Chapter 24Coronary Artery Dysfunction: Nursing Management My Nursing Test Banks

Chapter 24Coronary Artery Dysfunction: Nursing Management

MULTIPLE CHOICE

1.A client is learning about cholesterol. The nurse explains that the good cholesterol transports plasma cholesterol away from plaques and to the liver for metabolism. This type of cholesterol is called:

1.

high-density lipoprotein.

2.

low-density lipoprotein.

3.

very-high-density lipoprotein.

4.

very-low-density lipoprotein.

ANS: 1

High-density lipoprotein transports plasma cholesterol away from atherosclerotic plaques and to the liver for metabolism and excretion. Low-density lipoproteins, or bad cholesterol, are the main component of the atherosclerotic plaque. Very-low-density lipoproteins are considered more atherogenic and are more common in men and people with diabetes.

PTS:1DIF:ApplyREF:Hyperlipidemia

2.A client has a blood pressure of 124/78 mmHg and a triglyceride level of 160 mg/dL. Based on these results, the nurse knows that the client has:

1.

an optimal blood pressure and triglyceride level.

2.

a prehypertensive blood pressure and an optimal triglyceride level.

3.

a prehypertensive blood pressure and a borderline high triglyceride level.

4.

stage I hypertension and a high triglyceride level.

ANS: 3

Prehypertensive blood pressure ranges systolically from 120 to 139 mmHg or diastolically from 80 to 90 mmHg. Stage I hypertension is systolic blood pressure (SBP) of 140 to 159 mmHg or a diastolic blood pressure (DBP) of 90 to 99 mmHg. Optimal triglyceride levels are less than 150 mg/dL. Triglyceride levels from 150 to 199 mg/dL are considered borderline high. Triglyceride levels at 200 to 499 mg/dL are considered high.

PTS:1DIF:Analyze

REF: Table 24-1 Classification of Lipid Levels; Table 24-2 Blood Pressure Classification

3.The nurse measures a clients blood pressure to be 158/92 mmHg. The nurse recognizes that this blood pressure is classified as:

1.

normal.

2.

prehypertension.

3.

stage I hypertension.

4.

stage II hypertension.

ANS: 3

Normal blood pressure is SBP less than 120 mmHg and DBP less than 80 mmHg. A prehypertensive state is SBP of 120 to 139 mmHg or DBP of 80 to 90 mmHg. Stage I hypertension is SBP of 140 to 159 mmHg or DBP of 90 to 99 mmHg. Stage II hypertension is a SBP of 160 mmHg or higher or a DBP of 100 mmHg or higher.

PTS: 1 DIF: Analyze REF: Table 24-2 Blood Pressure Classification

4.A client is complaining of chest pain that occurs during exercise. This pain is relieved when the client rests. The nurse realizes that this client is experiencing which type of angina?

1.

Prinzmetals variant angina

2.

Silent angina

3.

Stable angina

4.

Unstable angina

ANS: 3

Stable angina is precipitated by factors that increase oxygen demand or reduce oxygen supply. Chest pain occurs predictably with the same onset, duration, and intensity and is relieved when the precipitating factor is removed or with nitroglycerin. Unstable angina is typified by an increase in frequency, duration, and intensity of symptoms at lower levels of activity and even at rest. Prinzmetals variant angina is a coronary artery spasm. Silent angina can occur with no pain at all and is common in diabetic patients.

PTS:1DIF:AnalyzeREF:Types of Angina

5.A client diagnosed with stable angina is undergoing a 12-lead electrocardiogram. Which of the following results is not expected?

1.

ST segment depression

2.

ST segment elevation

3.

T-wave flattening

4.

T-wave inversion

ANS: 2

During an episode of angina, T-wave flattening or inversions and ST segment depression may be seen on the electrocardiogram due to subendocardial ischemia. ST segment elevation is seen with impending or acute myocardial infarction.

PTS: 1 DIF: Analyze REF: Diagnostic Tests: Electrocardiogram

6.A client is scheduled for a cardiac angiogram. Which of the following should the nurse instruct the client about this diagnostic test?

1.

It is noninvasive.

2.

Contrast dye is injected.

3.

Clients can move about after the procedure.

4.

General anesthesia is used.

ANS: 2

A cardiac angiogram is a procedure that visualizes the structures of the heart and vessels. This is an invasive procedure; however, it does not need general anesthesia. The client is awake during the procedure. A contrast dye is injected, and the client may feel a warm sensation. The client must maintain bed rest with the leg straight for up to 4 to 6 hours after the catheter is removed.

PTS: 1 DIF: Apply REF: Diagnostic Tests: Coronary Angiography

7.When planning the care of a client diagnosed with stable angina, which of the following would be considered a goal of treatment?

1.

Decrease in ischemia and episodes of angina

2.

Prevent myocardial infection

3.

Reduction of risk factors

4.

Reduction of stress by education

ANS: 1

The primary goal for the treatment of stable angina is to improve the quality of life by decreasing episodes of angina and ischemia. The second goal is to increase the quantity of life by preventing progression to myocardial infarction and death. Reduction of risk factors and education are both parts of a treatment plan.

PTS: 1 DIF: Apply REF: Planning and Implementation: Goals

8.A client is prescribed a beta-blocker for treatment of coronary artery disease. Which of the following is the client most likely going to be prescribed?

1.

Amlodipine

2.

Atenolol

3.

Diltiazem hydrochloride

4.

Nicardipine

ANS: 2

Amlodipine, diltiazem hydrochloride, and nicardipine are all calcium channel blockers. Atenolol is a beta-blocker.

PTS:1DIF:Analyze

REF:Table 24-4 Common Medications for the Treatment of CAD

9.A client tells the nurse that using nitroglycerin tablets causes a tingling sensation and a headache. The nurse knows that this is:

1.

an emergency.

2.

an allergic reaction.

3.

evidence of toxicity.

4.

expected.

ANS: 4

Nitroglycerin tablets will cause a tingling sensation and can cause feelings of the heart pounding, as well as flushing and headache. These symptoms are not an emergency, an allergic reaction, or evidence of toxicity. These symptoms are expected with nitroglycerin tablets.

PTS:1DIF:AnalyzeREFharmacology

10.A nurse is considering contraindications to fibrinolytic therapy. Which of the following patients is an appropriate candidate for fibrinolytic therapy?

1.

A patent with a peptic ulcer disease

2.

A patient with a history of hemorrhagic stroke

3.

A patient with a history of a motor vehicle accident 1 year ago

4.

A patient with inflammatory bowel disease

ANS: 3

Contraindications to fibrinolytic therapy include active internal bleeding, active inflammatory bowel disease, active peptic ulcer disease, active pericarditis, defective homeostasis, gastrointestinal/genitourinary bleeding for less than 6 months, history of hemorrhagic stroke, known bleeding disorders, neurologic procedure within the past 2 months, recent surgery or trauma within 2 months, pregnancy, suspected aortic dissection, and uncontrolled hypertension.

PTS: 1 DIF: Analyze REF: Acute Coronary Syndrome: Pharmacology

11.A client is participating in cardiac rehabilitation and is currently engaging in supervised exercise, counseling, and education. The nurse realizes this client is in which phase of cardiac rehabilitation?

1.

Phase I

2.

Phase II

3.

Phase III

4.

Phase IV

ANS: 3

Phase I of cardiac rehabilitation begins in the hospital. Phase II of cardiac rehabilitation is the transitional phase and centers around recovery at home with increasing activity. Phase II of cardiac rehabilitation occurs in an outpatient rehabilitation facility, and it focuses on supervised exercise, counseling, and education. Phase IV of cardiac rehabilitation is the maintenance phase and focuses on long-term changes.

PTS: 1 DIF: Analyze REF: Patient and Family Teaching

12.A client tells the nurse that he ingests an NSAID when the angina pain gets really bad, and it eliminates the pain. The nurse suspects the client is experiencing:

1.

musculoskeletal pain.

2.

aortic dissection.

3.

mitral valve prolapse.

4.

pericarditis.

ANS: 1

Musculoskeletal pain is relieved with NSAIDs. The pain of aortic dissection and pericarditis would not be relieved with NSAIDs. Mitral valve prolapse may or may not have associated chest discomfort.

PTS:1DIF:Analyze

REF: Diagnostic Tests: Differential Diagnosis for Angina

13.A client is prescribed nicotinic acid as part of treatment for coronary artery disease. Which of the following should the nurse instruct the client regarding this medication?

1.

Ingest an aspirin 30 minutes before taking the medication and after eating.

2.

Expect a gritty taste.

3.

Anticipate constipation.

4.

Expect fatigue with this medication.

ANS: 1

Instructions to the client prescribed nicotinic acid include ingesting an aspirin 30 minutes to 1 hour before the medication and after food. A gritty taste is not associated with this medication. Constipation is not an expected gastrointestinal side effect of this medication. This medication does not cause fatigue.

PTS:1DIF:Apply

REF:Table 24-4 Common Medications for the Treatment of CAD

MULTIPLE RESPONSE

1.The nurse is assessing the pain of a client experiencing angina. Which of the following should be included in this assessment? (Select all that apply.)

1.

Precipitating event

2.

Quality

3.

Radiation

4.

Severity

5.

Timing

6.

Medication

ANS: 1, 2, 3, 4, 5

The memory aid PQRST can be used to assess a client experiencing symptoms of angina, and it includes precipitating event, quality, radiation, severity, and timing. Medication is not a part of this assessment.

PTS:1DIF:ApplyREF:Table 24-3 PQRST

2.A client is at risk for coronary artery disease. Which of the following should the nurse instruct as modifiable risk factors for this health condition? (Select all that apply.)

1.

Alcohol consumption

2.

Diabetes mellitus

3.

Family history

4.

Gender

5.

Low daily fruit intake

6.

Psychosocial index

ANS: 1, 2, 5, 6

Nonmodifiable risk factors are age, gender, and family history. Modifiable risk factors include hyperlipidemia, hypertension, tobacco abuse, diabetes mellitus, abdominal obesity, lack of physical activity, low daily fruit and vegetable intake, alcohol consumption, and psychosocial index.

PTS:1DIF:Apply

REF:Etiology: Nonmodifiable Risk Factors; Modifiable Risk Factors

3.A client is diagnosed with angina after describing the type of pain she experiences. Which of the following are characteristics of anginal pain? (Select all that apply.)

1.

Pressure

2.

Heavy

3.

Squeezing

4.

Stabbing

5.

Sharp

6.

Demonstrates a clenched fist over the sternum

ANS: 1, 2, 3, 6

Angina pain is typically described as pressure, heavy, squeezing, and it is demonstrated by placing a clenched fist over the sternum. This hand posture is referred to as Levines sign which is the universal sign for angina. Angina pain is not stabbing or sharp.

PTS: 1 DIF: Analyze REF: Assessment with Clinical Manifestations

4.A client is experiencing a sudden onset of chest pain. Which of the following will the nurse do to manage this chest pain?

1.

Administer intravenous morphine as prescribed.

2.

Provide oxygen.

3.

Insert an indwelling urinary catheter.

4.

Position the client on the left side.

5.

Administer nitroglycerin as prescribed.

6.

Administer aspirin as prescribed.

ANS: 1, 2, 5, 6

The emergency management of chest pain follows the memory aid MONA; that is,  morphine, oxygen, nitroglycerin, and aspirin. An indwelling urinary catheter and positioning the client on the left side are not interventions for the emergency management of chest pain.

PTS: 1 DIF: Apply REF: Red Flag: Emergency Management of Chest Pain

5.Which of the following will the nurse instruct a client being discharged to home after experiencing an acute myocardial infarction? (Select all that apply.)

1.

Understand cardiac condition

2.

How to manage chest pain

3.

Activity level

4.

Medications

5.

Risk factors

6.

Immunizations

ANS: 1, 2, 3, 4, 5

Discharge instructions for a client being discharged after experiencing an acute myocardial infarction include understanding cardiac condition, chest pain management, activity, medications, risk factors, diet, and signs and symptoms to report to the physician. Immunizations are not a part of discharge instructions after an acute myocardial infarction.

PTS: 1 DIF: Apply REF: Table 24-7 Discharge Instructions after AMI

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