Lewis Med-Surg Ch. 33 CAD and Acute Coronary
Syndrome
1. When developing a teaching plan for a 61-yr-old patient with multiple
risk factors for coronary artery disease (CAD), the nurse should focus
primarily on the
a. family history of coronary artery disease.
b. elevated low-density lipoprotein (LDL) level.
c. increased risk associated with the patient's gender.
d. increased risk of cardiovascular disease as people age.: ANS: B
Because family history, gender, and age are nonmodifiable risk
factors, the nurse should focus on the patient's LDL level. Decreases in
LDL will help reduce the patient's risk for developing CAD.
DIF: Cognitive Level: Apply (application)
2. Which nursing intervention is likely to be most effective when assisting
the patient with coronary artery disease to make appropriate dietary
changes?
a. Inform the patient about a diet containing no saturated fat and
minimal salt.
b. Help the patient modify favorite high-fat recipes by using
monounsaturat- ed oils.
c. Emphasize the increased risk for heart problems unless the patient
makes the dietary changes.
d. Give the patient a list of low-sodium, low-cholesterol foods that should
be included in the diet.: ANS: B
Lifestyle changes are more likely to be successful when consideration
is given to the patient's values and preferences. The highest
percentage of calories from fat should come from monounsaturated or
polyunsaturated fats. Although low-sodium and low-cholesterol foods
are appropriate, providing the patient with a list alone is not likely to
be successful in making dietary changes. Completely removing
saturated fat from the diet is not a realistic expectation. Up to 7% of
calories in the therapeutic lifestyle changes diet can come from
saturated fat. Telling the patient about the increased risk without
assisting further with strategies for dietary change is unlikely to be
successful.
,DIF: Cognitive Level: Analyze (analysis)
3. The nurse is admitting a patient who has chest pain. Which
assessment data suggest that the pain is caused by an acute myocardial
infarction (AMI)?
a. The pain increases with deep breathing.
b. The pain has lasted longer than 30 minutes.
c. The pain is relieved after the patient takes nitroglycerin.
,d. The pain is reproducible when the patient raises the arms.: ANS: B
Chest pain that lasts for 20 minutes or more is characteristic of AMI.
Changes in pain that occur with raising the arms or with deep
breathing are more typical of musculoskeletal pain or pericarditis.
Stable angina is usually relieved when the patient takes nitroglycerin.
DIF: Cognitive Level: Apply (application)
4. Which information from a patient helps the nurse confirm the
previous diagnosis of chronic stable angina?
a. "The pain wakes me up at night."
b. "The pain is level 3 to 5 (0 to 10 scale)."
c. "The pain has gotten worse over the last week."
d. "The pain goes away after a nitroglycerin tablet.": ANS: D
Chronic stable angina is typically relieved by rest or nitroglycerin
administration. The level of pain is not a consistent indicator of the
type of angina. Pain occurring at rest or with increased frequency is
typical of unstable angina.
DIF: Cognitive Level: Understand (comprehension)
5. After the nurse has finished teaching a patient about the use of
sublingual nitroglycerin (Nitrostat), which patient statement indicates that
the teaching has been effective?
a. "I can expect nausea as a side effect of nitroglycerin."
b. "I should only take nitroglycerin when I have chest pain."
c. "Nitroglycerin helps prevent a clot from forming and blocking blood
flow to my heart."
d. "I will call an ambulance if I still have pain after taking three
nitroglycerin 5 minutes apart.": ANS: D
The emergency response system (ERS) should be activated when
chest pain or other symptoms are not completely relieved after three
sublingual nitroglycerin tablets taken 5 minutes apart. Nitroglycerin
can be taken to prevent chest pain
or other symptoms from developing (e.g., before intercourse). Gastric
upset (e.g., nausea) is not an expected side effect of nitroglycerin.
Nitroglycerin does not impact the underlying pathophysiology of
coronary artery atherosclerosis.
DIF: Cognitive Level: Apply (application)
, 6. Which statement made by a patient with coronary artery disease after
the nurse has completed teaching about the therapeutic lifestyle changes
(TLC) diet indicates that further teaching is needed?
Syndrome
1. When developing a teaching plan for a 61-yr-old patient with multiple
risk factors for coronary artery disease (CAD), the nurse should focus
primarily on the
a. family history of coronary artery disease.
b. elevated low-density lipoprotein (LDL) level.
c. increased risk associated with the patient's gender.
d. increased risk of cardiovascular disease as people age.: ANS: B
Because family history, gender, and age are nonmodifiable risk
factors, the nurse should focus on the patient's LDL level. Decreases in
LDL will help reduce the patient's risk for developing CAD.
DIF: Cognitive Level: Apply (application)
2. Which nursing intervention is likely to be most effective when assisting
the patient with coronary artery disease to make appropriate dietary
changes?
a. Inform the patient about a diet containing no saturated fat and
minimal salt.
b. Help the patient modify favorite high-fat recipes by using
monounsaturat- ed oils.
c. Emphasize the increased risk for heart problems unless the patient
makes the dietary changes.
d. Give the patient a list of low-sodium, low-cholesterol foods that should
be included in the diet.: ANS: B
Lifestyle changes are more likely to be successful when consideration
is given to the patient's values and preferences. The highest
percentage of calories from fat should come from monounsaturated or
polyunsaturated fats. Although low-sodium and low-cholesterol foods
are appropriate, providing the patient with a list alone is not likely to
be successful in making dietary changes. Completely removing
saturated fat from the diet is not a realistic expectation. Up to 7% of
calories in the therapeutic lifestyle changes diet can come from
saturated fat. Telling the patient about the increased risk without
assisting further with strategies for dietary change is unlikely to be
successful.
,DIF: Cognitive Level: Analyze (analysis)
3. The nurse is admitting a patient who has chest pain. Which
assessment data suggest that the pain is caused by an acute myocardial
infarction (AMI)?
a. The pain increases with deep breathing.
b. The pain has lasted longer than 30 minutes.
c. The pain is relieved after the patient takes nitroglycerin.
,d. The pain is reproducible when the patient raises the arms.: ANS: B
Chest pain that lasts for 20 minutes or more is characteristic of AMI.
Changes in pain that occur with raising the arms or with deep
breathing are more typical of musculoskeletal pain or pericarditis.
Stable angina is usually relieved when the patient takes nitroglycerin.
DIF: Cognitive Level: Apply (application)
4. Which information from a patient helps the nurse confirm the
previous diagnosis of chronic stable angina?
a. "The pain wakes me up at night."
b. "The pain is level 3 to 5 (0 to 10 scale)."
c. "The pain has gotten worse over the last week."
d. "The pain goes away after a nitroglycerin tablet.": ANS: D
Chronic stable angina is typically relieved by rest or nitroglycerin
administration. The level of pain is not a consistent indicator of the
type of angina. Pain occurring at rest or with increased frequency is
typical of unstable angina.
DIF: Cognitive Level: Understand (comprehension)
5. After the nurse has finished teaching a patient about the use of
sublingual nitroglycerin (Nitrostat), which patient statement indicates that
the teaching has been effective?
a. "I can expect nausea as a side effect of nitroglycerin."
b. "I should only take nitroglycerin when I have chest pain."
c. "Nitroglycerin helps prevent a clot from forming and blocking blood
flow to my heart."
d. "I will call an ambulance if I still have pain after taking three
nitroglycerin 5 minutes apart.": ANS: D
The emergency response system (ERS) should be activated when
chest pain or other symptoms are not completely relieved after three
sublingual nitroglycerin tablets taken 5 minutes apart. Nitroglycerin
can be taken to prevent chest pain
or other symptoms from developing (e.g., before intercourse). Gastric
upset (e.g., nausea) is not an expected side effect of nitroglycerin.
Nitroglycerin does not impact the underlying pathophysiology of
coronary artery atherosclerosis.
DIF: Cognitive Level: Apply (application)
, 6. Which statement made by a patient with coronary artery disease after
the nurse has completed teaching about the therapeutic lifestyle changes
(TLC) diet indicates that further teaching is needed?
