143 Module 3 - Coronary Artery Disease (PRACTICE QUESTIONS)

A client with angina pectoris must learn how to reduce risk factors that exacerbate this condition. When developing the client's care plan, which expected outcome should a nurse include? A. Client will verbalize the intention to stop smoking. B. Client will verbalize an understanding of the need to call the physician if acute pain lasts more than 2 hours. C. Client will verbalize an understanding of the need to restrict dietary fat, fiber, and cholesterol. D. Client will verbalize the intention to avoid exercise.

A. A client with angina pectoris should stop smoking at once because smoking increases the blood carboxyhemoglobin level; this increase, in turn, reduces the heart's oxygen supply and may induce angina. The client must seek immediate medical attention if chest pain doesn't subside after three nitroglycerin doses taken 5 minutes apart; serious myocardial damage or even sudden death may occur if chest pain persists for 2 hours. To improve coronary circulation and promote weight management, the client should get regular daily exercise. The client should eat plenty of fiber, which may decrease serum cholesterol and triglyceride levels and minimize hypertension, in turn reducing the risk for atherosclerosis (which plays a role in angina).

Which of the following is inconsistent as a condition related to metabolic syndrome? A. Hypotension B. Insulin resistance C. Abdominal obesity D. Dyslipidemia

A. A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.

The nurse is teaching a client about atherosclerosis. The client asks the nurse what the substance causing atherosclerosis is made of. How does the nurse best respond? A. fatty deposits in the lumen of arteries B. cholesterol plugs in the lumen of veins C. blood clots in the arteries D. emboli in the veins

A. Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. The plaque does not involve blood clots in arteries, emboli in veins or cholesterol plugs in veins.

The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? A. potassium level of 6 mEq/L B. serum glucose of 124 mg/dL C. weight gain of 6 ounces D. bilateral rales and rhonchi

A. Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain is not significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed.

The nurse is assisting with a bronchoscopy at the bedside in a critical care unit. The client experiences a vasovagal response. What should the nurse do next? A. Check blood pressure. B. Assess pupils for reactiveness. C. Prepare to administer intravenous fluids. D. Suction the airway.

A. During a bronchoscopy, a vasovagal response may be caused by stimulating the pharynx, and it in turn may cause stimulation of the vagus nerve. The client may, therefore, experience a sudden drop in heart rate, leading to syncope. The nurse will need to assess blood pressure to assure circulation. Stimulation of the vagus nerve doesn't lead to pupillary dilation or bronchodilation. Stimulation of the vagus nerve increases gastric secretions.

What is the most likely reason a client has experienced a proliferation of atherosclerotic plaque in his/her coronary arteries? A. elevated blood cholesterol levels B. variant angina C. chronic epigastric pain D. diabetes mellitus

A. Elevated blood cholesterol promotes the development of foam cells that, in turn, promote the development of atherosclerotic plaque. Variant angina occurs when there is a deficit in myocardial oxygen supply; epigastric pain can be a gender-different cardiac symptom in women; diabetes mellitus is a metabolic disorder in which one may present without classic angina as a cardiac symptom.

A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? A. Elevated ST segment B. Prolonged PR interval C. Widened QRS complex D. Absent Q wave

A. Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.

Which statement by the client would lead the nurse to believe that the client has understood the teaching provided regarding angina? A. "Heavy meals and cigarette smoking can precipitate an angina attack." B. "There is no correlation between my hypertension and angina." C. "I will not exercise because it precipitates angina." D. "As long as I take the medicine, I can maintain my lifestyle."

A. The client should avoid stressful activities, especially in combination. For example, if the client eats a big meal, the client should not drink coffee or alcoholic beverages with that meal. If the client has just eaten a big meal, the client should not climb stairs; instead, the client should rest for a while. However, exercise is important and should not be eliminated, but managed in coordination with other activities. Smoking causes vasoconstriction that can result in angina attacks, so lifestyle changes like reducing fat and calories in the diet, moderate exercise, reducing alcohol intake, and avoiding smoking are all healthful choices. Hypertension does increase the risk of angina and coronary artery disease.

A client with a family history of coronary artery disease reports experiencing chest pain and palpitations during and after morning jogs. What would reduce the client's cardiac risk? A. smoking cessation B. antioxidant supplements C. a protein-rich diet D. exercise avoidance

A. The first line of defense for clients with CAD is lifestyle changes including smoking cessation, weight loss, stress management, and exercise. Clients with CAD should eat a balanced diet. Clients with CAD should exercise, as tolerated, to maintain a healthy weight. Antioxidant supplements, such as those containing vitamin E, beta carotene, and selenium, are not recommended because clinical trials have failed to confirm beneficial effects from their use.

The nurse is assessing a client with severe angina pectoris and electrocardiogram changes in the emergency room. What is the most important cardiac marker for the client? A. troponin B. creatine kinase C. lactate dehydrogenase D. myoglobin

A. This client exhibits signs of myocardial infarction (MI), and the most accurate serum determinant of an MI is troponin level. Creatine kinase, lactate dehydrogenase, and myoglobin tests can show evidence of muscle injury, but the studies are less specific indicators of myocardial damage than troponin.

When a client who has been diagnosed with angina pectoris reports experiencing chest pain more frequently, even at rest, that the period of pain is longer, and that it takes less stress for the pain to occur, the nurse recognizes that the client is describing which type of angina? A. Unstable B. Variant C. Intractable D. Refractory

A. Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

A client who is resting quietly reports chest pain to the nurse. The cardiac monitor indicates the presence of reversible ST-segment elevation. What type of angina is the client experiencing? A. variant angina B. stable angina C. silent angina D. intractable angina

A. Variant or Prinzmetal's angina is distinguished by pain occurrence during rest. Stable angina occurs with activity. Silent angina occurs without symptoms, and intractable angina is evidenced by incapacitating pain.

The nurse is working with a client who had an MI and is now active in rehabilitation. The nurse should teach this client to cease activity if which of the following occurs? A. The client experiences chest pain, palpitations, or dyspnea. B. The client experiences a noticeable increase in heart rate during activity. C. The client's oxygen saturation level drops below 96%. D. The client's respiratory rate exceeds 30 breaths/min.

ANS: A Rationale: Any activity or exercise that causes dyspnea and chest pain should be stopped in the client with CAD. Heart rate must not exceed the target rate, but an increase above resting rate is expected and is therapeutic. In most clients, a respiratory rate that exceeds 30 breaths/min is not problematic. Similarly, oxygen saturation slightly below 96% does not necessitate cessation of activity.

The nurse is caring for a client who has been diagnosed with an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of what? A. Lipids and fibrous tissue B. White blood cells C. Lipoproteins D. High-density cholesterol

ANS: A Rationale: As T-lymphocytes and monocytes infiltrate to ingest lipids on the arterial wall and then die, a fibrous tissue develops. This causes plaques to form on the inner lumen of arterial walls. These plaques do not consist of white cells, lipoproteins, or high-density cholesterol.

The nurse is caring for a client who has undergone percutaneous transluminal coronary angioplasty (PTCA). What is the major indicator of success for this procedure? A. Increase in the size of the artery's lumen B. Decrease in arterial blood flow in relation to venous flow C. Increase in the client's resting heart rate D. Increase in the client's level of consciousness (LOC)

ANS: A Rationale: PTCA is used to open blocked coronary vessels and resolve ischemia. The procedure may result in beneficial changes to the client's LOC or heart rate, but these are not the overarching goals of PTCA. Increased arterial flow is the focus of the procedures.

A client presents to the ED reporting severe substernal chest pain radiating down the left arm. The client is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU? A. Begin ECG monitoring. B. Obtain information about family history of heart disease. C. Auscultate lung fields. D. Determine if the client smokes.

ANS: A Rationale: The 12-lead ECG provides information that assists in ruling out or diagnosing an acute MI. It should be obtained within 10 minutes from the time a client reports pain or arrives in the ED. By monitoring serial ECG changes over time, the location, evolution, and resolution of an MI can be identified and monitored; life-threatening arrhythmias are the leading cause of death in the first hours after an MI. Obtaining information about family history of heart disease and whether the client smokes are not immediate priorities in the acute phase of MI. Data may be obtained from family members later. Lung fields are auscultated after oxygenation and pain control needs are met.

The triage nurse in the ED assesses an adult client who presents with reports of midsternal chest pain that has lasted for the last 5 hours. If the client's symptoms are due to an MI, what will have happened to the myocardium? A. It may have developed an increased area of infarction during the time without treatment. B. It will probably not have more damage than if the client came in immediately. C. It may be responsive to restoration of the area of dead cells with proper treatment. D. It has been irreparably damaged, so immediate treatment is no longer necessary.

ANS: A Rationale: When the client experiences lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated, the more likely the treatment will prevent or minimize myocardial tissue necrosis. Delays in treatment equate with increased myocardial damage. Despite the length of time the symptoms have been present, treatment needs to be initiated immediately to minimize further damage. Dead cells cannot be restored by any means.

What are the primary ways that tobacco use impacts CAD? Select all that apply. A. Decreases the supply of oxygen to the myocardium B. Increases platelet adhesion C. Raises the heart rate and blood pressure D. Causes the coronary arteries to dilate E. Increases the blood carbon monoxide level

ANS: A, B, C, E Rationale: Nicotinic acid in tobacco triggers the release of catecholamines (hormones that are released due to stress), which raise the heart rate and blood pressure and cause coronary arteries to constrict. This increases the risk of CAD and sudden cardiac death. Tobacco use also increases oxidation of low-density lipoprotein (good) cholesterol, which results in increased platelet adhesion and thrombus formation. Ischemia and reduced contractility can result in the increase in carbon monoxide levels and decreased oxygenation of the myocardium.

The nurse is assessing a client with acute coronary syndrome (ACS). The nurse includes a careful history in the assessment, especially with regard to signs and symptoms. What signs and symptoms are suggestive of ACS? Select all that apply. A. Dyspnea B. Unusual fatigue C. Hypotension D. Syncope E. Peripheral cyanosis

ANS: A, B, D Rationale: Systematic assessment includes a careful history, particularly as it relates to symptoms: chest pain or discomfort, difficulty breathing (dyspnea), palpitations, unusual fatigue, faintness (syncope), or sweating (diaphoresis). Each symptom must be evaluated with regard to time, duration, and the factors that precipitate the symptom and relieve it, and in comparison with previous symptoms. Hypotension and peripheral cyanosis are not typically associated with ACS.

The nurse providing care for a client post PTCA knows to monitor the client closely. For what complications should the nurse monitor the client? Select all that apply. A. Abrupt closure of the coronary artery B. Venous insufficiency C. Bleeding at the insertion site D. Retroperitoneal bleeding E. Arterial occlusion

ANS: A, C, D, E Rationale: Complications after the procedure may include abrupt closure of the coronary artery and vascular complications, such as bleeding at the insertion site, retroperitoneal bleeding, hematoma, and arterial occlusion, as well as acute kidney injury. Venous insufficiency is not a postprocedure complication of a PTCA.

A client with angina has been prescribed nitroglycerin. Before administering the drug, the nurse should inform the client about what potential adverse effects? A. Nervousness or paresthesia B. Throbbing headache or dizziness C. Drowsiness or blurred vision D. Tinnitus or diplopia

ANS: B Rationale: Headache and dizziness commonly occur when nitroglycerin is taken at the beginning of therapy. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not typically occur as a result of nitroglycerin therapy.

The nurse is creating a plan of care for a client with acute coronary syndrome. What nursing action should be included in the client's care plan? A. Facilitate daily arterial blood gas (ABG) sampling. B. Administer supplemental oxygen, as needed. C. Have client maintain supine positioning when in bed. D. Perform chest physiotherapy, as indicated.

ANS: B Rationale: Oxygen should be given along with medication therapy to assist with symptom relief. Administration of oxygen raises the circulating level of oxygen to reduce pain associated with low levels of myocardial oxygen. Physical rest in bed with the head of the bed elevated or in a supportive chair helps decrease chest discomfort and dyspnea. ABGs are diagnostic, not therapeutic, and they are rarely needed on a daily basis. Chest physiotherapy is not used in the treatment of ACS.

The nurse is caring for a client who is believed to have just experienced an MI. The nurse notes changes in the ECG of the client. What change on an ECG most strongly suggests to the nurse that ischemia is occurring? A. P-wave inversion B. T-wave inversion C. Q Wave changes with no change in ST or T wave D. P-wave enlargement

ANS: B Rationale: T-wave inversion is an indicator of ischemic damage to myocardium. Typically, few changes to P waves occur during or after an MI, whereas Q-wave changes with no change in the ST or T wave indicate an old MI.

A nurse is assigned four clients with diagnoses that rule out myocardial infarction (MI) due to chest pain. Which client's test results best demonstrate the specific diagnosis of unstable angina (USA)? A. A 63-year-old client with elevated troponins and no elevation in the ST segment. B. A 72-year-old client with an increase in myoglobin, no elevation in the ST segment, and no elevation in troponins. C. A 54-year-old client with elevated creatine kinase myocardial band (CK-MB) and ST segment elevations in two contiguous leads on the electrocardiogram (ECG). D. A 48-year-old client with T wave inversions, ST elevation, and abnormal Q waves.

ANS: B Rationale: The 72-year-old client with chest pain had clinical manifestations of coronary ischemia, but the ECG showed no evidence of an acute MI. The 72-year-old client had an elevated myoglobin, which is a biomarker but is not a very specific indicator of a cardiac event because an elevation may also occur due to seizures, muscle diseases, trauma, and surgery. The 63-year-old client had test results consistent with a non-ST-elevated myocardial infarction: elevated cardiac biomarkers but no ECG evidence of an acute MI. The 48- and 54-year-old clients had test results consistent with an ST-elevated myocardial infarction: elevated cardiac biomarkers, ECG changes in two contiguous leads, ST elevation, and Q wave abnormalities.

When assessing a client diagnosed with angina pectoris, it is most important for the nurse to gather what information? A. The client's activities, limitations, and level of consciousness after the attacks B. The client's symptoms and the activities that precipitate attacks C. The client's understanding of the pathology of angina D. The client's coping strategies surrounding the attacks

ANS: B Rationale: The nurse must gather information about the client's symptoms and activities, especially those that precede and precipitate attacks of angina pectoris. The client's coping, understanding of the disease, and status following attacks are all important to know, but causative factors are a primary focus of the assessment interview.

In preparation for cardiac surgery, a client was taught about measures to prevent venous thromboembolism. What statement indicates that the client clearly understood this education? A. I'll try to stay in bed for the first few days to allow myself to heal. B. I'll make sure that I don't cross my legs when I'm resting in bed. C. I'll keep pillows under my knees to help my blood circulate better. D. I'll put on those compression stockings if I get pain in my calves.

ANS: B Rationale: To prevent venous thromboembolism, clients should avoid crossing the legs. Activity is generally begun as soon as possible and pillows should not be placed under the popliteal space. Compression stockings are often used to prevent venous thromboembolism, but they would not be applied when symptoms emerge.

A client with type 2 diabetes and hypertension (HTN) has a routine follow-up appointment after a cardiac stent placement. On assessment the nurse notes the client weighs 250 lb/113.4 kg with a waist circumference of 40 inches/101.6 cm, blood pressure is 162/84 mm Hg, and fasting blood glucose is 220 mg/dl. Based on these findings, which syndrome should the nurse most suspect? A. Adams-Nance syndrome B. Postpericardiotomy syndrome C. Metabolic syndrome D. Alagille syndrome

ANS: C Rationale: A cluster of metabolic abnormalities known as metabolic syndrome is a major risk factor for cardiovascular disease. This diagnosis is made when the client has 3 of the 5 risk factors. These factors include a waist circumference of greater than 35.4 inches/89.9 cm, elevated triglycerides, reduced high-density lipoprotein cholesterol, HTN with a systolic blood pressure above 130 mm Hg, and fasting glucose greater than 100 mg/dL or drug treatment for elevated glucose. Adams-Nance syndrome is an inherited disorder characterized by paroxysmal tachycardia, arterial HTN, syncope, and seizures. Alagille syndrome is a rare genetic disorder that can affect multiple organ systems including the liver, heart, skeleton, eyes, and kidneys. Based on the information presented neither of the above syndromes is likely. Postpericardiotomy syndrome may occur to clients days or weeks after surgery, so a possibility exists, but the signs and symptoms are not presented. Postpericardiotomy is characterized by fever, pericardial/pleural/joint pain, friction rub, and dyspnea.

Family members bring a client to the ED with pale cool skin, sudden midsternal chest pain unrelieved with rest, and a history of CAD. How should the nurse best interpret these initial data? A. The symptoms indicate angina and should be treated as such. B. The symptoms indicate a pulmonary etiology rather than a cardiac etiology. C. The symptoms indicate an acute coronary episode and should be treated as such. D. Treatment should be determined pending the results of an exercise stress test.

ANS: C Rationale: Angina and MI have similar symptoms and are considered the same process but are on different points along a continuum. That the client's symptoms are unrelieved by rest suggests an acute coronary episode rather than angina. Pale, cool skin and sudden onset are inconsistent with a pulmonary etiology. Treatment should be initiated immediately regardless of diagnosis.

The nurse is participating in the care conference for a client with ACS. What goal should guide the care team's selection of assessments, interventions, and treatments? A. Maximizing cardiac output while minimizing heart rate B. Decreasing energy expenditure of the myocardium C. Balancing myocardial oxygen supply with demand D. Increasing the size of the myocardial muscle

ANS: C Rationale: Balancing myocardial oxygen supply with demand (e.g., as evidenced by the relief of chest pain) is the top priority in the care of the client with ACS. Treatment is not aimed directly at minimizing heart rate because some clients experience bradycardia. Increasing the size of the myocardium is never a goal. Reducing the myocardium's energy expenditure is often beneficial, but this must be balanced with productivity.

The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. Which risk factors should the nurse list that can be controlled or modified? A. Gender, obesity, family history, and smoking B. Inactivity, stress, gender, and smoking C. Cholesterol levels, hypertension, and smoking D. Stress, family history, and obesity

ANS: C Rationale: Four modifiable risk factors—cholesterol abnormalities, tobacco use, hypertension, and diabetes—are established risk factors for CAD and its complications. Inactivity and obesity are also modifiable risk factors associated with CAD. Stress, although not listed as a direct risk factor for CAD, contributes to hypertension, which is itself a risk factor. Gender and family history are risk factors that cannot be controlled.

The nurse is caring for an adult client who had symptoms of unstable angina upon admission to the hospital. What nursing diagnosis underlies the discomfort associated with angina? A. Ineffective breathing pattern related to decreased cardiac output B. Anxiety related to fear of death C. Ineffective cardiopulmonary tissue perfusion related to coronary artery disease (CAD) D. Impaired skin integrity related to CAD

ANS: C Rationale: Ineffective cardiopulmonary tissue perfusion directly results in the symptoms of discomfort associated with angina. Anxiety and ineffective breathing may result from angina chest pain, but they are not the causes. Skin integrity is not impaired by the effects of angina.

The public health nurse is participating in a health fair and interviews a client with a history of hypertension, who is currently smoking one pack of cigarettes per day. The client denies any of the most common manifestations of CAD. The nurse should expect the focuses of CAD treatment to be: A. drug therapy and smoking cessation. B. diet and drug therapy. C. diet therapy only. D. diet therapy and smoking cessation.

ANS: D Rationale: Due to the absence of symptoms, dietary therapy would likely be selected as the first-line treatment for possible CAD. Drug therapy would be determined based on a number of considerations and diagnostic findings, but would not be directly indicated. Smoking cessation is always indicated, regardless of the presence or absence of symptoms.

A client presents to the clinic reporting intermittent chest pain on exertion, which is eventually attributed to angina. The nurse should inform the client that angina is most often attributable to what cause? A. Decreased cardiac output B. Decreased cardiac contractility C. Infarction of the myocardium D. Coronary atherosclerosis

ANS: D Rationale: In most cases, angina pectoris is due to atherosclerosis. The disease is not a result of impaired cardiac output or contractility. Infarction may result from untreated angina, but it is not a cause of the disease.

The nurse is providing care for a client with high cholesterol and triglyceride values. In teaching the client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following? A. High HDL values and high triglyceride values B. Absence of detectable total cholesterol levels C. Elevated blood lipids, fasting glucose less than 100 D. Low LDL values and high HDL values

ANS: D Rationale: The desired goal for cholesterol readings is for a client to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol.

The hospital nurse is caring for a client who reports that an angina attack is beginning. Which action is the nurse's most appropriate initial action? A. Have the client sit down and put the head between the knees. B. Have the client perform pursed-lip breathing. C. Have the client stand still and bend over at the waist. D. Place the client on bed rest in a semi-Fowler position.

ANS: D Rationale: When a client experiences angina, the client is directed to stop all activities and sit or rest in bed in a semi-Fowler position to reduce the oxygen requirements of the ischemic myocardium. Pursed-lip breathing and standing will not reduce workload to the same extent. There is no need to have the client put the head between the legs because cerebral perfusion is not lacking

An ED nurse is assessing a 71-year-old female client for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female clients? Select all that apply. A. Shortness of breath B. Chest pain C. Anxiety D. Indigestion E. Nausea

ANS: D, E Rationale: Many women experiencing coronary events, including unstable angina, MIs, or sudden cardiac death events, are asymptomatic or present with atypical symptoms. These symptoms include indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among clients of all ages and genders.

A patient's is admitted with complaint of chest pain. The electrocardiogram (ECG) reveals ST segment elevation. What is the nurse's priority intervention? 1. Give the patient 162 mg of aspirin. 2. Draw blood for serum cardiac markers. 3. Place the patient on a cardiac monitor. 4. Call for a portable chest x-ray.

Answer: 1 Explanation: 1. As soon as the ECG is done the patient should receive aspirin. 2. Blood should be drawn for serum cardiac markers, but this is not the priority action. 3. The patient should be placed on a cardiac monitor, but this is not the priority intervention. 4. A portable chest x-ray will be taken, but this is not the priority intervention.

A patient tells the nurse that she has been experiencing a pain in the chest for the last 3 hours. What does this information suggest to the nurse? 1. The pain is of noncardiac origin. 2. The patient is in the midst of an acute myocardial infarction. 3. The patient is going to have a myocardial infarction within hours. 4. The patient is having continuous angina.

Answer: 1 Explanation: 1. Chest pain that lasts several seconds or constant pain over a period of hours is not typical pain associated with altered myocardial tissue perfusion. This information should suggest to the nurse that the pain is of noncardiac origin. 2. Pain associated with myocardial infarction will generally not last for 3 hours without deterioration of the patient's condition. 3. Anginal pain can herald myocardial infarction, but generally does not last for several hours. 4. Angina is not continuous.

The patient requires close monitoring during the first 24 hours after receiving thrombolytic therapy. What is the priority nursing intervention? 1. Monitor level of consciousness. 2. Administer pain medications. 3. Monitor for decreased output. 4. Monitor for pulmonary emboli.

Answer: 1 Explanation: 1. The first 24 hours after thrombolytic administration holds the highest risk for intracranial hemorrhage. The intervention that has the highest priority for the first 24 hours after thrombolytic therapy is assessing level of consciousness. 2. The nurse should treat the patient's pain, but this is not the highest priority intervention. 3. Monitoring for decreased output is an important intervention, but is not the highest priority. 4. The nurse should monitor for the development of pulmonary emboli, but this is not the highest priority intervention.

The nurse has completed teaching regarding cardiac risk factor reduction. Which patient statement would best indicate an understanding of the instructions? 1. I am going to start walking my dog for 30 or 40 minutes every day. 2. I will substitute vegetables for some of the fruit I have been eating. 3. I will increase weight-bearing activities. 4. I will avoid becoming dependent on laxatives.

Answer: 1 Explanation: 1. Unless contraindicated, patients should exercise at least 30 minutes a day, 5 to 6 days a week. 2. The goal is 4.5 or more cups of fruits or vegetables daily. There is no reason to substitute one for the other. 3. Increasing weight-bearing activities will help increase muscle mass and bone strength and may or may not help with reducing the risk of developing coronary artery disease, so this is not the best answer. 4. Avoiding laxatives will not reduce the patient's risk of developing coronary artery disease.

Which assessment techniques will the nurse use to evaluate the patient's cardiac output? Select all that apply. 1. Inspection of color changes in the periphery 2. Strength of pulses 3. Percussion of heart borders 4. Auscultation of heart sounds 5. Pulse pressure determination

Answer: 1, 2, 4, 5 Explanation: 1. Color changes in the periphery can indicate decreased cardiac output. 2. Strength of pulse is an indirect measure of cardiac output and contractility. 3. Percussion is incorrect because it measures heart size very crudely but not output. 4. Auscultation helps the nurse assess heart rate and rhythm, which can alter cardiac output. 5. Determination of pulse pressure is an indirect measure of stroke volume, which is a component of cardiac output.

A female patient presents to the emergency department with complaint of chest pain. Which findings would raise the nurse's suspicion that the chest pain is of cardiac origin? Select all that apply. 1. The patient has 2+ edema in her ankles. 2. The patient has bilateral xanthomas (indicates hyperlipidemia) 3. The chest pain is described as a burning in the center of the chest that is worse when supine. 4. The patient has an S3 heart sound. 5. The patient has a dull humming/whooshing sound just below the xiphoid process on auscultation.

Answer: 1, 2, 4, 5 Explanation: 1. Peripheral edema may indicate peripheral vascular disease of left ventricular dysfunction. This finding increases concern that the patient's chest pain may be cardiac. 2. Xanthomas are cholesterol-filled lesions commonly seen around the eyes and could indicate elevated lipids. Presence of these lesions would increase the likelihood that the patient's chest pain is cardiac. 3. Burning pain in the chest that is worse when supine is often related to esophageal reflux disease rather than of cardiac origin. 4. Presence of an S3 heart sound is not normal in an adult and increases concern that the chest pain is cardiac in origin. 5. A dull humming sound below the xiphoid process may be an abdominal bruit, which increases the concern for cardiovascular disease.

The nurse is performing a cardiovascular assessment. Which patient findings would indicate significant risk factors for the development of atherosclerosis? Select all that apply. 1. The patient has diabetes mellitus. 2. The patient tends to become anemic. 3. The patient's mother and sister had myocardial infarctions before age 50. 4. The patient has high levels of low-density lipoproteins. 5. The patient is a 50-year-old male.

Answer: 1, 3, 4, 5 Explanation: 1. Diabetes mellitus increases coronary artery/atherosclerotic disease risk by two- to fourfold. Diabetes can be controlled but is not curable. 2. Anemia is not a risk factor for coronary artery disease. 3. Family history of myocardial infarction increases risk for disease development. 4. LDL, or less desirable cholesterol, increases risk for development of coronary artery disease. 5. Being male is a nonmodifiable risk factor for development of coronary artery disease.

A patient is diagnosed with septic shock and has a decrease in afterload. The nurse would expect which initial changes in the patient's cardiac status? Select all that apply. 1. Increase in cardiac output 2. Increase in blood pressure 3. Decrease in cardiac output 4. Decrease in blood pressure 5. No change in blood pressure or cardiac output

Answer: 1, 4 Explanation: 1. Decreased afterload causes cardiac output to increase. This will occur initially in septic shock, but will change as sepsis continues. 2. Since blood pressure is a product of cardiac output and afterload, a decrease in afterload causes a decrease in blood pressure. 3. Initially the decrease in afterload will increase cardiac output. 4. Decrease in afterload results in decrease in blood pressure. 5. Changes in afterload will change both blood pressure and cardiac output.

A patient is admitted with a decrease in cardiac output. Which assessment findings would the nurse attribute to that condition? 1. Increased output of very clear urine 2. Cool hands and feet 3. Localized edema in the calf 4. Bounding apical impulse

Answer: 2 Explanation: 1. A decrease in cardiac output generally results in a decrease in urine output. 2. Cool distal extremities may be a useful marker of decreased cardiac output. 3. Localized edema in the calf is indicative of obstruction of venous blood flow from a clot in a leg vein. 4. The apical impulse would more likely be decreased when cardiac output is decreased.

Testing reveals that a patient's myocardial infarction (MI) damaged the papillary muscles of the mitral valve. The nurse plans care based on the knowledge that the patient is at high risk for which complication? 1. Extension of the myocardial damage 2. Catastrophic left heart failure 3. Pulmonary edema from right heart failure 4. Pulmonary embolism from clots in the left atrium

Answer: 2 Explanation: 1. All patients who have MI are at risk for extension of the damage. It is not specific to this patient. 2. The mitral valve is between the left ventricle and the left atrium. If the mitral valve suddenly becomes incompetent because of papillary muscle failure, catastrophic left heart failure will occur. 3. The mitral valve is on the left side of the heart. 4. The blood that goes through the mitral valve has already returned from the lungs and is about to be pumped to the systemic circulation.

A patient is diagnosed with atherosclerosis. How would the nurse explain the area injured by this inflammatory disorder? 1. Your arteries have three layers that are all damaged by atherosclerosis. 2. Atherosclerosis damages the lining of your arteries. 3. Atherosclerosis is also called 'hardening of the arteries' because it damages the outside layer, making it hard for your artery to stretch. 4. The middle layer of the wall of your arteries is injured by atherosclerosis, which allows plaque to build up.

Answer: 2 Explanation: 1. Atherosclerosis does not damage all three layers of the arteries. 2. Atherosclerosis is a chronic inflammatory disorder associated with injury to the intimal lining. It is a progressive disease characterized by formation of plaque in the intimal lining of medium and large arteries, including those in the aorta and its branches, the coronary arteries, and large vessels that supply the brain. 3. Atherosclerosis does not damage the outer layer of the artery. 4. Atherosclerosis does not damage the middle layer of the artery.

A patient is admitted with the complaint of chest pain. Questions about which history will best help the nurse determine if the pain is from cardiac or pulmonary origin? 1. Deficits in movement, timing of the pain, and dietary changes in the last 24 hours 2. What precipitated the pain, what it feels like, and where it is located 3. Changes in dietary habits, smoking history, and presence of cough 4. What home remedies were tried, activity level, and fluid intake changes

Answer: 2 Explanation: 1. Deficits in movement, timing of the pain, and dietary changes in the last 24 hours are not associated with either cardiac or pulmonary pain. 2. Precipitating factors, quality, and location will help the healthcare team discriminate between pain of cardiac origin and pain of respiratory origin. 3. This is important information to obtain, but would not help differentiate between pain of cardiac origin and pain of respiratory origin. 4. This is important information, but would not help to differentiate between pain of cardiac origin and pain of respiratory origin.

A patient is scheduled for an echocardiogram with measurement of ejection fraction. The nurse explains to the patient that this test will provide the most information about which cardiac characteristic? 1. The amount of blood the heart pumps every minute 2. The strength of the heartbeat 3. The amount of resistance the heart beats against 4. The amount of blood in the heart before it beats

Answer: 2 Explanation: 1. The amount of blood the heart pumps every minute is the cardiac output. Ejection fraction is related to cardiac output, but describing cardiac output does not fully explain ejection fraction. 2. Contractility is defined as the force of myocardial contraction and reflects the ability of the heart muscle to work independently of preload and afterload: the ability to function as a pump. Ejection fraction is a measure of the percent of blood ejected with each stroke volume and is used as an index of myocardial function. 3. Afterload is the amount of resistance the heart must beat against. Increasing afterload will affect both ejection fraction and cardiac output. 4. Preload represents the volume of blood in the ventricle at the end of diastole. A low preload can result in low cardiac output and may also affect ejection fraction.

A patient is scheduled for an exercise electrocardiogram. The nurse will ensure that which objects are in the room prior to the beginning of the test? 1. Oral fluids 2. A defibrillator 3. External pacemaker 4. Portable chest x-ray machine

Answer: 2 Explanation: 1. There is no reason that oral fluids are required for this test. 2. Emergency medications and a defibrillator should be present in the room during an exercise electrocardiogram test. The patient may respond poorly to the stress placed on the heart during exercise and may require an emergency response with this equipment. 3. There is no specific indication that it is necessary to have an external pacemaker present when this testing is taking place. 4. There is no reason for a portable x-ray machine to be present in the room during this test.

A patient with acute coronary syndrome has received thrombolytic therapy. The nurse would monitor and report which findings that indicate this therapy was successful? Select all that apply. 1. Respiratory rate of 18 per minute 2. Resolution of ST segment elevation 3. Resolution of chest pain 4. Occurrence of premature ventricular complexes 5. Occurrence of a headache

Answer: 2, 3, 4 Explanation: 1. Respiratory rate of 18 per minute is a normal respiratory rate and is not an indicator of the therapeutic effectiveness of thrombolytic therapy. 2. Resolution of ST segment elevation would indicate that ischemia is reduced and that the therapy is successful. 3. When the cardiac tissues are reperfused, pain abates. 4. Thrombolysis and reperfusion of the affected myocardium may be indicated by the occurrence of reperfusion arrhythmias, such as premature ventricular complexes or ventricular tachycardia. 5. Presence of a headache does not indicate reperfusion and may indicate an adverse effect is occurring.

The nurse has auscultated the patient's heart sounds and has measured vital signs. Which finding would the nurse evaluate as indicating greatest need for additional assessment? 1. Pulse pressure of 38 mm Hg 2. Bounding, vigorous pulse 3. Split of S2 4. Apical pulse of 66

Answer: 3 Explanation: 1. The pulse pressure reflects how much the heart can raise the pressure in the arterial system with each beat. Pulse pressure of 30 to 40 mm Hg does not indicate cause for concern because it is within the normal pulse pressure range. 2. A bounding vigorous pulse indicates increased myocardial contractility and would require additional assessment. This is not the priority need for reassessment. 3. The split of S2 indicates that one ventricle is emptying earlier or later than another and that contractility may, therefore, be diminished. This may be a result of a structural defect, a mechanical defect, or an electrical defect. This is the priority need for additional assessment. 4. The normal range of apical pulse is 60 to 80, so this is not a priority for additional assessment.

A patient with a steadily increasing preload was experiencing a corresponding increase in stroke volume, but it has now begun to decrease. Which rationale would the nurse provide for this occurrence? 1. This fluctuation will occur until maximum preload has been reached. 2. The patient's heart rate is increasing, which causes a drop in stroke volume. 3. The patient's preload has reached a critical point and now stroke volume will decrease. 4. It is necessary to assess for a secondary pathophysiological event causing the stroke volume to decrease.

Answer: 3 Explanation: 1. There is a point of maximum preload, but the cardiac output does not fluctuate until it is reached. 2. The information in this question does not support increase in the heart rate. 3. Until a critical point is reached, as preload increases, so does stroke volume. An optimal preload leads to an optimal stroke volume. Once past this point, an increase in preload results in a decrease in stroke volume. If the heart receives too much preload, it cannot effectively pump out that volume and stroke volume decreases. Stroke volume decreases because too much volume causes excessive stretching of the myocardial fibers and the ventricles cannot effectively contract. 4. There is no need to look for a different pathophysiological event, as the event at present is sufficient to cause decrease in cardiac output.

Testing indicates that a patient has a high preload. What changes would the nurse expect in this patient's cardiac function? Select all that apply. 1. Heart rate will decrease. 2. Afterload will increase. 3. Stroke volume will decrease. 4. Stroke volume will increase. 5. Blood pressure will decrease.

Answer: 3, 4 Explanation: 1. It is not possible to predict what change in heart rate will occur in the face of increased preload. Depending on the pathophysiology causing the increased preload, the rate may increase, may decrease, or may stay the same. 2. Afterload represents the force the heart must overcome to pump blood. It is not affected by preload. 3. If the increase in preload is high enough that a critical point is reached, stroke volume will decrease. 4. The greater the volume of blood in the ventricle, the greater the amount of stretch that the fibers experience. To a point, this increase in stretch will result in an increase in stroke volume. 5. It is not possible to determine if an increase in preload will cause a decrease in blood pressure. In most cases, increased preload will result in increased stroke volume, which will result in increased blood pressure.

A patient with diabetes is surprised to learn that he has been having angina when the only problem he has been experiencing is a bit of fatigue and shortness of breath. How should the nurse explain this to the patient? 1. Shortness of breath is the first symptom of angina. 2. There is no classic symptom of angina. 3. Slight fatigue is usually the first symptom of angina. 4. Persons with diabetes may experience pain differently.

Answer: 4 Explanation: 1. Anginal symptomology varies among patients. Shortness of breath may not occur in some patients. 2. Classic symptoms of angina include chest pain and shortness of breath. 3. Fatigue may occur in some patients, but is not a classic symptom associated with angina. 4. Not all patients with altered myocardial tissue perfusion have classic anginal chest pain symptoms. Persons with diabetes are especially prone to having silent ischemia and usually present with shortness of breath and fatigue because of the microvascular changes associated with diabetes leading to neuropathies and decreased sensitivity to pain.

A lipid panel has been drawn on a patient who has a family history of atherosclerosis. The nurse would explain that which value on the panel is most implicated in development of atherosclerosis? 1. High-density lipoprotein 2. Total cholesterol level 3. Triglyceride level 4. Low-density lipoprotein

Answer: 4 Explanation: 1. High-density lipoprotein is a desirable component of the lipid profile. 2. Total cholesterol level includes both good and bad cholesterol and is not as specific as another level when predicting risk for atherosclerosis. 3. High triglycerides are implicated in the development of coronary disease, but are not as specific as another value. 4. Once an artery has been inflamed by hypertension, smoking, viruses, high cholesterol, or high glucose, the body sends macrophages to the site of inflammation. The macrophages oxidize low-density lipoprotein. The engulfing of the low-density lipoproteins by the macrophages creates foam cells, which are the basic structure behind the fatty streaks of atherosclerosis.

It is suspected that a patient who was severely injured in an automobile accident may have had a myocardial infarction (MI) prior to the crash. Which laboratory test result drawn while the patient was in the emergency department would the nurse evaluate as supporting that theory? 1. Increased serum potassium 2. Increased creatine kinase level 3. Increased BNP level 4. Increased troponin level

Answer: 4 Explanation: 1. Potassium level changes may indicate damage to muscle tissue, but is not specific to heart muscle. 2. Creatine kinase levels do not rise until 4 to 12 hours after onset of myocardial necrosis. Unless a CK-MB level was drawn, the CK level is not specific to cardiac muscle. 3. BNP level is assessed for the presence of heart failure. 4. Troponin is a protein found in cardiac muscle and can appear in the blood as early as 1 to 3 hours after symptoms of MI. Troponin has a higher sensitivity and specificity of identifying myocardial damage than does creatine kinase.

Review of the medical record reveals that a patient has a summation gallop. Which pattern of heart sounds would the nurse expect? 1. S1 followed closely by S2 2. S1 followed closely by S2 followed closely by S3 3. S1 followed closely by a split S2 4. S4 followed by S1 followed by S2 followed by S3 followed by S4

Answer: 4 Explanation: 1. S1-S2 is the normal lub-dub sound of the heart and does not represent a summation gallop. 2. Presence of a third heart sound is documented as a ventricular gallop. 3. Splitting of S2 does occur, but this is not documented as a summation gallop. 4. The S4 heart sound is heard during atrial contraction, so it sounds as if it occurs before S1.

A patient is diagnosed with an acute myocardial infarction and ruptured papillary muscle. Which action is the highest priority for the nurse to complete? 1. Obtain an electrocardiogram. 2. Measure the patient's cardiac output. 3. Assess the patient's neurological status. 4. Assess respiratory status.

Answer: 4 Explanation: 1. This patient will have need for an electrocardiogram if one has not already been done, but this is not the highest priority. 2. Cardiac output measurement is important, but is not the highest priority intervention. 3. Assessment of the neurological system is very important but is not the highest priority. 4. In an acute situation, such as a myocardial infarction with papillary muscle damage, the left atrium and left ventricle cannot acutely compensate, which leads to backup pressure in the pulmonary vasculature, and acute pulmonary edema occurs. The nurse would detect this change on respiratory assessment.

A patient is diagnosed with Prinzmetal angina. Which assessment findings would the nurse attribute to this diagnosis? Select all that apply. 1. The patient experiences lightheadedness that occurs at rest. 2. The patient has chest pain that lasts several hours. 3. The patient can predict the level of activity that will cause the pain. 4. The patient is awakened from sleep by chest pain. 5. The patient has chest pain that is not related to physical activity.

Answer: 4, 5 Explanation: 1. Lightheadedness with rest is not characteristic of angina. 2. Chest pain that lasts several hours is not characteristic of angina. 3. Stable angina is chest pain that occurs with a predictable amount of exertion. 4. Prinzmetal angina, or variant angina, is not common, and is a form of unstable angina. It is chest pain that occurs at rest and often occurs at night. 5. Prinzmetal angina is chest pain that is not related to physical activity.

A middle-aged client presents to the ED reporting severe chest discomfort. Which finding is most indicative of a possible myocardial infarction (MI)? A. Intermittent nausea and emesis for 3 days B. Chest discomfort not relieved by rest or nitroglycerin C. Cool, clammy skin and a diaphoretic, pale appearance D. Anxiousness, restlessness, and lightheadedness

B. Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with acute coronary syndrome or MI, may also occur with angina and, alone, are not indicative of an MI.

A current client, an overweight 61-year-old with a history of diabetes mellitus, is status post-MI 1 month and has returned for a cardiology follow-up. Along with dietary changes, the nurse will discuss which nonpharmacologic lifestyle modification to reduce microvascular changes? A. Increased cholesterol consumption B. Glucose control C. Maintaining weight D. Increased nicotine use

B. Glucose and blood pressure control can reduce the microvascular changes associated with diabetes mellitus. Increased cholesterol consumption, nicotine use, and maintaining overweight status will contribute to continued coronary artery disease.

A client diagnosed with a myocardial infarction (MI) is being moved to the rehabilitation unit for further therapy. Which statement reflects a long-term goal of rehabilitation for the client with an MI? A. Prevention of another cardiac event B. Improvement in quality of life C. Limitation of the effects and progression of atherosclerosis D. Ability to return to work and a pre-illness functional capacity

B. Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life. Immediate objectives of rehabilitation of a client with an MI patient are to limit the effects and progression of atherosclerosis, to return the client to work and a pre-illness lifestyle, and to prevent another cardiac event.

Which term refers to preinfarction angina? A. Variant angina B. Unstable angina C. Stable angina D. Silent ischemia

B. Preinfarction angina is also known as unstable angina. Stable angina has predictable and consistent pain that occurs upon exertion and is relieved by rest. Variant angina is exhibited by pain at rest and reversible ST-segment elevation. Silent angina manifests through evidence of ischemia, but the client reports no symptoms.

To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? A. 30 minutes B. 60 minutes C. 9 days D. 6 to 12 months

B. The 60-minute interval is known as door-to-balloon time in which a PTCA can be performed on a client with a diagnosed MI. The 30-minute interval is known as door-to-needle time for the administration of thrombolytics after MI. The time frame of 9 days refers to the time until the onset of vasculitis after administration of streptokinase for thrombolysis in a client with an acute MI. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same client for acute MI.

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? A. Prepare the client for pulmonary artery catheterization. B. Assess the client's level of pain and administer prescribed analgesics. C. Assess the client's level of anxiety and provide emotional support. D. Ensure that the client's family is kept informed of the client's status.

B. The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and family members should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.

The client has had biomarkers tested after reporting chest pain. Which diagnostic marker of myocardial infarction remains elevated for as long as 2 weeks? A. CK-MB B. Troponin C. Total creatine kinase D. Myoglobin

B. Troponin remains elevated for a long period, often as long as 2 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin peaks within 12 hours after the onset of symptoms. Total creatine kinase (CK) returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.

The client asks the nurse to explain the difference between arteriosclerosis and atherosclerosis. Which is the best explanation the nurse can give to the client? A. Both are disorders in which the lining of the vessels become narrowed due to plaque. B. Both terms refer to the same disorder and can be used interchangeably. C. Arteriosclerosis is a loss of elasticity of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the arteries fill with plaque. D. Arteriosclerosis is when the vessels become dilated and weakened, whereas atherosclerosis is the deposit of fatty substances in the vessel lining.

C. Arteriosclerosis refers to the loss of elasticity or hardening of the arteries that accompanies the aging process, whereas atherosclerosis is a condition in which the lumen of arteries fills with fatty deposits called plaque. The two terms do not refer to the same disorder, nor can they be used interchangeably. The other responses provide the client with inaccurate information.

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? A. The pain got worse when I took a deep breath. B. The pain resolved after I ate a sandwich. C. The pain occurred while I was mowing the lawn. D. The pain lasted about 45 minutes.

C. Decreased oxygen supply to the myocardium causes angina pectoris. Lawn mowing increases the cardiac workload, which increases the heart's need for oxygen and may precipitate this chest pain. Anginal pain typically is self-limiting, lasting 5 to 15 minutes. Food consumption doesn't reduce angina pain, although it may ease pain caused by a GI ulcer. Deep breathing has no effect on anginal pain.

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? A. Magnesium B. Sodium C. Potassium D. Calcium

C. Hyperkalemia (high potassium) can result in the following ECG changes: tall peaked T waves, wide QRS, and bradycardia. The nurse should be prepared to administer a diuretic or an ion-exchange resin (sodium polystyrene sulfonate [Kayexalate]); IV sodium bicarbonate, or IV insulin and glucose. Imbalances in the other electrolytes listed would not result in peaked T waves.

After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as: A. Chest pain that occurs due to vasospasm B. Chest pain that occurs at rest C. Chest pain that is relieved by rest D. Chest pain that occurs with coronary artery disease

C. Stable angina is characterized as chest pain that is relieved with rest. Unstable angina is chest pain that occurs at rest. Prinzmetal angina is chest pain that results from vasospasm. Chest pain is associated with coronary artery disease due to a supply and demand problem.

The nurse provides care to a menopausal client, who states, I read a news article that says I am at risk for coronary vascular disease due to inflammation. Which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis? A. Avoiding use of caffeine B. Taking a daily multivitamin C. Addressing obesity D. Drinking at least 2 liters of water a day

C. The 2019 ACC/AHA Guideline on the Primary Prevention of Coronary Vascular Disease (CVD) indicates a relationship between body fat and the production of inflammatory and thrombotic (clot-facilitating) proteins. This information suggests that decreasing obesity and body fat stores via exercise, dietary modification, or developing drugs that target proinflammatory proteins may reduce risk factors for heart disease. The risk for CVD accelerates for clients after menopause due to withdrawal of endogenous estradiol levels, which can worsen many traditional CVD risk factors, including body fat distribution. Avoiding the use of caffeine, using a multivitamin, and drinking at least 2 liters of water a day are not actions that will address the prevention of inflammation that can lead to atherosclerosis.

A client reports midsternal chest pain radiating down his left arm. The nurse notes that the client is restless and slightly diaphoretic, and measures a temperature of 99.6 °F (37.6 °C); a heart rate of 102 beats/minute; regular, slightly labored respirations at 26 breaths/minute; and a blood pressure of 150/90 mm Hg. What assessment is the nurse's highest priority? A. cardiac output B. body temperature C. acute pain D. anxiety

C. The assessment of pain takes highest priority because it increases the client's pulse and blood pressure. During the acute phase of an MI, low-grade fever is an expected result of the body's response to myocardial tissue necrosis. The client's blood pressure and heart rate do not suggest a decreased cardiac output. Anxiety may be an important assessment, but addressing acute pain (the priority concern) may alleviate the client's anxiety.

A nurse is providing education to a client who has been experiencing unstable angina. What is the nurse's best explanation of this condition? A. "A coronary vessel has become completely plugged and is unable to deliver blood to your heart." B. "The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing." C. "There is serious narrowing of a coronary artery causing a reduction in oxygen to the heart." D. "Your body's response to a lack of oxygen in the heart muscle is causing the pain you are feeling."

C. Unstable angina is described as increased narrowing of coronary arteries with the heart experiencing episodes of ischemia even at rest. If a coronary vessel is completely occluded and unable to deliver blood to the cardiac muscle, a myocardial infarction has occurred. Prinzmetal angina is an unusual form of angina caused by spasm of the blood vessel and not just by vessel narrowing. Although pain is the body's response to ischemia in the heart muscle, this description could encompass angina or a myocardial infarction and is not specific enough to explain the condition.

A client who has been diagnosed with Prinzmetal's angina will present with which symptom? A. chest pain of increased frequency, severity, and duration B. prolonged chest pain that accompanies exercise C. radiating chest pain that lasts 15 minutes or less D. chest pain that occurs at rest and usually in the middle of the night

D. A client with Prinzmetal's angina will complain of chest pain that occurs at rest, usually between 12 and 8:00 AM, is sporadic over 3-6 months, and diminishes over time. Clients with stable angina generally experience chest pain that lasts 15 minutes or less and may radiate. Clients with Cardiac Syndrome X experience prolonged chest pain that accompanies exercise and is not always relieved by medication. Clients with unstable angina experience chest pain of increased frequency, severity, and duration that is poorly relieved by rest or oral nitrates.

The nurse is admitting a client with an elevated creatine kinase-MB isoenzyme (CK-MB). What is the cause for the elevated isoenzyme? A. cerebral bleeding B. I.M. injection C. skeletal muscle damage due to a recent fall D. myocardial necrosis

D. An increase in CK-MB is related to myocardial necrosis. An increase in total CK might occur for several reasons, including brain injuries such as cerebral bleeding; skeletal muscle damage, which can result from I.M. injections or falls; muscular or neuromuscular disease; vigorous exercise; trauma; or surgery.

The nurse is explaining the cause of angina pain to a client. What will the nurse say most directly caused the pain? A. complete closure of an artery B. a destroyed part of the heart muscle C. incomplete blockage of a major coronary artery D. a lack of oxygen in the heart muscle cells

D. Angina pectoris refers to chest pain that is brought about by myocardial ischemia. It is the result of cardiac muscle cells being deprived of oxygen due to the progressive symptoms of coronary artery disease. Artery blockage or closure leads to myocardial death. The destroyed part of the heart (death of heart tissue) is a myocardial infarction.

The nurse is caring for a client with coronary artery disease. What is the nurse's priority goal for the client? A. administer sublingual nitroglycerin B. decrease anxiety C. educate the client about his symptoms D. enhance myocardial oxygenation

D. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. A nurse administers sublingual nitroglycerin to treat acute angina pectoris, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care, neither is a priority when a client is compromised.

The nurse knows that women and older adult are at greater risk for a fatal myocardial event. Which factor is the primary contributor of this cause? A. Decreased sensation to pain B. Chest pain is typical C. Gender bias D. Vague symptoms

D. Often, women and elderly do not have the typical chest pain associated with a myocardial infarction. Some report vague symptoms (fatigue, abdominal pain), which can lead to misdiagnosis. Some older adults may experience little or no chest pain. Gender is not a contributing factor for fatal occurrence but rather a result of symptoms association.

A triage team is assessing a client to determine if reported chest pain is a manifestation of angina pectoris or an MI. The nurse knows that a primary distinction of angina pain is? A. Described as crushing and substernal B. Associated with nausea and vomiting C. Accompanied by diaphoresis and dyspnea D. Relieved by rest and nitroglycerin

D. One characteristic that can differentiate the pain of angina from a myocardial infarction is pain that is relieved by rest and nitroglycerine. There may be some exceptions (unstable angina), but the distinction is helpful especially when combined with other assessment data.

The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? A. Avoid fatty foods and exercise. B. Report changes in the usual pattern of chest pain. C. Take over-the-counter decongestants. D. Avoid situations that contribute to ischemic episodes.

D. Teaching for clients with Raynaud syndrome and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.

A client comes to the emergency department (ED) reporting precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? A. Raynaud syndrome B. Venous occlusive disease C. Cardiogenic shock D. Coronary artery disease

D. The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud syndrome in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.

The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? A. Sinus tachycardia B. Isolated premature ventricular contractions (PVCs) C. Frequent premature atrial contractions (PACs) D. ST elevation

D. The first signs of an acute MI are usually seen in the T wave and the ST segment. The T wave becomes inverted; the ST segment elevates (it is usually flat). An elevated ST segment in two contiguous leads is a key diagnostic indicator for MI (i.e., ST-elevation MI). This client requires immediate invasive therapy or fibrinolytic medications. Although the other ECG findings require intervention, elevated ST elevations require immediate and definitive interventions.

Which is the most important postoperative assessment parameter for a client recovering from cardiac surgery? A. Activity intolerance B. Blood glucose concentration C. Mental alertness D. Inadequate tissue perfusion

D. The nurse must assess the client for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood glucose and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for clients undergoing cardiac surgery.