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NRS 400 Exam 4 (1)
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Exam of 34 pages for the course cardiac exam nursing 400 at cardiac exam nursing 400 (NRS 400 Exam 4 (1))
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NRS 400 Exam 4Which patient is most likely to be in the fibrous stage of development of coronary artery
disease (CAD)?
a. Age 40 years, thrombus adhered to the coronary artery wall
b. Age 50 years, rapid onset of disease with hypercholesterolemia
c. Age 32 years, thickened coronary arterial walls with narrowed vessel lumen
d. Age 19 years, high low-density lipoprotein (LDL) cholesterol, lipid-filled smooth
muscle cells - ANS-C
What accurately describes the pathophysiology of CAD?
a. Partial or total occlusion of the coronary artery occurs during the stage of raised
fibrous plaque.
b. Endothelial changes may be caused by chemical irritants, such as hyperlipidemia or
by tobacco use.
c. Collateral circulation in the coronary circulation is more likely to be present in the
young patient with CAD.
d. The leading theory of atherogenesis proposes that infection and fatty dietary intake
are the basic underlying causes of atherosclerosis. - ANS-B
After obtaining patient histories, which patient does the nurse identify as having the
highest risk for CAD?
a. A white man, age 54 years, who is a smoker and has a stressful lifestyle
b. A white woman, age 75 years, with a BP of 172/100 mm Hg and who is physically
inactive
c. An Asian woman, age 45 years, with a cholesterol level of 240 mg/dL and a BP of
130/74 mm Hg
d. An obese Hispanic man, age 65 years, with a cholesterol level of 195 mg/dL and a
BP of 128/76 mm Hg - ANS-b. A white woman, age 75 years, with a BP of 172/100 mm
Hg and who is physically inactive
Priority Decision: What should the nurse emphasize when teaching women about the
risks and incidence of CAD?
a. Smoking is not as significant a risk factor for CAD in women as it is in men.
b. Women seek treatment sooner than do men when they have symptoms of CAD.
c. Estrogen replacement therapy in postmenopausal women decreases the risk for
CAD.
d. CAD is the leading cause of death in women, with a higher mortality rate after
myocardial infarction (MI) than in men. - ANS-D
,Which characteristics are associated with LDLs (select all that apply)?
a. Increases with exercise
b. Contains the most cholesterol
c. Has an affinity for arterial walls
d. Carries lipids away from arteries to liver
e. High levels correlate most closely with CAD
f. The higher the level, the lower the risk for CAD - ANS-b, c, e.
LDLs contain more cholesterol than the other lipoproteins, have an attraction for arterial
walls, and correlate most closely with increased incidence of atherosclerosis and CAD.
HDLs increase with exercise and carry lipids away from arteries to the liver for
metabolism. A high HDL level is associated with a lower risk of CAD.
Which serum lipid elevation, along with high LDL, is strongly associated with CAD?
a. Apolipoproteins
b. Fasting triglycerides
c. Total serum cholesterol
d. High-density lipoprotein (HDL) - ANS-b. Fasting triglycerides
The laboratory tests for 4 patients show the following results. Which patient should the
nurse teach first about preventing CAD because the patient is at the greatest risk for
CAD even without other risk factors?
a. Total cholesterol: 152 mg/dL, triglycerides: 148 mg/dL, LDL: 148 mg/dL, HDL: 52
mg/dL
b. Total cholesterol: 160 mg/dL, triglycerides: 102 mg/dL, LDL: 138 mg/dL, HDL: 56
mg/dL
c. Total cholesterol: 200 mg/dL, triglycerides: 150 mg/dL, LDL: 160 mg/dL, HDL: 48
mg/dL
d. Total cholesterol: 250 mg/dL, triglycerides: 164 mg/dL, LDL: 172 mg/dL, HDL: 32
mg/dL - ANS-D
The nurse is encouraging a sedentary patient with major risks for CAD to perform
physical exercise on a regular basis. In addition to decreasing the risk factor of physical
inactivity, the nurse tells the patient that exercise will directly contribute to reducing
which risk factors?
a. Diabetes and hypertension
b. Hyperlipidemia and obesity
c. Increased serum lipids and stressful lifestyle
d. Hypertension and increased serum homocysteine - ANS-b. Hyperlipidemia and
obesity
,During a routine health examination, a 48-year-old patient is found to have a total
cholesterol level of 224 mg/dL (5.8 mmol/L) and an LDL level of 140 mg/dL (3.6
mmol/L). What does the nurse teach the patient based on the Therapeutic Lifestyle
Changes diet (select all that apply)?
a. Use fat-free milk.
b. Abstain from alcohol use.
c. Reduce red meat in the diet.
d. Eliminate intake of simple sugars.
e. Avoid foods prepared with egg yolks. - ANS-A, C, E
To which patients should the nurse teach the Therapeutic Lifestyle Changes diet to
reduce the risk of CAD?
a. Patients who have had an MI
b. All patients to reduce CAD risk
c. Those with 2 or more risk factors for CAD
d. Those with a cholesterol level >200 mg/dL (5.2 mmol/L) - ANS-B
A 62-year-old woman smokes a pack of cigarettes per day and has a BP 138/88 mm
Hg. She has no symptoms of CAD, but a recent LDL level was 154 mg/dL (3.98
mmol/L). Based on these findings, the nurse would expect that which treatment plan
would be used first for this patient?
a. Diet and drug therapy
b. Exercise instruction only
c. Diet therapy and smoking cessation
d. Drug therapy and smoking cessation - ANS-C
What are manifestations of acute coronary syndrome (ACS) (select all that apply)?
a. Dysrhythmia
b. Stable angina
c. Unstable angina
d. ST-segment-elevation myocardial infarction (STEMI)
e. Non-ST-segment-elevation myocardial infarction (NSTEMI) - ANS-c, d, e.
Unstable angina, ST-segment-elevation myocardial infarction (STEMI), and
non-ST-segment-elevation myocardial infarction (NSTEMI) are conditions that are
manifestations of acute coronary syndrome (ACS). The other options are not
manifestations of ACS.
, Myocardial ischemia occurs because of increased oxygen demand and decreased
oxygen supply. What factors and disorders result in increased oxygen demand (select
all that apply)?
a. Hypovolemia or anemia
b. Increased cardiac workload with aortic stenosis
c. Narrowed coronary arteries from atherosclerosis
d. Angina in the patient with atherosclerotic coronary arteries
e. Left ventricular hypertrophy caused by chronic hypertension
f. Sympathetic nervous system stimulation by drugs, emotions, or exertion - ANS-B, D,
E, F
What causes the pain that occurs with myocardial ischemia?
a. Death of myocardial tissue
b. Dysrhythmias caused by cellular irritability
c. Lactic acid accumulation during anaerobic metabolism
d. Increased pressure in the ventricles and pulmonary vessels - ANS-c.
When the coronary arteries are occluded, contractility ceases after several minutes,
depriving the myocardial cells of glucose and oxygen for aerobic metabolism. Anaerobic
metabolism begins and lactic acid accumulates, irritating myocardial nerve fibers that
then transmit a pain message to the cardiac nerves and upper thoracic posterior roots.
The other factors may occur during vessel occlusion but are not the source of pain.
What types of angina can occur in the absence of CAD (select all that apply)?
a. Silent ischemia
b. Nocturnal angina
c. Prinzmetal's angina - ANS-C, d
16. Which characteristics describe unstable angina (select all that apply)?
a. Usually precipitated by exertion
b. New-onset angina with minimal exertion
c. Occurs only when the person is recumbent
d. Characterized by increased duration or severity
e. Usually occurs in response to coronary artery spasm - ANS-B, d
Tachycardia that is a response of the sympathetic nervous system to the pain of
ischemia is detrimental because it increases oxygen demand and
a. increases cardiac output.
b. causes reflex hypotension.
c. may lead to atrial dysrhythmias.
d. impairs perfusion of the coronary arteries.
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