the risk. Treatment of STEMI with thrombolytic therapy aims to limit the infarction size by dissolving the thrombus in the coronary artery and reperfusing the heart muscle. Signs and symptoms of bleeding during thrombolytic therapy include a drop in BP, increase in HR, sudden change in the patient's mental status, and blood in the urine or stool. The most reliable sign of blood flow restoration is the return of the ST segment to baseline on the ECG.

A patient with acute coronary syndrome (ACS) receives a prescription for niacin to treat hyperlipidemia. The nurse observes another care provider giving information about the medication to the patient. The nurse should question which item that was included in the education? 1 "Most side effects subside with time." 2 "Take the drug on an empty stomach." 3 "Decreased liver function may occur with high doses." 4 "A side effect is flushing and pruritus in the upper torso and face."

2 "Take the drug on an empty stomach. The drug should be taken with food. Side effects include flushing and pruritus in the upper torso and face as well as gastrointestinal (GI) disturbances. Most side effects subside with time. Decreased liver function may occur with high doses.

The nurse teaches a student nurse about acute pericarditis. Which statement made by the student nurse indicates effective learning? 1 "I should massage the patient in the chest region to relieve symptoms." 2 "The patient's chest pain can be relieved by sitting in the forward position." 3 "Acute pericarditis should be treated immediately by intravenous heparin." 4 "Treatment of acute pericarditis involves mitral valve repair or replacement."

2 "The patient's chest pain can be relieved by sitting in the forward position." Acute pericarditis is an inflammation of the pericardium that may occur within two to three days of acute myocardial infarction. The patient's chest pain is relieved after sitting in the forward position. The pain may return after a change in position or inspiration. Massaging the chest region may aggravate the symptoms. Intravenous heparin is given to a patient with an unstable thrombus or coronary artery spasm. Papillary muscle dysfunction treatment involves mitral valve repair or replacement. Acute pericarditis treatment involves nonsteroidal anti-inflammatory agents, aspirin, and corticosteroids.

A patient reports chest pain. The nurse should assess for which clinical manifestations associated with a myocardial infarction (MI)? Select all that apply. 1 Flushing 2 Ashen skin 3 Diaphoresis 4 Nausea and vomiting 5 S3 or S4 heart sounds

2 Ashen skin 3 Diaphoresis 4 Nausea and vomiting 5 S3 or S4 heart sounds 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.

The nurse assesses a patient who has been administered the tissue-type plasminogen activator alteplase for an acute myocardial infarction. Which assessment finding is the highest priority and should be reported to the primary health care provider immediately? 1 Anorexia 2 Hematuria 3 Oral temperature of 100.4° F (38° C) 4 Occasional premature ventricular contractions

2 Hematuria Alteplase is a proteolytic enzyme that digests threads and other substances in the blood, including clotting factors, thereby causing hypercoagulability of the blood and possibly bleeding, which is evidenced by blood in the urine. Anorexia and increased temperature are not issues directly related to this drug. Alteplase may cause premature ventricular contractions, which should be monitored, but this is usually not a problem because the drug has a short half-life.

The nurse assesses a patient with a family history of myocardial infarction (MI). Which assessment data indicates to the nurse that the patient has additional risk factors for coronary artery disease (CAD)? Select all that apply. 1 Smoking cessation three years ago 2 Serum cholesterol level of 260 mg/dL 3 Fasting triglyceride level of 110 mg/dL 4 High level of anxiety over last two years related to family issues 5 Lives with an adult child that smokes two packs of cigarettes per day 6 Works over 50 hours/week in an office as a receptionist with little time to exercise

2 Serum cholesterol level of 260 mg/dL 4 High level of anxiety over last two years related to family issues 5 Lives with an adult child that smokes two packs of cigarettes per day 6 Works over 50 hours/week in an office as a receptionist with little time to exercise Serum cholesterol level greater than 200 mg/dL is a risk factor for CAD. Stress is an additional risk factor for developing CAD. Secondhand smoke increases the risk of CAD. A sedentary job and lack of exercising are risk factors for CAD. Smoking cessation will lead to a reduced mortality rate after a period of 12 months. Fasting triglyceride levels above 150 mg/dL are a risk factor for CAD.

The nurse is providing teaching to a patient recovering from a myocardial infarction (MI). How should resumption of sexual activity be discussed? 1 Delegated to the health care provider 2 Discussed along with other physical activities 3 Avoided because it is embarrassing to the patient 4 Accomplished by providing the patient with written material

2 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.

Which statement made by the student nurse indicates effective learning regarding the instructions to be given to a patient that receives a prescription for nitroglycerin? 1 "I should direct the patient to inhale the spray containing medication." 2 "I should ask the patient to change position rapidly after the medication use." 3 "I should instruct the patient to report changes in the pattern of pain to the health care provider." 4 "I should encourage the patient to administer the medication every 30 minutes sublingually if symptoms persist."

3 Short-acting nitrates such as nitroglycerin (NTG) are first-line medications for angina. The nurse has to instruct the patient on NTG to report any changes in the pattern of pain, frequency of attack, or nocturnal angina to the health care provider. The nurse must direct the patient to spray the medication on his or her tongue. The nurse should ask the patient to slowly change positions after NTG use to avoid the effects of orthostatic hypotension. The nurse should ask the patient to take NTG every five minutes for a maximum of three doses if symptoms are not resolved.

In caring for the patient with angina the patient states, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever. It was similar to the pain I had at home. The pain went away rather quickly." What further assessment data should the nurse obtain from the patient? 1 "What precipitated the pain?" 2 "Has the pain changed this time?" 3 "In what areas did you feel this pain?" 4 "Rate the pain on a scale from 0 to 10

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

A patient that is being discharged from the hospital after acute coronary syndrome will be participating in cardiac rehabilitation. What information should the nurse provide about the early recovery phase of rehabilitation? 1 Therapeutic lifestyle changes should become lifelong habits. 2 Physical activity always begins in the hospital and continued at home. 3 Activity level is increased gradually with supervision by the rehabilitation team and with ECG monitoring. 4 The focus of rehabilitation will be on management of chest pain, anxiety, dysrhythmias, and other complications

3 Activity level is increased gradually with supervision by the rehabilitation team and with ECG monitoring. 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.

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? 1 Jugular venous distention 2 Abnormal S3 and S4 sounds 3 Ashen, clammy, and cool skin 4 Shortness of breath and anxiety

3 Ashen, clammy, and cool skin 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.

The nurse monitors a patient for complications of myocardial infarction. The nurse auscultates a new murmur at the cardiac apex. Which treatment strategies are appropriate for inclusion in the patient's care plan? Select all that apply. 1 Antiplatelets 2 Short-term corticosteroids 3 Cardiac surgery with mitral valve repair 4 Intraaortic balloon pump (IABP) therapy 5 Nonsteroidal antiinflammatory agents (NSAIDs)

3 Cardiac surgery with mitral valve repair 4 Intraaortic balloon pump (IABP) therapy Papillary muscle dysfunction is a complication of myocardial infarction and should be suspected if a new murmur at the cardiac apex is detected. It may occur if the infarcted area includes or is near the papillary muscle that attaches the mitral valve. The patient should be treated with nitroprusside, intraaortic balloon pump (IABP) therapy, or cardiac surgery with mitral valve repair to reduce the afterload of the heart. Antiplatelets, such as aspirin and nonsteroidal antiinflammatory agents, help treat acute pericarditis. Short-acting corticosteroids are effective in the treatment of Dressler syndrome.

The nurse assesses a patient with papillary muscle dysfunction. Which observation supports the patient's diagnosis? 1 Crackles 2 S3 heart sound 3 Murmur at the cardiac apex 4 Deep sound noted while auscultating at the lower sternal border

3 Murmur at the cardiac apex Papillary muscle dysfunction occurs if the papillary muscles attached to the mitral valves are involved in infarction. A patient may have papillary muscle infraction if a murmur is heard upon auscultation at the cardiac apex. The presence of crackles of breath sounds and S3 and S4 sounds of the heart indicate heart failure. The deep sound heard at the lower left sternal border upon auscultation indicates acute pericarditis.

Which is considered a nonmodifiable risk factor for coronary artery disease? 1 Obesity 2 Diabetes 3 Tobacco use 4 Family history of heart disease

4 Family history of heart disease is a nonmodifiable risk factor for coronary artery disease. Diabetes, obesity, and tobacco use are all considered modifiable risk factors for coronary artery disease.

After reviewing the medical records of four patients, the nurse identifies that which patient is at the highest risk of developing coronary artery disease (CAD)? 1 Patient A: 43-year-old nonsmoking African American male 2 Patient B: 26-year-old Hispanic male that smokes one pack of cigarettes per day 3 Patient C: 49-year-old Caucasian male with a blood pressure 139/82 mm Hg 4 Patient D: 72-year-old African American female with a cholesterol level of 300 mg/dL

4 Multiple risk factors increase the risk of CAD. Patient D has three risk factors: age over 55, African American ethnic background, and cholesterol level greater than 240 mg/dL. Patient A has two risk factors: middle age and male gender. Patient B has two risk factors for CAD: male gender and smoking. Patient C has two risk factors (age and gender) because the blood pressure is classified as prehypertension.

Which suggestion is most important for the nurse to provide to a patient with a waist circumference of 42 inches? 1 "Check your blood pressure regularly." 2 "Check your blood glucose levels regularly." 3 "Consume saturated fats for health reasons." 4 "Exercise regularly to maintain an ideal body weight."

4 Obesity is described as a waist circumference of more than 40 inches for men and more than 35 inches for women. 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 nurse provides a list of health-promoting regular physical activity examples to a patient with coronary artery disease (CAD). Which activity is appropriate to be included on the list? 1 Painting while seated 2 Performing carpentry 3 Jogging (7 to 8 miles per hour) 4 Brisk walking (3 to 4 miles per hour)

4 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.

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? 1 Monitors the patient for blood in the urine 2 Assesses the patient regularly for neurologic status changes 3 Draws blood samples from the patient before initiation of the therapy 4 Reduces the dose of the thrombolytic agent during episodes of chest pain

4 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 the urine and stool for 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.

The nurse provides education to a patient that receives a prescription for sublingual nitroglycerin for treatment of angina. Which statement made by the patient indicates the need for further teaching? 1 "I cannot take sildenafil and nitroglycerin at the same time." 2 "I can take a tablet 5 to 10 minutes before starting an activity that causes angina." 3 "After taking a tablet, I may experience a headache, dizziness, or flushing." 4 "After the bottle is open, the tablets lose potency and should be replaced every 12 months."

4 "After the bottle is open, the tablets lose potency and should be replaced every 12 months." After the bottle is open, the tablets lose potency and should be replaced every 6 months. The patient can take the medication prophylactically before starting an activity that is known to cause angina. In these cases the patient can take a tablet or spray 5 to 10 minutes before beginning the activity. Headache, dizziness, or flushing may occur after taking the medication. Patients should be instructed not to combine nitroglycerin with drugs used for erectile dysfunction (e.g., sildenafil [Viagra]) as severe hypotension can occur.

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 item? 1 Baked flounder 2 Angel food cake 3 Baked potato with margarine 4 Canned chicken noodle soup

4 Canned chicken noodle soup 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.

Diagnostic results of a patient indicate three-vessel coronary artery disease and 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? 1 Placement of drug-eluting stents 2 Percutaneous coronary intervention 3 Intraaortic balloon pump (IABP) therapy 4 Coronary revascularization with coronary artery bypass graft (CABG) surgery

4 Coronary revascularization with coronary artery bypass graft (CABG) surgery Coronary revascularization with CABG surgery 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 15-year-old patient that has a body mass index (BMI) of 32 kg/m 2. What is the first change in the coronary artery that occurs that makes patients susceptible to coronary artery disease? 1 Formation of thrombus in the coronary artery 2 Formation of fibrous plaque in the endothelium 3 Reduction of blood flow through the coronary arteries 4 Development of fatty streaks in the smooth muscles of the endothelium

4 Development of fatty streaks in the smooth muscles of the endothelium The endothelium of the coronary artery is usually unreactive to platelets, leukocytes, coagulation, fibrinolytic, and complement factors. Conditions such as hyperlipidemia, hypertension, and diabetes damage the endothelium, making them reactive to these substances. The patient is obese and therefore most likely has hyperlipidemia. Hyperlipidemia is a major risk factor for coronary artery disease. The first stage of coronary artery disease is the development of fatty streaks within the smooth muscles that appear by age 15.The fibrous plaque development takes place by age 30 and increases with age. As the age progresses, the fibrous plaque becomes larger in size. This compromises the integrity of the inner arterial wall. As more platelets get accumulated, there is thrombus formation. There is a reduction of blood flow through the coronary arteries because they are blocked due to the formation of fibrous plaque.

A patient is admitted to the intensive care unit with a diagnosis of myocardial infarction. The patient is in stable condition. The nurse recognizes what common medications that are used to treat this condition? Select all that apply. 1 Diuretics 2 Stool softeners 3 Prophylactic antibiotics 4 Dual antiplatelet therapy 5 Intravenous (IV) nitroglycerin 6 Low molecular weight heparin (LMWH)

4 Dual antiplatelet therapy 5 Intravenous (IV) nitroglycerin 6 Low molecular weight heparin (LMWH) 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 unfractionated heparin, 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 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? 1 Esmolol 2 Docusate 3 Ticagrelor 4 Morphine sulfate

4 Morphine sulfate 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.

After reviewing the lipid profile reports of four patients, the nurse expect that which patient will receive a prescription for cholestyramine? 1 Patient with a triglyceride level of 138 mg/dL 2 Patient with a total cholesterol level of 180 mg/dL 3 Patient with high-density lipoprotein (HDL) cholesterol of 60 mg/dL 4 Patient with low-density lipoprotein (LDL) cholesterol of 190 mg/dL

4 Patient with low-density lipoprotein (LDL) cholesterol of 190 mg/dL Patients with LDL cholesterol levels greater than 160 mg/dL are at a risk for acquiring coronary artery disease and would benefit from receiving cholestyramine. Patients with a triglyceride level of 138 mg/dL are not at a risk for coronary heart disease and cholestyramine is not indicated. Patients with total cholesterol levels less than 200 mg/dL do not require drug treatment because they are not at risk of developing coronary heart disease. Patients with HDL less than 40 mg/dL are at a risk of developing coronary heart disease and must be treated with appropriate drugs.

A patient recently diagnosed with coronary artery disease (CAD) asks the nurse: "What caused my problem?" The nurse responds that the CAD was most likely caused by what? 1 Orthostatic hypotension 2 Low oxygen saturation of the blood 3 The heart's inability to pump effectively 4 Fatty deposits on the walls of the coronary arteries

4 Fatty deposits on the walls of the coronary arteries 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.

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? 1 Give a high-dose statin. 2 Give 162 to 325 mg aspirin (chewable). 3 Start O 2 by nasal cannula to keep O 2 saturation above 93%. 4 Provide the patient with instructions related to cough and deep breathing exercises.

4. Provide the patient with instructions related to cough and deep breathing exercises. 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. Aspirin is part of the antiplatelet therapy. Statins are lipid-lowering drugs. They block synthesis of cholesterol and increase LDL receptors in the liver.

To prevent in-stent restenosis post coronary stent placement the nurse educates the patient on which topic? Dual antiplatelet therapy Need for a stool softner Lifelong Beta-Blocker therapy Short-term Antidysrhythmic drugs

Dual antiplatelet therapy

Which drug causes vasodilation by preventing conversion of angiotensin I to angiotensin II? 1 Enalapril 2 Losartan 3 Amlodipine 4 Nitroglycerin 00:00:06 Question Answer Confidence ButtonsJust a guessPretty sureNailed it

1 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. Nitroglycerin is short-acting nitrate that causes peripheral vasodilation, thereby decreasing preload and afterload.

Which statement by an 84-year-old patient with coronary artery disease (CAD) indicates understanding of discharge teaching about physical activity? 1 "I will use longer rest periods between exercise sessions." 2 "I can stop exercising as soon as my cardiac symptoms disappear." 3 "I should exercise outside all the time to achieve better results" 4 "I have to exercise for longer periods of time and more vigorously compared with younger people."

1 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.

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which population has the highest incidence of CAD? 1 White male 2 Hispanic male 3 African American male 4 Native American female

1 The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men. Hispanic individuals have lower rates of CAD than non-Hispanic whites or African Americans. African Americans have an earlier age of onset and more severe CAD than whites and more than twice the mortality rate of whites of the same age. Native Americans have increased mortality in 35-year-old and under people, and have major modifiable risk factors, such as diabetes.

Which drug produces an anticoagulant effect by interfering with hepatic synthesis of vitamin K-dependent clotting factors? 1 Warfarin 2 Prasugrel 3 Argatroban 4 Eptifibatide

1 Warfarin interferes with hepatic synthesis of the vitamin K-dependent clotting factors that result in an anticoagulant effect. Prasugrel causes an antiplatelet effect by inhibiting platelet aggregation. Argatroban acts by directly inhibiting the clotting factor thrombin and results in an anticoagulant effect. Eptifibatide prevents the binding of fibrinogen to platelets, thereby blocking platelet aggregation.

The nurse recognizes that which type of myocardial infarction (MI) may occur due to blockage of the right coronary artery? 1 Inferior wall MI 2 Anteroseptal MI 3 Anterolateral MI 4 Anterior wall MI

1 Inferior wall MI 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. Anterior wall infarctions result from blockages in the left anterior descending artery.

When planning emergent care for a patient with a suspected myocardial infarction (MI), what should the nurse anticipate administrating? 1 Oxygen, nitroglycerin, aspirin, and morphine 2 Aspirin, nitroprusside, dopamine, and oxygen 3 Nitroglycerin, lorazepam, oxygen, and warfarin 4 Oxygen, furosemide, nitroglycerin, and meperidine

1 Oxygen, nitroglycerin, aspirin, and morphin 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 provides medication education to a patient who recently was diagnosed with coronary artery disease (CAD) and that will begin taking lipid-lowering medications. What should the nurse include in the teaching? Select all that apply. 1 A major side effect of simvastatin is muscle weakness and pain. 2 Ezetimibe is an example of lipid-lowering medications that are called statins. 3 With niacin, flushing of the face and neck may occur within 20 minutes of taking the drug. 4 Liver enzymes need to be monitored at initiation of simvastatin and with dosage increase. 5 Ezetimibe, in combination with statins, produces greater reduction of low-density lipoprotein (LDL) levels.

1 A major side effect of simvastatin is muscle weakness and pain. 3 With niacin, flushing of the face and neck may occur within 20 minutes of taking the drug. 4 Liver enzymes need to be monitored at initiation of simvastatin and with dosage increase. 5 Ezetimibe, in combination with statins, produces greater reduction of low-density lipoprotein (LDL) levels. Unfortunately, many side effects are common with niacin, which include severe flushing of the face and neck within 20 minutes after taking the drug and may last 30 to 60 minutes. 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; it is a statin. Simvastatin increases LDL receptors in the liver; therefore live enzymes need to be assessed when initiating the drug and with dose changes.

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. 1 Bradypnea 2 Dysrhythmias 3 Bradycardia 4 Hypotension 5 Decreased ejection fraction

1 Bradypnea 4 Hypotension 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.

The nurse is preparing an initial care plan for a patient that presents with chest pain. What is the priority nursing intervention? 1 Monitoring the patient's ECG 2 Discussing the losses associated with chronic illness 3 Encouraging verbalization of feelings, perceptions, and fears 4 Advising the patient to avoid heavy meals and extreme weather conditions

1 Monitoring the patient's ECG A patient with chest pain may have acute coronary syndrome. The priority is to stabilize the patient, determine the plan of care, and prevent complications. Ongoing care should include continuous ECG monitoring. The nurse should help the patient with anxiety and stress to work on the losses due to chronic illness to prevent sudden depression-related cardiac workload. A patient with chronic stable angina is advised to avoid heavy meals and extreme weather to reduce the probability of symptoms. The nurse should encourage verbalization of feelings, perceptions, and fears that increases workload on heart.

A patient with a diagnosis of unstable angina is admitted to the intensive care unit. The nurse anticipates that which drug therapies will be prescribed? Select all that apply. 1 Nitrates 2 Antiplatelet therapy 3 Anticoagulant therapy 4 Beta-adrenergic blockers 5 Angiotensin-converting enzyme (ACE) inhibitors

1 Nitrates 2 Antiplatelet therapy 3 Anticoagulant therapy Nitrates are the first line of drug therapy for angina because of their mechanisms of dilating peripheral blood vessels to reduce cardiac workload and dilating the coronary arteries and collateral vessels to increase blood flow to ischemic areas of the heart. Antiplatelet therapy works in different ways to inhibit platelet activation and aggregation. Anticoagulants have several different mechanisms of action to prevent the formation of fibrin and thrombin and interfere with formation of clotting factors. Beta-adrenergic blockers are commonly used in the treatment of chronic stable angina and acute coronary syndrome. ACE inhibitors are used for heart failure, tachycardia, myocardial infarction, hypertension, diabetes, and chronic kidney disease.

When providing nutritional counseling for patients at risk for coronary artery disease (CAD), which dietary selections should the nurse encourage them to include in their meal-planning? Select all that apply. 1 Tofu 2 Walnuts 3 Flaxseed 4 Whole milk 5 Orange juice

1,2,3 Tofu, walnuts, and flaxseed 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 complementary lipid-lowering agents may be recommended to a patient for reduction of total cholesterol? Select all that apply. 1 Soy 2 Psyllium 3 Flaxseed 4 Plant sterols 5 Red yeast rice 6 Omega-3 fatty acids

1,2,4,5 There is scientific evidence that plant sterols, soy, red yeast rice, and psyllium all contribute to the total reduction of cholesterol. There is some evidence that flaxseed may reduce the risk of heart disease, diabetes, and stroke, but not lower total cholesterol. Omega-3 fatty acids are responsible for the reduction of triglyceride levels, but not total cholesterol.

A nurse who is preparing a patient for cardiac catheterization should perform a baseline assessment of vital signs, pulse oximetry, and heart and lung sounds. What other vital assessment should the nurse include? 1 Anemia 2 Allergies 3 Dysrhythmia 4 Mental status

2 Before performing a cardiac catheterization, the nurse should assess the patient for an allergy to contrast medium, which would have an immediate adverse effect on the patient receiving this procedure. Anemia, dysrhythmia, and change in mental status present less immediate complications during a cardiac catheterization procedure.

Which drug binds to antithrombin III, enhancing its effects? 1 Warfarin 2 Bivalirudin 3 Dalteparin 4 Ticagrelor

3 Dalteparin binds to antithrombin III, enhancing its effect. Warfarin interferes with hepatic synthesis of vitamin K-dependent clotting factors, producing an anticoagulant effect. Bivalirudin acts by directly inhibiting the clotting factor, thrombin. Ticagrelor inhibits platelet aggregation and is used along with aspirin.

A patient with hyperlipidemia has been prescribed niacin. The nurse administers aspirin 30 minutes before administering niacin for what reason? 1 To relieve pain 2 To prevent clotting of blood 3 To prevent flushing of skin 4 To prevent the formation of atherosclerotic plaque

3 Flushing of the face and neck is a common side effect of niacin. Premedicating the patient with aspirin reduces flushing. Aspirin is an analgesic and antiplatelet medication. Platelet aggregation prevents the formation of atherosclerotic plaque. In this case the most likely reason for the nurse to administer this drug is to relieve flushing.

The rupture of plaque in the artery occurs in which stage of the pathogenesis of arterial disease? 1 Fatty streak 2 Fibrous plaque 3 Complicated lesion 4 Chronic endothelial injury

3 The rupture of plaque in the artery occurs when the lesion is complicated. The plaque ruptures, and thrombus formation occurs, as does further narrowing or total occlusion of the vessel. Fibrous plaque occurs when collagen covers the fatty streak, narrowing the artery, thus reducing the blood flow. When the fatty streak forms, lipids accumulate and migrate into the smooth muscle cells. Chronic endothelial injury occurs secondary to exposure of toxins, infections, and certain disease processes.

A patient phones a health care provider's office and states, "I am having severe chest tightness that won't go away even when I lie down." In addition to contacting emergency responders, what instruction should the nurse provide to the patient? 1 "Lie down with your feet elevated." 2 "Go to a neighbor's house to get assistance." 3 "Take chewable aspirin. The total dose should be 325 mg." 4 "Take your blood pressure. It will be useful information for your care."

3 The symptoms described by the patient may be due to acute coronary syndrome (ACS). Advise the patient to take chewable aspirin; the dose is 162 to 325 mg (typically 4 baby aspirin or 2 adult aspirin). The patient should not increase oxygen demand by walking to a neighbor's house or by taking the BP. The patient's BP may be elevated and lying with the feet elevated will most likely increase the BP.

The nurse is providing postoperative care to a patient that underwent coronary artery bypass graft (CABG) surgery. The nurse should monitor the patient for what common complication? 1 Dehydration 2 Paralytic ileus 3 Atrial dysrhythmias 4 Acute respiratory distress syndrome

3 Atrial dysrhythmias Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first three days following CABG surgery. Although dehydration, paralytic ileus, and acute respiratory distress syndrome could occur, they are not common complications.

Which drug reduces triglycerides by decreasing the hepatic synthesis and secretion of very-low-density lipoproteins (VLDL)? 1 Niacin 2 Fluvastatin 3 Gemfibrozil 4 Cholestyramine

3 Gemfibrozil 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 with acute coronary syndrome (ACS) is scheduled for an off-pump coronary artery bypass (OPCAB) surgery. The nurse reviews the patient's history and notes the presence of multiple co-morbidities. The nurse identifies that the OPCAB procedure is used for this type of patient for what reason? 1 It does not involve a sternotomy. 2 It is associated with decreased postoperative spasms. 3 It is associated with less blood loss and less renal dysfunction. 4 It uses a robot to perform the surgery which is associated with increased precision.

3 It is associated with less blood loss and less renal dysfunction. The off-pump coronary artery bypass (OPCAB) is a procedure which allows for access to all coronary vessels. OPCAB is useful for patients with multiple co-morbidities since it is associated with less blood loss, less renal dysfunction, less postoperative atrial fibrillation, and fewer neurologic complications. It involves a median sternotomy. This type of surgery does not have an advantage of decreased postoperative spasms. The robotic or totally endoscopic coronary artery bypass (TECAB) surgery uses a robot to perform CABG surgery.

Which drug acts by direct inhibition of the clotting factor thrombin? 1 Heparin 2 Felodipine 3 Enoxaparin 4 Argatroban

4 Argatroban is a 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.

Which type of angina occurs in the absence of significant coronary artery disease (CAD)? 1 Silent angina 2 Unstable angina 3 Prinzmetal's angina 4 Microvascular angina

4 Microvascular angina occurs in the absence of coronary atherosclerosis or vasospasm. It is mainly associated with abnormalities of coronary microcirculation. Silent ischemia mostly occurs in patients with diabetes because diabetic neuropathy affects the nerves that innervate the cardiovascular system. Unstable angina occurs due to the rupture of thickened plaque. Prinzmetal's angina often occurs at rest in response to spasms of a major coronary artery.

A patient asks the nurse about resuming sexual activity after acute coronary syndrome (ACS). What should the nurse include in the patient's teaching plan? 1 Take a hot shower just before intercourse to provide relaxation. 2 Limit the time, including foreplay, to 30 minutes to prevent overexertion. 3 Wait an hour after ingesting a large meal before engaging in sexual activity. 4 Taking a prophylactic nitrate may decrease chest pain during sexual activity.

4 Taking a prophylactic nitrate may decrease chest pain during sexual activity. Hot or cold showers should be avoided just before or after intercourse. Consumption of food and alcohol should be reduced before intercourse is anticipated (e.g., waiting 3-4 hours after ingesting a large meal before engaging in sexual activity). There is no established time limit. Foreplay is desirable because it allows a gradual increase in heart rate before orgasm.

The nurse is caring for a patient 24 hours after the patient was diagnosed with ST segment elevation myocardial infarction (STEMI). The nurse should monitor the patient for what complication of myocardial infarction (MI)? 1 Unstable angina 2 Cardiac tamponade 3 Sudden cardiac death 4 Cardiac dysrhythmias

4 Cardiac dysrhythmias 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.

To reduce a patient's risk of coronary artery disease (CAD), the nurse recognizes that dietary teaching is needed when the patient's high density lipoprotein (HDL) and low-density lipoprotein (LDL) profile reveals what two abnormal results? 1 Increased HDLs; increased LDLs 2 Decreased HDLs; decreased LDLs 3 Increased HDLs; decreased LDLs 4 Decreased HDLs; increased LDLs

4 Decreased HDLs; increased LDLs The risk of CAD is associated with increased LDLs (> 160 mg/dL) and decreased HDLs (< 40 mg/dL).

Diagnostic tests confirm that a patient has experienced a ST-segment-elevation myocardial infarction (STEMI). The nurse should prepare the patient for what first line of treatment? 1 Antiplatelet and statins therapy 2 Dual antiplatelet therapy and heparin 3 Transmyocardial laser revascularization 4 Percutaneous coronary intervention (PCI)

4 Percutaneous coronary intervention (PCI) Emergent PCI is the first line of treatment for patients with confirmed STEMI (i.e., ST-elevation on the ECG and/or positive cardiac biomarkers). The goal is to open the blocked artery within 90 minutes of arrival to a facility that has an interventional cardiac catheterization laboratory. Antiplatelet and statins therapy improves vein graft patency in a patient who has undergone CABG involving the saphenous vein. Dual antiplatelet therapy and heparin will help a patient with ongoing angina and negative cardiac markers. Transmyocardial laser revascularization is used for a patient with advanced coronary artery disease and persistent angina even after maximum medical therapy.

The nurse is caring for a patient that is scheduled for an angioplasty with placement of a drug-eluting stent. The nurse recalls that the steps of the stent procedure occur in what order? 1. Balloon is inflated. 2. Blockage is identified. 3. Improved blood flow occurs. 4. Intimal lining grows over the stent and provides a smooth vascular surface 5. Stent is placed into the coronary artery.

Correct1.Blockage is identified. Correct2.Stent is placed into the coronary artery. Correct3.Balloon is inflated. Correct4.Improved blood flow occurs. Correct5.Intimal lining grows over the stent and provides a smooth vascular surface After blockage is identified, treatment options, including angioplasty with stent placement, are explored. Stents are small, expandable tubes that are inserted during angioplasty into a blocked section of the coronary artery to open the artery and improve blood flow. During angioplasty, the balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall to keep the narrowed artery open. Because the stent is like woven mesh, the cells lining the blood vessel grow through and around the stent to help secure it. Drug-eluting stents are coated with drugs that prevent scar tissue from growing into the artery. Drug-eluting stents may lower the chance that the patient will need a second procedure (angioplasty or surgery) to open the artery again.

Which complication of a myocardial infarction may be treated with high dose aspirin? Heart failure Ventricular tachycardia Dressler's syndrome Papillary muscle dysfunction

Dressler's syndrome

A patient is prescribed a statin drug to decrease levels of low-density lipoproteins and triglycerides. The nurse should teach the patient to observe for what symptoms? Select all that apply. 1 Rash 2 Pruritus 3 Flushing 4 Muscle pain 5 Muscle weakness 6 Gastrointestinal disturbances

1 Rash 4 Muscle pain 5 Muscle weakness 6 Gastrointestinal disturbances Statin drugs have been found to lower low-density lipoproteins and triglycerides. Common side effects of this class of drugs include rash, myopathy, rhabdomyolysis, and gastrointestinal disturbance, as well as elevated enzyme levels. Flushing and pruritus in the upper torso and face have not been cited as a side effect of statins but may be seen with the use of niacin.

Which type of angina increases in frequency, duration, and severity as the time progresses? 1 Unstable angina 2 Prinzmetal's angina 3 Microvascular angina 4 Chronic stable angina

1 Unstable angina 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.

The nurse assesses an older patient for risk factors for coronary artery disease (CAD). What question should the nurse ask the patient? 1 What is your BMI number? 2 Did you receive a pneumococcal vaccine? 3 When did you last have a bowel movement? 4 Did you travel abroad within the last 12 months?

1 What is your BMI number? 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.

The nurse is caring for a patient two days after the patient experienced a myocardial infarction. The nurse should monitor the patient for what complications? Select all that apply. 1 Pericarditis 2 Heart failure 3 Dysrhythmia 4 Dressler syndrome 5 Cardiogenic shock

1, 2, 3, 5 Dysrhythmia, heart failure, pericarditis, and cardiogenic shock are all serious complications that can arise immediately and several days after myocardial infarction. Dressler syndrome is also a possible complication post myocardial infarction but presents as pericarditis with effusion and fever that develops four to six weeks later.

After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement? 1 "I will replace my nitroglycerin supply every six months." 2 "I can take up to five tablets every three minutes for relief of my chest pain." 3 "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin." 4 "I will take the nitroglycerin 10 minutes before a planned activity that usually causes chest pain."

2 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.

A patient experiences prolonged chest pain that is not immediately reversible. The patient's health care provider explains that the cause of the pain is that a once-stable atherosclerotic plaque has ruptured, causing platelet aggregation and thrombus formation. The nurse recognizes this meets the definition of what diagnosis? 1 Unstable angina 2 Acute coronary syndrome (ACS) 3 ST segment elevation myocardial infarction (STEMI) 4 Non-ST segment elevation myocardial infarction (NSTEMI)

2 Acute coronary syndrome (ACS) When ischemia is prolonged and not immediately reversible, ACS develops. 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.

Which drug breaks up the fibrin meshwork in clots? 1 Nadolol 2 Alteplase 3 Valsartan 4 Nicardipine

2 Alteplase 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.

The nurse is examining the ECG of a patient who has just been admitted with a suspected myocardial infarction (MI). Which ECG change is most indicative of prolonged or complete coronary occlusion? 1 Sinus tachycardia 2 Pathologic Q wave 3 Fibrillatory P waves 4 Prolonged PR interval

2 Pathologic Q wave The presence of a pathologic Q wave, which often accompanies ST segment elevation myocardial infarction (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 recalls that coronary revascularization with coronary artery bypass graft (CABG) surgery is recommended for which patients? Select all that apply. 1 Patients with severe aortic stenosis 2 Patients who fail medical management 3 Patients with left main coronary artery or three-vessel disease 4 Patients who are not candidates for percutaneous coronary intervention (PCI) 5 Patients who have failed percutaneous coronary intervention (PCI) and continue to have chest pain

2 Patients who fail medical management 3 Patients with left main coronary artery or three-vessel disease 4 Patients who are not candidates for percutaneous coronary intervention (PCI) 5 Patients who have failed percutaneous coronary intervention (PCI) and continue to have chest pain Coronary revascularization with CABG is recommended for patients who have diabetes mellitus, have left main coronary artery or three-vessel disease, patients who are not candidates for percutaneous intervention and who have failed percutaneous intervention and continue to have chest pain, and those who are expected to have longer-term benefits with this surgery than with catheterization. Severe aortic stenosis is not an indicator for cardiac revascularization surgery.

A patient is scheduled for a coronary artery bypass graft (CABG) surgery. The nurse reviews the surgical plan and notes that the type of graft that will be used is prone to future stenosis and graft occlusion. Therefore the nurse anticipates postoperative use of antiplatelet and statin therapy to improve graft patency. Which type of graft will be used for the surgery? 1 Radial artery graft 2 Saphenous vein graft 3 Gastroepiploic artery graft 4 Internal mammary artery graft

2 Saphenous vein graft 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.

A patient with angina takes a total of three nitroglycerin tablets, five minutes apart. The patient's chest pain is not relieved. What is the nurse's priority action? 1 Assess vital signs. 2 Repeat the medication in five minutes. 3 Contact the emergency medical services (EMS). 4 Instruct the patient to lie quietly and to take deep breaths.

3 A patient with angina who takes sublingual nitroglycerin 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 or to provide patient instructions.

A patient with chronic stable angina has received a prescription for sublingual (SL) nitroglycerin. The nurse tells the patient that orthostatic hypotension is a side effect of the drug. What should the nurse include in the patient's teaching about preventing complications associated with the side effect? 1 "Take your blood pressure daily and record the measurement." 2 "Take the medication with each meal, while you are in a seated position." 3 "Avoid sudden changes in position after taking nitroglycerin to prevent falls." 4 "If the medication causes a tingling sensation, this indicates that the hypotension will be more severe."

3 Nitrates cause vasodilatation, which in turn causes peripheral pooling of blood. If a patient changes position suddenly (from recumbent to erect posture), there is a sudden drop of blood pressure, which is known as orthostatic hypotension. This decreases the blood supply to the brain, which may lead to dizziness and falling. Taking the blood pressure daily will not prevent orthostatic hypotension. The medication should be taken as needed, not with each meal. If there is no tingling sensation when taking the drug, then the medication may be expired or ineffective; the sensation is not associated with the degree of severity of the hypotension.

The nurse is performing an assessment on a newly admitted patient who presented to the emergency department with reports of chest pain. Which assessment data would indicate that the patient has stable angina? 1 The patient developed chest pain shortly after going to bed. 2 The patient developed chest pain while sitting and reading a book. 3 The pain developed when the patient was jogging and subsided after the patient rested. 4 The pain starts approximately the same time every day without regard to activity level.

3 Pain associated with stable angina is precipitated by increased demand of myocardial muscle for oxygen that happens with exercising or other activity and subsides with rest in 5 to 15 minutes. Prinzmetal's angina (variant angina) occurs at rest. Nocturnal angina occurs when patient is supine in bed. Prinzmetal's angina (variant angina) is characterized by pain that occurs at the same time of the day.

A patient is recovering from an uncomplicated myocardial infarction (MI). Which instructions will the nurse include when discussing physical activity? 1 "Start out with 30-minute sessions." 2 "Be sure to perform physical activity at least twice a week." 3 "Physical activity should be regular, rhythmic, and repetitive." 4 "Your heart rate during exercise should only go up to 30 beats over your resting heart rate.

3 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

The nurse recognizes that which medication(s) may relieve spasms associated with radial artery coronary artery bypass surgery? Select all that apply. 1 Captopril 2 Carvedilol 3 Nicardipine 4 Verapamil 5 Tenecteplase

3 Nicardipine 4 Verapamil 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 and verapamil are calcium channel blockers that 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. Carvidilol, 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.

Which is a characteristic of a complicated lesion? 1 Formation of a fibrous plaque 2 Lipid-filled smooth muscle cells 3 Platelet aggregation and adhesion 4 Transport of lipids into arterial intima

3 Platelet aggregation and adhesion A complicated lesion is characterized by accumulation of platelets leading to thrombus formation. Formation of a fibrous plaque is the beginning of progressive changes in the endothelium of the arterial wall. It is called the fibrous plaque stage. Fatty streaks are the earliest lesions of atherosclerosis and are characterized by lipid-filled smooth muscle cells. Transport of lipids into the arterial intima occurs in the fibrous plaque stage.

A patient experienced sudden cardiac death (SCD) while hospitalized and survived. The nurse expects that what preventive treatment will be prescribed? 1 External pacemaker 2 An electrophysiologic study (EPS) 3 Medications to prevent dysrhythmias 4 Implantable cardioverter-defibrillator (ICD)

4 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.

A patient takes atorvastatin to lower the patient's LDL level and to increase the HDL level. The patient reports a recent onset of muscle weakness and pain. The nurse identifies that what lab studies should be performed? 1 Electrolytes 2 Renal function tests 3 Thyroid function tests 4 Creatine kinase isoenzymes

4 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. Creatine kinase isoenzymes (e.g., CK-MM) should be assessed is symptoms of myopathy occur. Performing electrolytes, thyroid function tests, and/or renal function tests are not necessary for the patient described.

The nurse provides information to a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates understanding of the teaching? 1 "I will add weightlifting to my daily exercise program." 2 "I will change my diet to increase my intake of saturated fats." 3 "I need to switch to smokeless tobacco instead of smoking cigarettes." 4 "I will change my lifestyle to alter patterns that add to my stress."

4 "I will change my lifestyle to alter patterns that add to my stress." Health-promoting behaviors for those at risk for CAD include: 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.

The nurse is providing care to a patient with chronic stable angina that is scheduled for a cardiac catheterization. What finding associated with myocardial ischemia could be obtained by this diagnostic procedure? 1 ST segment depression 2 Cardiac enlargement 3 Abnormal cardiac wall motion 4 70% block in right coronary artery

4 70% block in right coronary artery Cardiac catheterization is an invasive diagnostic procedure to find out the location and severity of blockages in the coronary circulation. ST segment depression is an important diagnostic finding for the presence of myocardial ischemia, which is obtained by electrocardiography (ECG). Cardiac enlargement is a sign of heart failure that can be seen on an x-ray. Echocardiography is used to detect the presence of abnormal wall motion due to myocardial ischemia.

The nurse recognizes that which type of medication may be prescribed for a patient with an ejection fraction of 25%? 1 Lipid lowering agent 2 Beta-adrenergic blocker 3 Calcium channel blocker 4 Angiotensin-converting enzyme (ACE) inhibitor

4 Angiotensin-converting enzyme (ACE) inhibitor Patients with chronic stable angina who have an ejection fraction (EF) of 40% or less should take an ACE inhibitor indefinitely, unless contraindicated. These drugs result in vasodilation and reduced blood volume. They also prevent ventricular remodeling, and prevent 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.

Which of the following findings support a diagnosis of unstable angina? ST depression Positive troponin level ST elevation Pain relief with rest

ST depression

The nurse reviews the medical records of four patients with chest pain. The nurse identifies that which patient will benefit from nitroprusside and intraaortic balloon pump (IABP) therapy? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

c 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.

The nurse assesses a patient with diabetes who reports shortness of breath, neck pain, and hypoglycemic symptoms. The patient's blood pressure is 130/86 mm Hg, heart rate is 102 beats/minute, respiratory rate is 24 breaths/minute, and the fingerstick blood glucose is 136 mg/dL. The nurse recognizes that the patient is experiencing what? 1 Myocardial infarction 2 Late-stage diabetic ketoacidosis 3 Early-onset diabetic ketoacidosis 4 Hyperosmolar hyperglycemic nonketotic syndrome

1 Myocardial infarction Signs and symptoms of a myocardial infarction (MI) include shortness of breath, neck pain, and cool, clammy skin. Although cool, clammy skin may resemble a hypoglycemic reaction, when found along with shortness of breath and neck pain it is very specific for an MI. The patient is not experiencing a complication of diabetes (ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome). The blood glucose is close to normal, and further diagnostics would be required to determine a diabetic complication. Only cool, clammy skin is indicative of hypoglycemia.

Which type of angina occurs as a result of coronary vasospasm? 1 Nocturnal angina 2 Prinzmetal's angina 3 Microvascular angina 4 Chronic stable angina

2 Prinzmetal's angina is chest pain that occurs as a result of coronary vasospasm. Nocturnal angina occurs at night, during sleep. Microvascular angina is a result of myocardial ischemia secondary to microvascular disease, affecting the small, distal branches of coronary arteries. Chronic stable angina is the result of myocardial ischemia caused by an oxygen supply/demand mismatch.

A patient survived an episode of sudden cardiac death (SCD) and is recovering in the intensive care unit (ICU). The nurse anticipates which intervention to prevent a recurrence? 1 Drug therapy with beta-blocker 2 Coronary artery bypass graft (CABG) 3 Percutaneous coronary intervention (PCI) 4 Implantable cardioverter-defibrillator (ICD)

4 Implantable cardioverter-defibrillator (ICD) The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD. A coronary artery bypass graft is not necessary.

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? 1 Monitors the patient for blood in the urine 2 Assesses the patient regularly for neurologic status changes 3 Draws blood samples from the patient before initiation of the therapy 4 Reduces the dose of the thrombolytic agent during episodes of chest pain

4 Reduces the dose of the thrombolytic agent during episodes of chest pain 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 the urine and stool for 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.

A patient asks the nurse about resuming sexual activity after acute coronary syndrome (ACS). What should the nurse include in the patient's teaching plan? 1 Take a hot shower just before intercourse to provide relaxation. 2 Limit the time, including foreplay, to 30 minutes to prevent overexertion. 3 Wait an hour after ingesting a large meal before engaging in sexual activity. 4 Taking a prophylactic nitrate may decrease chest pain during sexual activity.

4 Taking a prophylactic nitrate may decrease chest pain during sexual activity. Taking a prophylactic nitrate may decrease chest pain during sexual activity. Hot or cold showers should be avoided just before or after intercourse. Consumption of food and alcohol should be reduced before intercourse is anticipated (e.g., waiting 3-4 hours after ingesting a large meal before engaging in sexual activity). There is no established time limit. Foreplay is desirable because it allows a gradual increase in heart rate before orgasm.

To prevent a DVT in the client s/p CABG surgery, the nurse should perform which action? Administer pain medication Apply sequential compression devices Encourage coughing and deep breathing Perform meticulous handwashing

Apply sequential compression devices

Which assessment finding suggests that a client who had an MI is developing right sided heart failure? Pericardial friction rub ST elevation Lower extremity edema crackles

Lower extremity edema

Clients with diabetes often develop what condition? Prinzmetal angina Silent ischemia Collateral circulation Pulsus alternans

Silent ischemia

The nurse should encourage the client to increase what food product into their diet to reduce the risk of CAD? Egg yolks Walnuts Coconut oil whole milk

Walnuts

The nurse is describing the progressive development of coronary artery disease to a patient with coronary artery disease (CAD). The nurse recalls that the stages of development occurs in what order? 1. Thrombus formation occurs. 2. Collateral circulation is formed; new blood circulation routes are created or utilized. 3. Fibrous plaque narrows the vessel lumen. 4. Streaks of fat develop within the smooth muscle cells.

Correct1.Streaks of fat develop within the smooth muscle cells. Correct2.Fibrous plaque narrows the vessel lumen. Correct3.Thrombus formation occurs. Correct4.Collateral circulation is formed; new blood circulation routes are created or utilized 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.

Which of the following is a modifiable risk factor for CAD? Family History Increasing Age Lipid levels Cardiac Biomarkers

Lipid levels

The nurse is caring for four male patients in a health care facility. Which patient has the highest risk for developing coronary artery disease (CAD)? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4

patient 3 Obesity, high serum cholesterol, low high-density cholesterol, and diabetes mellitus increase the risk of coronary artery disease. Obesity is measured using body mass index (BMI), which is calculated as weight/height2. The acceptable range of BMI is 18.5 to 24.9 kg/m2, of serum cholesterol is 40 mg/dL, of glycosylated hemoglobin (Hb A1C) is 2, serum cholesterol of 200 mg/dL, HDL cholesterol of 38 mg/dL, and Hb A1C of 7.4 mg/dL. Therefore Patient 3 has the highest risk for acquiring coronary artery disease. Patients 1, 2, and 4 have normal BMIs, serum cholesterol levels, HDL levels, and Hb A1C levels. These patients are not are risk for developing CAD.

A patient experiences anginal pain. What is an appropriate nursing intervention? 1 Position the patient upright and supply oxygen. 2 Encourage the patient to perform isometric exercises. 3 Place the patient in recumbent position during the attack. 4 Recommend a salt-rich diet to prevent orthostatic hypotension.

1 A patient with angina should be placed in an upright position and supplied oxygen to provide comfort and to attain an appropriate amount of oxygen in blood unless contraindicated. A recumbent positioning of the patient may precipitate the attack. Isometric exercises are stressful and may exacerbate the symptoms by increasing the cardiac workload. Salt and saturated fat foods are restricted in the patient to prevent further complications.

Which factor leads to total occlusion of the coronary artery? 1 Thrombus formation in the coronary artery 2 Transport of cholesterol into the arterial intima 3 Smooth muscle proliferation of the arterial wall 4 Lipid-filled smooth muscle cells in the coronary artery

1 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.

Which drug prevents platelet aggregation by inhibiting cyclooxygenase? 1 Aspirin 2 Heparin 3 Abciximab 4 Clopidogrel

1 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 patient experiences mild chest pain during inspiration, while coughing, and while performing daily activities. Sitting in a forward position relieves the pain. The nurse identifies that the patient is experiencing what complication of myocardial infarction? 1 Pericarditis 2 Left-sided heart failure 3 Ventricular aneurysm 4 Papillary muscle dysfunction

1 Chest pains experienced during inspiration, coughing, and performing activities that goes away upon sitting forward indicate acute pericarditis in the patient. Left-sided heart failure occurs initially with subtle signs such as mild dyspnea, restlessness, agitation, or slight tachycardia. A ventricular aneurysm may result from thinning of the infarcted myocardial walls. Papillary muscle dysfunction occurs when the infarcted area includes the papillary muscle that attaches to the mitral valve.

A nurse teaches a patient about strategies to prevent angina caused by coronary artery disease. The nurse tells the patient that if a heavy meal is eaten, to rest for 1 to 2 hours after the meal. What is the rationale for this instruction? 1 Eating a heavy meal would divert more blood to the gastrointestinal system. 2 Heavy meals cause obesity and increase the susceptibility to myocardial ischemia. 3 Eating a heavy meal can cause physical inactivity, which could precipitate angina. 4 Heavy meals cause excessive heat production, which leads to peripheral vasodilation.

1 Eating a heavy meal would divert more blood to the gastrointestinal system. 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 notes that a patient's medication history includes clopidogrel. The nurse recognizes that this medication belongs to which drug class? 1 Antiplatelet 2 Opioid analgesic 3 Vitamin K antagonist 4 Nonsteroidal antiinflammatory drug (NSAID)

1 Clopidogrel (Plavix) is an antiplatelet medication, used commonly in patients with cardiovascular disease. Plavix is not an opioid analgesic, NSAID, or vitamin K antagonist.

The nurse is reviewing a patient's lipid profile results. Which level increases the patient's risk of coronary artery disease (CAD)? 1 Decreased triglycerides 2 Elevated low-density lipoproteins (LDL) 3 Elevated high-density lipoproteins (HDL) 4 Decreased very-low-density lipoproteins (VLDL)

2 Elevated LDLs contain more cholesterol than any of the other lipoproteins and have an affinity for arterial walls. Elevated LDL levels correlate most closely with an increased incidence of atherosclerosis and CAD. Elevated HDL, decreased triglycerides, and VLDL are all negative risk factors for CAD.

What is the reason behind prescribing low-molecular-weight heparin (LMWH) after a stent placement? 1 To stabilize the stent and prevent dislodgement 2 To prevent thrombosis formation within the stent 3 To prevent an anaphylactic reaction related to the stent anaphylaxis 4 To allow for a smooth vascular surface within the intimal lining that grows over the stent 00:00:02 Question Answer Confidence Buttons it

2 Stent placement is associated with many risks. Dual antiplatelet drugs are taken to prevent thrombosis formation within the stent. LMWH is not an appropriate treatment for stent displacement or anaphylaxis. LMWH does not help healing in the vessel wall.

A nurse provides discharge teaching to a patient prescribed nitroglycerin sublingual tablets for the treatment of chronic stable angina. Which statement made by the patient indicates the need for further teaching? 1 "The sublingual tablets will expire six months from the time the bottle is opened." 2 "I will put the bottle in my front or back pant pockets before I leave the house." 3 "I can use this medication before exercising to prevent angina from occurring." 4 "Possible side effects include a warm feeling, headache, or lightheadedness.

2 Sublingual nitroglycerin should not be stored in pant pockets because body heat can cause degradation of the nitroglycerin tablets. Flushing (warm feeling), headache, or dizziness (lightheadedness) may occur following sublingual nitroglycerin administration. Sublingual nitroglycerin can be used prophylactically before starting an activity that is known to cause an anginal attack. Sublingual nitroglycerin tablets tend to lose potency once the bottle has been opened; therefore it should be replaced every six months.

Which statement by a patient diagnosed with stable angina indicates understanding of the disease process? 1 "Angina is caused by spasms within a coronary blood vessel." 2 "Angina is causing an irreversible damage to my cardiac muscles by cardiac ischemia." 3 "Anginal pain is caused by an increased demand for oxygen or a decreased supply of oxygen." 4 "Symptoms of angina start when the process of atherosclerosis completely occludes a coronary artery."

3 A mismatch between oxygen demand of cardiac muscles and supply of oxygen leads to myocardial ischemia, which is manifested as pain. Prinzmetal's angina is caused by coronary vasospasm. Myocardial ischemia is completely reversible. The patient will start to experience symptoms of ischemia when the coronary artery is blocked by 75% or more.

The nurse reviews a patient's laboratory results and recognizes that which result is most indicative of myocardial infarction? 1 Increased myoglobin 2 Increased C-reactive protein 3 Increased creatine kinase-MB 4 Increased white blood cell count

3 Biochemical markers, such as creatine kinase (CK) and troponin are released specifically by myocardial cells when injured and are detectable in the blood. The CK enzymes are fractionated into bands. The creatine kinase-MB (CK-MB) is specific to heart muscles and helps to quantify myocardial damage. Myoglobin, although one of the first markers to increase after a myocardial infarction (MI), does not have as high of a cardiac specificity as others. C-reactive protein is increased after an MI as a result of the inflammation caused by tissue damage; however, it is also not as highly specific to cardiac tissue. An increased white blood cell count may be present after an MI but is due to a generalized inflammatory response.

A patient that is being discharged from the hospital after acute coronary syndrome will be participating in cardiac rehabilitation. What information should the nurse provide about the early recovery phase of rehabilitation? 1 Therapeutic lifestyle changes should become lifelong habits. 2 Physical activity always begins in the hospital and continued at home. 3 Activity level is increased gradually with supervision by the rehabilitation team and with ECG monitoring. 4 The focus of rehabilitation will be on management of chest pain, anxiety, dysrhythmias, and other complications.

3 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.

A patient is scheduled for drug-eluting stent (DES) placement after balloon angioplasty. The nurse recalls that the reason the DES is coated with paclitaxel is what? 1 To avoid patient noncompliance to oral drugs 2 To promote patency of the affected blood vessel 3 To reduce the risk of overgrowth of the intimal lining within the stent 4 To decrease the dose of dual antiplatelet drugs that are taken to prevent stent thrombosis

3 Stents may be coated with certain medications such as paclitaxel. These medications help check the overgrowth of new intima over the stent wall, thus preventing restenosis. Drug-eluting stents do not help in promoting drug compliance or promoting the patency of the affected blood vessel. The dose of dual antiplatelet therapy is not dependent on the type of stent used.

The nurse teaches a student nurse about diagnostic studies used for acute coronary syndrome. Which statement made by the student nurse indicates effective learning? 1 "A nitroprusside stress echocardiogram is used for patients with acute pericarditis." 2 "A pathogenic Q wave is always present in the electrocardiogram (ECG) of patients with unstable angina." 3 "Serum cardiac markers are proteins that are released from necrotic heart muscle." 4 "Coronary angiography is the only way to confirm the diagnosis of unstable angina."

3 "Serum cardiac markers are proteins that are released from necrotic heart muscle." Serum cardiac markers such as myoglobin, creatine kinase, cardiac-specific troponin I (cTnI), and cardiac-specific troponin T (cTnT) are released in patients with myocardial infarction (MI) into the blood from necrotic heart muscle. These markers are important to diagnose MI. A patient with a pathologic Q wave and ST-elevated MI has prolonged coronary occlusion because the MI evolves with time. Pharmacologic stress echocardiogram testing with dobutamine, dipyridamole, or adenosine simulates the effects of exercise and is performed on patients who are unable to exercise or have abnormal, nondiagnostic baseline echocardiograms. A coronary angiography is used for patients with stable or high-risk unstable angina

The nurse recalls that which artery is most commonly used for bypass graft? 1 Radial artery 2 Gastroepiploic artery 3 Inferior epigastric artery 4 Internal mammary artery

4 Bypass graft surgery involves the replacement of blood vessels that transport blood between the aorta and the blocked coronary artery. The internal mammary artery (IMA) is the most common artery used for bypass graft. The long-term patency rate for an IMA graft is greater than 90 percent after 10 years. Procedures involving the radial, gastroepiploic, or inferior epigastric artery have a comparatively short-term patency rate.

A patient with Prinzmetal's angina who takes a short-acting nitrate reports feeling dizzy while changing positions. What prescription does the nurse anticipate? 1 Esmolol 2 Morphine sulfate 3 Intravenous heparin 4 Intravenous fluid bolus

4 Intravenous fluid bolus Prinzmetal's angina is treated with short-acting nitrates, such as nitroglycerin. Orthostatic hypotension is a common side effect of nitroglycerin because of the depletion of body fluid volume. Therefore the patient must be administered intravenous fluid bolus. Beta blockers such as esmolol can lead to hypotension, which may further worsen the patient's condition. Intravenous heparin is administered to a patient undergoing thrombolytic therapy; heparin is not suggested for a patient with Prinzmetal's angina. Morphine sulfate is the drug of choice for chest pain during angina that is unrelieved by nitroglycerin.