Chapter 21: Care of Patients With Coronary Artery Disease and Cardiac Surgery My Nursing Test Banks

Chapter 21: Care of Patients With Coronary Artery Disease and Cardiac Surgery

MULTIPLE CHOICE

1. The nurse explains that the pain of coronary artery disease (CAD) is related to:

a.

congestion.

b.

ischemia.

c.

edema.

d.

inflammation.

ANS: C

The pain of CAD is related to ischemia of tissues as tissues respond to encroaching necrosis.

DIF: Cognitive Level: Comprehension REF: 451 | 453 OBJ: 2 (theory)

TOP: CAD: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse explains that following a myocardial infarction (MI), the pumping efficiency of the heart is altered because there is:

a.

loss of impulse from the sinoatrial node.

b.

necrosis of the myocardium.

c.

diminished blood flow.

d.

inflammation and swelling of the myocardium.

ANS: B

Necrosis of the myocardium is what causes the loss in pumping efficiency. There is diminished blood flow and swelling, but the cause of loss of cardiac output is that there is less muscle to contract.

DIF: Cognitive Level: Application REF: 458 OBJ: 2 (theory)

TOP: MI: Pathophysiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The patient was admitted with chest pain to rule out a myocardial infarction (MI). Which cardiac enzyme test is most indicative of an MI?

a.

Troponin

b.

Myoglobin

c.

CPK

d.

CK-MB

ANS: A

Elevated troponin levels are most indicative of an MI as these enzymes are specific to heart muscle damage. Elevated troponin, along with elevated CK-MB are the best diagnostic lab values when determining if an MI has occurred. CPK rises with injury to other muscles as well as cardiac muscle. Myoglobin levels rise with cardiac damage but are as indicative as other enzymes.

DIF: Cognitive Level: Application REF: 459 OBJ: 5 (theory)

TOP: MI: Cardiac Enzymes KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The postmyocardial infarction (MI) patient is placed on a low-fat diet as well as daily simvastatin (Zocor). The nurse instructs that while on this drug, the patient should:

a.

have blood work every 2 months to check for liver damage.

b.

drink grapefruit juice daily to help metabolize the drug.

c.

take medication with a meal to diminish gastrointestinal discomfort.

d.

report any rash on the face or neck to the physician.

ANS: A

The statins have a potential for causing liver damage. Grapefruit juice interferes with the metabolism of the drug. The drug can be taken without regard to meals and does not cause a rash.

DIF: Cognitive Level: Application REF: 453 | Clinical Cues, 454 | Table 21-1

OBJ: 2 (clinical) TOP: Statins: Precaution

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. The patient on a low-fat diet following a myocardial infarction (MI) states he can eat fish to help lower cholesterol because of its high content of:

a.

fiber.

b.

omega-3 fatty acids.

c.

trans fat.

d.

saturated fat.

ANS: B

Fish have a high content of omega-3 fatty acids, which are helpful in reducing cholesterol. Fiber is more closely related to gastrointestinal health. Trans fat and saturated fat are not high in content in fish and should be avoided.

DIF: Cognitive Level: Application REF: 453 | Complementary and Alternative Therapies

OBJ: 3 (clinical) TOP: Low-Fat Diet: Omega-3

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. The patient with angina asks what to do if the first nitroglycerin tablet (NGT) does not relieve the pain. What instruction by the nurse is correct?

a.

Take 2 tablets 10 minutes after the first dose and go to the ER if you are still having pain.

b.

Take a second tablet 15 minutes after the first dose and call the physician if you are still having pain.

c.

Take 2 more tablets 30 minutes apart, and then rest for 20 minutes.

d.

Take 2 more tablets 5 minutes apart and notify the physician if your pain is not relieved.

ANS: D

If the first NTG tablet does not relieve pain, 2 more tablets 5 minutes apart should be taken. If pain is not relieved within 15 minutes, notify the physician.

DIF: Cognitive Level: Application REF: 458 | Patient Teaching

OBJ: 3 (clinical) TOP: Angina: Nitroglycerin Tablets

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The nurse explains the difference between exertional angina and unstable angina is that unstable angina occurs:

a.

on heavy exertion.

b.

when the blood pressure increases sharply.

c.

when the body reacts to high stress levels.

d.

unpredictably, even in sleep.

ANS: D

Unstable angina attacks are unpredictable and do not follow a pattern as do stable angina attacks. Unstable angina can progress into a myocardial infarction (MI) and a medical emergency.

DIF: Cognitive Level: Application REF: 455 OBJ: 3 (theory)

TOP: Angina: Unstable Angina KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse suggests to the patient with angina that a daily dose of 81 mg of aspirin is an inexpensive therapy to help:

a.

reduce clotting.

b.

dilate coronary vessels.

c.

alleviate pain associated with angina.

d.

lower cholesterol.

ANS: A

Daily doses of aspirin reduce clotting by prolonging clotting time, thus helping prevent clots that can cause an MI.

DIF: Cognitive Level: Comprehension REF: 455 OBJ: 4 (theory)

TOP: Angina: Use of Aspirin KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. Heart disease in women is manifested by a variety of subtle signs. Which sign is typically seen in women?

a.

Fainting

b.

Chest pain

c.

Dizziness

d.

Fatigue

ANS: D

Women frequently experience fatigue with heart disease. Many women do not even experience chest pain. Fainting and dizziness are not typical signs of heart disease in women.

DIF: Cognitive Level: Comprehension REF: 452 | Box 21-1, 458

OBJ: 2 (theory) TOP: CAD in Women

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

10. The patient states that he had a cardiac catheterization 10 years ago and wonders if any of the postprocedure care has changed. Which response by the nurse is most accurate?

a.

We will only roll you to the same side as the catheter insertion site.

b.

You will lay flat for several hours, and we will place a sandbag over the dressing in the groin.

c.

You will most likely be up and about within about 2 hours after the procedure if your doctor uses an arterial closure device at the catheter insertion site.

d.

We will encourage you to flex and extend your legs when you return from the procedure to prevent a clot from forming at the insertion site.

ANS: C

Most physicians use an arterial closure device at the puncture site, which enables the patient to be ambulatory within 2 hours after the cardiac catheterization procedure. The patient may be turned to either side. Sandbags were used in the past to prevent bleeding from the puncture site and the patient had to lay flat for several hours. Flexing and extending the legs immediately after the procedure would likely cause bleeding from the site.

DIF: Cognitive Level: Application REF: 459 OBJ: 4 (theory)

TOP: Angiogram: Aftercare KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. The drug alteplase (t-PA) is given to the patient with a myocardial infarction (MI). The nurse is aware the drug will:

a.

dissolve the obstruction in the coronary artery.

b.

dilate vessels to relieve pain.

c.

strengthen cardiac contraction.

d.

increase cardiac output.

ANS: A

Alteplase (t-PA) is a thrombolytic drug that will dissolve the clot if given within 12 hours of the MI.

DIF: Cognitive Level: Comprehension REF: 460 OBJ: 2 (clinical)

TOP: MI: t-PA KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. The nurse counsels a patient that the administration of thrombolytic drugs would be contraindicated in the patient who is:

a.

hypotensive.

b.

being treated for a bleeding ulcer.

c.

presently taking warfarin (Coumadin).

d.

prone to asthma attacks.

ANS: B

Thrombolytic agents are contraindicated in people with uncontrolled hypertension, GI bleeds, recent intracranial or intraspinal surgery, or aneurysm because of threat of excessive bleeding.

DIF: Cognitive Level: Application REF: 460 OBJ: 2 (clinical)

TOP: MI: Thrombolytic Agents KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse clarifies that the stool softener is given as a part of routine postmyocardial infarction (MI) care in order to prevent:

a.

bradycardia from straining at stool.

b.

fluid retention from retained bowel contents.

c.

respiratory difficulty from abdominal distention.

d.

discomfort from painful gas.

ANS: A

Bearing down or straining at stool can trigger bradycardia, whereas anal stretching can cause tachycardia.

DIF: Cognitive Level: Comprehension REF: 461 OBJ: 3 (clinical)

TOP: MI: Aftercare KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. Following a cardiac catheterization with coronary angiography, the physician writes an order to increase the patients fluid intake. The nurse knows that increasing the fluid intake is ordered for what reason?

a.

Reducing the nausea related to the dye absorption

b.

Maintaining adequate blood pressure and perfusion

c.

Diluting the urine to prevent kidney damage

d.

Making up for fluid lost during the angiogram

ANS: C

The dye used in a cardiac catheterization with coronary angiography is excreted through the kidneys and may cause damage to the kidneys. Fluid is encouraged to dilute urine to prevent kidney damage.

DIF: Cognitive Level: Application REF: 459 | Safety Alert

OBJ: 4 (theory) TOP: Cardiac Catheterization

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. The nurse assesses a friction rub in a patient who is 2 days postmyocardial infarction (MI). The nurse recognizes this finding as an indicator of:

a.

a recurrent MI.

b.

pleural effusion.

c.

pericarditis.

d.

angina.

ANS: C

Friction rubs indicate pericarditis resulting from the inflamed area of the infarct rubbing on the pericardium. The pericarditis needs to be addressed with antibiotics.

DIF: Cognitive Level: Application REF: 461 | Table 21-3

OBJ: 2 (theory) TOP: MI: Complications

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

16. The 60-year-old female in the postcoronary care unit confides to the nurse, My life is over. Ill never be able to care for my family, take a vacation, or work in my garden. Which response by the nurse is most supportive?

a.

You are doing great! Of course youll be able to do all those things in a few weeks.

b.

You may have to give up some things, but there are other activities you might enjoy.

c.

You are feeling a little blue today. Ill get you some medication to help your anxiety.

d.

You sound a little down. Tell me what you think is going to keep you from those activities; we might be able to address the problems.

ANS: D

Helping patients identify and face depression is helpful in dispelling it, and talking about her concerns will open up conversation and address the concerns in a problem-solving approach. Telling her that she will be able to resume all activities may be instilling false hope. Medication is not warranted at this point.

DIF: Cognitive Level: Analysis REF: 460-463 OBJ: 8 (theory)

TOP: MI: Depression KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

17. The patient in the emergency room with a myocardial infarction (MI) becomes pale, diaphoretic, and hypotensive and complains of feeling cold. The nurse recognizes that these signs are which post-MI complication?

a.

Cardiogenic shock

b.

Pleural effusion

c.

Ventricular fibrillation

d.

Pulmonary embolus

ANS: A

Cardiogenic shock is characterized by all the signs mentioned. Cardiogenic shock is a medical emergency.

DIF: Cognitive Level: Application REF: 461 | Table 21-3

OBJ: 5 (theory) TOP: MI: Cardiogenic Shock

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. Following patient teaching regarding a scheduled minimally invasive direct coronary artery bypass (MIDCAB), the nurse determines the need for further instruction when the patient makes which statement?

a.

It frightens me to think that my heart will be stopped during surgery.

b.

This surgery bypasses my artery that is blocked, and replaces it with sections of a vein or artery taken from another part of my body.

c.

This surgery will hopefully control my angina since nothing else we have tried has worked.

d.

I may come out of surgery with vessels removed from my legs.

ANS: A

The MIDCAB procedure is less invasive than the traditional coronary artery bypass graft (CABG) procedure and does not require the patient be placed on the heart-lung machine due to stopping the heart for an extended period. Both procedures are used to treat angina that has not responded to more conservative treatment and utilize either the mammary artery or sections of the saphenous vein for the graft.

DIF: Cognitive Level: Application REF: 465-466 OBJ: 7 (theory)

TOP: CABG and MIDCAB Surgery KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

19. The patient being evaluated for a heart transplant asks the nurse what the survival rate is. Which is the correct response by the nurse?

a.

Im not really sure. It is better if you ask your surgeon.

b.

Every patient has different circumstances, but the average 5-year survival rate is 70%.

c.

The survival rate is excellent. Almost all patients with a heart transplant live past 10 years.

d.

There are not any really good statistics for me to give you an accurate estimate.

ANS: B

Identifying individual cases vary while giving accurate statistics is the most helpful response. Stating Im not really sure does not instill confidence in the nurses ability or knowledge. Although a significant number of patients live past 10 years following heart transplant, responding that almost all patients live past 10 years is inaccurate and instills false hope.

DIF: Cognitive Level: Application REF: 466 OBJ: 7 (theory)

TOP: Heart Transplant KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

20. The nurse reading admission data on a patient recognizes information that puts the patient at risk for coronary artery disease (CAD). Which characteristic place the patient at risk? (Select all that apply.)

a.

38-year-old African American

b.

Low-density lipoprotein (LDL) 120, high-density lipoprotein (HDL) 68

c.

Taking oral birth control pills

d.

Nonsmoker for 10 years

e.

Diagnosed with diabetes 2 years ago

ANS: A, C, E

African Americans have an ethnic tendency to CAD. Taking birth control pills and diabetes are both risk factors for CAD. The lipid values are extremely healthy, as is the smoking cessation.

DIF: Cognitive Level: Analysis REF: 451 OBJ: 1 (theory)

TOP: CAD: Risk Factors KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

21. The nurse instructs a patient that the pain of angina is due to ischemia of the myocardium, which is brought on by which factors? (Select all that apply.)

a.

Exertion

b.

Emotional excitement

c.

Eating heavy meals

d.

Exposure to cold

e.

Allergic reaction

ANS: A, B, C, D

Angina is not brought on by allergy.

DIF: Cognitive Level: Comprehension REF: 453-454 OBJ: 3 (theory)

TOP: Angina: Precipitators KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. Herbs and supplements that have been found to lower cholesterol naturally are: (Select all that apply.)

a.

garlic.

b.

bananas.

c.

oatmeal.

d.

St. Johns wort.

e.

soy products.

ANS: A, C, E

Garlic, whole-grain foods, and soy products are thought to decrease cholesterol. Bananas and St. Johns wort do not.

DIF: Cognitive Level: Comprehension REF: 453 | Complementary and Alternative Therapies

OBJ: 3 (clinical) TOP: Hyperlipidemia: Herbal Remedies

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

23. The nurse is aware that a positive diagnosis of a myocardial infarction (MI) is based on which diagnostic test results? (Select all that apply.)

a.

Electrocardiographic (ECG) changes in the QRS complex

b.

Elevation of low-density lipoprotein (LDH)

c.

Elevation of troponin levels

d.

Elevated white blood cell (WBC) count

e.

Elevated T wave

ANS: A, C, E

Elevation of enzymes and altered QRS patterns are positive for diagnosis of MI. Elevation of T wave and WBC count, although present, are not specific to MI formation.

DIF: Cognitive Level: Application REF: 459 OBJ: 1 (theory)

TOP: MI: Diagnosis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. The nurse clarifies that the MONA protocol for drug administration in the emergent stage of a myocardial infarction (MI) involves the use of which therapies? (Select all that apply.)

a.

Aspirin

b.

Morphine

c.

Nitrates

d.

Antibiotics

e.

Oxygen

f.

Anticoagulants

ANS: A, B, C, E

Morphine, oxygen, nitrates, and aspirin are the components of MONA therapy.

DIF: Cognitive Level: Comprehension REF: 460 OBJ: 2 (clinical)

TOP: MONA Therapy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

25. The nurse encourages the patient who has had a myocardial infarction (MI) to enroll in the outpatient cardiac rehabilitation service, which offers: (Select all that apply.)

a.

diet counseling.

b.

supervised progressive exercise.

c.

stress reduction techniques.

d.

sexual counseling.

e.

administration of cardiotonic drugs.

ANS: A, B, C

Rehabilitation services offer diet and stress reduction counseling and supervised progressive exercise.

DIF: Cognitive Level: Comprehension REF: 462-463 OBJ: 3 (clinical)

TOP: Cardiac Rehabilitation: Services KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

26. During the acute phase following a myocardial infarction (MI), the nurse prepares for the possibility of the patient receiving a temporary pacemaker in which circumstance(s)? (Select all that apply.)

a.

The patients heart rate continues to remain above 100 beats/minute.

b.

The patient is experiencing continued angina pain.

c.

The patient experiences complete heart block.

d.

The patients systolic BP drops below 100 consistently.

e.

The patients pulse rate remains below 40 beats/minute.

ANS: C, E

A temporary pacemaker is warranted when the patients pulse consistently remains below 40 beats/minute and when the patient experiences complete heart block. Complete heart block means that the electrical impulse for contraction does not go through the atrioventricular node to the ventricles and the ventricles are not signaled to contract. A heart rate above 100, continued angina pain, and a consistent systolic BP below 100 would not be corrected by a pacemaker.

DIF: Cognitive Level: Application REF: 461 OBJ: 6 (theory)

TOP: Temporary Pacemaker KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

COMPLETION

27. The nurse uses a diagram to show how obstruction of an artery has caused an area of necrosis called a(n) _________.

ANS:

infarct

infarction

Tissue necrosis from arterial obstruction is referred to as an infarct.

DIF: Cognitive Level: Knowledge REF: 458 OBJ: 1 (theory)

TOP: Infarct: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. The nurse is aware that the patients cardiac rehabilitation levels of physical activity are designated through ____________ units.

ANS:

metabolic equivalent

MET

One MET is the amount of oxygen needed by the body at rest. The patients rehabilitation program slowly progresses stepwise to higher energy expenditures over a period of months.

DIF: Cognitive Level: Comprehension REF: 463 OBJ: 4 (clinical)

TOP: Cardiac Rehabilitation KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

MATCHING

Place the events of arterial obstruction in proper sequence.

a.

Platelets adhere to plaque.

b.

Deposits of low-density lipoproteins (LDLs) accumulate.

c.

Fibrous plaque is laid down in vessel.

d.

Streaks of fatty material are laid down in arteries.

e.

Platelets clump.

f.

Platelets calcify.

29. Step 1

30. Step 2

31. Step 3

32. Step 4

33. Step 5

34. Step 6

29. ANS: D DIF: Cognitive Level: Comprehension REF: 452

OBJ: 2 (theory) TOP: Thrombus Formation

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

30. ANS: B DIF: Cognitive Level: Comprehension REF: 452

OBJ: 2 (theory) TOP: Thrombus Formation

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

31. ANS: C DIF: Cognitive Level: Comprehension REF: 452

OBJ: 2 (theory) TOP: Thrombus Formation

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

32. ANS: A DIF: Cognitive Level: Comprehension REF: 452

OBJ: 2 (theory) TOP: Thrombus Formation

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

33. ANS: E DIF: Cognitive Level: Comprehension REF: 452

OBJ: 2 (theory) TOP: Thrombus Formation

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

34. ANS: F DIF: Cognitive Level: Comprehension REF: 452

OBJ: 2 (theory) TOP: Thrombus Formation

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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