Chap 38; Coronary Artery Disease

The nurse provides discharge instructions to a patient who was hospitalized because of chest pain. The patient receives a prescription for nitroglycerin. Which patient statement indicates the need for further instruction? "I should store my nitroglycerin in a dark container." "I should stop what I'm doing and lie down if chest pain occurs." "I should place a nitroglycerin tablet under my tongue if chest pain occurs." "I should not take more than one nitroglycerin tablet to treat my chest pain."

"I should not take more than one nitroglycerin tablet to treat my chest pain." Rationale A patient who is prescribed nitroglycerin for the treatment of chest pain can take three doses of nitroglycerin to relieve chest pain. It is best to store nitroglycerin in a dark container and keep it cool and dry like most medications. A patient who believes that it is inappropriate to take more than one nitroglycerin tablet requires further education. During a bout of chest pain, the patient should stop performing all activities and lie down to help decrease the workload on the heart. Placing the nitroglycerin tablet under the tongue will promote fast absorption of the medication and provide prompt pain relief. p. 775

A patient reports an inability to walk continuously for 30 minutes daily. Which guidance would the nurse provide this patient in order to reduce the risk for coronary artery disease? Select all that apply. Select all that apply "Walk any distance you can." "Use the stairs when needing to go down two flights." "Use the elevator when going up flights." "Create your own exercise regimen." "Park your car farther away from a site than necessary."

"Walk any distance you can." "Use the stairs when needing to go down two flights." "Park your car farther away from a site than necessary." Rationale A patient who is unable to tolerate 30 minutes of walking may be advised to do other physical activities that can also decrease the risk for coronary artery disease. These include suggestions such as walking any tolerable distance and using stairs instead of an elevator to go two floors down or one floor up. Patients with cars should park them at a farther site than necessary and walk the remaining distance. Exercise regimens should not be started by the patient without discussing with their primary health care provider first. p. 771

During a home visit, the nurse uses a glucometer to determine that a patient's fasting blood glucose level is 140 mg/dL. What nursing instruction is most beneficial to the patient? "You should decrease sugary syrups in your diet." "You should start eating sugarless cookies regularly." "You should buy a glucometer of another brand." "You should report to the primary health care provider."

"You should report to the primary health care provider." Rationale A fasting blood glucose level greater than 100 mg/dL indicates diabetes mellitus and may be associated with metabolic acidosis in the patient. A patient with an increased blood glucose level should report to the primary health care provider immediately to reduce the risk of further complications such coronary artery disease. Decreased consumption of sugary syrups, eating sugarless cookies, and buying a new glucometer are less likely to be beneficial to the patient. p. 771

Which patient is at a high risk for myocardial infarction (MI)? An atherosclerotic patient with triglycerides greater than 500 mg/dL A patient who is consuming less than 200 mg/dL of cholesterol per day A mild hypertensive patient who is consuming less than 1500 mg/day of sodium An obese patient whose daily consumption of saturated fats comprises 5% to 6% of his diet

An atherosclerotic patient with triglycerides greater than 500 mg/dL Rationale An atherosclerotic patient with a high triglyceride level is at a high risk for myocardial infarction (MI) due to the increased serum levels of cholesterol and lipids. The optimum caloric intake recommended from saturated fats is 5% to 6%; the obese patient is not at risk. The optimum amount of sodium consumed in a day should not be more than 1500 mg. A cholesterol intake of less than 200 mg/day is an optimum amount and may not increase the risk for MI. pp. 771-772

A patient is at risk for myocardial infarction (MI). Which nursing actions would be beneficial? Select all that apply. Select all that apply Assessing specific risks Implementing a customized care plan Referring to specialists for treatment Ensuring compliance with medications Preparing a care plan to decrease the risk

Assessing specific risks Preparing a care plan to decrease the risk Rationale Assessing specific risk factors for myocardial infarction (MI) would help a nurse figure out a strategy for modifying them to decrease the risk. Preparing a care plan to decrease the risk helps reduce the chances of developing the disease. A care plan should be implemented only after confirmation of the disease for maximum benefit. The patient would need a referral to a specialist and medication compliance if he or she develops the disease. p. 772

Which nursing interventions are appropriate for a patient who is prescribed nitroglycerin? Select all that apply. Checking the patient's drug history for sildenafil Instructing the patient to take the medication with food Monitoring the patient's blood pressure at regular intervals Asking the patient to lie with the head of the bed at a comfortable level Assessing the patient for cough, shortness of breath, edema, and weight gain

Checking the patient's drug history for sildenafil Monitoring the patient's blood pressure at regular intervals Asking the patient to lie with the head of the bed at a comfortable level Rationale While providing care to a patient who is prescribed nitroglycerin, the nurse should monitor for the use of sildenafil, assess blood pressure at regular intervals, and ask the patient to lie down with the head of the bed at a comfortable level. Sildenafil, when administered with nitroglycerin, can cause a drastic drop in blood pressure; therefore, the nurse should avoid administering these drugs together. Blood pressure is monitored at regular intervals because nitroglycerin causes vasodilation, which can cause hypotension. Instructing the patient to lie down with the head of the bed at a comfortable level will reduce the risk of hypotension. Nitroglycerin does not need to be taken with food. Cough, shortness of breath, edema, and weight gain are associated with beta blockers, not nitrates. p. 775

Which complementary and alternative therapy can be helpful in preventing coronary atherosclerotic disease? Reducing or stopping smoking Avoiding foods with trans-fatty acids Taking a multivitamin tablet each day Consuming foods high in omega-3 fatty acids

Consuming foods high in omega-3 fatty acids Rationale Consuming omega-3 fatty acids from fish and plant sources has been effective in decreasing lipid levels, stabilizing atherosclerotic plaque, and reducing sudden death from myocardial infarction (MI). Smoking reduction or cessation and avoiding trans-fatty acids are standard health promotion recommendations. There is no evidence that taking a multivitamin aids in the prevention of coronary atherosclerotic disease. p. 791

Which are modifiable, lifestyle-related risk factors for coronary artery disease? Select all that apply. Select all that apply Diabetes Older age Tobacco use Family history Absence of physical activity

Diabetes Tobacco use Absence of physical activity Rationale Tobacco use is a risk factor associated with coronary artery disease. This is a modifiable risk factor for coronary artery disease that can be avoided by quitting smoking. Absence of physical activity is a modifiable risk factor. Lifestyle changes include physical activity that can help to avoid the risk of coronary artery disease. Diabetes is a risk factor associated with coronary artery disease. This condition can be well managed with insulin and antidiabetic drugs. Older age is not a modifiable risk factor. Family history is a risk factor in patients with coronary artery disease, which cannot be modified. p. 771

The nurse is teaching a group of teens about prevention of heart disease. Which point should the nurse emphasize? Reduce abdominal fat. Avoid stress. Do not smoke or chew tobacco. Avoid alcoholic beverages.

Do not smoke or chew tobacco. Rationale Tobacco exposure, including secondhand smoke, reduces coronary blood flow; causes vasoconstriction, endothelial dysfunction, and thickening of the vessel wall; increases carbon monoxide; and decreases oxygen. Because it is highly addicting, beginning smoking in the teen years may lead to decades of exposure. Teens are not likely to experience metabolic syndrome from obesity but are very likely to use tobacco. The risk for smoking outweighs the risk for alcohol use. Avoiding stress is a lesser modifiable risk factor, which is less likely to cause heart disease in teens. p. 771

The nurse teaches a patient diagnosed with coronary artery disease to eat foods rich in omega-3 fatty acids. How would this dietary change help to manage the patient's condition? Select all that apply. Select all that apply It reduces the lipid levels. It reduces the hypertension. It reduces the glucose levels. It stabilizes the atherosclerotic plaques. It reduces the incidence of sudden death from myocardial infarction.

It reduces the lipid levels. It stabilizes the atherosclerotic plaques. It reduces the incidence of sudden death from myocardial infarction. Rationale Omega-3 fatty acids act by reducing lipid levels, stabilizing atherosclerotic plaques, and reducing the incidence of sudden death from myocardial infarction. Foods rich in omega-3 fatty acids should therefore be included in the diet of patients with coronary artery disease. Omega-3 fatty acids may not aid in the reduction of hypertension of the patient or a decrease in glucose levels. p. 791

A patient diagnosed with myocardial infarction has the following labs: potassium 3.5 mEq/L, calcium 8.5 mg/dL, magnesium 1.0 mEq/L, and pH 7.36. What value should be reported to the health care provider first? pH 7.36 Calcium 8.5 mg/dL Potassium 3.5 mEq/L Magnesium 1.0 mEq/L

Magnesium 1.0 mEq/L Rationale The magnesium level of 1.0 mEq/L is low, which could lead to changes in normal conduction. Calcium (8.5 mg/dL), potassium (3.5 mEq/L), and pH (7.36) are normal. p. 770

The nurse is caring for a patient diagnosed with a 55% blockage of the coronary arteries. What should the nurse monitor the patient for? Weight loss Bradycardia P wave elevation Shortness of breath

Shortness of breath Rationale Shortness of breath is important to monitor for in a patient with a 55% blockage of the coronary arteries because it can be a sign of decreased blood flow resulting from the blockage. Weight loss is not a sign of decreased blood flow, but weight gain would be. Bradycardia would not likely result from blockage. P wave elevation is not indicative of anything. pp. 770, 785

What is the goal of health promotion efforts for people at risk for coronary artery disease? To cure the disease To provide prompt treatment To alter modifiable risk factors To control non-modifiable risk factors

To alter modifiable risk factors Rationale Health promotion efforts are aimed at altering modifiable risk factors and decrease the risk for coronary artery disease. Secondary prevention includes efforts to cure the disease. Prompt treatment is provided once the disease has occurred. Non-modifiable risk factors cannot be controlled or altered. p. 772

Which vitamin is most likely to be associated with the prevention of myocardial infarction (MI)? Vitamin A Vitamin C Vitamin D Vitamin E

Vitamin E Rationale Vitamin E and vitamin B and are helpful in reducing the risks associated with myocardial infarction (MI). These vitamins contain antioxidants that prevent cell damage. Vitamins A, C, and D are consumed to reduce the risk of cardiovascular diseases. p. 791

A patient diagnosed with myocardial infarction has the following labs: potassium 3.5 mEq/L, calcium 8.5 mg/dL, magnesium 1.8 mEq/L, and pH 7.31. What value should be reported to the health care provider first? pH 7.31 Calcium 8.5 mg/dL Potassium 3.5 mEq/L Magnesium 1.8 mEq/L

pH 7.31 Rationale A pH of 7.31 indicates acidosis, which may lead to changes in normal conduction. Calcium (8.5 mg/dL), potassium (3.5 mEq/L), and magnesium (1.8 mEq/L) levels are normal. p. 770