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40 Cards in this Set

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While taking nursing histories of patients, the nurse identifies that the patient with the hightest risk for coronary artery disease is the patient who is:
a. an African-American man, age 65, with obesity and a BP of 160/85
b. a Caucasian man, age 54, who is a smoker and has a stressful lifestyle
c. an Asian woman, age 45, with a cholesterol level of 240 mg/dl and a BP of 130/75
d. a Caucasian woman, age 72, with a BP of 172/100 and who is physically inactive
d. The Caucasian woman has one unmodibiable risk factor (age) and two major modifiable risk factors (HTN and physical inactivity). Her gender risk is as high as a man's because of her age. The Caucasian man has one unmodifiable risk factor (gender), one major modifiable risk factor (smoking), and one minor modifiable risk factor(stressful lifestyle). The African-American man has an unmodifiable risk factor (HTN), and one minor modifiable risk factor (obesity), but African-American men are at less risk for CAD than are Caucasians of the same age. The Asian woman has only one major modifiable risk factor (hyperlipidemia), and Asians in the United States have fewer MIs than do Caucasians.
The desirable level for TOTAL CHOLESTEROL is _____.
<200 mg/dl
The desirable level for TRIGLYCERIDES is _____.
<190 mg/dl
The desirable level for LDL is _____.
<130 mg/dl
The desirable level for HDL is _____.

(men or women)
men >37 mg/dl

women >40 mg/dl
The nurse is encouraging a sedentary patient with major risks for CAD to perform physical exercise on a regular basis. In addition to decreasing the risk factor of physical inactivity, the nurse tells the patient that exercise will also directly contribute to reducing the risk factors of:
a. hyperlipidemia and obesity
b. diabetes mellitus and HTN
c. elevated serum lipids and stressful lifestyle
d. HTN and elevated serum homocysteine
a. Increased exercise without an increase in caloric intake will result in weight loss, reducing the risk associate with obesity, and exercise increases lipid metabolism and increases HDL2, reducing CAD risk. Exercise may also indirectly reduce the risk of CAD by controlling HTN, promoting glucose metabolism in diabetes, and reducing stress. Although research is needed to determine whether a decline in homocysteine can reduce the risk of heart disease, it appears that the dietary modifications will be indicated for risk reduction.
Two risk factors for CAD that are considered to increase the workload of the heart and increase myocardial oxygen demand include:
a. HTN and elevated serum lipds
b. cigarette smoking and diabetes mellitus
c. cigarette smoking and physical inactivity
d. type A behavior pattern and HTN
d. Stress r/t a type A behavior pattern is associated with increased sympathetic nervous system stimulation, increasing HR and contractility and thus the workload of the heart. HTN also increases the workload of the heart by requiring more force to pump blood through the diseased arterial vasculature.
During a routine health exam, a 48-year-old man is found to have a total cholesterol level of 224 mg/dl and an LDL level of 140. The nurse teaches the patient that a Step 1 dietary change should include:
a. use of skim or 1% milk
b. elimination of red meat from the diet
c. elimination of alcohol and use of simple sugars
d. avoidance of all egg yolks and food prepared with whole eggs
a. Step 1 dietary changes include decreased intake of saturated fat and cholesterol and the substitution of skim or 1% milk for whole milk.
A 62-year-old woman has HTN and smokes 1 pack of cigarettes per day. She has no symptoms of CAD, but a recent LDL level is 154 mg/dl. Based on these findings, the nurse would expect that the treatment for the patient would include:
a. diet therapy only
b. drug therapy only
c. diet and drug therapy
d. exercise instruction only
a. Diet therapy is indicated for a patient without CAD who has two or more risk factors and an LDL level equal to or greater than 130 mg/dl. When the patient's LDL levels are equal to or greater than 160 mg/dl, drug therapy would be added to diet therapy. Exercise is indicated to reduce risk factors throughout treatment.
A patient with CAD has a total cholesterol of 280 mg/dl, LDL of 140 mg/dl, and a triglyceride level of 340 mg/dl. The nurse recognizes that an antilipemic drug that would be indicated for the patient is:
a. gemfibrozil (Lopid)
b. lovastatin (Mevacor)
c. nicotinic acid (niacin)
d. cholestyramine (Questran)
c. This patient has elevated cholesterol, LDLs, and triglyceride levels, and nicotinic acid is highly effective in lowering both cholesterol and triglyceride levels by interfering with their synthesis.
Angina pectoris, the pain, most likely occurs with myocardial ischemia as a result of:
a. death of myocardial tissue
b. arrhythmias caused by cellular irritability
c. lactic acid accumulation during anaerobic metabolism
d. elevated pressure in the ventricles and pulmonary vessels
c. When the coronary arteries are occluded, contractility ceases after several minutes, depriving the myocardial cells of glucose and oxygen for aerobic metabolism. Anaerobic metabolism begins and lactic acid accumulates, irritating myocardial nerve fibers that then transmit a pain message to the cardiac nerves and upper thoracic posterior roots.
The patient's cardiac catheterization report reveals a 95% blockage of the left anterior descending artery. The patient is at greatest risk for an infarction of the:
a. lateral wall
b. inferior wall
c. anterior wall
d. posterior wall
c. Location and areas of MIs correlate with the coronary arteries and the areas of the heart they normally perfuse. Anterior wall infarctions are usually caused by lesions in the left anterior descending artery; lateral wall infarctions by occlusion of the left circumflex or descending artery; inferior wall infarctions by occlusion of the right coronary artery or left circumflex artery; and posterior wall infarctions by lesions in the left circumflex artery.
The point in the healing process of the myocardium following an infarct where early scar tissue results in an unstable heart wall is:
a. 2-3 days after MI
b. 4-10 days after MI
c. 10-14 days after MI
d. 6 weeks after MI
c. At 10-14 days after MI, the myocardium is considered to be especially vulnerable to increased stress because of the unstable state of healing at this point, and this is the time that the patient is also increasing physical activity. At 2-3 days, removal of necrotic tissue is taking place by phagocytic cells, and by 4-10 days, the tissue has been cleared and a collagen matrix for scar tissue has been deposited. Healing with scar tissue replacement of the necrotic area is usually complete by 6 weeks.
As an acute coronary syndrome, unstable angina must be identified and treated because:
a. the pain may be severe and disabling
b. ECG changes and arrhythmias may occur during an attack
c. atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen
d. the spasm of a major coronary artery may cause total occlusion of the vessel with progression to MI
c. Unstable angina is associated with deterioration of a once stable atherosclerotic plaque that ruptures, exposing the intima to blood and stimulating platelet aggregation and local vasoconstriction with thrombus formation. Patients with unstable angina require immediate hospitalization and monitoring because the lesion is at increased risk of complete thrombosis of the lumen with progression to MI.
The nurse suspects stable angina rather than MI pain in the patient who reports chest pain:
a. is relieved by nitroglycerin
b. is a sensation of tightness or squeezing
c. does not radiate to the neck, back, or arms
d. is precipitated by physical or emotional exertion
a. One of the primary differences between the pain of angina and the pain of an MI is that angina pain is usually relieved by rest or nitro, which reduces the oxygen demand of the heart, while MI pain is not. Both angina and MI pain can cause a pressure or squeezing sensation; may radiate to the neck, back, arms, fingers, and jaw; and may be precipitated by exertion.
A patient, admitted to the hospital for evaluation of chest pain, has normal cardiac enzyme values 4 hours after the onset of pain. A noninvasive diagnostic test that can differentiate angina from other types of chest pain is a(n):
a. ECG
b. exercise stress test
c. coronary angiogram
d. transesophageal echocardiogram
b. An exercise stress test will reveal ECG changes that indicate impaired coronary circulation when the oxygen demand of the heart is increased. A single ECG is not conclusive for CAD, and negative findings do not rule out CAD. Echocardiograms of various types may identify abnormalities of myocardial wall motion under stress but are indirect measures of CAD. Coronary angiography can detect narrowing of coronary arteries but is an invasive procedure.
A 52-year-old man is admitted to the ER with severe chest pain. The nurse suspects an MI upon finding that the patient:
a. has pale, cool, clammy skin
b. reports nausea and vomited once at home
c. is anxious and has a feeling of impending doom
d. has had no relief of the pain with rest or position change
d. The pain of an MI is usually severe, is usually unrelieved by nitro, rest, or position change, and usually lasts more than the 15 or 20 minutes typical of angina pain. All of the other symptoms may occur with angina as well as an MI.
To detect and treat the most common complication of MI, the nurse:
a. measures hourly urine output
b. ausculatates the chest for crackles
c. uses continuous cardiac monitoring
d. takes VS q2hr for the first 8 hours
c. The most common complication of MI is cardiac arrhythmias, especially ventricular arrhythmias that may be life-threatening. Continuous cardiac monitoring allows for identification and treatment of arrhythmias that may cause further deterioration of the cardiovascular status.
In the patient with an acute MI, the nurse would expect diagnostic testing to reveal:
a. ECG changes at the onset of pain
b. an enlarged heart with distended upper lobe veins
c. CK-MB enzyme elevations that peak 24 hours after the infarct
d. the appearance of troponin in the blood 48 hours after the infarct
c. Creatine kinase, MB band, is a tissue enzyme that is specific to cardiac muscle and is released into the blood when myocardial cells die. CK-MB levels begin to rise about 6 hours after an acute MI, peak in about 24 hours, and return to normal within 2-3 days, and this increase can demonstrate the presence of cardiac damage and the approximate extent of the damage. Troponin, a myocardial muscle protein released with myocardial damage, rises as quickly as CK and remains elevated for 2 weeks. ECG changes often are not apparent immediately after infarct and may be normal when the patient seeks medical attention. An enlarged heart determined by x-ray indicates cardiac stress but is not diagnostic of acute MI.
A second 12-lead ECG performed on a patient 4 hours after the onset of chest pain reveals ST-segment elevation. The nurse recognizes that this finding indicates a:
a. transient ischemia typical of unstable angina
b. lack of permanent damage to myocardial cells
c. myocardial infarction associated with prolonged and complete coronary thrombosis
d. myocardial infarction associated with transient or incomplete coronary artery occlusion
c. A differentiation is made between myocardial infarcts that have ST-segment elevations on ECG and those that do not. Chest pain that is accompanied by ST-segment elevations is associated with prolonged and complete coronary thrombosis and is treated with reperfusion therapy.
Identify the class of drugs that are used to DECREASE PRELOAD:

a. nitrates
b. calcium channel blockers
c. antiplatelet agents
d. beta-adrenergic blockers

(can have more than one answer)
a. nitrates
Identify the class of drugs that are used to DILATE CORONARY ARTERIES:

a. nitrates
b. calcium channel blockers
c. antiplatelet agents
d. beta-adrenergic blockers

(can have more than one answer)
a. nitrates

b. calcium channel blockers
Identify the class of drugs that are used to PREVENT THROMBOSIS OF PLAQUES:

a. nitrates
b. calcium channel blockers
c. antiplatelet agents
d. beta-adrenergic blockers

(can have more than one answer)
c. antiplatelet agents
Identify the class of drugs that are used to DECREASE HEART RATE:

a. nitrates
b. calcium channel blockers
c. antiplatelet agents
d. beta-adrenergic blockers

(can have more than one answer)
d. beta-adrenergic blockers
Identify the class of drugs that are used to DECREASE AFTERLOAD:

a. nitrates
b. calcium channel blockers
c. antiplatelet agents
d. beta-adrenergic blockers

(can have more than one answer)
a. nitrates

b. calcium channel blockers

d. beta-adrenergic blockers
Identify the class of drugs that are used to DECREASE MYOCARDIAL CONTRACTILITY:

a. nitrates
b. calcium channel blockers
c. antiplatelet agents
d. beta-adrenergic blockers

(can have more than one answer)
b. calcium channel blockers

d. beta-adrenergic blockers
When teaching the patient with angina about taking nitroglycerin tablets, the nurse instructs the patient:

a. to take the tablet with a large amount of water so it will dissolve right away
b. to lie or sit down and place one tablet under the tongue when chest pain occurs
c. that if one tablet does not relieve the pain in 15 minutes the patient should go to the hospital
d. that if the tablet causes dizziness and a headache the medication should be stopped and the doctor notified
b. A common complication of nitrates is dizziness caused by orthostatic hypotension, so the patient should sit or lie down and place the tablet under the tongue. The tablet should be allowed to dissolve under the tongue, and to prevent the tablet from being swallowed, water should not be taken with it. If the pain is not relieved, 2 more tablets may be taken at 5-minute intervals, but if the pain is present after 15 minutes and 3 tablets, the patient should seek medical attention.
A strategy used to prevent the development of tolerance to the effects of transdermal nitrates includes:

a. removing the patch during the night
b. changing the sites of the patch every day
c. using the patch only when chest pain occurs
d. applying the patch on an alternate-day schedule
a. The body has a tendency to develop tolerance not only to the side effects of nitrates but also to the antianginal effect. Providing a nitrate-free period of at least 8 hours within each 24-hour period for any route of administration is usually effective in preventing development of tolerance. Night is the best time to remove the patch unless the patient has nocturnal angina. Patches are designed for continuous nitrate therapy and should not be used on a prn basis. The sites should be changed daily to prevent skin irritation and alterations in absorption, but this does not affect tolerance.
The drug that controls ventricular arrhythmias in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
d. IV amiodarone (Cordarone)
The drug that relieves pain by decreasing O2 demand and increasing O2 supply in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
e. IV nitroglycerin
The drug that helps prevent ventricular remodeling in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
f. ACE inhibitors
The drug that relieves anxiety and cardiac workload in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
b. IV morphine
The drug that is associated with decreased reinfarction and increased survival in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
a. beta-adrenergic blockers
The drug that minimizes bradycardia from vagal stimulation in the treatment of MI is:

a. beta-adrenergic blockers
b. IV morphine
c. stool softeners
d. IV amiodarone (Cordarone)
e. IV nitroglycerin
f. ACE inhibitors
c. stool softeners
A patient with an MI has a nursing diagnosis of anxiety related to possible lifestyle changes and perceived threat of death. The nurse determines that outcome criteria have been met when the patient states:

a. "I'm just going to take this recovery one step at a time"
b. "I feel much better and am ready to get on with my life"
c. "How soon do you think I will be able to go back to work?"
d. "I know you are doing everything possible to save my life"
a. This patient is indicating positive coping with a realization that recovery takes time and that lifestyle changes can be made as needed. The patient who is just going to get on with his life is probably in denial about the seriousness of the condition and the changes that need to be made. Nervous questions about the expected duration and effect of the condition indicate the presence of anxiety, as does the statement regarding the HCPs role in treatment.
A 58-year-old patient is in a cardiac rehab program. The nurse teaches the patient to stop exercising if:

a. the HR exceeds 150 beat/min
b. the patient develops pain or dyspnea
c. the respiratory rate increases to 30 breaths/min
d. the HR is 30 beats over the resting HR
b. Any activity or exercise that causes dyspnea and chest pain should be stopped in the patient with CAD. The training target for a healthy 58-year-old is 80% of maximum HR, or 132 beats/min, but in a patient with cardiac disease undergoing cardiac conditioning, the HR should not exceed 20 beats/min over the resting pulse rate.
Sudden cardiac death in persons with CAD occurs most often as a result of:

a. an acute MI
b. heart trauma
c. cardiac arrhythmias
d. primary left ventricular outlfow obstruction
c. The majority of persons who experience sudden cardiac death as a result of CAD do not have an acute MI but have arrhythmias that cause death, probably as a result of electrical instability of the myocardium.
Clinical manifestations in the older adult that would alert the nurse to the possibility of acute MI include:

a. diaphoresis and nausea
b. back and abdominal pain
c. tachycardia and elevated BP
d. dyspnea and profound weakness
d. An older adult often has altered responses to CAD and MI, resulting in atypical symptoms, and sudden dyspnea and profound weakness should be investigated.
When teaching an older adult with CAD how to manage the treatment program for angina, the nurse instructs the patient:

a. to sit for 3-5 minutes before standing when getting out of bed
b. to exercise only twice a week to avoid unnecessary strain on the heart
c. that lifestyle changes are not as necessary as they would be in a younger person
d. that aspirin therapy is contraindicated in older adults because of the risk for bleeding
a. Orthostatic hypotension may cause dizziness and falls in older adults taking antianginal agents that decrease preload, and they should be cautioned about changing positions slowly.
While teaching women about the risks and incidence of CAD, the nurse stresses that:

a. women have an increased incidence of sudden death compared with men
b. smoking is not as significant a risk factor for CAD in women as it is in men
c. estrogen replacement therapy in postmenopausal women decreases the risk for CAD
d. CAD is the leading cause of death in women, with a higher mortality rate following MI than men
d. CAD is the number-one killer of American women, and they have a much higher mortality rate within 1 year following MI than do men. Recent research indicates that estrogen replacement does not reduce the risk for CAD even though estrogen lowers LDL and raises HDL cholesterol. Smoking carries specific problems for women because smoking has been linked to a decrease in estrogen levels and to early menopause and has been identified as the most powerful contributor to CAD in women under the age of 50. Men have a higher incidence of sudden cardiac death.