Patho Chp 24 Coronary Circulation Disorders
A patient is diagnosed with atherosclerotic plaque in the coronary arteries. Which statement about coronary plaque is correct? Plaque is a stable narrowing that can be resolved with diet changes. Plaque is at risk for rupture that could result in occlusion of the artery. Plaque in the coronary arteries causes collateral circulation that will prevent damage to the heart. Plaque remains asymptomatic and causes no change in coronary oxygenation.
Plaque is at risk for rupture that could result in occlusion of the artery. When atherosclerotic plaque ruptures, it is the stimulus for thrombogenesis and blood flow obstruction. Plaque cannot be resolved with just dietary changes. Plaque causes narrowing that can decrease oxygen to the coronary muscle. Collateral circulation can develop, but may not prevent damage to heart muscle.
The nurse administers a chewable aspirin to a patient who reports worsening chest pain at rest. The patient asks the nurse why the aspirin is needed. Which explanation by the nurse is accurate? "Aspirin is used to help alleviate the pain associated with acute coronary syndrome." "Aspirin is used to vasodilate the coronary arteries to increase blood flow to the heart muscle." "Aspirin is used to slow the heart rate to prevent the heart from working too hard." "Aspirin is used with acute coronary syndrome because of its antiplatelet function, which helps prevent thrombosis."
"Aspirin is used with acute coronary syndrome because of its antiplatelet function, which helps prevent thrombosis." Non-enteric-coated chewable aspirin should be given at presentation of symptoms and continued throughout the patient's life because of its antiplatelet function in preventing future thrombosis and coronary artery occlusion. Morphine sulfate may be administered intravenously in the presence of persistent ischemic chest pain, unless there are contraindications such as hypotension. Short-acting sublingual nitroglycerin should be administered under the patient's tongue every 5 minutes for up to 3 doses for vasodilation. Beta blockers are used to slow the heart rate.
The nurse is discussing coronary artery disease (CAD) with a colleague. Which statement by the nurse is accurate? "Atherosclerosis begins with small particles of high-density lipoproteins in the tunica intima." "Coronary artery disease decreases quality of life but does not increase risk of death." "Decreased levels of high-density lipoproteins (HDLs) decrease the risk of CAD." "Atherosclerosis causes narrowed arteries and decreased blood flow."
"Atherosclerosis causes narrowed arteries and decreased blood flow." The development of atherosclerotic plaque protruding into the vessel lumen leads to a narrowed artery, which disrupts laminar blood flow. thereby reducing blood delivery to distal tissue. Progressive narrowing of the coronary artery occurs as the atherosclerotic plaque builds up and decreased blood flow results in insufficient supply to distal tissues such as the myocardium. The first steps of atherosclerosis involve the accumulation of small particles of low-density lipoprotein (LDL), not HDL, cholesterol in the tunica intima. Increased, not decreased, levels of high-density lipoproteins (HDLs) decrease the risk of atherosclerosis. Decreases in oxygenated blood supply to the coronary arteries both decrease a patient's ability to function and increase the risk of death.
A patient's laboratory test results demonstrate an elevated C-reactive protein (CRP). The patient asks the nurse, "What does this mean?" Which response by the nurse is accurate? "Increased C-reactive protein levels show that inflammation has caused angina that will lead to a myocardial infarction (MI)." "Decreased C-reactive protein levels interfere with the heart's electrical activity." "C-reactive protein (CRP) level is strongly associated with atherosclerosis and coronary artery disease (CAD)." "C-reactive protein levels indicate that damage to the heart muscle has impacted the heart's pumping ability."
"C-reactive protein (CRP) level is strongly associated with atherosclerosis and coronary artery disease (CAD)." An elevated plasma or serum C-reactive protein level is strongly associated with atherosclerosis and CAD, and is predictive of cardiovascular events such as MI, stroke, peripheral artery disease, and sudden cardiac death. CRP does not impact the electrical activity or pumping activity of the heart. Increased levels do indicate inflammation, but that alone does not lead to angina or MI, because those are caused by the narrowing of the lumen of the artery.
A patient undergoing an electrocardiogram (ECG) asks the nurse the purpose of the test. Which explanation by the nurse is accurate? "ECG is a test used to assess the pumping ability of the heart." "ECG is a test used to assess the electrical activity of the heart." "ECG is a test used to determine cardiac output of the heart." "ECG is a test used to measure the preload and afterload in the heart."
"ECG is a test used to assess the electrical activity of the heart." The electrocardiogram (ECG) is used to assess and record the heart's electrical activity and show the presence of dysrhythmias related to cardiovascular disease. It cannot determine preload, afterload, cardiac output, or the pumping ability of the hear
The nurse is teaching a patient with coronary artery disease about nonmodifiable risk factors. Which statement by the patient shows that teaching has been effective? "Elevated lipid levels are genetic and I cannot change the levels." "Family history is something I cannot change." "Depression is a disease that I cannot change." "Obesity is a disease and cannot be changed."
"Family history is something I cannot change." A patient cannot change family history, so it is classified as a nonmodifiable risk factor. Patients can learn methods to minimize or manage depression; therefore, it is considered a modifiable risk factor. Elevated lipid levels increase the risk of fatty deposits inside blood vessels. Lipid levels can be controlled through diet, exercise, and medications, and are considered a modifiable risk factor. A patient can change obesity and therefore it is classified as a modifiable risk factor.
A patient with hypertension (HTN) states, "I feel fine. Why do I continually need follow-up?" Which explanation by the nurse is accurate? "Hypertension causes increased cardiac output and puts more work on the heart." "Hypertension should be screened so that blood pressure can be managed, but it will not impact your heart." "Hypertension can cause organ damage to the heart, brain, kidneys, and eyes without symptoms." "Hypertension causes decreased afterload on the left ventricle and makes it harder for the heart to pump."
"Hypertension can cause organ damage to the heart, brain, kidneys, and eyes without symptoms." While some of the most common symptoms that hypertensive patients report are headaches and nocturia, many patients have no symptoms of HTN. HTN has an impact on the heart and its functions. HTN causes increased afterload, which decreases cardiac output.
A patient at high risk for sudden cardiac arrest asks about treatment options to prevent it.Which statement by the nurse is accurate? "A wearable cardioverter-defibrillator vest is a permanent treatment option that requires no surgical operation." "Pacemaker insertion is needed to help decrease mortality for patients at high risk for sudden cardiac arrest." "Implantable cardioverter-defibrillators (ICDs) are the best option to decrease mortality for patients at high risk for sudden cardiac arrest." "It is best to get an automated external defibrillators (AED) to keep at home to decrease mortality for patients at high risk for sudden cardiac arrest."
"Implantable cardioverter-defibrillators (ICDs) are the best option to decrease mortality for patients at high risk for sudden cardiac arrest." Implantable cardioverter-defibrillator implantation has been associated with reduced mortality in patients who are at high risk for sudden cardiac death. Pacemakers are indicated mainly for symptomatic bradydysrhythmias or for patients with asymptomatic bradydysrhythmia if development of serious or symptomatic dysrhythmia is likely. A wearable cardioverter-defibrillator vest is a temporary option until an ICD can be implanted. An AED is not the best option, because it requires a second person to operate.
The nurse is teaching a colleague about cardiac output. Which statement by the nurse is accurate? "Decreased preload will increase cardiac output." "Decreased stroke volume will increase the cardiac output." "Increased stroke volume and heart rate will increase cardiac output." "Increased stroke volume and bradycardia will increase cardiac output."
"Increased stroke volume and heart rate will increase cardiac output." Cardiac output (CO) is the amount of blood pumped from the left or right ventricle. It is determined by stroke volume (SV) and heart rate (HR) as represented by the equation: CO = SV x HR. Decreased HR or SV will decrease CO. Decreased preload will decrease stroke volume.
The nurse is assessing a patient with diabetes for clinical manifestations of coronary artery disease. The patient states, "Since I've had no chest pain, why are you concerned about cardiac disease?" Which statement by the nurse is accurate? "Diabetes causes more severe symptoms of heart problems so you would feel more chest pain if you had any heart problems." "It is common for people with diabetes to not experience the classic signs of heart problems such as chest pain." "People with diabetes have a better prognosis for decreasing heart problems." "Diabetes decreases the risk of heart disease, but everyone should be screened for heart disease."
"It is common for people with diabetes to not experience the classic signs of heart problems such as chest pain." Diabetes increases the risk of coronary artery disease, due to high blood sugar causing damage to vessel walls. Many people may live with widespread coronary artery obstruction but never experience the typical symptoms of angina pectoris. Episodes of silent ischemia are estimated to be present in one-third of patients who are treated for angina, a higher prevalence being likely for patients with diabetes. The pathogenesis for silent ischemia is unclear, but is thought to be related to a defective anginal warning system as a result of problems in peripheral and central neural processing of pain which decreases pain felt.
The nurse is teaching a patient about the effects of hypertension on the heart. Which patient statement indicates that the teaching has been effective? "It is important to maintain my blood pressure because it will slow the signs of aging." "It is important to maintain my blood pressure to maintain a good urinary output." "It is important to maintain my blood pressure in order to keep my heartbeat strong." "It is important for me to maintain my blood pressure in order to prevent damage to my heart."
"It is important for me to maintain my blood pressure in order to prevent damage to my heart." Hypertension is a risk factor for development of coronary artery diease and can affect the left ventricle of the heart critically. Over time, this leads to left-sided heart failure. Hypertension does not affect signs of aging, strength of heartbeat, or urinary output as critically.
A patient is diagnosed with periodontal disease. The nurse explains to the patient how periodontal disease is associated with coronary artery disease (CAD). Which statement by the nurse is accurate? Periodontal disease is a disease that has no association to CAD." "Periodontal disease is a nonmodifiable risk factor that is associated with a decreased risk of development of CAD." "Periodontal disease is an inflammatory process that may be associated with increased risk of CAD." "Periodontal disease is a nonmodifiable risk factor that may be associated with increased risk of CAD."
"Periodontal disease is an inflammatory process that may be associated with increased risk of CAD." Periodontal disease is an inflammatory process that may be associated with increased risk of coronary artery disease. Infections have been associated with CAD as well as periodontal disease, which makes the diseases possibly related due to shared risk factors and inflammatory processes. Peridontal disease is a modifiable risk factor.
A patient with hypertension (HTN) has not been able to decrease blood pressure with diet and exercise over the past 6 months. The patient asks about the next step in managing the hypertension. Which statement by he nurse is appropriate? "Since lifestyle modifications have not been effective alone, medications may be added to get the blood pressure in the healthy range." "Lifestyle modifications are the best way to lower blood pressure, so continue to stick with the diet and exercise for now." "Medications will only need to be started if the blood pressure worsens." "Medications will be started so lifestyle modifications are no longer needed."
"Since lifestyle modifications have not been effective alone, medications may be added to get the blood pressure in the healthy range." Since lifestyle modifications have not been effective alone, medications need to be added to get the blood pressure in the heatlhy range to help prevent target organ damage. Once a diagnosis of HTN has been made, every treatment needs to be considered to lower the blood pressure. Even if medications are started, lifestyle modifications should be continued.
A baby is born with tetralogy of Fallot. The parents ask the nurse what this diagnosis means for their child. Which explanation by the nurse is accurate? "Your child has a simple ventricular septal defect, which is usually asymptomatic and has an excellent long-term prognosis." "Your child has an enlarged heart and will require monitoring during the first year of life." "Your child has pulmonary valve stenosis and a transesophageal echocardiography (TEE) will be performed to fix the valve defect." "Your child will require open heart surgery in the first year of life to correct congenital heart defects."
"Your child will require open heart surgery in the first year of life to correct congenital heart defects.".. Tetralogy of Fallot is a complex heart defect that involves pulmonary valve stenosis, a large ventricular septal defect, an overriding aorta causing deoxygenated blood from the right ventricle to flow directly into the aorta instead of the pulmonary artery, and right ventricular hypertrophy, in which the right ventricle is thicker and must work harder to contract. Infants and children with simple ventricular septal defects are usually asymptomatic and have an excellent long-term prognosis. A ventricular septal defect as part of the complex disease process of tetralogy of Fallot requires open heart surgery, typically during the first year of life. TEE is just a test and does not fix any malformations. Monitoring alone will not be treatment for Tetralogy of Fallot.
A patient is diagnosed with acute coronary syndrome (ACS). The patient asks the nurse to explain the diagnosis. Which information should the nurse include? ACS is a diagnosis used when a myocardial infarction has occurred. ACS is a diagnosis used when the patient has had a ST-segment elevation myocardial infarction. ACS means that the patient has a stable plaque lesion that is decreasing blood flow to the heart muscle. ACS is diagnosed when clinical signs and symptoms related to myocardial ischemia or infarction are found.
ACS is diagnosed when clinical signs and symptoms related to myocardial ischemia or infarction are found. Acute coronary syndrome (ACS) is diagnosed when clinical signs and symptoms related to myocardial ischemia or infarction are found. ACS diagnosis alone does not confirm a myocardial infarction has occurred. A stable plaque lesion is associated with stable angina. ACS can mean unstable angina or a non-ST-segment elevation ACS.
The nurse is assessing a patient for risk factors of coronary artery disease. Which factor is considered nonmodifiable? Sedentary lifestyle Age 62 years Stress level Elevated lipid levels
Age 62 years As age increases, so does the risk of coronary artery disease. The patient cannot change their age, so it is classified as a nonmodifiable risk factor. Patients can learn methods to minimize or manage stress; therefore, it is considered a modifiable risk factor. Elevated lipid levels increase the risk of fatty deposits inside blood vessels. Lipid levels can be controlled through diet, exercise, and medications and are considered a modifiable risk factor. A lack of activity increases the risk of the formation of plaque seen in coronary artery disease. A patient can change their activity level and therefore it is classified as a modifiable risk factor.
The nurse is teaching a patient about strategies to decrease the risk for coronary artery disease. Which diet choice demonstrates that the patient accurately understands the nurse's instruction? Liver Coconut milk Almonds Egg yolks
Almonds Nuts contain unsaturated fats, providing essential nutrients without cholesterol. Coconut products are high in saturated fats and increase the risk for coronary artery disease. Egg yolks are high in saturated fat and cholesterol, increasing the risk for coronary artery disease. Egg whites are low in fat. Liver has animal fats that contribute to elevated levels of low-density lipoproteins and increase the risk for coronary artery disease.
A patient is dizzy, lightheaded, and has a blood pressure of 74/32 mmHg. The nurse recognizes that hypotension can have which consequences for the heart? Can lead to increased oxygen delivery to the coronary arteries. Can increases preload, which leads to increased cardiac output Can decrease afterload, making it easier for the heart to pump oxygen to the heart muscle Can lead to increased cardiac oxygen demand
Can lead to increased cardiac oxygen demand Hypotension results in increased myocardial oxygen requirements and lower oxygen delivery, and may accelerate the time to irreversible injury of cardiac muscle. Hypotension does reduce afterload, but it also decreases preload, which decreases cardiac output leading to insufficient blood flow through the heart. This causes decreased blood flow, and therefore decreased oxygen delivery, to the coronary muscle.
The nurse is teaching a class of parents about health promotion for children. Which recommendation should the nurse include to help prevent or regress coronary artery disease (CAD)? Children should maintain a healthy weight, blood pressure, and not be exposed to smoke. Children should eat a balanced diet and avoid snacks. Children should exercise twice a day for a minimum of 20 minutes each session. Children should live in a smoke-free environment.
Children should maintain a healthy weight, blood pressure, and not be exposed to smoke. Children and young adults are not immune to atherosclerosis, which is the leading cause of death in developed and developing countries. Interventions to promote a healthy lifestyle, such as maintaining a healthy weight and blood pressure, and abstaining from smoking are necessary to prevent atherosclerosis, or to regress developed and developing atheromas at any age before they cause coronary artery disease. Just exercising, diet, and a smoke-free environment alone are not enough to prevent CAD.
The nurse is caring for a patient with unstable angina. Which symptom indicates that the patient may be experiencing a myocardial infarction? Chest pain Tachycardia Cool mottled skin Dyspnea
Cool mottled skin Cool mottled skin indicates a decrease in supply of oxygenated blood to the body and possible heart failure. This manifestation is not present with unstable angina and indicates the possible occurrence of a myocardial infarction. Chest pain, tachycardia, and dyspnea are present with unstable angina and do not indicate a progression to myocardial infarction.
A patient with narrowing of the coronary arteries denies any symptoms or episodes of chest pain. Which condition should the nurse suspect? Acute coronary syndrome (ACS) Unstable angina Myocardial infarction (MI) Coronary artery disease (CAD)
Coronary artery disease (CAD) Decreased blood flow to the heart occurs with coronary artery disease. Unstable angina, myocardial infarction, and acute coronary syndrome are the result of the blood flow to the heart being occluded or disrupted.
A patient is undergoing testing to verify a diagnosis of hypertension. Which symptom(s) might the patient with suspected hypertension report to the nurse? Restless legs when sleeping Frequent headaches and nocturia Burning sensation upon urinating Polyuria, polyphagia, and polydipsia
Frequent headaches and nocturia The most common symptoms that hypertensive patients report are headaches and nocturia. Polyuria, polyphagia, and polydipsia are signs of diabetes mellitus. Burning sensation when urinating indicates a urinary tract infection. Restless legs while sleeping can be associated with electrolyte or muscle issues and is not associated with hypertension. Hypertension (HTN) increases the afterload on the left ventricle. This can lead to ventricular remodeling and lead to heart failure. HTN can lead to decreased perfusion to the organs such as the kidneys, brain, heart, and eyes.
A patient presents with a high risk for sudden cardiac death due to dysrhythmia. Which treatment should the nurse expect to be ordered that will best address the patient's condition? A wearable cardioverter-defibrillator vest Implantable cardioverter-defibrillators (ICDs) Pacemaker insertion An automated external defibrillator (AED)
Implantable cardioverter-defibrillators (ICDs) Implantable cardioverter-defibrillators (ICDs) are best to help prevent death from cardiac arrest. This treatment has been associated with reduced mortality in patients who are at high risk for sudden cardiac death. Pacemakers are indicated mainly for symptomatic bradydysrhythmias or for patients with asymptomatic bradydysrhythmia if development of serious or symptomatic dysrhythmia is likely. A wearable cardioverter-defibrillator vest is a temporary option until an ICD can be implanted. An AED is not the best option, because it requires a second person to operate.
A patient with a heart rate of 150 beats/min reports chest pain. The nurse should recognize this heart rate can lead to which condition? Occlusion of the coronary arteries that will decrease oxygenation to the coronary muscles Increased myocardial oxygen demand that can cause cell damage due to decreased oxygenation Increased cardiac output and better coronary perfusion to the coronary arteries Decreased oxygen demand leaving more oxygen available for the tissues of the body
Increased myocardial oxygen demand that can cause cell damage due to decreased oxygenation Increased, not decreased, myocardial oxygen requirements, resulting from tachycardia (abnormal rapid heart rate, generally more than 100 beats per minute) may accelerate the time to irreversible coronary injury due to decreased oxygenation of the coronary muscles. Tachycardia does not result in better perfusion to the coronary arteries. Tachycardia does not cause occlusion of the arteries.
The nurse is teaching a patient about the risk factors for coronary artery disease. Which risk factor is considered modifiable? Age Gender Ethnicity Insulin resistance
Insulin resistance A patient can change their activity or diet to decrease obesity, and therefore it is classified as a modifiable risk factor. Age, gender, and ethnicity cannot be changed, making them nonmodifiable risk factors. Additional Learning Major modifiable risk factors that contribute to a risk of CAD include: Smoking and tobacco use. Lack of physical activity. Poor nutrition. Obesity. Hypertension. Dyslipidemias. Insulin resistance. Metabolic syndrome. Sleep apnea. Stress. Depression.
A patient with a history of atherosclerosis has chest pain that is unrelated to activity, unpredictable, and often occurs while at rest. The patient reports the pain has been becoming more frequent and severe. The nurse recognizes that the patient is at severe risk for which disorder? Coronary artery disease Myocardial infarction Hypertension Stable angina
Myocardial infarction This patient's angina is unpredictable and occurs at rest, which places the patient at high risk of a myocardial infarction. Hypertension alone does not result in severe chest pain at rest. Stable angina is a predictable form of angina, which usually occurs when the work of the heart is increased by physical exertion, exposure to cold, or stress. Coronary artery disease is the cause of angina, which is a result of chest pain.
A patient with a history of atherosclerosis has chest pain that is unrelated to activity, unpredictable, and often occurs while at rest. The patient reports the pain has been becoming more frequent and severe. The nurse recognizes that the patient is at severe risk for which disorder? Stable angina Coronary artery disease Hypertension Myocardial infarction
Myocardial infarction This patient's angina is unpredictable and occurs at rest, which places the patient at high risk of a myocardial infarction. Hypertension alone does not result in severe chest pain at rest. Stable angina is a predictable form of angina, which usually occurs when the work of the heart is increased by physical exertion, exposure to cold, or stress. Coronary artery disease is the cause of angina, which is a result of chest pain.
Which risk factor for coronary artery disease should the nurse consider as modifiable? Gender Age Periodontal disease Ethnicity
Periodontal disease Peridontal disease can be modified by dental care. Gender, age, and ethnicity are nonmodifiable risk factors.
Which statement reflects the function of an electrocardiogram (ECG). Shows the presence of dysrhythmias Reveals valvular strength Computes cardiac preload Measures cardiac output
Shows the presence of dysrhythmias The electrocardiogram (ECG) is used to assess and record the heart's electrical activity and show the presence of dysrhythmias related to cardiovascular disease. An ECG may indicate cardiac irregularities but cannot determine preload, cardiac output, or the strength of the valves.
The nurse is caring for a patient with a history of atherosclerosis. The patient reports chest pain that occurs with physical exertion or stress and is relieved with a sublingual nitroglycerine tablet. The nurse recognizes the patient as most likely experiencing which disorder? Acute coronary syndrome Myocardial infarction Stable angina Prinzmetal angina
Stable angina Stable angina is a predictable form of angina, which usually occurs when the work of the heart is increased by physical exertion, exposure to cold or stress, and is relieved by nitroglycerin. Prinzmetal (variant) angina occurs unpredictably and often at night. The patient is currently experiencing a predictable form of angina. Clinical manifestations of myocardial infarction include pain that is less predictable, more prolonged, and unrelieved by sublingual nitroglycerin. Clinical manifestations of acute coronary syndrome include pain that is more severe and longer than previously experienced, is not predictable, and is unrelieved by sublingual nitroglycerin.
A patient with an elevated C-reactive protein (CRP) is being evaluated for coronary artery disease. For which complication is the patient most at risk? Pericardial inflammation Atrial fibrillation Stroke Heart failure
Stroke With coronary artery disease and elevated C-reactive protein, the patient is at risk for a stroke. An elevated plasma or serum CRP level is strongly associated with atherosclerosis and CAD and is predictive of cardiovascular events such as MI, stroke, peripheral artery disease, and sudden cardiac death. CRP does not impact the electrical activity (such as atrial fibrillation) or pumping activity (such as heart failure) of the heart. Increased levels indicate inflammation, but that alone does not lead to angina or myocardial infarction, because those are caused by narrowing of the lumen of the artery.
A patient diagnosed with atherosclerosis in the coronary arteries reports chest pain while exercising, but states it subsides with rest. Which description about the patient's chest pain is correct? The chest pain is a sign of a myocardial infarction (MI). The chest pain is a sign of collateral circulation that bypasses any occlusion. The chest pain is a result of imbalance of myocardial oxygen supply and demand. The chest pain is a sign of plaque that has ruptured and completely occluded a coronary artery.
The chest pain is a result of imbalance of myocardial oxygen supply and demand. The chest pain is symptom of oxygenation imbalance. The sudden imbalance of myocardial oxygen consumption, which is the amount of oxygen consumed by the heart, and the myocardial demand, which is the amount of energy required, is the hallmark of acute coronary syndrome (ACS). The chest pain alone does not indicate that an MI has occurred or an artery has been completely occluded. Even partial occlusion can cause chest pain without cellular death. Collateral circulation cannot bypass any occlusion to prevent damage.
A patient has been diagnosed with suspected mitral regurgitation. Which diagnostic test should the nurse expect to be ordered to confirm the diagnosis? Coronary angiogram Transesophageal echocardiography (TEE) Electrocardiogram (ECG) Chest x-ray
Transesophageal echocardiography (TEE Transesophageal echocardiography (TEE) is the standard diagnostic test used for initial evaluation and as follow-up for the patient with known or suspected valvular disorder to determine cause, severity, hemodynamic effects, prognosis, and timing of interventions. Electrocardiogram is measurement of the electrical signals of the heart, not the valve function. Coronary angiogram is used to look at perfusion of the coronary angiogram. Diagnosis may be based on incidental findings on chest x-ray or other noninvasive testing or as a result of auscultation of a heart murmur during a physical examination, but TEE is best for visualization.