Coronary Artery Disease AQ
For a health care research study, the nurse is identifying obese women at risk of developing coronary artery disease (CAD). What are the appropriate criteria for the selection of at-risk women? Select all that apply. Multiple selection question "Pear"-shaped figure "Apple"-shaped figure Age of less than 40 years Waist circumference more than 30 inches Body mass index (BMI) greater than 30 kg/m 2
"Apple"-shaped figure Body mass index (BMI) greater than 30 kg/m 2 Obesity is a major risk factor for the development of coronary artery diseases (CAD). Women below the age of 40 are generally premenopausal. The cardioprotective effects of estrogen make premenopausal women less susceptible for developing atherosclerosis, which can lead to CAD. Apple-shaped obesity is the type of obesity in which there is more fat deposition around the abdomen. This condition is a major risk factor for development of coronary artery disease. Obesity in women is defined as having a body mass index of 30 or greater, which is a major risk factor for development of coronary artery disease. Evidence suggests that people having fat deposition around the thigh and hip regions (pear-shaped figure) are less susceptible to develop coronary artery disease than people having fat deposition around the abdomen (apple-shaped obesity). Obesity in women is defined as having a waist circumference more than 35 inches; therefore the criterion should be "waist circumference greater than 35 inches."
The nurse provides information to a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates understanding of the teaching? Multiple choice question "I will add weightlifting to my daily exercise program." "I will change my diet to increase my intake of saturated fats." "I need to switch to smokeless tobacco instead of smoking cigarettes." "I will change my lifestyle to alter patterns that add to my stress."
"I will change my lifestyle to alter patterns that add to my stress." Health-promoting behaviors for those at risk for CAD include: improving physical activity such as brisk walking (three to four miles/hour for at least 30 minutes five or more times a week); reducing total fat and saturated fat intake; stopping all tobacco use, and altering patterns that are conducive to stress.
The nurse provides discharge teaching to a patient who is newly diagnosed with coronary artery disease (CAD). Which statement made by the patient indicates understanding of the dietary modifications that need to be implemented after discharge home? Multiple choice question "I will not eat bacon or any pork products." "I will eat only fried eggs instead of boiled eggs." "I may continue to enjoy French fries with hot dogs." "I will drink no more than one glass of whole milk per day."
"I will not eat bacon or any pork products." Nutritional guidelines recommended for the patient with CAD include a low-cholesterol and low-fat diet; therefore the patient has to avoid bacon and any pork products. Egg yolk is high in cholesterol and the patient with CAD has to avoid fried food. French fries are high in fat because of their preparation process. Low-fat or nonfat milk is recommended for the patient with CAD.
What instruction should the nurse give to a patient to reduce the risk of coronary artery disease (CAD) by lowering LDL cholesterol? Select all that apply. Multiple selection question "Increase complex carbohydrates such as fruit." "Increase fiber intake by eating food such as legumes." "Choose foods made with whole grains such as brown rice." "Avoid fatty fish such as tuna." "Fat intake should be about 40% of total calories."
"Increase complex carbohydrates such as fruit." "Increase fiber intake by eating food such as legumes." "Choose foods made with whole grains such as brown rice." It is recommended to increase the intake of complex carbohydrates, fiber, and whole grains. The AHA recommends eating fatty fish twice a week. Fat intake should be about 25-35% of total daily calories.
Which advice regarding modifiable risk factors would the nurse give to a patient who has a blood pressure of 150/100 mm Hg? Select all that apply. Multiple selection question "Reduce total fat intake." "Reduce salt in your diet." "Increase daily physical activity." "Ingest smaller and more frequent meals." "Reduce the amount of complex carbohydrates and fibers in your diet."
"Reduce salt in your diet." "Increase daily physical activity." Blood pressure of 150/100 mm Hg meets the criteria for clinical hypertension. The nurse would advise this patient to consume less salt to lower blood pressure and to exercise daily to reduce the risk of coronary artery disease (CAD) from hypertension. The nurse would advise a reduction in total fat intake for the patient who has elevated serum lipids. In the case of obesity, the nurse would advise the patient to eat smaller and more frequent meals. For the patient who has elevated serum lipids, the nurse would advise an increase the amount of complex carbohydrates, fiber, and vegetable proteins in the diet.
A nurse is assessing a 15-year-old patient that has a body mass index (BMI) of 32 kg/m 2. What is the first change in the coronary artery that occurs that makes patients susceptible to coronary artery disease? Multiple choice question Formation of thrombus in the coronary artery Formation of fibrous plaque in the endothelium Reduction of blood flow through the coronary arteries Development of fatty streaks in the smooth muscles of the endothelium
Development of fatty streaks in the smooth muscles of the endothelium The endothelium of the coronary artery is usually unreactive to platelets, leukocytes, coagulation, fibrinolytic, and complement factors. Conditions such as hyperlipidemia, hypertension, and diabetes damage the endothelium, making them reactive to these substances. The patient is obese and therefore most likely has hyperlipidemia. Hyperlipidemia is a major risk factor for coronary artery disease. The first stage of coronary artery disease is the development of fatty streaks within the smooth muscles that appear by age 15.The fibrous plaque development takes place by age 30 and increases with age. As the age progresses, the fibrous plaque becomes larger in size. This compromises the integrity of the inner arterial wall. As more platelets get accumulated, there is thrombus formation. There is a reduction of blood flow through the coronary arteries because they are blocked due to the formation of fibrous plaque.
A nurse teaches a patient about strategies to prevent angina caused by coronary artery disease. The nurse tells the patient that if a heavy meal is eaten, to rest for 1 to 2 hours after the meal. What is the rationale for this instruction? Multiple choice question Eating a heavy meal would divert more blood to the gastrointestinal system. Heavy meals cause obesity and increase the susceptibility to myocardial ischemia. Eating a heavy meal can cause physical inactivity, which could precipitate angina. Heavy meals cause excessive heat production, which leads to peripheral vasodilation.
Eating a heavy meal would divert more blood to the gastrointestinal system. The digestive system requires more blood supply for a longer period of time to digest heavy meals. Therefore blood is diverted to the gastrointestinal system, which causes reduced blood supply to the myocardium. Physical inactivity does not cause an anginal attack; angina can be precipitated by physical exertion. Eating heavy meals causes obesity in due course of time, and this increases the susceptibility of an individual to have coronary artery disease. This is not a valid reason here, because the patient already has coronary artery disease. Eating heavy meals does not cause peripheral pooling of blood.
The nurse is reviewing a patient's lipid profile results. Which level increases the patient's risk of coronary artery disease (CAD)? Multiple choice question Decreased triglycerides Elevated low-density lipoproteins (LDL) Elevated high-density lipoproteins (HDL) Decreased very-low-density lipoproteins (VLDL)
Elevated low-density lipoproteins (LDL) Elevated LDLs contain more cholesterol than any of the other lipoproteins and have an affinity for arterial walls. Elevated LDL levels correlate most closely with an increased incidence of atherosclerosis and CAD. Elevated HDL, decreased triglycerides, and VLDL are all negative risk factors for CAD.
The nurse is caring for a patient with liver impairment and should question a prescription for which lipid-lowering medication? Multiple choice question Niacin Ezetimibe Icosapent ethyl Cholestyramine
Ezetimibe Ezetimibe should not be used by patients with liver impairment. Niacin's side effects subside with time, although decreased liver function may occur with high doses. Icosapent ethyl has no major liver-related side effects. Cholestyramine is safe for long-term use.
Which individuals would the nurse identify as having the highest risk for coronary artery disease (CAD)? Multiple choice question A 45-year-old depressed male with a high-stress job A 60-year-old male with below-normal homocysteine levels A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m 2
A 45-year-old depressed male with a high-stress job The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m 2 depicts normal weight. The patient with two risk factors is at greatest risk for developing CAD.
A nurse who is preparing a patient for cardiac catheterization should perform a baseline assessment of vital signs, pulse oximetry, and heart and lung sounds. What other vital assessment should the nurse include? Multiple choice question Anemia Allergies Dysrhythmia Mental status
Allergies Before performing a cardiac catheterization, the nurse should assess the patient for an allergy to contrast medium, which would have an immediate adverse effect on the patient receiving this procedure. Anemia, dysrhythmia, and change in mental status present less immediate complications during a cardiac catheterization procedure.
When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food item? Multiple choice question Baked flounder Angel food cake Baked potato with margarine Canned chicken noodle soup
Canned chicken noodle soup Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content. Baked flounder, angel food cake, and baked potato with margarine are all low in sodium and low in fat and would be appropriate for this diet.
To reduce a patient's risk of coronary artery disease (CAD), the nurse recognizes that dietary teaching is needed when the patient's high density lipoprotein (HDL) and low-density lipoprotein (LDL) profile reveals what two abnormal results? Multiple choice question Increased HDLs; increased LDLs Decreased HDLs; decreased LDLs Increased HDLs; decreased LDLs Decreased HDLs; increased LDLs
Decreased HDLs; increased LDLs The risk of CAD is associated with increased LDLs (> 160 mg/dL) and decreased HDLs (< 40 mg/dL).
Which drug reduces triglycerides by decreasing the hepatic synthesis and secretion of very-low-density lipoproteins (VLDL)? Multiple choice question Niacin Fluvastatin Gemfibrozil Cholestyramine
Gemfibrozil Gemfibrozil decreases the hepatic synthesis and secretion of VLDLs, which reduces the levels of triglycerides. Niacin inhibits the synthesis of VLDLs and low-density lipoproteins (LDL). Fluvastatin blocks the synthesis of cholesterol and increases the LDL receptors in the liver. Cholestyramine binds with the bile acids in the intestines, forming an insoluble complex. The binding results in the removal of LDL and cholesterol.
What will the nurse include when educating an older adult patient about a physical activity program to reduce the risk for coronary artery disease? Select all that apply. Multiple selection question Include longer warm-up periods. Plan indoor exercise on summer days. Include shorter periods of low-level activity. Include shorter rest periods between sessions. Exercise a minimum of 60 minutes on most days of the week.
Include longer warm-up periods. Plan indoor exercise on summer days Longer warm-up periods are recommended for older adult patients to prevent injury and additional stress. Because older adults have a decreased ability to sweat efficiently, they are at a higher risk for heat intolerance and should therefore be encouraged to plan exercise indoors when it is hot outside. An older adult's physical activity program should include longer, not shorter, rest periods between sessions, longer, not shorter, periods of low-level activity, and exercising at a minimum of 30 minutes, not 60 minutes, on most days of the week as able.
A nurse is caring for a patient with a history of chronic stable angina that reports chest pain. What is a characteristic of pain related to this type of angina? Multiple choice question It generally lasts longer than 15 to 20 minutes. It will be relieved by rest, nitroglycerin, or both. It is frequently associated with vomiting and extreme fatigue. It indicates that irreversible myocardial damage is occurring.
It will be relieved by rest, nitroglycerin, or both. Chronic stable angina is characterized by intermittent chest pain, often described as pressure or tightness that occurs over a period of time in the same pattern, onset, and intensity. It commonly subsides when precipitating factors have stopped and the patient is at rest or with the use of nitroglycerin. The pain usually lasts just 5 to 15 minutes and does not always indicate irreversible myocardial damage. Vomiting and extreme fatigue are symptoms of myocardial infarction and are not commonly seen in chronic stable angina.
A patient is classified as having stage 2 hypertension on the basis of the blood pressure recorded. The nurse notes that the primary goal of therapy for the patient is to normalize the blood pressure. What should be the patient's target blood pressure? Multiple choice question 130/80 mm Hg 140/90 mm Hg 150/90 mm Hg Less than 120/80 mm Hg
Less than 120/80 mm Hg The nurse's goal is to normalize the blood pressure (BP) of this patient. Therefore, the target blood pressure would be 120/80 mm Hg, which is a normal BP. If the patient has a blood pressure within 140 to 159/90 to 99 mm Hg range, then the patient has stage 1 hypertension. This can be controlled by drugs and lifestyle modifications. If the BP of the patient is within 120 to 139/80 to 89 mm Hg, then the patient has prehypertension. Lifestyle modifications are required for this patient to normalize the blood pressure. Blood pressure of 150/90 is indicative of stage 2 hypertension.
The nurse is auscultating the heart sounds of a patient with a myocardial infarction (MI). A new murmur is heard at the cardiac apex. The nurse suspects which complication? Multiple choice question Acute pericarditis Dressler syndrome Ventricular aneurysm Papillary muscle dysfunction
Papillary muscle dysfunction Papillary muscle dysfunction is a complication of a myocardial infarction and is assessed by the auscultation of a new murmur at the cardiac apex. Acute pericarditis is a complication of a myocardial infarction characterized by the auscultation of a friction rub at the mid to lower left sternal border. Dressler syndrome is a complication that develops several weeks after the myocardial infarction and a pericardial friction rub is auscultated at the mid to lower left sternal border. Ventricular aneurysm is a complication of a myocardial infarction without the development of a new murmur or friction rub.
After reviewing the lipid profile reports of four patients, the nurse expect that which patient will receive a prescription for cholestyramine? Multiple choice question Patient with a triglyceride level of 138 mg/dL Patient with a total cholesterol level of 180 mg/dL Patient with high-density lipoprotein (HDL) cholesterol of 60 mg/dL Patient with low-density lipoprotein (LDL) cholesterol of 190 mg/dL
Patient with low-density lipoprotein (LDL) cholesterol of 190 mg/dL Patients with LDL cholesterol levels greater than 160 mg/dL are at a risk for acquiring coronary artery disease and would benefit from receiving cholestyramine. Patients with a triglyceride level of 138 mg/dL are not at a risk for coronary heart disease and cholestyramine is not indicated. Patients with total cholesterol levels less than 200 mg/dL do not require drug treatment because they are not at risk of developing coronary heart disease. Patients with HDL less than 40 mg/dL are at a risk of developing coronary heart disease and must be treated with appropriate drugs.
Which is a characteristic of a complicated lesion? Multiple choice question Formation of a fibrous plaque Lipid-filled smooth muscle cells Platelet aggregation and adhesion Transport of lipids into arterial intima
Platelet aggregation and adhesion A complicated lesion is characterized by accumulation of platelets leading to thrombus formation. Formation of a fibrous plaque is the beginning of progressive changes in the endothelium of the arterial wall. It is called the fibrous plaque stage. Fatty streaks are the earliest lesions of atherosclerosis and are characterized by lipid-filled smooth muscle cells. Transport of lipids into the arterial intima occurs in the fibrous plaque stage.
The nurse provides teaching to a patient recently diagnosed with coronary artery disease (CAD). Which information related to health promotion should the nurse include? Select all that apply. Multiple selection question Reduce total fat intake Decrease the amount of fiber in the diet Increase complex carbohydrates in the diet Perform isometric exercises at least 10 minutes daily Perform moderate physical activity for at least 30 minutes a minimum of five days a week
Reduce total fat intake Increase complex carbohydrates in the diet Perform moderate physical activity for at least 30 minutes a minimum of five days a week Dietary modifications should include a decrease in total fat intake as well as an increase in complex carbohydrates (whole grains, fruits, and vegetables). A moderate physical activity program should include isotonic exercises, such as walking, hiking, or jogging performed for at least 30 minutes on most week days (e.g., at least 5 days a week). Modifications should include an increase in fiber. Consumption of alcohol and simple sugars will lead to an elevated triglyceride level. Isometric exercises, such as weight lifting, are recommended to increase muscle strength two days per week only.
The nurse assesses a patient with a family history of myocardial infarction (MI). Which assessment data indicates to the nurse that the patient has additional risk factors for coronary artery disease (CAD)? Select all that apply. Multiple selection question Smoking cessation three years ago Serum cholesterol level of 260 mg/dL Fasting triglyceride level of 110 mg/dL High level of anxiety over last two years related to family issues Lives with an adult child that smokes two packs of cigarettes per day Works over 50 hours/week in an office as a receptionist with little time to exercise
Serum cholesterol level of 260 mg/dL High level of anxiety over last two years related to family issues Lives with an adult child that smokes two packs of cigarettes per day Works over 50 hours/week in an office as a receptionist with little time to exercise Serum cholesterol level greater than 200 mg/dL is a risk factor for CAD. Stress is an additional risk factor for developing CAD. Secondhand smoke increases the risk of CAD. A sedentary job and lack of exercising are risk factors for CAD. Smoking cessation will lead to a reduced mortality rate after a period of 12 months. Fasting triglyceride levels above 150 mg/dL are a risk factor for CAD.
Upon taking a lipid-lowering medication for hyperlipidemia, a patient reports muscle pain. The nurse notes the patient has elevated liver enzymes and creatine kinase levels. It is most likely that the patient takes which lipid-lowering medication? Multiple choice question Niacin Colestipol Simvastatin Gemfibrozil
Simvastatin Muscle pain and elevated creatine kinase levels are manifestations of rhabdomyolysis. Elevated liver enzymes and rhabdomyolysis are adverse effects of statin drugs such as simvastatin. Side effects of niacin include pruritus and flushing. High doses of this drug may cause decreased liver function. Gemfibrozil is a fibric acid derivative that can cause rhabdomyolysis when given with a statin drug. Colestipol is a bile-acid sequestrant drug. This drug does not have any major adverse effects except that it lowers the absorption of drugs such as warfarin, digoxin, and thiazide diuretics. Colestipol is not related to rhabdomyolysis.
Which complementary lipid-lowering agents may be recommended to a patient for reduction of total cholesterol? Select all that apply. Multiple selection question Soy Psyllium Flaxseed Plant sterols Red yeast rice Omega-3 fatty acids
Soy Psyllium Plant sterols Red yeast rice There is scientific evidence that plant sterols, soy, red yeast rice, and psyllium all contribute to the total reduction of cholesterol. There is some evidence that flaxseed may reduce the risk of heart disease, diabetes, and stroke, but not lower total cholesterol. Omega-3 fatty acids are responsible for the reduction of triglyceride levels, but not total cholesterol.
A patient with hyperlipidemia has been prescribed niacin. The nurse administers aspirin 30 minutes before administering niacin for what reason? Multiple choice question To relieve pain To prevent clotting of blood To prevent flushing of skin To prevent the formation of atherosclerotic plaque
To prevent flushing of skin Flushing of the face and neck is a common side effect of niacin. Premedicating the patient with aspirin reduces flushing. Aspirin is an analgesic and antiplatelet medication. Platelet aggregation prevents the formation of atherosclerotic plaque. In this case the most likely reason for the nurse to administer this drug is to relieve flushing.
A nurse provides teaching to a patient about smoking cessation to decrease the risk of coronary artery disease (CAD). Why does the nurse discourage cigarette smoking? Select all that apply. Multiple selection question Tobacco smoking increases estrogen levels. Tobacco smoking decreases blood pressure. Tobacco smoke increases the low-density lipoprotein levels. Nicotine in tobacco smoke causes release of catecholamines. Carbon monoxide, found in tobacco smoke, affects the O 2-carrying capacity of haemoglobin.
Tobacco smoke increases the low-density lipoprotein levels. Nicotine in tobacco smoke causes release of catecholamines. Carbon monoxide, found in tobacco smoke, affects the O 2-carrying capacity of haemoglobin. Nicotine present in tobacco smoke stimulates the release of catecholamines. Catecholamines have a stimulatory effect on the sympathetic nervous system that causes an increase in heart rate and blood pressure. Carbon monoxide present in tobacco smoke has a greater affinity to hemoglobin than does oxygen. Therefore carbon monoxide reduces the oxygen-carrying capacity of blood. Tobacco smoke is known to increase the level of low-density lipoproteins and subsequently a decrease in high-density lipoproteins. All of these factors can lead to atherosclerosis. Tobacco smoke is known to decrease estrogen levels in premenopausal women, thereby increasing their susceptibility for coronary artery disease.
When providing nutritional counseling for patients at risk for coronary artery disease (CAD), which dietary selections should the nurse encourage them to include in their meal-planning? Select all that apply. Multiple selection question Tofu Walnuts Flaxseed Whole milk Orange juice
Tofu Walnuts Flaxseed Tofu, walnuts, and flaxseed are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly. Whole milk and orange juice have no benefits for CAD.
The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which population has the highest incidence of CAD? Multiple choice question White male Hispanic male African American male Native American female
White male The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men. Hispanic individuals have lower rates of CAD than non-Hispanic whites or African Americans. African Americans have an earlier age of onset and more severe CAD than whites and more than twice the mortality rate of whites of the same age. Native Americans have increased mortality in 35-year-old and under people, and have major modifiable risk factors, such as diabetes.