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NSG420 Exam 1 Ch33(questions well answered) A+ graded
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NSG420 Exam 1 Ch33(questions well answered) A+ graded
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NSG420 Exam 1 Ch33(questions wellanswered) A+ graded
1. The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD).
Which factor should the nurse focus on during the teaching session?
a. Family history of coronary artery disease
b. Elevated low-density lipoprotein (LDL) level
c. Greater risk associated with the patient's gender
d. Increased risk of cardiovascular disease with aging - correct answer ✔✔ANS: B
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 is likely to be most effective when assisting the patient with coronary
artery disease to make appropriate dietary changes?
a. Inform the patient about a diet containing no saturated fat and minimal salt.
b. Emphasize the increased cardiac risk unless the patient makes dietary changes.
c. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet. - correct answer
✔✔ANS: 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 monounsaturated or
polyunsaturated 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 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. The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is
from an acute myocardial infarction?
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. - correct answer ✔✔ANS: 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 from a patient helps the nurse confirm the previous diagnosis of chronic stable
angina?
a. "The pain wakes me up at night."
b. "The pain is level 3 to 5 (0 to 10 scale)."
c. "The pain has gotten worse over the last week."
d. "The pain goes away after a nitroglycerin tablet." - correct answer ✔✔ANS: 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. Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat)
has been effective?
a. "I can expect nausea as a side effect of nitroglycerin."
b. "I should only take nitroglycerin when I have chest pain."
c. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart."
d. "I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart." - correct answer
✔✔ANS: D
The emergency response system (ERS) should be activated when chest pain or other symptoms are not
completely relieved after three 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 the 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." - correct answer ✔✔ANS: D
, Although only 30% of the daily calories should come from fats, most of the fat in the TLC diet should
come from monounsaturated 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. Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing
anginal episodes 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." - correct answer ✔✔ANS: 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 O2 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 is most specific for the nurse to monitor in
determining whether the patient has had an AMI?
a. Myoglobin
b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin - correct answer ✔✔ANS: 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 but are not helpful in determining whether an acute MI is in progress.
9. Diltiazem (Cardizem) is prescribed for a patient with newly diagnosed Prinzmetal's (variant) angina.
Which action of diltiazem is accurate for the nurse to include in the teaching plan?
a. Reduces heart palpitations.
b. Prevents coronary artery plaque.
c. Decreases coronary artery spasms.
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