Lewis's med-surg chapter 33 practice questions

Which patient is most likely to be in the fibrous stage of development of coronary artery disease (CAD)?

a. Age 40 years, thrombus adhered to the coronary artery wall

b. Age 50 years, rapid onset of disease with hypercholesterolemia

c. Age 32 years, thickened coronary arterial walls with narrowed vessel lumen

d. Age 19 years, high low-density lipoprotein (LDL) cholesterol, lipid-filled smooth muscle cells

c. Age 32 years, thickened coronary arterial walls with narrowed vessel lumen

What accurately describes the pathophysiology of CAD?

a. Partial or total occlusion of the coronary artery occurs during the stage of raised fibrous plaque.

b. Endothelial changes may be caused by chemical irritants, such as hyperlipidemia or by tobacco use.

c. Collateral circulation in the coronary circulation is more likely to be present in the young patient with CAD.

d. The leading theory of atherogenesis proposes that infection and fatty dietary intake are the basic underlying causes of atherosclerosis.

b. Endothelial changes may be caused by chemical irritants, such as hyperlipidemia or by tobacco use.

After obtaining patient histories, which patient does the nurse identify as having the highest risk for CAD?

a. A white man, age 54 years, who is a smoker and has a stressful lifestyle

b. A white woman, age 75 years, with a BP of 172/100 mm Hg and who is physically inactive

c. An Asian woman, age 45 years, with a cholesterol level of 240 mg/dL and a BP of 130/74 mm Hg

d. An obese Hispanic man, age 65 years, with a cholesterol level of 195 mg/dL and a BP of 128/76 mm Hg

b. A white woman, age 75 years, with a BP of 172/100 mm Hg and who is physically inactive

Priority Decision: What should the nurse emphasize when teaching women about the risks and incidence of CAD?

a. Smoking is not as significant a risk factor for CAD in women as it is in men.

b. Women seek treatment sooner than do men when they have symptoms of CAD.

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 after myocardial infarction (MI) than in men.

d. CAD is the leading cause of death in women, with a higher mortality rate after myocardial infarction (MI) than in men.

Which characteristics are associated with LDLs (select all that apply)?

a. Increases with exercise

b. Contains the most cholesterol

c. Has an affinity for arterial walls

d. Carries lipids away from arteries to liver

e. High levels correlate most closely with CAD

f. The higher the level, the lower the risk for CAD

b. Contains the most cholesterol

c. Has an affinity for arterial walls

e. High levels correlate most closely with CAD

Which serum lipid elevation, along with high LDL, is strongly associated with CAD?

a. Apolipoproteins

b. Fasting triglycerides

c. Total serum cholesterol

d. High-density lipoprotein (HDL)

b. Fasting triglycerides

The laboratory tests for 4 patients show the following results. Which patient should the nurse teach first about preventing CAD because the patient is at the greatest risk for CAD even without other risk factors?

a. Total cholesterol: 152 mg/dL, triglycerides: 148 mg/dL, LDL: 148 mg/dL, HDL: 52 mg/dL

b. Total cholesterol: 160 mg/dL, triglycerides: 102 mg/dL, LDL: 138 mg/dL, HDL: 56 mg/dL

c. Total cholesterol: 200 mg/dL, triglycerides: 150 mg/dL, LDL: 160 mg/dL, HDL: 48 mg/dL

d. Total cholesterol: 250 mg/dL, triglycerides: 164 mg/dL, LDL: 172 mg/dL, HDL: 32 mg/dL

d. Total cholesterol: 250 mg/dL, triglycerides: 164 mg/dL, LDL: 172 mg/dL, HDL: 32 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 directly contribute to reducing which risk factors?

a. Diabetes and hypertension

b. Hyperlipidemia and obesity

c. Increased serum lipids and stressful lifestyle

d. Hypertension and increased serum homocysteine

b. Hyperlipidemia and obesity

During a routine health examination, a 48-year-old patient is found to have a total cholesterol level of 224 mg/dL (5.8 mmoI/L) and an LDL level of 140 mg/dL (3.6 mmol/L). What does the nurse teach the patient based on the Therapeutic Lifestyle Changes diet (select all that apply)?

a. Use fat-free milk.

b. Abstain from alcohol use.

c. Reduce red meat in the diet.

d. Eliminate intake of simple sugars.

e. Avoid foods prepared with egg yolks.

a. Use fat-free milk.

c. Reduce red meat in the diet.

e. Avoid foods prepared with egg yolks.

To which patients should the nurse teach the Therapeutic Lifestyle Changes diet to reduce the risk of CAD?

a. Patients who have had an MI

b. All patients to reduce CAD risk

c. Those with 2 or more risk factors for CAD

d. Those with a cholesterol level >200 mg/dL (5.2 mmol/L)

b. All patients to reduce CAD risk

Patient-Centered Care: A 62-year-old woman smokes a pack of cigarettes per day and has a BP 138/88 mm Hg. She has no symptoms of CAD, but a recent LDL level was 154 mg/dL (3.98 mmol/L). Based on these findings, the nurse would expect that which treatment plan would be used first for this patient?

a. Diet and drug therapy

b. Exercise instruction only

c. Diet therapy and smoking cessation

d. Drug therapy and smoking cessation

c. Diet therapy and smoking cessation

What are manifestations of acute coronary syndrome (ACS) (select all that apply)?

a. Dysrhythmia

b. Stable angina

c. Unstable angina

d. ST-segment-elevation myocardial infarction (STEMI)

e. Non—ST-segment-elevation myocardial infarction (NSTEMI)

c. Unstable angina

d. ST-segment-elevation myocardial infarction (STEMI)

e. Non—ST-segment-elevation myocardial infarction (NSTEMI)

Myocardial ischemia occurs because of increased oxygen demand and decreased oxygen supply. What factors and disorders result in increased oxygen demand (select all that apply)?

a. Hypovolemia or anemia

b. Increased cardiac workload with aortic stenosis

c. Narrowed coronary arteries from atherosclerosis

d. Angina in the patient with atherosclerotic coronary arteries

e. Left ventricular hypertrophy caused by chronic hypertension

f. Sympathetic nervous system stimulation by drugs, emotions, or exertion

b. Increased cardiac workload with aortic stenosis

d. Angina in the patient with atherosclerotic coronary arteries

e. Left ventricular hypertrophy caused by chronic hypertension

f. Sympathetic nervous system stimulation by drugs, emotions, or exertion

What causes the pain that occurs with myocardial ischemia?

a. Death of myocardial tissue

b. Dysrhythmias caused by cellular irritability

c. Lactic acid accumulation during anaerobic metabolism

d. Increased pressure in the ventricles and pulmonary vessels

c. Lactic acid accumulation during anaerobic metabolism

What types of angina can occur in the absence of CAD (select all that apply)?

a. Silent ischemia

b. Nocturnal angina

c. Prinzmetal's angina

d. Microvascular angina

e. Chronic stable angina

c. Prinzmetal's angina

d. Microvascular angina

Which characteristics describe unstable angina (select all that apply)?

a. Usually precipitated by exertion

b. New-onset angina with minimal exertion

c. Occurs only when the person is recumbent

d. Characterized by increased duration or severity

e. Usually occurs in response to coronary artery spasm

b. New-onset angina with minimal exertion

d. Characterized by increased duration or severity

Tachycardia that is a response of the sympathetic nervous system to the pain of ischemia is detrimental because it increases oxygen demand and...

a. increases cardiac output.

b. causes reflex hypotension.

c. may lead to atrial dysrhythmias.

d. impairs perfusion of the coronary arteries.

d. impairs perfusion of the coronary arteries.

Which effects contribute to making nitrates the first-line therapy for the treatment of angina (select all that apply)?

a. Decrease preload

b. Decrease afterload

c. Dilate coronary arteries

d. Decrease heart rate (HR)

e. Prevent thrombosis of plaques

f. Decrease myocardial contractility

a. Decrease preload

b. Decrease afterload

c. Dilate coronary arteries

The patient has used sublingual nitroglycerin (NTG) and various long-acting nitrates but now has an ejection fraction of 38% and is considered at a high risk for a cardiac event. Which medication would first be added for vasodilation and to reduce ventricular remodeling?

a. Captopril

b. Clopidogrel (Plavix)

c. Diltiazem (Cardizem)

d. Metoprolol (Lopressor)

a. Captopril

When teaching the patient with angina about taking sublingual NTG tablets, what should the nurse teach the patient?

a. Lie or sit and place 1 tablet under the tongue when chest pain occurs.

b. Take the tablet with a large amount of water so that it will dissolve right away.

c. If 1 tablet does not relieve the pain in 15 minutes, the patient should go to the hospital.

d. If the tablet causes dizziness and a headache, stop the medication and call the doctor or go to the hospital.

a. Lie or sit and place 1 tablet under the tongue when chest pain occurs.

Which guidelines should the nurse use to teach an older adult with CAD how to manage the treatment program for angina?

a. To sit for 2 to 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. To sit for 2 to 5 minutes before standing when getting out of bed

When a patient reports chest pain, why must unstable angina be identified and rapidly treated?

a. The pain may be severe and disabling.

b. Electrocardiogram (ECG) changes and dysrhythmias may occur during an attack.

c. Rupture of unstable plaque may cause complete thrombosis of the vessel lumen.

d. Spasm of a major coronary artery may cause total occlusion of the vessel with progression to MI.

c. Rupture of unstable plaque may cause complete thrombosis of the vessel lumen.

The nurse suspects stable angina rather than MI pain in the patient who reports that his chest pain

a. is relieved by NTG.

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. is relieved by NTG.

A patient admitted to the hospital for evaluation of chest pain has no abnormal serum cardiac biomarkers 4 hours after the onset of pain. What noninvasive diagnostic test can be used to differentiate angina from other types of chest pain?

a. 12-1ead ECG

b. Exercise stress test

c. Coronary angiogram

d. transesophageal echocardiogram

b. Exercise stress test

A 52-year-old man is admitted to the emergency department with severe chest pain. On what basis would the nurse suspect an MI?

a. He has pale, cool, clammy skin.

b. He reports nausea and vomited once at home.

c. He says he is anxious and has a feeling of impending doom.

d. He reports he has had no relief of the pain with rest or position change.

d. He reports he has had no relief of the pain with rest or position change.

At what point in the healing process of the myocardium following an infarct does early scar tissue result in an unstable heart wall?

a. 2 to 4 days after MI

b. 4 to 10 days after MI

c. 10 to 14 days after MI

d. 6 weeks after MI

c. 10 to 14 days after MI

To detect and treat the most common complication of MI, what should the nurse do?

a. Measure hourly urine output.

b. Auscultate the chest for crackles.

c. Use continuous cardiac monitoring.

d. Take vital signs every 2 hours for the first 8 hours.

c. Use continuous cardiac monitoring.

During the assessment, the nurse identifies crackles in the lungs and an S3 heart sound. Which complication of MI should the nurse suspect and further investigate?

a. Pericarditis

b. Heart failure

c. Ventricular aneurysm

d. Papillary muscle dysfunction

b. Heart failure

In the patient with chest pain, which results can distinguish unstable angina from an MI?

a. ECG changes present at the onset of the pain

b. A chest x-ray showing left ventricular hypertrophy

c. Serum troponin levels increased 4 to 6 hours after the onset

d. Creatine kinase MB (CK-MB) elevations that peak 6 hours after the infarct

c. Serum troponin levels increased 4 to 6 hours after the onset

A second 12-lead ECG performed on a patient 4 hours after the onset of chest pain reveals ST segment elevation. What does the nurse recognize that this finding indicates?

a. Transient ischemia typical of unstable angina

b. Lack of permanent damage to myocardial cells

c. MI associated with prolonged and complete coronary thrombosis

d. MI associated with transient or incomplete coronary artery occlusion

c. MI associated with prolonged and complete coronary thrombosis

What phrase describes transmyocardial laser revascularization (TMR)?

a. Structure applied to hold vessels open

b. Requires anticoagulation following the procedure

c. Laser-created channels in the heart muscle to allow blood flow to ischemic areas

d. Surgical construction of new vessels to carry blood beyond obstructed coronary artery

c. Laser-created channels in the heart muscle to allow blood flow to ischemic areas

Which treatment is used first for the patient with a confirmed MI to open the blocked artery within 90 minutes of arrival to a health care facility?

a. TMR

b. Stent placement

c. Coronary artery bypass graft (CABG)

d. Percutaneous coronary intervention (PCI)

d. Percutaneous coronary intervention (PCI)

A patient is scheduled to have CABG surgery. What should the nurse explain is involved with the procedure?

a. A synthetic graft will be used as a tube for blood flow from the aorta to a coronary artery distal to an obstruction.

b. A stenosed coronary artery will be resected, and a synthetic arterial tube graft will be inserted to replace the diseased artery.

c. The internal mammary artery will be detached from the chest wall and attached to a coronary artery distal to the stenosis.

d. Reversed segments of a saphenous artery from the aorta will be anastomosed to the coronary artery distal to an obstruction.

c. The internal mammary artery will be detached from the chest wall and attached to a coronary artery distal to the stenosis.

Collaboration: In planning care for a patient who has just returned to the unit following a PCI, the nurse may delegate which activity to unlicensed assistive personnel (UAP)?

a. Monitor the IV fluids and measure urine output.

b. Check vital signs and report changes in HR, BP, or pulse oximetry.

c. Explain to the patient the need for frequent vital signs and pulse checks.

d. Assess circulation to the extremity used by checking pulses, skin temperature, and color.

b. Check vital signs and report changes in HR, BP, or pulse oximetry.

Interprofessional care of the patient with NSTEMI differs from that of a patient with STEMI in that NSTEMI is more often initially treated with what?

a. PCI

b. CABG

c. Acute intensive drug therapy

d. Reperfusion therapy with thrombolytics

c. Acute intensive drug therapy

During treatment with reteplase (Retavase) for a patient with a STEMI, which finding should most concern the nurse?

a. Oozing of blood from the IV site

b. BP of 102/60 mm Hg with an HR of 78 bpm

c. Decrease in the responsiveness of the patient

d. Intermittent accelerated idioventricular rhythms

c. Decrease in the responsiveness of the patient

The nurse recognizes that thrombolytic therapy for the treatment of an MI has not been successful when the patient displays which manifestation?

a. Continues to have chest pain

b. Develops gastrointestinal (GI) bleeding

c. Has a marked increase in CK-MB levels within 3 hours of therapy

d. Develops premature ventricular contractions and ventricular tachycardia during treatment

a. Continues to have chest pain

When the patient who is diagnosed with an MI is not relieved of chest pain with IV NTG, which medication will the nurse expect to be used?

a. IV morphine sulfate

b. Calcium channel blockers

c. IV administration of amiodarone

d. Angiotensin-converting enzyme (ACE) inhibitors

a. IV morphine sulfate

What is the rationale for using docusate sodium (Colace) for a patient after an MI?

a. Relieves cardiac workload

b. Minimizes vagal stimulation

c. Controls ventricular dysrhythmias

d. Prevents the binding of fibrinogen to platelets

b. Minimizes vagal stimulation

A patient who has hypertension just had an MI. Which type of medication should the nurse expect to be added to decrease the cardiac workload?

a. ACE inhibitor

b. ß-adrenergic blocker

c. Calcium channel blocker

d. Angiotensin Il receptor blocker (ARB)

b. ß-adrenergic blocker

A patient with an MI is exhibiting anxiety while being taught about possible lifestyle changes. Which patient statement indicates to the nurse that the anxiety is relieved?

a. "I'm 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. "I'm going to take this recovery one step at a time."

Priority Decision: A patient hospitalized for evaluation of unstable angina has severe chest pain and calls the nurse. Prioritize the subsequent interventions from 1 (highest priority) to 6 (lowest priority). The appropriate medical prescriptions and protocols are available to the nurse.

a. Notify the provider.

b. Obtain a 12-lead ECG.

c. Check the patient's vital signs.

d. Apply oxygen per nasal cannula.

e. Perform a focused assessment of the chest.

f. Assess pain (PQRST) and medicate as ordered.

1. d. Apply oxygen per nasal cannula.

2. c. Check the patient's vital signs.

3. b. Obtain a 12-lead ECG.

4. f. Assess pain (PQRST) and medicate as ordered.

5. e. Perform a focused assessment of the chest.

6. a. Notify the provider.

Which statement indicates the patient is experiencing anger as the psychologic response to his acute MI?

a. "Yes, I'm having a little chest pain. it's no big deal."

b. "I don't think I can take care of myself at home yet."

c. "What's going to happen if I have another heart attack?"

d. "I hope my wife is happy after harping about my eating habits."

d. "I hope my wife is happy after harping about my eating habits."

Which activity should the nurse and patient identify as a moderate-energy activity during rehabilitation after an Ml?

a. Golfing

c. Cycling at 13 mph

b. Walking at 5 mph

d. Mowing the lawn by hand

a. Golfing

A 58-year-old patient is in a cardiac rehabilitation program. Which sign or symptom should the nurse teach the

a. Pain or dyspnea develop

b. The HR exceeds 150 bpm

c. The respiratory rate increases to 30

d. The HR is 30 bpm over the resting HR

a. Pain or dyspnea develop

When counseling the patient about sexual activity following an MI, what should the nurse do?

a. Wait for the patient to ask about resuming sexual activity.

b. Discuss sexual activity while teaching about other physical activity.

c. Have the patient ask the health care provider when sexual activity can be resumed.

d. Inform the patient that impotence is a common long-term complication following MI

b. Discuss sexual activity while teaching about other physical activity.

What advice about sexual activity should the nurse give to a male patient who has had an MI?

a. The patient should use the superior position

b. Prophylactic NTG may be used if angina occurs

c. Foreplay may cause too great an increase in HR

d. Performance can be enhanced with the use of sildenafil (Viagra)

b. Prophylactic NTG may be used if angina occurs

A patient is hospitalized after a successful resuscitation of an episode of sudden cardiac death (SCD). During the care of the patient, what nursing intervention is MOST important?

a. continous ECG monitoring

b. auscultation of the carotid arteries

c. frequent assessment of heart sounds

d. monitoring airway status and respirations

a. continous ECG monitoring