Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. When developing a teaching plan for a 61-yr-old patient with multiple risk factors for coronary artery disease (CAD), the nurse should focus primarily on the
a....
1. When developing a teaching plan for a 61-yr-old patient with multiple risk factors
for coronary artery disease (CAD), the nurse should focus primarily on the
a.
family history of coronary artery disease.
b.
elevated low-density lipoprotein (LDL) level.
c.
increased risk associated with the patient’s gender.
d.
increased risk of cardiovascular disease as people age.
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.
DIF: Cognitive Level: Apply (application) REF: 703
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
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.
Help the patient modify favorite high-fat recipes by using monounsaturated oils.
c.
Emphasize the increased risk for heart problems unless the patient makes the
dietary changes.
d.
Give the patient a list of low-sodium, low-cholesterol foods that should be
included in the diet.
ANS: B
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 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.
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.”
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. 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 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 still have pain after taking three nitroglycerin 5
minutes apart.”
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.”
ANS: D
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