SHERPATH: Coronary Artery Disease

A patient with atherosclerosis asks the nurse to describe the events leading to the development of the atherosclerosis. In which order does the nurse describe the pathophysiological events? "Lipids were able to access and accumulate in the smooth muscle cells of the blood vessels." "Chronic injury led to the damage of your endothelium, or cells lining your blood vessels." "A build-up of collagen resulted in a partial or total blockage of your blood vessels." "The blood vessel narrowed due to accumulation of fibrous protein."

1. "Chronic injury led to the damage of your endothelium, or cells lining your blood vessels." 2. "Lipids were able to access and accumulate in the smooth muscle cells of the blood vessels." 3. "The blood vessel narrowed due to accumulation of fibrous protein." 4. "A build-up of collagen resulted in a partial or total blockage of your blood vessels." Chronic endothelial injury results in damage to the endothelium. This leads to a buildup of lipids in the smooth muscle cells, or a fatty streak. Collagen covers the fatty streak, leading to a partial occlusion of the blood vessels. A rupture of the fibrous plaque results in a thrombus, and potentially, total occlusion of the vessel.

While assessing a patient for cardiovascular risk factors, the nurse notices that the patient is experiencing dyspnea while talking. What is the nurse's priority action? A. Assess breath sounds and pulse oximetry. B. Ask how the patient feels about the dyspnea. C. Ask whether there is a history of congestive heart failure. D. Ask whether the patient has been diagnosed with diabetes.

A. Assess breath sounds and pulse oximetry. The priority for the nurse is always patient safety. Dyspnea is a symptom of coronary artery disease (CAD) and should be assessed further to determine the severity of the symptom.

A patient has voiced displeasure with the dietary changes the health care provider has recommended. Which questions would the nurse use to discuss the importance of managing dietary modifications with a patient who has coronary artery disease (CAD)? Select all that apply. A. "Which recommended changes have you implemented?" B. "Do you have a family history of CAD?" C. "Have you had any stressful life events since your last visit?" D. "Do you know why these changes were recommended to you?" E. "Do you know the potential consequences of not following the diet?"

A. "Which recommended changes have you implemented?" Knowing what changes have been implemented by the patient provides information as to which changes the patient is able and willing to make and will assist in reinforcing previous patient instructions. D. "Do you know why these changes were recommended to you?" Asking the patient what he or she understands about why the dietary changes were recommended will help the nurse explain the reasoning behind the recommended changes. E. "Do you know the potential consequences of not following the diet?" Asking the patient whether he or she understands the consequences of not following the diet can provide more information about the patient's understanding of the importance of dietary regulations.

A patient's spouse asks the nurse about alternative methods to reduce coronary artery disease (CAD) risk factors because of potential side effects of a medication prescribed for her husband. Which response by the nurse is appropriate? A. Discuss gradually increasing physical activity. B. Tell her that saturated fat should be 10% of daily intake. C. Discuss selecting foods to decrease the high density lipoprotein (HDL) level. D. Tell her that he should increase his soluble fiber intake to 30-40 g daily to help lower cholesterol.

A. Discuss gradually increasing physical activity. Discussing a gradual increase in physical activity to decrease CAD risk will address the concern voiced by the spouse.

A 50-year-old male patient with a family history of coronary artery disease (CAD) presents with mild dyspnea on exertion and occasional chest pain. The patient eats primarily red meat and vegetables, smokes cigars, and is physically inactive. What recommendations from the nurse are appropriate in the management of this high-risk patient? Select all that apply. A. Eat less red meat. B. Have genetic testing done. C. Start estrogen therapy. D. Begin an exercise regimen. E. Switch to chewing tobacco.

A. Eat less red meat. Dietary risk factors, such as eating red meat, are modifiable, and the nurse should recommend a decrease in the amount of red meat the patient consumes. Consumption of all foods high in saturated fat should be decreased. D. Begin an exercise regimen. Physical activity is an important modifiable risk factor that the nurse should recommend to a patient at high risk for CAD.

When assessing a patient with coronary artery disease (CAD), which finding is expected? A. Swelling in the legs B. Brisk capillary refill C. Clear breath sounds D. Warm, dry, pink skin

A. Swelling in the legs Edema in the lower extremities indicates cardiovascular dysfunction and would be an expected assessment finding in a patient with CAD.

The nurse would use which statement to describe to the patient with coronary artery disease (CAD) how fatty streaks are formed? A. "Damaged arteries allow platelets to form a thrombus." B. "Damaged arteries allow lipids to be deposited in the intima." C. "Infections cause bacteria to move inside the artery wall." D. "Increased cholesterol intake directly causes plaque formation."

B. "Damaged arteries allow lipids to be deposited in the intima." Damaged arteries allow lipids to be deposited in the inside of the artery to form fatty streaks, beginning the process of atherosclerosis.

A patient returns to the office after starting statin therapy. Which statement by the patient would indicate the need for further assessment by the nurse? A. "My face is red and itchy." B. "I am having trouble walking." C. "I had a couple of headaches last week." D. "I am having trouble falling asleep at night."

B. "I am having trouble walking." Muscle weakness or spasms interfering with the ability to walk may be a sign of myopathy, a statin side effect. Liver enzymes should be monitored.

The nurse identifies which patient as being at greatest risk for coronary artery disease (CAD)? A. 70-year-old man with hypotension B. 80-year-old woman with hyperlipidemia C. 45-year-old woman who has a cholesterol level of 200 mg/dL D. 46-year-old man with blood pressure of 135/80 mm Hg who drinks a glass of wine every night

B. 80-year-old woman with hyperlipidemia Age (greater than 75 years), gender, postmenopausal status, and the diagnosis of hyperlipidemia put this patient at greatest risk for CAD.

A patient at risk for coronary artery disease (CAD) has a serum triglyceride level of 160 mg/dL and a low-density lipoprotein (LDL) level of 180 mg/dL. Which dietary recommendations by the nurse are crucial for reducing the risk for CAD in this patient? Select all that apply. A.Eat more eggs B. Eliminate alcohol C. Eat more broccoli D. Eat more shellfish E. Drink one glass of red wine at night

B. Eliminate alcohol Patients with elevated serum triglyceride levels should reduce or eliminate alcohol and simple sugars from their diets. C. Eat more broccoli Patients with elevated LDL levels should eat more complex carbohydrates, including fruits and vegetables. D. Eat more shellfish Shellfish are rich in polyunsaturated fats, which should represent the majority of fats eaten.

A patient with cardiovascular disease has an elevated low-density lipoprotein (LDL) level but refuses to take any medication. The nurse anticipates which therapy recommendation from the health care provider? A. Flaxseed B. Psyllium C. Egg yolks D. Peanut oil

B. Psyllium Psyllium has been shown to reduce both total cholesterol and LDL levels.

A patient at high risk for development of coronary artery disease (CAD) indicates that the necessary lifestyle changes to decrease the risk for disease are too difficult. How should the nurse respond to help the patient understand the importance of making necessary changes? Select all that apply. A. "You may die if you do not make changes." B. "You have to make the necessary changes." C. "Are you aware of the major risk factors for CAD that you have?" D. "What aspect of your current lifestyle is most important for you to maintain?" E. "You can take medication to reduce the risk instead of making lifestyle changes."

C. "Are you aware of the major risk factors for CAD that you have?" The nurse should ask the patient to identify his or her personal risk factors to put the risk in perspective. D. "What aspect of your current lifestyle is most important for you to maintain?" The nurse should first help the patient clarify personal values to assist in relating suggested changes to those values.

Which statement by the patient with coronary artery disease (CAD) demonstrates understanding of how to modify dietary fat intake by substituting monounsaturated or polyunsaturated fats for saturated fats? A. "I substituted palm oil for soybean oil." B. "I am using less cream cheese on my bagel." C. "I ordered a cheese with egg white sandwich." D. "I no longer snack on walnuts and now just eat peanuts."

C. "I ordered a cheese with egg white sandwich." Ordering the egg white reduces the cholesterol content of the sandwich; an egg white is a good substitute for a whole egg, which is high in saturated fat.

The health care team is caring for a patient with coronary artery disease (CAD) who has hepatitis C. The patient's triglyceride level is 658 mg/dL. Which drug would the best choice to administer to this patient initially? A. Nitrates B. Diuretics C. Omega-3 fatty acid D. 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins)

C. Omega-3 fatty acid Omega-3 fatty acid inhibits synthesis and/or secretion of triglycerides and is appropriate for patients with very high (≥500 mg/dL) levels of triglycerides.

How would the nurse explain to the patient with coronary artery disease (CAD) why chronically elevated levels of C-reactive protein (CRP) are a good predictor of CAD? A. "Low-density lipoproteins represent oxidation and coronary artery disease." B. "Low-density lipoproteins are only elevated when triglyceride levels are high." C. "Chronically elevated CRP levels are associated with the immune response." D. "Chronically elevated CRP levels are associated with plaque formation."

D. "Chronically elevated CRP levels are associated with plaque formation." A chronically elevated CRP level is a marker of inflammation that can predict risk of cardiac disease and cardiac events, even in patients with normal lipid values.

The nurse is assessing a patient with coronary artery disease (CAD) for response to lipid-lowering therapy. Which question is a priority for the nurse to ask in order to determine the effectiveness of the therapy? A. "Have you had any rashes or skin lesions?" B. "How often are you taking the medication?" C. "Are you noticing any changes in bowel habits?" D. "Have you had any chest pain in the last week?"

D. "Have you had any chest pain in the last week?" Asking about chest pain allows the nurse to determine whether any manifestations of CAD have occurred. The goal of therapy is to decrease CAD manifestations of CAD.

A patient with a family history of coronary artery disease (CAD) smokes one pack of cigarettes per day, drinks socially, exercises infrequently, and eats a diet rich in complex grains and vegetables. The patient recently lost a spouse to cancer. Which question should the nurse ask the patient to learn more about the social history related to CAD? A. "With whom do you exercise?" B. "Which grains do you prefer?" C. "Do you primarily eat fresh or canned vegetables?" D. "How are you coping with the loss of your spouse?"

D. "How are you coping with the loss of your spouse?" It is important to identify any negative psychological states to learn more about the stress levels of the patient as part of a thorough assessment for CAD risk.

Which process would result in the development of myocardial ischemia in a patient with coronary artery disease (CAD)? A. An increase in serum lipids B. An increase in collagen fibrils C. A decreased oxygen demand or an increased oxygen supply D. An increased demand for oxygen or a decreased supply of oxygen

D. An increased demand for oxygen or a decreased supply of oxygen When the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, myocardial ischemia occurs.