Complex Health Challenges I - Cardiac Disorders

Which symptom of chronic heart failure (HF) is an early sign of the disease? A. Dyspnea B. Ventricular remodelling C. Cardiac myopathy D. Biventricular failure

A

Which class of drugs improves cardiac contractility? A. Diuretics B. Inotropics C. Antihypertensives D. Vasodilators

B Inotropic medications (e.g., dobutamine, milrinone) increase myocardial contractility without increasing oxygen consumption.

Which physical assessment findings would be indicative of myocardial infarction (MI)? Select all that apply. One, some, or all responses may be correct. A. Pulses alternans B. Anxiety C. Substernal chest pressure D. Fatigue E. Systolic murmur F. Indigestion

A, B, C, D, E, F

Which symptom is associated with heart failure (HF)? Select all that apply. One, some, or all responses may be correct. A. Fatigue B. Dependent edema C. Nausea D. Weight loss E. Gastrointestinal bloating

A, B, C, E

Which type of medication is used as first-line therapy for heart failure (HF)? A. Angiotensin-converting enzyme (ACE) inhibitors B. Neprilysin C. β-Adrenergic blockers D. Spironolactone

A ACE inhibitors are the first-line therapy for the treatment of HF. Because cardiac output (CO) is dependent on afterload in chronic HF, the reduction in systemic vascular resistance seen with the use of ACE inhibitors produces a significant increase in CO.

For which patient would the nurse expect to facilitate lipid screening? A. 42-year-old male with a history of chronic kidney disease B. 56-year-old female with a waist circumference of 86 cm C. 28-year-old male with a family history of hyperlipidemia D. 49-year-old male with an A1C level 4.2%

A The patient's age and existing chronic kidney disease would make lipid screening appropriate.

Which term is considered synonymous with coronary artery disease (CAD)? Select all that apply. One, some, or all responses may be correct. A. Arteriosclerotic heart disease (ASHD) B. Congenital heart disease C. Wolff-Parkinson-White (WPW) syndrome D. Cardiovascular heart disease (CVHD) E. Ischemic heart disease F. Coronary heart disease

A, D, E, F

Which statement describes an overall goal for a patient with heart failure (HF)? A. Eliminate shortness of breath episodes B. Have no complications related to HF C. Have no adverse medication effects D. Live without pain

B

Which nursing action takes priority when a hospitalized post-operative patient tells the nurse that she is having chest pain? A. Perform vital signs and obtain an ECG. B. Administer sublingual nitroglycerin and intravenous morphine. C. Call the rapid response team and the provider. D. Inform the cardiac catheterization lab and interventional cardiologist.

A As this would be new chest pain, the priority would be to assess the patient's hemodynamic response via vital sign assessment and to attempt to discover if the pain is associated with electrical changes within the heart via the ECG.

Which diagnostic test would be the most useful in confirming the diagnosis of Prinzmetal's angina? A. Coronary angiography B. Serum CK-MB band levels C. ECG D. Serum troponin levels

A Coronary angiography is the only way to confirm the presence of coronary artery spasms and the diagnosis of Prinzmetal's angina.

Which effect do diuretics have on left ventricular function? A. Improve cardiac output (CO) B. Increase venous return C. Increase afterload D. Increase intravascular volume

A Diuretics decrease venous return to the left ventricle, reducing preload and improving CO.

Which characteristic is associated with heart failure (HF)? A. Ventricular dysfunction B. Preload deficits C. Impaired valve functions D. Pulmonary embolism

A HF is characterized by ventricular dysfunction. The event may be acute or chronic. Other features of HF include reduced exercise tolerance, decreased quality of life, and shorter life expectancy.

Which term describes the most common form of heart failure (HF)? A. HF with reduced ejection fraction (HFrEF) B. HF with preserved ejection fraction (HFpEF) C. HF with mid-range ejection fraction (HFmEF) D. Mixed HF

A HFrEF results from an inability of the heart to pump blood effectively and is the most common form of HF.

Which factor causes an increased oxygen demand? A. Hypertension B. Heart failure C. Low blood volume D. Coronary artery spasm

A Hypertension is a factor that causes an increased oxygen demand or consumption. Other factors that increase oxygen demand include anxiety, the use of some drugs, hyperthermia, and hyperthyroidism. Heart failure is a factor that causes a decreased oxygen supply, not an increased oxygen demand. Low blood volume is a factor that causes a decreased oxygen supply, not an increased oxygen demand. Coronary artery spasm is a factor that causes a decreased oxygen supply, not an increased oxygen demand.

Which nursing action can improve gas exchange, thereby improving cardiac output, in chronic heart failure? A. Administering IV morphine B. Reducing oxygen saturation C. Using supplemental oxygen at all times D. Increasing respiratory efforts

A IV morphine reduces preload and afterload and decreases myocardial oxygen demands, thereby improving cardiac output.

Which group of medications is reserved for patients in cardiogenic shock? A. Inotropics B. Angiotensin-converting enzyme (ACE) inhibitors C. Diuretics D. Vasodilators

A Inotropic drugs are reserved to treat unstable patients with reduced ejection fraction. Their use is confined to patients in cardiogenic shock.

Which medication would a nurse question before administering to a patient with chronic stable angina and liver cirrhosis? A. Heparin B. Diltiazem C. Nitrostat D. Atenolol

A Patients with liver disease are at risk of bleeding due to abnormalities of the clotting system; therefore, Heparin is contraindicated.

For which classification of medications should the nurse increase their monitoring for respiratory side effects? A. Calcium channel blockers B. Nitrates C. Low molecular weight heparin D. Adenosine diphosphate receptor antagonists

A Shortness of breath and auscultation of crackles, secondary to heart failure, is common with calcium channel blockers.

Which individual would the nurse identify as having the highest risk for coronary artery disease (CAD)? A. A 45-year-old depressed male with a high-stress job B. A 60-year-old male with below-normal homocysteine levels C. A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels D. A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2

A Studies demonstrate that depression and stressful states can contribute to the development of CAD. This patient has two risk factors.

Which compensatory mechanism is initially triggered in cardiac stress? A. Sympathetic nervous system activation B. Ventricular hypertrophy C. Neurohormonal responses D. Ventricular dilation

A Sympathetic nervous system activation is often the first compensatory mechanism triggered in low cardiac output states.

Which patient would be most likely to have fewer complications from a myocardial infarction (MI)? A. An older adult with previous coronary artery disease (CAD) B. A younger adult with no history of coronary artery disease (CAD) C. A younger adult with no coronary artery disease (CAD), but has a family history of CAD D. An older adult with no history of coronary artery disease (CAD)

A The degree of pre-established collateral circulation influences the severity of infarction. Over time, and in adults with a history of CAD, collateral circulation may be well established and provide alternative blood supplies to otherwise compromised myocardium. Due to the established alternative blood supply, the severity of the infarction may be less with less complications

Which factor contributes to the progressive occlusion of coronary arteries and atherosclerotic lesions? A. Deposit of fatty material beneath the vessel's intimal layer B. Collateral circulation C. Coronary artery spasms D. Activation of the intrinsic coagulation pathway by platelets

A The deposit of fatty material beneath the vessel's intimal layer is characteristic of the fatty streak stage of atherosclerotic lesions.

Which condition is a common cause of pulmonary edema? A. Left ventricular failure B. Right ventricular failure C. Atrial fibrillation D. Cyanosis

A The most common cause of pulmonary edema is acute left ventricular failure, secondary to acute myocardial infarction. There is an abnormal, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lungs.

Which intervention would the nurse anticipate being ordered for a patient with heart failure (HF) who is currently in Fowler's position on mechanical ventilation, experiencing significant volume overload, dyspnea, and pulmonary edema? A. Treating with ultrafiltration B. Monitoring C. Repositioning D. Administering vasopressors

A The patient should be treated with ultrafiltration to rapidly remove intravascular fluid volume while maintaining hemodynamic stability.

Which patient situation reflects a priority teaching moment for patient recovering from a myocardial infarction (MI)? A. One day post MI who states that they are cured after receiving IV morphine B. In phase II recovery who says that they are considering lifestyle changes C. The spouse of a patient being discharged who indicates that she is afraid to have sexual intercourse with her husband D. Newly started on propranolol who reports gastrointestinal upset

A This patient's knowledge deficit could be very problematic. The patient is likely in denial of their current condition believing that the absence of pain (which was relieved by the morphine) means that they are no longer is at risk. This patient is likely to not decrease their activity level or engage in other contraindicated behaviors, increasing their risk for further myocardial damage.

Which characteristic is associated with unstable angina (UA)? A. The pain is unpredictable in nature. B. The pain only occurs with the use of some stimulant medications. C. The intensity of pain remains constant over time. D. The pain never occurs while at rest.

A Unlike chronic stable angina, UA follows a very unpredictable pattern, including pain at rest.

Which phrase describes ventricular assist devices (VADs)? A. Offers mechanical circulatory support B. Can replace cardiac resynchronization therapy (CRT) C. Ability to cardiovert and defibrillate the ventricles D. Used for life-threatening dysrhythmias

A VADs are a mechanical circulatory support device. These devices sustain patients with HF in deteriorating conditions, especially those awaiting cardiac transplantation.

Match the characteristics of angina to its etiology. A. Provoked by exertion B. Occurs primarily at rest C. Triggered by ADLs (not exertion) D. Changes frequency, duration, or severity patterns 1. Coronary vasospasm 2. Myocardial ischemia 3. Plaque rupture 4. Microvascular disease

A - 2 B - 1 C - 4 D - 3

Match the type of fat to its associated food. A. Egg yolk B. Avocado C. Flaxseed D. Butter 1. Monounsaturated 2. Saturated 3. Unsaturated 4. Saturated 5. Polyunsaturated

A - 2 B - 1 C - 5 D - 4

Match the occluded coronary artery to the type of myocardial infarction (MI) it is associated with. A. Inferior wall MI B. Anterior wall MI C. Lateral wall MI 1. Left anterior descending artery 2. Left circumflex artery 3. Right coronary artery

A - 3 B - 1 C - 2

Which substance is derived from triglycerides? A. Phospholipids B. Fatty acids C. Chylomicrons D. Low density lipoproteins

B

Which physiologic change poses a potential complication for a male patient with hypertension who works as an air traffic controller? Select all that apply. One, some, or all responses may be correct. A. Hyperlipidemia B. Atherosclerosis C. Chronic obstructive pulmonary disease D. Left ventricular hypertrophy E. Alteration in coagulation F. Hyperglycemia

A, B, D, E, F High levels of cortisol from long-term stress may be the mechanism behind how stress can increase cholesterol. Adrenaline may also be released, and these hormones can trigger a "fight or flight" response to deal with the stress. This response will then trigger triglycerides, which can boost "bad" cholesterol. This is a physiologic change for a hypertensive male with a high-stress job. Hypertension makes the heart work harder to pump blood out to the body and contributes to atherosclerosis, stroke, kidney disease, and heart failure. This is a physiologic change for a hypertensive male with a high-stress job. Left ventricular hypertrophy is a sequalae of hypertension. The left ventricle has to pump harder against the higher pressure in the vasculature, causing the muscular tissue of the ventricle to enlarge. This is a physiologic change for a hypertensive male with a high-stress job. Acute mental stress activates the sympathetic nervous system, whereby catecholamine release from the adrenal medulla and sympathetic nerve endings triggers coagulation and fibrinolysis activation to result in net hypercoagulability. This is a physiologic change for a hypertensive male with a high-stress job. When stressed, insulin levels fall, glucagon and epinephrine (adrenaline) levels rise, and more glucose is released from the liver. This is a physiologic change for a hypertensive male with a high-stress job.

Which description of chest pain would be consistent with the sensation women may feel during a myocardial infarction (MI)? Select all that apply. One, some, or all responses may be correct. A. "I'm feeling a bit short of breath." B. "I'm having severe chest pain and pain radiating down my left arm." C. "I've been feeling a bit run down this morning." D. "I feel a little pressure in my chest." E. "This is the worst pain I have ever had."

A, C, D Shortness of breath, with or without chest discomfort, is a common non-traditional MI symptom for women. Fatigue is a common non-traditional symptom for women experiencing an MI. Some women do not feel the classic "elephant on the chest" pain sensation during an MI. Often the pain sensations are more subtle in women than in men.

Which condition is a precipitating cause of heart failure (HF)? Select all that apply. One, some, or all responses may be correct. A. Anemia B. Hip fracture C. Hypothyroidism D. Chronic bronchitis E. Pulmonary embolism

A, C, D The decreased oxygen-carrying capacity of the blood seen in anemia creates an increase in cardiac output (CO) to meet tissue demands. This leads to increased cardiac workload and increased load volume. Severe hypothyroidism decreases myocardial contractility, thus decreasing CO, predisposing the patient to HF. Hypothyroidism indirectly predisposes patients to an increased risk of atherosclerosis, which is highly associated with HF. The increase in pulmonary pressure resulting from a pulmonary obstruction leads to pulmonary hypertension and an overall decrease in CO.

Which benefit of inotropic medications makes them preferred for treating patients with unstable heart failure? Select all that apply. One, some, or all responses may be correct. A. Improve contractility B. Decrease mortality rates C. Increase cardiac output D. Decrease left ventricular diastolic pressure E. Decrease systemic vascular resistance (SVR)

A, C, D, E

Which patient has contraindications to undergoing heart transplantation? Select all that apply. One, some, or all responses may be correct. A. A homeless patient with allergies B. A patient with a history of pneumonia C. An obese patient with a body mass index (BMI) of 42 kg/m2 D. A patient with breast cancer in remission E. A patient with uncontrolled diabetes mellitus (DM)

A, C, E The homeless status of the patient is a relative contraindication to undergoing heart transplantation, as the patient has no support system to provide assistance postsurgery. Morbid obesity (BMI of ≥40 kg/m2) is a relative contraindication to undergoing heart transplantation. This is due to poor outcomes from long wait times related to challenges in identifying appropriately size-matched donors and longer-term morbidity. Uncontrolled DM is a relative contraindication to undergoing heart transplantation as patients with DM are at greater risk for a lower survival rate.

Which description of chest pain would the nurse expect from a male patient if he were experiencing unstable angina (UA) or a myocardial infarction (MI)? Select all that apply. One, some, or all responses may be correct. A. "This is the worst pain I have ever experienced." B. "The pain didn't last very long." C. "It feels like someone is stabbing me with a knife." D. "I feel like an elephant is on my chest." E. "I feel a burning sensation in my abdomen." F. "My left arm is tingling."

A, D, E, F Severe pain is a common descriptor of UA. A feeling of heaviness is a common sensation with UA or during an MI. Pain in the epigastric region is common with MI. It is sometimes dismissed as being GI in nature, which complicates the timely diagnosis of a MI. Stimulation of the nerves causes referred pain that can travel up the chin, down the left arm, or to the intrascapular region.

Which factor is a main indication for transplantation? Select all that apply. One, some, or all responses may be correct. A. Ischemia B. Dysrhythmias C. Remodelling D. Comorbidities E. Dilated cardiomyopathy

A, E The main indications for transplantation are ischemic heart disease and dilated cardiomyopathy.

Which behaviour would be consistent with coronary artery disease (CAD) risk reduction? A. Exercise regularly to meet the recommended target of 250 minutes/week. B. Limit salt intake to 2300 mg/day. C. Modify lifestyle choices to obtain/maintain a BMI between 24.9-38.5. D. Limit caloric intake to 1 200 calories/day.

B

When caring for a patient at a 6-month evaluation following heart transplantation surgery, which assessment finding would require immediate follow-up? A. Trace pedal edema B. Enlarged lymph node C. Occasional coughing D. Approximated incision

B An enlarged lymph node is an abnormal finding and would require immediate follow-up in a heart transplantation patient. Immunosuppressive therapy is prescribed to prevent rejection of the transplanted heart, but it could result in increased risk for cancer or infection.

Which statement about angina is accurate? A. Indicates that a small portion of myocardium has died and is malfunctional B. Results from myocardial cells being temporarily deprived of oxygen C. Always leads to myocardial infarction D. Can be successfully cured by nitrates

B Angina is the clinical manifestation of reversible myocardial ischemia and occurs when myocardial nerve fibres are irritated by the increased lactic acid produced when oxygen cannot be used for aerobic metabolism.

Which response by the nurse is best when a patient questions the necessity of testing for a methicillin-resistant Staphylococcus aureus (MRSA) infection? A. "This is a preventive measure and part of routine care." B. "Any active infection would disqualify you as a donor recipient." C. "If positive, you would need treatment for MRSA infection before the procedure." D. "There are too many risk factors involved with performing transplantation on a person with an active MRSA infection."

B Because an active infection, including MRSA infection, is an absolute contraindication for heart transplantation, the nurse's best response is to explain the necessity of MRSA testing prior to heart transplantation.

Which patient would most likely benefit from aggressive post-operative pain management? A. Coronary artery bypass graft (CABG) B. Off-pump coronary artery bypass (OPCAB) C. Cardiac catheterization D. Percutaneous coronary intervention (PCI)

B Because patients with thoracotomy incisions report higher levels of pain than those with sternotomy incisions, patients who undergo OPCAB may experience more postoperative surgical-site pain.

Which pattern of pain intensity, duration, or severity is most consistent with chest pain related to myocardial infarction (MI)? A. Occurs most often in the right side of the chest B. Not relieved by changes in position C. Has a short duration D. Usually the only symptom patients have

B Chest pain associated with an MI is not relieved by changing position. It is also not relieved by rest or with nitrate administration.

Which characteristic is associated with chronic stable angina? A. Has an unpredictable onset B. Occurs intermittently over a long period of time C. Has a variable duration D. Changes in intensity over time

B Chronic stable angina does occur intermittently over time; however, it has a stable pattern of onset, duration, and intensity of symptoms.

Which cardiac assessment finding would be most indicative of left ventricular dysfunction in the patient experiencing a myocardial infarction (MI)? A. Systolic murmur B. Third heart sound (S3) C. Jugular venous distention D. Peripheral edema

B During an MI, auscultation may reveal a third heart sound (S3) or fourth heart sound (S4) suggestive of ventricular dysfunction. A systolic murmur would be evidence of papillary muscle or mitral valve disfunction, not left ventricular dysfunction in the patient experiencing an MI. Jugular venous distension would suggest right ventricular failure, not left ventricular dysfunction in the patient experiencing MI. Peripheral edema would suggest right ventricular failure, not left ventricular dysfunction in the patient experiencing MI.

For which antilipidemic medication would the nurse question an order in a patient with cirrhosis of the liver? A. Niacin B. Ezetimibe C. Cholestyramine D. Colestipol

B Ezetimibe acts in the small intestine to inhibit uptake of cholesterol. Adverse effects are infrequent, but include mild GI disturbance (e.g., diarrhea) fatigue, headache, and cough. Its use would be avoided in patients with moderate to severe liver disease and pregnant or breast-feeding persons.

Administering intravenous Lasix as prescribed has which benefit for a patient with heart failure? A. Increases venous return B. Decreases intravascular volume C. Improves gas exchange D. Decreases cardiac contractility

B Lasix is a potent diuretic that decreases venous return by decreasing intravascular volume. Decreasing venous return (preload) reduces the amount of volume returned to the left ventricle during diastole, improving cardiac output.

Which dietary recommendation would be appropriate for an obese male patient with hypertension trying to reduce their risk for coronary artery disease (CAD)? A. Use processed foods whenever possible. B. Use low-fat cheese and milk products. C. Avoid vegetable-based meat substitutes. D. Drink vegetable juice in place of eating whole vegetables.

B Low fat dairy products are a good choice. The 2015-2020 Dietary Guidelines for Americans and the American Heart Association suggest consuming low fat dairy products to reduce calorie and saturated fat intake, which could improve heart health.

Which statement indicates that the patient requires additional instruction in reducing cardiac risk factors? A. "I would like to add weightlifting to my exercise program." B. "I can't keep my blood pressure normal without medication." C. "I can change my diet to decrease my intake of saturated fats." D. "I will change my lifestyle to reduce activities that increase my stress."

B Many people will attain a healthy weight, better glycemic control, and less plaque formation through lifestyle changes alone which ultimately will decrease blood pressure.

Which pharmacological therapy would the ED nurse expect to initially manage a client with chest pain of two hours' duration, ECG findings consistent with an acute MI, and occasional ventricular dysrhythmias? A. Diuretics B. Nitroglycerin spray C. β-Adrenergic blockers D. Thrombolytic therapy with tissue plasminogen activator

B Nitroglycerin, sublingual (SL) spray or translingual, is the initial management of chest pain. The ultimate goal is to increase blood flow to the myocardium to preserve heart muscle. The nearly immediate vasodilation caused by nitrates helps to increase coronary artery blood flow. While IV route is also an option, the nurse should not wait to establish an IV, so the SL administration is indicated.

Which cardiac revascularization procedure uses a mesh-like frame to stabilize the coronary artery? A. Coronary artery bypass graft B. Percutaneous coronary intervention (PCI) C. Fibrinolytic therapy D. Transmyocardial laser revascularization

B PCI generally includes the placement of one or more stents. Stents, either "bare metal" or "drug-eluting" are expandable mesh-like frames to open the vessel for blood flow.

Which activity recommendation would a nurse make for a patient who is in Phase I recovery after acute coronary syndrome (ACS)? A. Climbing eight to 10 stairs B. Range-of-motion exercises in bed C. Brisk walk lasting five minutes D. Lifting a three-pound weight three times with left arm

B Range-of-motion exercises in bed would be appropriate in the hospital phase (Phase I), especially for patients who experienced extensive myocardium injury. Activity is incrementally increased as tolerated. The goal for this patient would be to provide for some movement to avoid the complications of venous thromboembolism (deep vein thrombosis or pulmonary embolism).

Which nursing action is a priority when caring for a patient with heart failure (HF) who becomes significantly tachycardic and tachypneic when discussing their condition? A. Providing education on HF B. Teaching relaxation techniques C. Administering supplemental oxygen D. Placing the patient on strict bed rest

B Reduction of anxiety is an important nursing function, especially for a patient who is clearly anxious about the condition.

For which patient would the nurse expect Ezetimibe to be added to their pharmacologic management of hyperlipidemia? A. 28-year-old with a Framingham risk score (FRS) ≤10% B. 45-year-old with a Framingham risk score (FRS) of 23% and a 25% reduction of LDL-C with first-line medication C. 47-year-old with an FRS of 8% and an A1C of 4.5% D. 55-year-old with an FRS of 16% and a LDL-C of 1.8 mmol/L

B The FRS of 23% puts this patient at high risk. The goal of statin therapy is a 50% reduction of LDL-C. In addition to assessing medication compliance and appropriate lifestyle changes, it is likely that Ezetimibe would be added to the pharmacologic management.

Which statement about the interpretation of ECG findings in the assessment of MI is accurate? A. The ST segment is always involved if there is an MI. B. When a patient initially presents to the ED with chest pain, the ECG may be normal. C. Electrical disruption within the heart associated with coronary artery narrowing are always immediately reflected on the ECG. D. The changes in ECG waveforms do not reflect the degree of myocardial involvement.

B The disruption of electrical pathways within the heart are not always immediate upon myocardial cell death. The changes can be immediate or can evolve over time. Serial ECGs are done when there is a normal ECG in the presence of angina or other history/symptoms suggestive of MI.

Which ECG change is most indicative of prolonged or complete coronary occlusion in a patient with a newly diagnosed MI? A. Sinus tachycardia B. Pathological Q-wave C. Fibrillatory P-waves D. Prolonged PR interval

B The presence of a pathological Q-wave, as it often accompanies ST-segment elevation myocardial infarction (STEMI), is indicative of complete coronary occlusion.

Which statement describes the relationship between coronary artery disease (CAD) risk and substance use? A. Patients under the influence of illicit drugs admitted to the emergency department predominately are experiencing a myocardial infarction (MI). B. The major risk associated with illicit drug use is the increased risk of coronary artery spasm. C. Indigenous people are at less risk for CAD associated with substance use than non-indigenous people. D. Cannabis has been legalized in Canada as there are no known CAD risk factors.

B The use of illicit drugs, such as cocaine and methamphetamine, can produce coronary artery spasm resulting in myocardial ischemia and chest pain.

Which patient statements indicates that further teaching is required after participating in patient education on nitroglycerin use? A. "I will replace my nitroglycerin supply every six months." B. "I can take up to five tablets every three minutes for relief of my chest pain."C. "I will take acetaminophen to treat the headache caused by nitroglycerin."D. "I will take the nitroglycerin 10 minutes before planned activity that usually causes chest pain."

B This is an inaccurate understanding of the dosing information. The correct dosing is one tablet every five minutes three times for a total of 15 tablets.

Which intervention would the nurse initiate when caring for a patient with a PaO2 of 90% who reports fatigue, dyspnea, and difficulty moving around? A. Ambulation B. Oxygen therapy C. Teaching about end-of-life care D> Teaching on the risk factors for heart failure (HF)

B Treatment for HF includes oxygen therapy if indicated. A patient experiencing fatigue and dyspnea with a PaO2 of below 90% would require oxygen therapy.

Which teaching point would the nurse include when providing education to a patient with heart failure (HF)? A. Using oxygen if saturations fall below 80% B. Monitoring PaCO2 at home C. Detecting late signs and symptoms D. Continuing to exercise

D Regular activity and exercise periods should be prescribed for all patients with stable chronic HF.

Which goal is the aim of the interprofessional management of chronic stable angina? A. Increasing oxygen demand B. Decreasing coronary blood flow C. Decreasing oxygen supply D. Decreasing risk factors

D Risk reduction remains an important strategy throughout one's life. Helping patients adopt and maintain healthy lifestyle behaviours is useful in the overall management of chronic stable angina.

Which nutritional program are patients with heart failure (HF) generally advised to follow? A. Weight Watchers diet B. Diabetic diet C. Low-fat diet D. Dietary approach to stop hypertension (DASH)

D The DASH diet is effective as first-line nutritional therapy for patients with systolic hypertension. Diet education and weight management are critical in the control of HF.

Which change occurs in coronary artery disease (CAD)? Select all that apply. One, some, or all responses may be correct. A. Diffuse involvement of plaque formation in coronary veins B. Abnormal levels of cholesterol, especially low-density lipoproteins C. Accumulation of lipid plaques or calcification within the coronary arteries D. Development of angina due to a decreased blood supply to the heart muscle E. Chronic vasoconstriction of coronary arteries leading to permanent vasospasm

B, C, D There are abnormal levels of cholesterol, especially low-density lipoproteins, in CAD. In CAD, there is an accumulation or calcification within the coronary arteries. Development of angina due to a decreased blood supply to the heart muscle occurs in CAD.

Which follow up appointment would the primary care nurse expect to coordinate for a patient who survived a sudden cardiac death (SCD) episode? Select all that apply. One, some, or all responses may be correct. A. Nutritionist B. Electrophysiologist (EP) C. Family counselor D. Coronary angiogram E. Serial electrocardiograms F. Mental health provider

B, C, D, E, F Most survivors of SCD have a lethal ventricular dysrhythmia that is likely to recur. The EP study will identify which electrical pathways are problematic. Family members and caregivers are often incredibly stressed by the episode and are anxious and fearful about a recurrence. Family counseling will help the family members talk about their concerns and develop coping strategies. Most SCD episode are linked to existing undiagnosed CAD. The angiogram will confirm the link if present. Electrocardiograms is a diagnostic tool to understand the link between SCD and existing CAD. Many survivors adopt a "time bomb" mentality and develop fear, anxiety, and depression at the possibility of SCD recurrence. Lifestyle changes that may be necessitated by the episode, such as driving restrictions, further challenge the survivor's coping skills.

Which statement describes a goal of treating heart failure (HF)? A. Eliminate symptoms. B. Prevent adverse effects to treatments. C. Increase the cardiac workload. D. Prolong survival.

D The aim of treating HF is to prolong survival.

Which condition is included in the clinical spectrum of acute coronary syndrome (ACS)? Select all that apply. One, some, or all responses may be correct. A. Sudden cardiac death B. Unstable angina C. Chronic stable angina D. ST-elevation myocardial infarction (STEMI) E. Non-ST-elevation myocardial infarction (NSTEMI)

B, D, E

Which factor is assessed by the "S" in the PQRST angina assessment? A. Symmetry of pain B. Start time of pain C. Severity of pain D. Saturation of oxygen

C

Which underlying disease is common in heart failure (HF)? A. Peripheral venous distension B. Renal failure C. Coronary artery disease D. Distal neuropathy

C

Which benefit does decreasing afterload have on heart failure? A. Increases myocardial oxygen B. Dilates cardiac arteries C. Reduces pulmonary congestion D. Increases intravascular fluid

C Afterload is the resistance against which the left ventricle must pump. If afterload is reduced, the cardiac output improves and pulmonary congestion thereby decreases.

Which definitive diagnostic test would be indicated for a patient with known coronary artery disease (CAD) who received routine comprehensive CAD follow-up care two weeks ago with new onset of angina that occurs only at night? A. Lipid profile B. 12-Lead ECG C. Coronary angiography D. Holter monitor

C Angina is caused by ischemia. Coronary angiography would be indicated to assess the patency of the coronary arteries and blood flow to the myocardium.

Which assessment will provide for the early identification of the most common complication of myocardial infarction (MI)? A. Urinary output measurement B. Blood pressure monitoring C. ECG monitoring D. Continuous pulse oximetry

C Continuous ECG monitoring will provide for the early identification of dysrhythmias, which are the most common complication following an MI. Ventricular fibrillation is the most common lethal dysrhythmia and is usually preceded by proventricular contractions or ventricular tachycardia.

For which condition is emergent percutaneous coronary intervention (PCI) indicated? A. Chronic stable angina B. Left-sided heart failure C. Acute myocardial infarction (MI) D. Coronary artery disease (CAD)

C Emergent PCI is recommended as the first line of treatment for patients with confirmed MI (i.e., definitive ECG changes, presence of cardiac markers, or both). The goal is to open the affected artery within 90 minutes of the patient's arrival at the ED.

Which intervention would be indicated for a patient five days after a myocardial infarction (MI) who is restless and apprehensive? A. Provide all care and do everything for the patient. B. Structure the environment and the routine so that the patient can rest. C. Allow the patient to participate in planning and carrying out activities. D. Encourage the family to provide for the patient's physical care and give emotional support.

C It is common for MI patients, as they begin to move beyond the initial shock of their situation, to begin to comprehend the life-changing nature of their condition. Fear and anxiety are common reactions and involving the patient directly in decision making and their care will allow them some control over what is perceived to be an out-of-control situation.

Which characteristic of heart failure is associated with malfunctioning of the left ventricle? A. Hepatomegaly B. Peripheral edema C. Pulmonary edema D. Jugular venous distension (JVD)

C Malfunction of the left ventricle leads to increased pulmonary pressure, which causes fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli. This is manifested as pulmonary congestion and edema.

Which nursing action would limit the risk of sternal incision infection in a post-operative coronary artery bypass grafting (CABG) patient? A. Ensure that the top sheet is not drawn up above the patient's waist to avoid contact with the incision. B. Ensure the sternal wound dressing is not changed in the first 48 hours. C. Ensure that the incision is covered with an impermeable barrier during endotracheal suctioning. D. Apply soft restraints to ensure the patient does not touch the incision.

C Pulmonary secretions that make contact with the sternal incision are the predominate source of infection for sternal wounds. Using a barrier during endotracheal suctioning will help to prevent secretions from making contact with the dressing/incision.

Which ECG finding is consistent with non-ST-elevation myocardial infarction (NSTEMI)? A. ST-segment elevation B. Presence of Q-waves C. No Q-waves D. T-wave inversion

C Q-waves are not seen in NSTEMI. ST-segment elevation is the defining characteristic of ST-segment elevation (STEMI), not NSTEMI. Pathological Q-waves in the same leads as the ST elevation is characteristic of STEMI, not NSTEMI. T-wave inversion is found in STEMI, not NSTEMI.

Which statement about collateral circulation is accurate? A. New arterial anastomoses form only when necessary to increase blood flow. B. Rapid-onset heart disease causes immediate formation of collateral circulation providing sufficient blood supply. C. Genetics play a role in a person's ability to develop collateral circulation. D. Collateral circulation develops only when atherosclerotic changes decrease arterial blood flow to the myocardium.

C The inherited predisposition to develop new blood vessels (angiogenesis) promotes the presence of collateral circulation.

During which myocardial infarction (MI) recovery period is the patient most vulnerable to increased stress on the myocardium? A. Three weeks after the infarction. B. Four to six days after the infarction. C. 10 to 14 days after the infarction. D. When healing is complete, at six to eight weeks.

C The patient's activity level may be increasing while the scar tissue in the injured myocardium is still weak. The increased cardiac workload in response to increased physical activity puts stress on the still weak scar tissue and increases the risk of rupture.

Which condition is considered a causative factor in right-sided heart failure (HF)? A. Biventricular failure B. Pulmonary edema C. Left-sided heart failure D. Cor pulmonale

C The primary cause of right-sided HF is left-sided HF. Left-sided failure results in pulmonary congestion and increased pressure in the blood vessels of the lungs (pulmonary hypertension).

Which procedure would the nurse expect to prepare for when caring for a post-myocardial infarction (MI) patient who suddenly develops dyspnea, pulmonary edema, and a systolic murmur at the cardiac apex radiating toward the axilla? A. ECG B. Coronary angiography C. Open heart surgery D. Cardioversion

C These symptoms are indicative of papillary muscle rupture, which is a life-threatening complication of MI. Mitral valve replacement via open heart surgery is the definitive and immediate treatment.

Which type of diuretic is the first choice for chronic heart failure (HF)? A. Potassium sparing B. Loop C. Thiazide D. Osmotic

C Thiazide diuretics may be the first choice for chronic HF because of their convenience, safety, low cost, and effectiveness. They are particularly useful in treating edema secondary to HF and in controlling hypertension.

Which question would be most appropriate for the nurse to ask a patient with angina after the patient reports the pain started while at rest, is dull and aching, does not radiate, and is a "4" on the pain scale? A. "What did you eat for lunch?" B. "Is your pain radiating to your left arm?" C. "Have you had pain like this before?" D. "What medications are you taking?"

C This question represents the "T" in the PQRST assessment. Assessment data for precipitating events, quality of pain, radiation, and severity have been collected. Evaluation of the timing of the pain would be the next step.

Which statement by a patient with hypertension most clearly demonstrates their appropriate understanding of risk modification behaviors? A. "As long as I maintain my blood pressure less than 140/90, I am good to go." B. "I can continue to have my Friday night drinks with the guys." C. "I plan to do sitting Tai Chi every 90 minutes while I am at my desk." D. "There is nothing I can do about the stress I feel at work."

C This statement suggests that the patient is taking responsibility for changes in their behaviour that are intended to decrease their CAD risk. Seated Tai Chi is an excellent alternative for those who have a sedentary work environment and who cannot leave their work for walks or other physical mobility. Tai Chi offers both physical (strength/mobility) and psychological (stress reduction) benefits.

Which non-traditional symptom is most likely to be an indication of a myocardial infarction (MI) in an older adult? A. Angina B. New onset of incontinence C. New onset of confusion D. Flushing of the skin

C While non-specific to MI, confusion in the elderly is a cause for concern. Decreased blood flow to the brain may account for the new onset of confusion.

Which statement by the nurse is the most appropriate response to a patient, who after coronary artery disease (CAD) risk reduction education states, "I don't plan on changing my diet." A. "What is preventing you from changing your diet?" B. "Are you sure you understand the consequences of your decision?" C. "I am glad that you took the time to evaluate your options and respect your decision." D. "Perhaps you should talk with your spouse before deciding."

C While this might be hard to do, self-determination dictates that the patient has the ultimate responsibility for their health outcomes. The nurse, after providing patient teaching has done their part, and the ultimate decision of the patient must be supported

Which statement differentiates coronary artery disease (CAD) risk between males and females? A. Women are at more risk than men until age 65. B. At-risk waist circumference measurements do not differ for men and women. C. Reproductive influences affect CAD risk for women. D. Men have more stressful jobs, therefore are at higher risk.

C Women experience different risk related to the female reproductive system, including early age of menarche, contraceptive use, pregnancy, and premature menopause.

Place in sequence of the developmental stages of atherosclerotic lesions. A. Fatty streak B. Complicated lesion C. Chronic endothelial injury D. Fibrous plaque

C, A, D, B

Which factor is a major modifiable risk for coronary artery disease (CAD)? A. Depression B. Substance use C. Diabetes mellitus D. Tobacco use

D

Which factor primarily puts an individual at risk for heart failure (HF)? A. Hyperlipidemia B. Tobacco smoking C. Obesity D. Hypertension

D

When caring for a patient who is next on the transplantation list and is waiting at the hospital for a donor heart to become available, which statement by the patient indicates the need for additional teaching? A. "I am so depressed. There's no telling when a heart will be available." B. "My family and I are close enough that we don't believe we need to go to a heart transplantation support group." C. "My wife is nervous about the amount of medication I will have to take after surgery, so she bought me a medication organizer." D. "I'm going home to wait since I only live about 2 hours' drive from the hospital."

D Because the new heart must be transplanted within 4 hours after removal from the donor, the patient's statement about going home now is concerning, because most transplantation centres require patients to arrive within 2 hours from notification. Although this patient lives about 2 hours from the hospital, this does not take into account the possibility of traffic or another reason that travel time may be extended.

Which statement about diabetes mellitus does the nurse take into consideration when planning coronary artery disease (CAD) risk reduction education for Indigenous people? A. Because CAD is not common in the Indigenous population, risk reduction education is not necessary. B. Indigenous people rarely develop diabetes mellitus due to their low reliance on processed foods. C. Indigenous people are less likely to develop complications from their diabetes such as CAD. D. The incidence of diabetes in Indigenous people is very high.

D Diabetes is considered endemic in the Indigenous population, and they are at very high risk of developing diabetes associated complications; therefore, CAD risk reduction should be emphasized when providing their health care.

Which effect is expected with the administration of Metoprolol? A. Increased heart rate B. Enhanced myocardial contractility C. Stimulation of renin secretion D. Decreased myocardial oxygen consumption

D Metoprolol is a β-adrenergic blocker and works to decrease heart rate and myocardial contractility, thereby decreasing myocardial oxygen consumption.

Which action should the nurse take when providing patient education of the resumption of sexual activity after a myocardial infarction (MI)? A. Delegate to primary care provider. B. Avoid discussing because it is embarrassing to the patient. C. Accomplish the teaching by providing written material to the patient. D. Discuss along with other physical activities.

D Nurses may feel uncertain about how and when to begin counselling about resumption of sexual activity. It is helpful to consider sex a physical activity and to discuss or explore feelings about it when discussing other physical activities with the patient.

Which risk reduction strategy would the nurse prioritize for a patient for the most immediate result in reducing mortality due to coronary artery disease? A. Dietary changes B. Caregiver stress reduction class C. Weight reduction plan D. Smoking cessation

D The benefits of smoking cessation are dramatic and almost immediate. The more immediate positive reinforcement of the behaviour change will support continuation of the behaviour and their success may encourage other behaviour changes.

Which complication should the nurse anticipate when providing care for a patient diagnosed 24 hours earlier with ST-segment elevation myocardial infarction (STEMI)? A. Unstable angina B. Cardiac tamponade C. Sudden cardiac death D. Cardiac dysrhythmias

D The most common complication after MI is dysrhythmias, which are present in 80% of patients.

Which statement about cardiac markers is accurate? A. Cardiac markers are proteins released by the heart when oxygen levels drop. B. Serum creatine kinase is preferred to serum troponin to assess myocardial tissue damage. C. Serum levels of creatine kinase peak within 48 hours. D. Serum levels of troponin peak within 48 hours.

D The serum levels of troponin increase three to 12 hours after the onset of MI and peak at 24 to 48 hours. Cardiac markers are intracellular enzymes that are released into the blood in large quantities when the heart muscle cells die, not when oxygen levels drop. Increased serum troponin values have greater sensitivity and specificity for myocardial injury than serum creatine kinase. Serum levels of creatine kinase peak within 24, not 48, hours

Place in order the sequence a lesion forms within the endocardium. A. Exposed intima B. Thrombus formation C. Local vasoconstriction D. Enhanced platelet aggregation E. Plaque rupture

E, A, D, C, B

Which cause of pulmonary edema accompanies heart failure (HF)? A. Pulmonary hypertension B. Acute left ventricular failure C. Acute myocardial infarction (AMI) D. Pulmonary embolism

V