Chapter 37: Coronary Artery Disease
and Acute Coronary Syndrome - Exam 3
correctly answered to pass
The nurse is developing a teaching plan for a patient with coronary artery disease (CAD). Which factor
would 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. Elevated low-density
lipoprotein (LDL) level.
Because family history, gender, and age are non-modifiable 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.
Which nursing intervention is likely to be most effective when assisting the patient with coronary artery
disease to make 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. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
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.
The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain may
be 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. The pain has
lasted longer than 30 minutes.
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.
Which patient statement would help 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 with a nitroglycerin tablet." - correct answer ✔✔ANS: d. "The pain goes away
with a nitroglycerin tablet."
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.
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 blocking blood flow to my heart."
d. "I will call an ambulance if I have pain 5 minutes after taking nitroglycerin." - correct answer ✔✔ANS:
d. "I will call an ambulance if I have pain 5 minutes after taking nitroglycerin."
The emergency response system (ERS) should be activated when chest pain or other symptoms are the
same or worse 5 minutes after taking a sublingual nitroglycerin tablets. 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.
Which statement made by a patient with coronary artery disease indicates that further diet 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. "I will miss being
able to eat peanut butter sandwiches."
Although only 30% of the daily calories should come from fats, most of the fat in the 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 diet. The other patient comments indicate a good
understanding of the recommended diet.
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. "It is
important not to suddenly stop taking the carvedilol."
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