NURS 346 Exam 2 EXAM ELABORATIONS LATEST UPDATED VERSION 100% GUARANTEED (GRADED A+)

Which condition is likely in the female population who reports chest pain while performing daily activities and has no significant coronary atherosclerosis? - silent ischemia - nocturnal angina - angina decubitus - microvascular angina - Answer️- microvascular angina A patient with chronic stable angina asks the nurse about the origin of the pain. Which condition would the nurse explain as the cause of the pain? - atherosclerosis - myocardial ischemia - movement of thromboembolus - coronary artery vasoconstriction - Answer️- myocardial ischemia A patient with CAD is being seen in an outpatient health care setting for a routine examination. The patient states, "over the past few months, I have needed increased amounts of insulin to control my Type 1 DM." Which goal would the nurse include in the care plan, aimed at preventing the progression of CAD? - Maintain a Hb A1C level of less than 7% - Maintain a BMI of 31 and 35 kg/m - Maintain a fasting triglyceride level of less than 175 mg/dL - maintain a serum cholesterol level of less than 250 mg/dL - Answer️- Maintain a Hb A1C level of less than 7% Which statement made by the student nurse indicates effective learning about cardiovascular diseases? - Nicotine stimulates catecholamine release - Isometric exercise provides relief from angina - Manifestations of angina often occur in the late evenings - Decreased heart rate increases myocardial oxygen demand - Answer️- Nicotine stimulates catecholamine release The nurse provides medication teaching to a patient who has been prescribed sublingual nitroglycerin tablets. Which statement made by the patient indicates the need for further education? - When I put the tablet under my tongue, I should feel a tingling sensation. - I can continue taking tablets until the pain goes away, each five minutes apart - I will need to be careful when I stand up because nitroglycerin can cause dizziness - If chest pain occurs, I will stop what I am doing and place one tablet under my tongue - Answer️- I can continue taking tablets until the pain goes away, each five minutes apart Which type of angina occurs as a result of coronary vasospasm? - nocturnal angina - prinzmetal's angina - microvascular angina - chronic stable angina - Answer️- prinzmetal's angina Which statement by a patient diagnosed with chronic stable angina indicates understanding of the disease process? - angina is caused by spasms with a coronary blood vessel - anginal pain is caused by an increased demand or a decreased supply of oxygen - angina is causing an irreversible damage to my cardiac muscles by cardiac ischemia - anginal symptoms start when atherosclerosis completely occludes a coronary artery - Answer️- anginal pain is caused by an increased demand or a decreased supply of oxygen The nurse educates a patient with stable angina regarding the administration of nitroglycerin spray. Which statement made by the patient indicates effective learning? - I need to inhale the spray if chest pain occurs - I need to spray the medication on my chest every 5 minutes during the attack - I should take the med five minutes before beginning an activity that causes angina - I should report a tingling sensation associated with the med to my HCP - Answer️- I should take the med five minutes before beginning an activity that causes angina Which statement made by the nurse indicates effective learning about the instructions for a patient who is prescribed nitroglycerin? - I should direct the patient to inhale the spray containing medication - I should ask the patient to change position rapidly after the medication use - I should instruct the patient to report changes in the pattern of pain to the HCP - I should encourage the patient to administer the med every 30 minutes sublingually if symptoms persist - Answer️- I should instruct the patient to report changes in the pattern of pain to the HCP A patient reports episodic chest pain lasting a few minutes that is provoked by exertion and relieved within 10 minutes upon resting. Which cause of the patient's symptoms would the nurse suspect? - spasm of major coronary artery - Exposure of the thrombogenic surface - Myocardial ischemia due to coronary artery disease - Myocardial ischemia secondary to microvascular disease - Answer️- Myocardial ischemia due to coronary artery disease The nurse provides information to a patient about ways to decrease risk factors for CAD. Which statement by the patient indicates understanding of the teaching? - I will add weightlifting to my daily exercise program - I will change my diet to increase my intake of saturated fats - I will change my lifestyle to alter patterns and decrease my stress - I need to switch to smokeless tobacco instead of smoking cigarettes - Answer️- I will change my lifestyle to alter patterns and decrease my stress Which sources of polyunsaturated fat would the nurse include in a teaching plan for a patient with CAD? SATA: - Walnuts - Palm Oil - Egg yolk - Soybeans - Sour cream - Answer️- Walnuts - Soybeans Which advice regarding modifiable risk factors would the nurse give yo a patient who has a BP of 150/100 mm Hg? SATA: - Increase total fat intake - Reduce salt in your diet - Increase daily physical activity - Ingest smaller and more frequent meals - Reduce dietary complex carbs and fiber - Answer️- Reduce salt in your diet - Increase daily physical activity Which individual would the nurse identify as having the highest risk for CAD? - A 45 year old male with depression and a high stress job - A 60 year old male with below normal homocysteine levels - A 54 year old female vegetarian with elevated HDL levels - A 62 year old female who has a sedentary lifestyle and BMI of 23 kg/m - Answer️- A 45 year old male with depression and a high stress job A male patient who has CAD has serum levels of LDL 98 mg/dL and HDL 47 mg/dL. Which information would the nurse include in patient teaching? - consume a diet low in fats - reduce total caloric intake - increase intake of olive oil - the lipid levels are normal - Answer️- the lipid levels are normal Which patient is at the highest risk of developing CAD? - Patient A: 43 year old nonsmoking black female - Patient B: 26 year old Hispanic male who smokes one pack/ day - Patient C: 64 year old Caucasian male with a BP of 119/78 mmHg - Patient D: 56 year old female with a cholesterol level of 300 mg/dL - Answer️- Patient D: 56 year old female with a cholesterol level of 300 mg/dL Which change occurs first that makes patients susceptible to coronary artery disease? - formation of thrombus in the coronary artery - formation of fibrous plaque in the endothelium - reduction of blood flow through the coronary arteries - development of fatty streaks in the smooth muscles of the endothelium - Answer️- development of fatty streaks in the smooth muscles of the endothelium Which risk factor for CAD is considered nonmodifiable? - Obesity - Diabetes - Tobacco use - family history of heart disease - Answer️- family history of heart disease A 78 year old patient has a diagnosis of HTN with a cholesterol level of 250 mg/dL and a fasting triglyceride level of 195 mg/dL. Which level of risk does the patient have for CAD? - none - low - high - unable to determine - Answer️- high A nurse assesses a patient whose angiogram revealed an 80% blockage of the left circumflex artery and 70% blockage of the right coronary artery. The patient does mot show any symptoms of coronary ischemia. Which reason explains this finding? - Production of C- reactive proteins - Formation of collateral circulation - Pulmonary artery supplies oxygenated blood to the heart - lowering of LDL levels in the body - Answer️- Formation of collateral circulation A patient recently diagnosed with CAD asks the nurse: "What caused my problem?" Which cause would the nurse explain? - orthostatic hypotension - low oxygen saturation of the blood - the heart's inability to pump effectively - fatty deposits on the walls of the coronary arteries - Answer️- fatty deposits on the walls of the coronary arteries The nurse provides health promotion teaching to a patient recently diagnosed with CAD. Which information would the nurse include? SATA: - Reduce total fat intake - Decrease the amount of fiber in the diet - Increase complex carbohydrates in the diet - Perform isometric exercises at least 10 minutes daily - Perform moderate physical activity at least 30 minutes 5 days a week - Answer️- Reduce total fat intake - Increase complex carbohydrates in the diet - Perform moderate physical activity at least 30 minutes 5 days a week A nurse teaches a patient about strategies to prevent angina caused by CAD. The nurse tells the patient to rest for one to two hours after a heavy meal. What is the rationale for this instruction? - eating a heavy meal would divert more blood to the GI system - heavy meals cause obesity and increase the susceptibility to myocardial ischemia - eating a heavy meal can cause physical inactivity, which could precipitate angina - heavy meals can cause excessive heat production, which leads to peripheral vasodilation - Answer️- eating a heavy meal would divert more blood to the GI system Which question would the nurse ask the older patient regarding risk factors for CAD? - What is your BMI? - Did you receive a pneumococcal vaccine? -When did you late have a bowel movement? - Did you travel abroad within the last 12 months? - Answer️- What is your BMI? The community health nurse is planning health promotion teaching to prevent coronary artery disease. Which population has the highest incidence of CAD? - white male - hispanic male - black male - native american female - Answer️- white male When providing nutritional counseling for patient at risk for CAD, which dietary selections should the nurse encourage to include in their meal planning? SATA: - Tofu - Walnuts - Flaxseed - Whole milk - Orange Juice - Answer️- Tofu - Walnuts - Flaxseed The nurse provides medication education to a patient diagnosed with CAD who will begin taking lipid-lowering meds. Which information would the nurse include in the teaching? SATA: - A major side effect of simvastatin is muscle weakness and pain - Ezetimibe is an example of lipid-lowering medications that are called statins - With niacin, flushing of the face and neck may occur within 20 minutes of taking the drug - Liver enzymes need to be monitored at initiation of simvastatin and with dosage increase - Ezetimibe, in combination with statins, produces greater reduction of LDL - Answer️- A major side effect of simvastatin is muscle weakness and pain - With niacin, flushing of the face and neck may occur within 20 minutes of taking the drug - Liver enzymes need to be monitored at initiation of simvastatin and with dosage increase - Ezetimibe, in combination with statins, produces greater reduction of LDL Which intervention would the nurse plan for a patient who smokes cigarettes and is predisposed to developing CAD? - recommend smokeless tobacco - encourage the use of filtered cigarettes - suggest smoking low- nicotine cigarettes - discuss medication to help with tobacco cessation - Answer️- discuss medication to help with tobacco cessation A patient has a family history of myocardial infarction. Which data indicates to the nurse that the patient has additional risk factors for CAD? SATA: - smoking cessation three years ago - serum cholesterol level of 260 mg/dL - fasting triglyceride level of 110 mg/dL - high level of anxiety over the last two years related to family issues - works over 50 hours/ week in an office with little time to exercise - lives with an adult child who smokes two packs of cigarettes/day - Answer️- serum cholesterol level of 260 mg/dL - high level of anxiety over the last two years related to family issues - works over 50 hours/ week in an office with little time to exercise - lives with an adult child who smokes two packs of cigarettes/day Which symptoms in a 55 year old female patient would the nurse recognize as possibly indicating unstable angina? - dyspnea, hyperglycemia and polyuria - altered mentation with difficulty breathing - fatigue, indigestion and SOB - peripheral edema with decreased urinary output - Answer️- fatigue, indigestion and SOB The nurse provides a list of health-promoting regular physical activity examples to a patient with CAD. Which activity would the nurse include on the list? - painting while seated - performing carpentry - jogging (7-8 mph) - brisk walking (3-4 mph) - Answer️- brisk walking (3-4 mph) The nurse provides education to a patient who receives a prescription for sublingual nitroglycerin for treatment of angina. Which statement made by the patient indicates the need for further teaching? - I cannot take sildenafil and nitroglycerin at the same time - After the bottle is open, the tablets should be replaced every 12 months - after taking a tablet, I may experience a headache, dizziness or flushing - I can take a tablet 5-10 minutes before starting an activity that causes angina - Answer️- After the bottle is open, the tablets should be replaced every 12 months A patient with a diagnosis of unstable angina is admitted to the intensive care unit. Which drug therapies will the nurse anticipate to be prescribed? SATA: - nitrates - antiplatelet therapy - anticoagulant therapy - Beta Blockers - ACE Inhibitors - Answer️- nitrates - antiplatelet therapy - anticoagulant therapy Which physical assessment findings will the nurse expect when caring for a patient with cor pulmonale? SATA: - Bradypnea - weight loss - pedal edema - hepatomegaly - jugular vein distention - Answer️- pedal edema - hepatomegaly - jugular vein distention Which foods would the nurse encourage a patient with diabetes mellitus and CAD to limit intake of to help reduce the % of saturated fat in their diet? - chicken and turkey - frozen and canned vegetables - enriched flour products - dairy products - Answer️- dairy products Which intervention by the nurse would provide stabilization for a patient with cor pulmonale who has an enlarged liver, distended neck veins, and clear fluid accumulated in the pleural space? - restricting sodium diet - monitoring for infection - monitor liver functioning - positioning the patient at a 45 degree angle - Answer️- restricting sodium diet The nurse provides care for a 54 year old female patient who has had no menstrual periods for a year. The nurse identifies that the patient is at risk for which conditions? SATA: - blood clots - depression - osteoporosis - bladder infections - endometrial cancer - CAD - Answer️- depression - osteoporosis - bladder infections - CAD Which assessment data is a nonmodifiable risk factor for CAD? - diabetes - white male - hyperlipidemia - cigarette smoking - Answer️- white male A patient is diagnosed with diabetes mellitus. The nurse recognizes that which coping strategies used by the patient indicate problem-focused coping? SATA: - Including exercise in the daily routine - searching for information about diabetes - scheduling an appointment for a massage - enrolling for a diabetes education program - expressing concerns about diabetes with friends - Answer️- Including exercise in the daily routine - searching for information about diabetes - enrolling for a diabetes education program While reviewing the lab reports of a patient with Type 2 Diabetes mellitus, the nurse concludes that the patient has high risk for macrovascular complications. Which finding supports the nurse's conclusion? - The patient has triglycerides of 137 mg/dL - The patient has blood pressure of 130/80 mmHg - The patient has HDL of 45 mg/dL - The patient has LDL of 120 mg/dL - Answer️- The patient has LDL of 120 mg/dL A patient, admitted with Type 1 diabetes, asks the nurse what "type 1" means. What is the nurse's best response? - There is decreased insulin secretion, cellular resistance to insulin that is produced, or both. - An increased amount of adipose tissue has led to an insufficient amount of insulin being produced. - The body produce autoantibodies that destroy beta cells in the pancreas - The insulin being made is not used by the tissues properly, leading to high blood sugar - Answer️- The body produces autoantibodies that destroy beta cells in the pancreas A patient who had been diagnosed with pre-diabetes six months ago is following up in the outpatient diabetes clinic. The nurse is reviewing the assessment data and understands the nest reflection of good management of this condition is what? - A 20 pound weight loss - Hemoglobin A1C of 5.5% - Reduction of total cholesterol to 200 mg/dL - Decrease in polyuria, polydipsia, and polyphagia - Answer️- Hemoglobin A1C of 5.5% Which persons are the most suited for diabetes screening? SATA: - A person with HTN - A person who is physically inactive - A person with polycystic ovarian syndrome - A person who delivered a baby weighing 9 lbs - A person whose BMI is 25 kg/m - Answer️- A person with HTN - A person who is physically inactive - A person with polycystic ovarian syndrome To demonstrate an understanding of Somogyi effect, the nurse correctly identifies which defining characteristics? SATA: - Documented morning hyperglycemia - Caused by not rotating injection sites - May be avoided by consuming a bedtime snack - Treatment is a lower dose of insulin in the evening - Documented hypoglycemia between 2:00 AM and 4:00 AM - Requires an adjustment of administration time of evening insulin - Answer️- Documented morning hyperglycemia - May be avoided by consuming a bedtime snack - Treatment is a lower dose of insulin in the evening - Documented hypoglycemia between 2:00 AM and 4:00 AM Which statements best describe glargine? SATA: - There is no pronounced peak action time - It should be administered subcutaneously - It should be administered orally with food and water each morning - It should be diluted or mixed with other insulin or solutions in the same syringe - If it does not achieved glycemic goals, the administrator of a mealtime insulin may be required - Answer️- There is no pronounced peak action time - It should be administered subcutaneously - If it does not achieved glycemic goals, the administrator of a mealtime insulin may be required The nurse is discussing a healthy eating plan for a patient with diabetes. Which should the nurse include in the teaching about diabetes and diet? - avoid nonnutritive sweeteners - consume a high protein diet for weight loss - if ingesting alcohol, also consume carbs - Include 50-60 g/day of dietary fiber - Answer️- if ingesting alcohol, also consume carbs The nurse is preparing to administer levothyroxine to a patient newly diagnosed with hypothyroidism. The patient's resting heart rate is 100. Which initial action should the nurse take? - Administer the med - Notify the HCP - Obtain a BP measurement - Administer all other scheduled meds except levothyroxine - Answer️- Obtain a BP measurement A nurse is providing discharge teaching to a patient with a new diagnosis of type 1 diabetes mellitus who will need to give self-injections of insulin at home. Which statement by the patient indicated to the nurse that the discharge teaching was effective? - I can use my lower forearm for insulin injections - If my intermediate-acting insulin looks cloudy, I should discard the bottle. - I need to rotate sites of injection to allow for better absorption of the insulin - I should push the plunger all the way down and then remove the needle as soon as possible - Answer️- I need to rotate sites of injection to allow for better absorption of the insulin A patient with diabetes is waiting in the preoperative holding area for a hernia operation. The patient asks the nurse if the daily insulin dose should be taken. Which response is the most appropriate? - Replace the insulin with an oral drug - I will check with the surgeon and let you know - Take half of the dose of insulin because you are fasting - Avoid taking insulin because it may cause hypoglycemia - Answer️- I will check with the surgeon and let you know A patient with type 2 diabetes wants to stop taking metformin and manage the diabetes with diet and exercise. The patient states that cutting out carbs was featured on television recently as treatment for diabetes and is considering the paleo diet. Which responses by the nurse are most appropriate? SATA: - Weight loss for overweight patients is recommended as a management strategy for type 2 diabetes - you should maintain a healthy balance of nutrients to maintain blood glucose and overall health - There is no ideal number of carbs to consume, so you should individualize your meal plan - Carbs are only found in grain-based products, so any diet that eliminates these foods is best recommended - Patients with diabetes only need to be concerned with their blood sugars, not with their lipid levels or BP goals - Answer️- Weight loss for overweight patients is recommended as a management strategy for type 2 diabetes - you should maintain a healthy balance of nutrients to maintain blood glucose and overall health - There is no ideal number of carbs to consume, so you should individualize your meal plan A patient reports weight loss, increased appetite, chest pain and hair loss. Assessment findings include large and protruding eyes; skin that is warm, smooth, and moist; an elevated blood pressure; and an increased heart rate. The nurse suspects that the patient has which condition? - Goiter - Hyperthyroidism - Addison's disease - Hypoparathyroidism - Answer️- Hyperthyroidism A nurse is assessing a patient who has thick, dry skin; weight gain; and cold insensitivity. What possible cause does the nurse suspect? - Hypothyroidism - Hyperthyroidism - Addison's disease - Cushing syndrome - Answer️- Hypothyroidism