Chapter 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. The nurse is caring for a patient with angina pectoris who asks what happens to make his body experience pain. The nurse explains that pain results from which underlying causative factor? a. Congestion that backs up into the lungs b. Inadequate blood flow and poor oxygen supply c. Edema from fluid overload d. Inflammation in the vessels ANS: B Angina pectoris (chest pain) occurs when blood supply to the heart is decreased or totally obstructed. Pain results from ischemia (inadequate blood and oxygen supply). PTS:1 DIF: Cognitive Level: Comprehension REF: 450 OBJ:2 (theory) TOP: CAD: Pain KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. How does a myocardial infarction (MI) alter the pumping efficiency of the heart? a. An MI reduces the impulse from the sinoatrial node. b. An MI causes myocardial necrosis. c. An MI shunts all myocardial blood flow to a specific cardiac region. d. An MI causes myocardial swelling and inflammation. ANS: B Myocardial necrosis (damaged or dead heart muscle tissue) cannot contract effectively, which decreases pumping efficiency (cardiac output). PTS:1 DIF: Cognitive Level: Comprehension REF: 450 OBJ:2 (theory) TOP: MI: Pathophysiology KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI). The nurse observes that the patient is experiencing electrocardiogram (ECG) changes and reviews new laboratory results. Which laboratory value should the nurse report immediately? a. Troponin of 2.4 mcg/L b. Potassium of 3.4 mEq/L c. Creatine phosphokinase of 134 IU/L d. Sodium of 133 mEq/L ANS: A The patient has a significantly elevated troponin. The abnormal troponin, along with ECG changes, indicates that the patient is likely experiencing an MI. (Elevated troponin levels are most indicative of an MI as these enzymes are specific to heart muscle damage.) While the nurse should report the abnormally low potassium of 3.4 (low normal) sodium, these findings are of lesser priority than the elevated troponin. PTS:1 DIF: Cognitive Level: Analysis REF: 458 OBJ:5 (theory) TOP: MI: Cardiac Enzymes KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse is caring for a post–myocardial infarction (MI) patient who has been started on daily simvastatin (Zocor) and a low-fat diet. Which statement best indicates that the nurse’s teaching has been successful? a. “I will need to have blood work every month while taking Zocor.” b. “I should take my Zocor with grapefruit juice to help absorption. c. “I should call my doctor if I experience unexplained muscle pain.” d. “I should take Zocor an hour before my biggest meal of the day.”