Exam 2 EAQs: Ch. 33 - Coronary Artery Disease

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

Thrombus formation in the coronary artery 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.

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

White male 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.

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? Baked flounder Angel food cake Baked potato with margarine Canned chicken noodle soup

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.

A patient that takes digoxin daily is being treated for hyperlipidemia. The nurse should question a prescription for what lipid-lowering drug that the patient is scheduled to take? Niacin Icosapent Atorvastatin Cholestyramine

Cholestyramine Fibric acid derivatives, such as cholestyramine, interfere with the absorption of many drugs including digoxin. Icosapent ethyl is an omega-3 fatty acid. Niacin is in the broad category name of niacin. Atorvastatin is an HMG-CaA reductase inhibitor (statin).

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

Complicated lesion 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 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? Electrolytes Renal function tests Thyroid function tests Creatine kinase isoenzymes

Creatine kinase isoenzymes 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.

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? Increased HDLs; increased LDLs Decreased HDLs; decreased LDLs Increased HDLs; decreased LDLs Decreased HDLs; increased LDLs

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

The nurse provides information to a patient about preventing coronary artery disease (CAD) by maintaining healthy serum low-density lipoproteins (LDL) and high-density lipoprotein (HDL) levels. The nurse should include what goals? Decreased LDLs; decreased HDLs Decreased LDLs; increased HDLs Increased LDLs; increased HDLs Increased LDLs; decreased HDLs

Decreased LDLs; increased HDLs Low-density lipoproteins (LDLs) 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 (HDL) levels and decreasing low-density lipoprotein (LDL) 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.

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

Family history of heart disease 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.

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? Orthostatic hypotension Low oxygen saturation of the blood The heart's inability to pump effectively Fatty deposits on the walls of the coronary arteries

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 auscultating the heart sounds of a patient with a myocardial infarction (MI). A new murmur is heard at the cardiac apex. The nurse suspects which complication? Acute pericarditis Dressler syndrome Ventricular aneurysm Papillary muscle dysfunction

Papillary muscle dysfunction Papillary muscle dysfunction is a complication of a myocardial infarction and is assessed by the auscultation of a new murmur at the cardiac apex. Acute pericarditis is a complication of a myocardial infarction characterized by the auscultation of a friction rub at the mid to lower left sternal border. Dressler syndrome is a complication that develops several weeks after the myocardial infarction and a pericardial friction rub is auscultated at the mid to lower left sternal border. Ventricular aneurysm is a complication of a myocardial infarction without the development of a new murmur or friction rub.

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

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

What instruction should the nurse give to the patient who is predisposed to coronary artery disease (CAD)? Select all that apply. "Avoid consuming tofu." "Drink whole or 2% milk." "Limit concentrated fruit juice." "Decrease the intake of beans." "Choose foods such as buckwheat and oats."

"Limit concentrated fruit juice." "Choose foods such as buckwheat and oats." Concentrated fruit juices are high in added sugar and should be limited. Buckwheat and oats are made whole grain and are recommended. Beans are a good source of fiber and are recommended. The AHA recommends eating tofu because it contains alpha-linolenic acid, which becomes omega-3 fatty acid in the body. Patients should select fat free or low fat dairy products.

The nurse is caring for a patient with liver impairment and should question a prescription for which lipid-lowering medication? Niacin Ezetimibe Icosapent ethyl Cholestyramine

Ezetimibe Ezetimibe should not be used by patients with liver impairment. Niacin's side effects subside with time, although decreased liver function may occur with high doses. Icosapent ethyl has no major liver-related side effects. Cholestyramine is safe for long-term use.

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

"Reduce salt in your diet." "Increase daily physical activity." Blood pressure of 150/100 mm Hg meets the criteria for clinical hypertension. The nurse would advise this patient to consume less salt to lower blood pressure and to exercise daily to reduce the risk of coronary artery disease (CAD) from hypertension. The nurse would advise a reduction in total fat intake for the patient who has elevated serum lipids. In the case of obesity, the nurse would advise the patient to eat smaller and more frequent meals. For the patient who has elevated serum lipids, the nurse would advise an increase the amount of complex carbohydrates, fiber, and vegetable proteins in the diet.

For a health care research study, the nurse is identifying obese women at risk of developing coronary artery disease (CAD). What are the appropriate criteria for the selection of at-risk women? Select all that apply. "Pear"-shaped figure "Apple"-shaped figure Age of less than 40 years Waist circumference more than 30 inches Body mass index (BMI) greater than 30 kg/m 2

"Apple"-shaped figure Body mass index (BMI) greater than 30 kg/m 2 Obesity is a major risk factor for the development of coronary artery diseases (CAD). Women below the age of 40 are generally premenopausal. The cardioprotective effects of estrogen make premenopausal women less susceptible for developing atherosclerosis, which can lead to CAD. Apple-shaped obesity is the type of obesity in which there is more fat deposition around the abdomen. This condition is a major risk factor for development of coronary artery disease. Obesity in women is defined as having a body mass index of 30 or greater, which is a major risk factor for development of coronary artery disease. Evidence suggests that people having fat deposition around the thigh and hip regions (pear-shaped figure) are less susceptible to develop coronary artery disease than people having fat deposition around the abdomen (apple-shaped obesity). Obesity in women is defined as having a waist circumference more than 35 inches; therefore the criterion should be "waist circumference greater than 35 inches."

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

"Exercise regularly to maintain an ideal body weight." 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 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? "I will add weightlifting to my daily exercise program." "I will change my diet to increase my intake of saturated fats." "I need to switch to smokeless tobacco instead of smoking cigarettes." "I will change my lifestyle to alter patterns that add to my stress."

"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 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? "I will not eat bacon or any pork products." "I will eat only fried eggs instead of boiled eggs." "I may continue to enjoy French fries with hot dogs." "I will drink no more than one glass of whole milk per day."

"I will not eat bacon or any pork products." 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.

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? "The sublingual tablets will expire six months from the time the bottle is opened." "I will put the bottle in my front or back pant pockets before I leave the house." "I can use this medication before exercising to prevent angina from occurring." "Possible side effects include a warm feeling, headache, or lightheadedness.

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

"I will use longer rest periods between exercise sessions." 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.

What instruction should the nurse give to a patient to reduce the risk of coronary artery disease (CAD) by lowering LDL cholesterol? Select all that apply. "Increase complex carbohydrates such as fruit." "Increase fiber intake by eating food such as legumes." "Choose foods made with whole grains such as brown rice." "Avoid fatty fish such as tuna." "Fat intake should be about 40% of total calories."

"Increase complex carbohydrates such as fruit." "Increase fiber intake by eating food such as legumes." "Choose foods made with whole grains such as brown rice." It is recommended to increase the intake of complex carbohydrates, fiber, and whole grains. The AHA recommends eating fatty fish twice a week. Fat intake should be about 25-35% of total daily calories.

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? Anemia Allergies Dysrhythmia Mental status

Allergies 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 condition best describes the development of arterial anastomoses? Atheromas Angioedema Angiogenesis Atherosclerosis

Angiogenesis Angiogenesis (development of new blood vessels) best describes the development of arterial anastomoses, which are new arterial connections forming between two vessels that are not usually connected. Atheromas (atheromatous plaques) are fatty deposits that form within and on the layers of the coronary artery walls during atherosclerosis. Atherosclerosis is an arterial disease characterized by gradual arterial narrowing due to atheroma formation within and on the coronary artery walls. If arterial blockage from atherosclerosis forms very gradually, the process of angiogenesis has been known to create collateral circulation around the arterial blockage. Angioedema is the rapid and severe swelling of the soft tissues (e.g., skin or mucosa) caused by medications, allergies, or an inherited condition.

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? ST segment depression Cardiac enlargement Abnormal cardiac wall motion 70% block in right coronary artery

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.

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

A 45-year-old depressed male with a high-stress job 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/m 2 depicts normal weight. The patient with two risk factors is at greatest risk for developing CAD.

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. A major side effect of simvastatin is muscle weakness and pain. Ezetimibe is an example of lipid-lowering medications that are called statins. With niacin, flushing of the face and neck may occur within 20 minutes of taking the drug. Liver enzymes need to be monitored at initiation of simvastatin and with dosage increase. Ezetimibe, in combination with statins, produces greater reduction of low-density lipoprotein (LDL) levels.

A major side effect of simvastatin is muscle weakness and pain. With niacin, flushing of the face and neck may occur within 20 minutes of taking the drug. Liver enzymes need to be monitored at initiation of simvastatin and with dosage increase. 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 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? Formation of thrombus in the coronary artery Formation of fibrous plaque in the endothelium Reduction of blood flow through the coronary arteries Development of fatty streaks in the smooth muscles of the endothelium

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.

What is an appropriate nursing intervention for a patient who smokes cigarettes and is predisposed to developing coronary artery disease? Recommend smokeless tobacco. Encourage the use of filtered cigarettes. Suggest smoking low nicotine cigarettes. Discuss medication to assist with smoking cessation.

Discuss medication to assist with smoking cessation. The patient must be encouraged to quit smoking. Smoking cessation medications such as bupropion can be used to prevent the withdrawal symptoms of nicotine. Even if the patient is using smokeless tobacco, the risk of developing coronary artery disease is the same. Changing to filtered cigarettes does not affect the risk of developing coronary artery disease. Changing from high-nicotine to low-nicotine cigarettes also does not affect the risk of getting coronary heart disease.

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? Eating a heavy meal would divert more blood to the gastrointestinal system. Heavy meals cause obesity and increase the susceptibility to myocardial ischemia. Eating a heavy meal can cause physical inactivity, which could precipitate angina. Heavy meals cause excessive heat production, which leads to peripheral vasodilation.

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

Elevated low-density lipoproteins (LDL) 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.

A nurse assesses a patient whose angiogram revealed an 80% blockage of the left circumflex artery and 70% blockage of the right coronary artery. The patient does not show any symptoms of coronary ischemia. What is the most likely reason for this finding? Formation of collateral circulation Increased production of C-reactive proteins in the liver Pulmonary artery supplies oxygenated blood to the heart Lowering of low-density lipoprotein (LDL) levels in the body

Formation of collateral circulation Collateral circulation develops as an inherited predisposition to develop new blood vessels or in the presence of chronic ischemia. With sufficient collateral circulation, the heart may still receive an adequate amount of blood and oxygen; therefore the patient is asymptomatic. Lowering LDL levels does not prevent coronary ischemia in the patient whose myocardial blood supply is already compromised. The pulmonary artery consists of deoxygenated blood and does not supply blood to the coronary arteries unless there is a congenital anatomic variation. C-reactive proteins are inflammatory markers that are increased in patients with coronary artery disease. These are not associated with reducing coronary ischemia.

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

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.

The lipid profile of a patient is indicative of hyperlipidemia. A nurse advises the patient to consume a diet rich in nutrients that increase high-density lipoprotein (HDL) levels based on what rationale? Select all that apply. HDLs transport lipids to the liver for metabolism. HLs prevent stiffening of arterial walls. HDLs prevent deposition of lipids in the blood vessels. HDLs inhibit the production of low-density lipoproteins (LDLs). HDLs stimulate the liver to break down more LDLs.

HDLs transport lipids to the liver for metabolism. HDLs prevent deposition of lipids in the blood vessels. High-density lipoproteins and low-density lipoproteins are vehicles for mobilization of fats. HDLs contain fewer lipids than proteins and mobilize lipids from the arteries to the liver for metabolism, thereby preventing the deposition of lipids on the vessel wall. LDLs have more lipid content than proteins and tend to deposit lipids in the arterial walls. HDLs prevent the deposition of lipids and do not directly alter the vessel wall or make it noncompliant. HDLs do not interfere with the production or breakdown of LDLs.

What will the nurse include when educating an older adult patient about a physical activity program to reduce the risk for coronary artery disease? Select all that apply. Include longer warm-up periods. Plan indoor exercise on summer days. Include shorter periods of low-level activity. Include shorter rest periods between sessions. Exercise a minimum of 60 minutes on most days of the week.

Include longer warm-up periods. Plan indoor exercise on summer days. Because older adults have a decreased ability to sweat efficiently, they are at a higher risk for heat intolerance and should therefore be encouraged to plan exercise indoors when it is hot outside. An older adult's physical activity program should include longer, not shorter, rest periods between sessions, longer, not shorter, periods of low-level activity, and exercising at a minimum of 30 minutes, not 60 minutes, on most days of the week as able.

The nurse considers a patient's risk for coronary artery disease (CAD). The patient's assessment findings include age 78, African American, diagnosis of hypertension, cholesterol level of 250 mg/dL, and a fasting triglyceride level of 195 mg/dL. The nurse determines that the patient is at what risk for CAD? No risk Low risk High risk Additional information is needed

High risk Increasing age is a nonmodifiable risk factor for coronary artery disease. Hypertension is the second major risk factor in CAD. The risk of CAD is associated with a serum cholesterol level greater than 200 mg/dL or a fasting triglyceride level greater than 150 mg/dL. This patient has several risk factors for CAD and is therefore considered high risk. The patient has too many risk factors to be considered low or at no risk, and additional information is not necessary.

A 55-year-old patient with cardiovascular disease (CVD) receives a recommendation from the health care provider to take 81 mg of aspirin daily. The nurse reviews the patient's medical record and identifies which medication contraindications? Select all that apply. History of stroke Postmenopause The patient's age History of gastrointestinal bleeding Calculated ten-year CVD risk of 10%

History of stroke History of gastrointestinal bleeding Aspirin is an antiplatelet drug that can be used to prevent the development of coronary artery disease. It prevents the aggregation of platelets, which can prevent plaque from increasing in size. Due to the increased risk of bleeding, a history of gastrointestinal bleeding and/or a history of stroke are contraindications. Low-dose aspirin is recommended for adults age 50 to 59 years old who have a calculated 10-year CVD risk of 10% or more and are not at increased risk of bleeding. Postmenopause is not a contraindication.

The nurse identifies that which risk factors predispose a patient to metabolic syndrome? Select all that apply. Hypertension LDL: 65 mg/dL Central obesity Elevated fasting blood glucose Fasting triglyceride level: 175 mg/dL

Hypertension Central obesity Elevated fasting blood glucose Fasting triglyceride level: 175 mg/dL The assessment findings that are considered risk factors for metabolic syndrome include central obesity, hypertension, abnormal serum lipids, and an elevated fasting blood glucose. A fasting triglyceride level of 175 mg/dL is increased. An LDL level of 65 mg/dL is normal.

A nurse is caring for a patient with a history of chronic stable angina that reports chest pain. What is a characteristic of pain related to this type of angina? It generally lasts longer than 15 to 20 minutes. It will be relieved by rest, nitroglycerin, or both. It is frequently associated with vomiting and extreme fatigue. It indicates that irreversible myocardial damage is occurring.

It will be relieved by rest, nitroglycerin, or both. 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.

A patient is classified as having stage 2 hypertension on the basis of the blood pressure recorded. The nurse notes that the primary goal of therapy for the patient is to normalize the blood pressure. What should be the patient's target blood pressure? 130/80 mm Hg 140/90 mm Hg 150/90 mm Hg Less than 120/80 mm Hg

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

The nurse is caring for patients who are receiving treatment to reduce lipoproteins and cholesterol. Which findings describe a patient who would experience intensified effects when given warfarin? A: pain in knee joint when walking, no imflammation B: rashes on skin, nausea, diarrhea, ALT 66 C: rash, nausea, weak muscles, further weakening of skeletal muscles, ALT 60 D: flushing and itching below the neck, diarrhea, dyspepsia, nausea, vomiting, orthostatic hypotension, and elevated homocysteine levels

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

The nurse is caring for four male patients in a health care facility. Which patient has the highest risk for developing coronary artery disease (CAD)? A: 110lbs | 4'9" | 200 mg/dL cholesterol | 40 mg/dL HDL | 5% A1C B: 143 | 5'5" | 190 | 55 | 6.5% C: 136 | 5'1" | 204 | 38 | 7.4% D: 154 | 5'7" | 175 | 48 | 6.8%

Patient C 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/height 2. The acceptable range of BMI is 18.5 to 24.9 kg/m 2, 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.

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)? Patient A: 43-year-old nonsmoking African American male Patient B: 26-year-old Hispanic male that smokes one pack of cigarettes per day Patient C: 49-year-old Caucasian male with a blood pressure 139/82 mm Hg Patient D: 72-year-old African American female with a cholesterol level of 300 mg/dL

Patient D: 72-year-old African American female with a cholesterol level of 300 mg/dL 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.

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

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.

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

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.

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. Smoking cessation three years ago Serum cholesterol level of 260 mg/dL Fasting triglyceride level of 110 mg/dL High level of anxiety over last two years related to family issues Lives with an adult child that smokes two packs of cigarettes per day Works over 50 hours/week in an office as a receptionist with little time to exercise

Serum cholesterol level of 260 mg/dL High level of anxiety over last two years related to family issues Lives with an adult child that smokes two packs of cigarettes per day 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.

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. Rash Pruritus Flushing Muscle pain Muscle weakness Gastrointestinal disturbances

Rash Muscle pain Muscle weakness 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.

The nurse provides teaching to a patient recently diagnosed with coronary artery disease (CAD). Which information related to health promotion should the nurse include? Select all that apply. Reduce total fat intake Decrease the amount of fiber in the diet Increase complex carbohydrates in the diet Perform isometric exercises at least 10 minutes daily Perform moderate physical activity for at least 30 minutes a minimum of five days a week

Reduce total fat intake Increase complex carbohydrates in the diet Perform moderate physical activity for at least 30 minutes a minimum of five days a week Dietary modifications should include a decrease in total fat intake as well as an increase in complex carbohydrates (whole grains, fruits, and vegetables). A moderate physical activity program should include isotonic exercises, such as walking, hiking, or jogging performed for at least 30 minutes on most week days (e.g., at least 5 days a week). Modifications should include an increase in fiber. Consumption of alcohol and simple sugars will lead to an elevated triglyceride level. Isometric exercises, such as weight lifting, are recommended to increase muscle strength two days per week only.

Which behaviors can help reduce psychologic risk factors that contribute to the development of coronary artery disease (CAD)? Select all that apply. Monitoring glucose levels daily Setting realistic goals for exercise Changing eating patterns and habits Increasing activities to a prescribed fitness level Planning time for adequate rest and sleep Learning effective stress management techniques

Setting realistic goals for exercise Planning time for adequate rest and sleep Learning effective stress management techniques Planning time for adequate rest and sleep contributes to the patient's psychologic well-being, which can reduce the risk for development of CAD. Setting realistic goals for exercise also increases psychologic well-being, because reaching attainable goals can help boost the patient's level of confidence. Learning effective stress management techniques helps reduce the risk for development of CAD by helping the patient better manage his or her stress levels. Increasing activities to a prescribed fitness level, monitoring glucose levels daily, and managing eating patterns and habits are all appropriate behaviors to aid in the reduction of risk factors for CAD, but they address physiologic, not psychologic, components.

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 the patient takes which lipid-lowering medication? Niacin Colestipol Simvastatin Gemfibrozil

Simvastatin Muscle pain and elevated creatine kinase levels are manifestations of rhabdomyolysis. Elevated liver enzymes and rhabdomyolysis are adverse effects of statin drugs such as 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.

Which complementary lipid-lowering agents may be recommended to a patient for reduction of total cholesterol? Select all that apply. Soy Psyllium Flaxseed Plant sterols Red yeast rice Omega-3 fatty acids

Soy Psyllium Plant sterols Red yeast rice 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 patient with hyperlipidemia has been prescribed niacin. The nurse administers aspirin 30 minutes before administering niacin for what reason? To relieve pain To prevent clotting of blood To prevent flushing of skin To prevent the formation of atherosclerotic plaque

To prevent flushing of skin 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.

A nurse provides teaching to a patient about smoking cessation to decrease the risk of coronary artery disease (CAD). Why does the nurse discourage cigarette smoking? Select all that apply. Tobacco smoking increases estrogen levels. Tobacco smoking decreases blood pressure. Tobacco smoke increases the low-density lipoprotein levels. Nicotine in tobacco smoke causes release of catecholamines. Carbon monoxide, found in tobacco smoke, affects the O 2-carrying capacity of haemoglobin.

Tobacco smoke increases the low-density lipoprotein levels. Nicotine in tobacco smoke causes release of catecholamines. Carbon monoxide, found in tobacco smoke, affects the O 2-carrying capacity of haemoglobin. 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 for coronary artery disease.

A nurse reviews a patient's medical history and identifies which findings as major modifiable risk factors? Select all that apply. Age Gender Tobacco use BP 150/92 mm Hg Genetic predisposition Cholesterol 180 mg/dL Waist circumference 42 inches

Tobacco use BP 150/92 mm Hg Waist circumference 42 inches Major modifiable risk factors include BP > 140/90 mm Hg, tobacco use, and waist circumference > 40 inches in men and > 35 inches in women. Age, genetic predisposition, and gender are nonmodifiable. A total cholesterol level > 200 mg/dL is a risk factor.

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. Tofu Walnuts Flaxseed Whole milk Orange juice

Tofu Walnuts Flaxseed 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.

When advising an obese patient about ways to prevent coronary artery disease (CAD), the nurse suggests using tofu instead of chicken when making food dishes. Which reason led the nurse to make this suggestion? Select all that apply Tofu has a high salt content. Tofu has very low fiber content. Tofu is a good source of alpha-linolenic acid. Tofu increases the triglyceride levels in the body. Tofu increases omega-3 fatty acid levels in the body.

Tofu is a good source of alpha-linolenic acid. Tofu increases omega-3 fatty acid levels in the body. The American Heart Association recommends consuming tofu and other soybean products because they are rich sources of alpha-linolenic acid. Alpha-linolenic acid is converted to omega-3 fatty acids, which reduce the risk of coronary artery disease by lowering the triglyceride levels in the body. A diet high in salt may increase blood pressure, which could make an individual more susceptible to developing coronary artery disease. A high-fiber diet is preferred to prevent coronary artery disease because fiber is known to reduce total cholesterol and low-density lipoprotein levels. Increased triglyceride levels make an individual more susceptible to atherosclerosis.

Which food sources of polyunsaturated fat would the nurse include in a teaching plan for a patient with coronary artery disease (CAD)? Select all that apply. Walnuts Palm oil Egg yolk Sour cream Food from soybeans

Walnuts Food from soybeans Polyunsaturated fats are found in greatest amounts in many kinds of nuts and in foods from plants including safflower, sunflower, corn, soybean, and cottonseed oils. Palm oil, egg yolk, and sour cream are major dietary sources of saturated fat.

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

What is your BMI number? Risk for CAD increases with obesity, which is defined as a BMI more than 30 kg/m 2. 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.