Lewis Chapter 34 CAD & ACS questions with complete answers
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Course
USMLE
Institution
USMLE
Which nursing intervention will be most effective when assisting the patient with
coronary artery disease (CAD) to make appropriate dietary changes?
A few days after experiencing a myocardial infarction (MI) and successful
percutaneous coronary intervention, the patient states, "I just had a ...
Lewis Chapter 34 CAD & ACS
1. When developing a teaching plan for a 61-year-old man with the following risk factors
for coronary artery disease (CAD), the nurse should focus on the
a. family history of coronary artery disease.
b. increased risk associated with the patient's gender.
c. increased risk of cardiovascular disease as people age.
d. elevation of the patient's low-density lipoprotein (LDL) level. - Answer D
Because family history, gender, and age are nonmodifiable risk factors, the nurse
should focus on the patient's LDL level. Decreases in LDL will help reduce the patient's
risk for developing CAD.
2. Which nursing intervention will be most effective when assisting the patient with
coronary artery disease (CAD) to make appropriate dietary changes?
a. Give the patient a list of low-sodium, low-cholesterol foods that should be included in
the diet.
b. Emphasize the increased risk for heart problems unless the patient makes the dietary
changes.
c. Help the patient modify favorite high-fat recipes by using monosaturated oils when
possible.
d. Inform the patient that a diet containing no saturated fat and minimal salt will be
necessary. - Answer C
Lifestyle changes are more likely to be successful when consideration is given to the
patient's values and preferences. The highest percentage of calories from fat should
come from monosaturated fats. Although low-sodium and low-cholesterol foods are
appropriate, providing the patient with a list alone is not likely to be successful in making
dietary changes. Completely removing saturated fat from the diet is not a realistic
expectation. Up to 7% of calories in the therapeutic lifestyle changes (TLC) diet can
come from saturated fat. Telling the patient about the increased risk without assisting
further with strategies for dietary change is unlikely to be successful.
3. Which assessment data collected by the nurse who is admitting a patient with chest
pain suggest that the pain is caused by an acute myocardial infarction (AMI)?
a. The pain increases with deep breathing.
b. The pain has lasted longer than 30 minutes.
c. The pain is relieved after the patient takes nitroglycerin.
d. The pain is reproducible when the patient raises the arms. - Answer B
Chest pain that lasts for 20 minutes or more is characteristic of AMI. Changes in pain
that occur with raising the arms or with deep breathing are more typical of
musculoskeletal pain or pericarditis. Stable angina is usually relieved when the patient
takes nitroglycerin.
,4. Which information given by a patient admitted with chronic stable angina will help the
nurse confirm this diagnosis?
a. The patient states that the pain "wakes me up at night."
b. The patient rates the pain at a level 3 to 5 (0 to 10 scale).
c. The patient states that the pain has increased in frequency over the last week.
d. The patient states that the pain "goes away" with one sublingual nitroglycerin tablet. -
Answer D
Chronic stable angina is typically relieved by rest or nitroglycerin administration. The
level of pain is not a consistent indicator of the type of angina. Pain occurring at rest or
with increased frequency is typical of unstable angina.
5. After the nurse has finished teaching a patient about the use of sublingual
nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been
effective?
a. "I can expect some nausea as a side effect of nitroglycerin."
b. "I should only take the nitroglycerin if I start to have chest pain."
c. "I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes apart."
d. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."
- Answer C
The emergency medical services (EMS) system should be activated when chest pain or
other symptoms are not completely relieved after 3 sublingual nitroglycerin tablets taken
5 minutes apart. Nitroglycerin can be taken to prevent chest pain or other symptoms
from developing (e.g., before intercourse). Gastric upset (e.g., nausea) is not an
expected side effect of nitroglycerin. Nitroglycerin does not impact the underlying
pathophysiology of coronary artery atherosclerosis.
6. Which statement made by a patient with coronary artery disease after the nurse has
completed teaching about therapeutic lifestyle changes (TLC) diet indicates that further
teaching is needed?
a. "I will switch from whole milk to 1% milk."
b. "I like salmon and I will plan to eat it more often."
c. "I can have a glass of wine with dinner if I want one."
d. "I will miss being able to eat peanut butter sandwiches." - Answer D
Although only 30% of the daily calories should come from fats, most of the fat in the
TLC diet should come from monosaturated fats such as are found in nuts, olive oil, and
canola oil. The patient can include peanut butter sandwiches as part of the TLC diet.
The other patient comments indicate a good understanding of the TLC diet.
7. After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing
anginal episodes, which statement by a patient indicates that the teaching has been
effective?
a. "Carvedilol will help my heart muscle work harder."
, b. "It is important not to suddenly stop taking the carvedilol."
c. "I can expect to feel short of breath when taking carvedilol."
d. "Carvedilol will increase the blood flow to my heart muscle." - Answer B
Patients who have been taking -adrenergic blockers can develop intense and frequent
angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases
myocardial contractility. Shortness of breath that occurs when taking -adrenergic
blockers for angina may be due to bronchospasm and should be reported to the health
care provider. Carvedilol works by decreasing myocardial oxygen demand, not by
increasing blood flow to the coronary arteries.
8. A patient who has had chest pain for several hours is admitted with a diagnosis of
rule out acute myocardial infarction (AMI). Which laboratory test should the nurse
monitor to help determine whether the patient has had an AMI?
a. Myoglobin
b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin - Answer D
Troponin levels increase about 4 to 6 hours after the onset of myocardial infarction (MI)
and are highly specific indicators for MI. Myoglobin is released within 2 hours of MI, but
it lacks specificity and its use is limited. The other laboratory data are useful in
determining the patient's risk for developing coronary artery disease (CAD) but are not
helpful in determining whether an acute MI is in progress.
9. Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's
(variant) angina. When teaching the patient, the nurse will include the information that
diltiazem will
a. reduce heart palpitations.
b. decrease spasm of the coronary arteries.
c. increase the force of the heart contractions.
d. help prevent plaque from forming in the coronary arteries. - Answer B
Prinzmetal's angina is caused by coronary artery spasm. Calcium channel blockers
(e.g., diltiazem, amlodipine [Norvasc]) are a first-line therapy for this type of angina.
Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), and -
adrenergic blockers decrease sympathetic stimulation of the heart (i.e., palpitations).
Medications or activities that increase myocardial contractility will increase the incidence
of angina by increasing oxygen demand.
10. The nurse will suspect that the patient with stable angina is experiencing a side
effect of the prescribed metoprolol (Lopressor) if the
a. patient is restless and agitated.
b. blood pressure is 90/54 mm Hg.
c. patient complains about feeling anxious.
d. cardiac monitor shows a heart rate of 61 beats/minute. - Answer B
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