N123 Chp 34 Coronary Artery Disease

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. STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals. Text Reference - p. 731

A nurse 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 during a cardiac catheterization? 1 Allergies 2 Anemia 3 Dysrhythmia 4 Mental status

1 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. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal. Text Reference - p. 758

To decrease the risk of medication-induced cardiovascular events, the nurse should instruct the patient to avoid which medication? 1 Celecoxib, a COX-2 inhibitor 2 Lisinopril, an ACE-inhibitor 3 Aspirin, an antiplatelet drug 4 Diazepam, a benzodiazepine

1 Celecoxib has been linked to increased cardiovascular events and should therefore be avoided. Lisinopril, an antihypertensive, is cardioprotective. Aspirin is recommended for heart health due to its antiplatelet effects. Diazepam does not have an impact on cardiovascular health. Text Reference - p. 775

The nurse is caring for patients on medication to lower lipid levels. For which patient is the use of penicillin contraindicated? 1 Patient with indigestion, constipation, and bloating 2 Patient with pain in the joints without inflammation 3 Patient with itching below the neck and blood pressure of 80/50 mm Hg 4 Patient with rashes and alanine aminotransferase level of 58 units per liter

1 Indigestion, constipation, and bloating are side effects of cholestyramine therapy, which interferes with the absorption of penicillin. Penicillin is contraindicated for the patient with these symptoms. The patient with arthralgia may be on medication with icosapent ethyl, which is an omega-3 fatty acid. The patient with pruritus and hypotension may be on medications with niacin. The patient with rashes and elevated levels of liver enzymes may be on drugs such as fenofibrate or gemfibrozil. Text Reference - p. 739

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. Text Reference - p. 740

Which individuals would the nurse identify as having the highest risk for coronary artery disease (CAD)? 1 A 45-year-old depressed male with a high-stress job 2 A 60-year-old male with below normal homocysteine levels 3 A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels 4 A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2

1 The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight. The patient with two risk factors is at greatest risk for developing CAD. Text Reference - p. 732

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic groups would the nurse select as the highest priority for this intervention? 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. Text Reference - p. 732

A nurse is caring for a patient with a history of chronic stable angina who complains of chest pain. Which factor is true of ischemia related to angina? 1 It generally lasts longer than 15 to 20 minutes. 2 It will be relieved by rest, nitroglycerin, or both. 3 It indicates that irreversible myocardial damage is occurring. 4 It is frequently associated with vomiting and extreme fatigue.

2 Chronic stable angina is characterized by intermittent chest pain, often described as pressure or tightness that occurs over a period of time in the same pattern, onset, and intensity. It commonly subsides when precipitating factors have stopped and the patient is at rest or with the use of nitroglycerin. The pain usually lasts just 5 to 15 minutes and does not always indicate irreversible myocardial damage. Vomiting and extreme fatigue are symptoms of myocardial infarction and are not commonly seen in chronic stable angina. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response. Text Reference - p. 740

Upon taking a lipid-lowering medication for hyperlipidemia, a patient reports muscle pain. The nurse notes the patient has elevated liver enzymes and creatine kinase levels. It is most likely that which lipid-lowering medication was taken by the patient? 1 Niacin 2 Simvastatin 3 Gemfibrozil 4 Colestipol

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

A 67-year-old patient has coronary artery disease (CAD). Which question should the nurse ask to assess a need for additional teaching? 1 When did you last have a bowel movement? 2 Did you have any recent weight gain? 3 Did you travel abroad within the last 12 months?

2 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. Text Reference - p. 735

A nurse is teaching a patient about strategies to prevent angina caused by coronary artery disease. The nurse tells the patient to avoid heavy meals, because they can further compromise the blood supply to the heart. What is the most likely reason for the nurse to give such advice? 1 Eating a heavy meal can cause physical inactivity, which could precipitate angina. 2 Eating a heavy meal would divert more blood to the gastrointestinal system. 3 Heavy meals cause obesity and increase the susceptibility to myocardial ischemia. 4 Heavy meals cause excessive heat production, which leads to peripheral vasodilation.

2 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. Text Reference - p. 740

The patient recently diagnosed with coronary artery disease (CAD) asks the nurse: "What caused my problem?" Which response by the nurse is the most appropriate? 1 "The heart is not able to pump effectively." 2 "Fatty deposits on the walls of coronary arteries." 3 "Low oxygen saturation of your blood." 4 "Orthostatic hypotension caused this problem."

2 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. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." Text Reference - p. 731

What instruction should the nurse give to the patient who has a body mass index of 30.0 kg/m2? Select all that apply. 1 "Eat bacon." 2 "Eat soybeans." 3 "Eat red yeast rice." 4 "Eat cream cheese." 5 "Consume palm oil."

2, 3 The patient has a body mass index of 30.0 kg/m2, which is above the healthy range of 18.5 to 24.9 kg/m2. The patient can eat soybeans, because they are a lipid-lowering agent. The patient can also eat red yeast rice because there is strong scientific evidence that red yeast rice reduces total cholesterol, low-density lipoproteins, and triglycerides. The patient should not eat bacon, cream cheese, or palm oil, because they contain saturated fatty acids and may further increase obesity. Text Reference - p. 738

A nurse is advising a 24-year-old obese female about smoking cessation, because smoking can lead to coronary artery disease. Why does the nurse discourage cigarette smoking? Select all that apply. 1 Tobacco decreases blood pressure. 2 Tobacco causes release of catecholamines. 3 Tobacco increases the estrogen levels in the body. 4 Smoking decreases the oxygen levels in the blood. 5 Tobacco increases the low-density lipoprotein levels.

2, 4, 5 Nicotine present in tobacco smoke stimulates the release of catecholamines. Catecholamines have a stimulatory effect on the sympathetic nervous system that causes an increase in heart rate and blood pressure. Carbon monoxide present in tobacco smoke has a greater affinity to hemoglobin than does oxygen. Therefore carbon monoxide reduces the oxygen-carrying capacity of blood. Tobacco smoke is known to increase the level of low-density lipoproteins and subsequently a decrease in high-density lipoproteins. All of these factors can lead to atherosclerosis. Tobacco smoke is known to decrease estrogen levels in premenopausal women, thereby increasing their susceptibility to get coronary artery disease. Text Reference - p. 734

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

3 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. Text Reference - p. 764

A nurse reviews a patient's medical history and identifies which findings as the most important risk factors for coronary artery disease? 1 Age, family history, hypertension, smoking, and stress 2 Diabetes, high cholesterol, personality type, and smoking 3 Diabetes, high cholesterol, hypertension, obesity, and smoking 4 Alcohol consumption, diabetes, high cholesterol, obesity, and stress

3 Major risk factors for coronary artery disease are cigarette smoking, increased blood pressure, obesity, blood glucose level greater than 130 mg/dL or known diabetes mellitus, and increased serum cholesterol. Other risk factors, such as family history, stress, and age, as well as personality type and alcohol consumption, are also risk factors for heart disease but are not as crucial as the items listed in the correct answer. Text Reference - p. 732

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

3 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. Text Reference - p. 745

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice? 1 Baked flounder 2 Angel food cake 3 Baked potato with margarine 4 Canned chicken noodle soup

4 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. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency. Text Reference - p. 737

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 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. Text Reference - p. 745

The nurse has been teaching a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates an adequate understanding? 1 "I will add weightlifting to my 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 reduce activities that increase my stress."

4 Health-promoting behaviors for those at risk for CAD include: improving physical activity such as brisk walking (three to four miles/hour for at least 30 minutes five or more times a week); reducing total fat and saturated fat intake; stopping all tobacco use, and altering patterns that are conducive to stress. Text Reference - p. 736

When teaching a patient about modifying risk related to serum lipid levels, what action should the nurse teach to help lower the risk of coronary artery disease? 1 Decrease low-density and high-density lipoprotein levels. 2 Increase low-density and high-density lipoprotein levels. 3 Increase low-density lipoproteins and decrease high-density lipoprotein levels. 4 Increase high-density lipoproteins and decrease low-density lipoprotein levels.

4 Low-density lipoproteins contain more cholesterol than any other lipoprotein and have an attraction to arterial walls, whereas high-density lipoproteins carry lipids away from the arteries to the liver for metabolism and prevent lipid accumulation within the arterial walls. Therefore, increasing high-density lipoprotein levels and decreasing low-density lipoprotein levels are most helpful in lowering the patient's risk of coronary artery disease. The nurse should not advise the patient to decrease high-density lipoproteins or increase low-density lipoprotein levels, because these actions would be counterproductive. STUDY TIP: In the first pass through the exam, answer what you know and skip what you do not know. Answering the questions you are sure of increases your confidence and saves time. This is buying you time to devote to the questions with which you have more difficulty. Text Reference - p. 733

Which patient would the nurse identify being at higher risk for developing coronary artery disease (CAD)? 1 43-year-old nonsmoking African American male 2 26-year-old Hispanic male smoking one pack of cigarettes per day 3 49-year-old Caucasian male with blood pressure 152/92 mm Hg 4 72-year-old African American female with a cholesterol level of 300 mg/dL

4 Multiple risk factors increase the risk of CAD, and this patient has three risk factors: age over 55, African American ethnic background, and cholesterol level greater than 240 mg/dL. The middle-aged nonsmoking AfricanAmerican male has only two risk factors: middle age and male gender: Caucasian middle-age males are more prone to develop CAD. The Hispanic patient has only two risk factors for CAD: male gender and smoking. The middle-aged white male has only two risk factors (age and gender), because systolic blood pressure is less than 160 mm Hg. Text Reference - p. 732

Which patient is showing signs of increased low-density lipoprotein (LDL) receptors in the liver because of the therapeutic effects of lipid-lowering treatment? 1 A patient with itching and flushing on the face 2 A patient with pain in the joints without inflammation 3 A patient with rashes and mild gastrointestinal disturbance 4 A patient with weak muscles and break-down of skeletal muscles

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. These drugs increase the LDL receptors in the liver. The patient with pruritus and flushing on the face may be receiving niacin treatment. The patient with pain in the joints, or arthralgia, may be receiving omega-3 fatty acid treatment. The patient with rashes and mild gastrointestinal disturbances may be receiving treatment with fibric acid derivatives such as fenofibrate. Text Reference - p. 739