Lewis-CAD Test Bank QUESTIONS
WITH CORRECT ANSWERS GRADED
A+
Which electrocardiographic (ECG) change by a patient with chest pain is most
important for the nurse to report rapidly to the health care provider?
a. Inverted P wave
b. Sinus tachycardia
c. ST-segment elevation
d. First-degree atrioventricular block
ANS: C
The patient is likely to be experiencing an ST-segment-elevation myocardial
infarction. Immediate therapy with percutaneous coronary intervention or
thrombolytic medication is indicated to minimize myocardial damage. The other ECG
changes may also suggest a need for therapy but not as rapidly.
A patient with acute coronary syndrome has returned to the coronary care unit
after having angioplasty with stent placement. Which assessment data
indicate the need for immediate action by the nurse?
a. Report of chest pain
b. Heart rate 102 beats/min
c. Pedal pulses 1+ bilaterally
d. Blood pressure 103/54 mm Hg
ANS: C
The patient's chest pain indicates that restenosis of the coronary artery may be
occurring and requires immediate actions, such as administration of oxygen and
nitroglycerin, by the nurse. The other information indicates a need for ongoing
assessments by the nurse.
A patient admitted to the coronary care unit (CCU) with an ST-segment-
elevation myocardial infarction (STEMI) is restless and anxious. The blood
,pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this
information, which patient problem is the priority?
a. Anxiety
b. Acute pain
c. Stress management
d. Decreased cardiac output
ANS: D
The hypotension and tachycardia indicate decreased cardiac output and shock from
the damaged myocardium. This will result in decreased perfusion to all vital organs
(e.g., brain, kidney, heart) and is a priority
The nurse is developing a teaching plan for a 64-year-old patient with coronary
artery disease (CAD). Which factor should the nurse focus on during the
teaching session?
a. Family history of coronary artery disease
b. Elevated low-density lipoprotein (LDL) level
c. Greater risk associated with the patient's gender
d. Increased risk of cardiovascular disease with aging
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.
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. Emphasize the increased cardiac risk unless the patient makes dietary
changes.
c. Help the patient modify favorite high-fat recipes by using monounsaturated
oils.
d. Give the patient a list of low-sodium-cholestrol foods include in the diet.
ANS: C
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.
The nurse is admitting a patient who has chest pain. Which assessment data
suggest that the pain is from an acute myocardial infarction?
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.
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.
Which patient statement indicates that the nurse's teaching about sublingual
nitroglycerin (Nitrostat) 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."
WITH CORRECT ANSWERS GRADED
A+
Which electrocardiographic (ECG) change by a patient with chest pain is most
important for the nurse to report rapidly to the health care provider?
a. Inverted P wave
b. Sinus tachycardia
c. ST-segment elevation
d. First-degree atrioventricular block
ANS: C
The patient is likely to be experiencing an ST-segment-elevation myocardial
infarction. Immediate therapy with percutaneous coronary intervention or
thrombolytic medication is indicated to minimize myocardial damage. The other ECG
changes may also suggest a need for therapy but not as rapidly.
A patient with acute coronary syndrome has returned to the coronary care unit
after having angioplasty with stent placement. Which assessment data
indicate the need for immediate action by the nurse?
a. Report of chest pain
b. Heart rate 102 beats/min
c. Pedal pulses 1+ bilaterally
d. Blood pressure 103/54 mm Hg
ANS: C
The patient's chest pain indicates that restenosis of the coronary artery may be
occurring and requires immediate actions, such as administration of oxygen and
nitroglycerin, by the nurse. The other information indicates a need for ongoing
assessments by the nurse.
A patient admitted to the coronary care unit (CCU) with an ST-segment-
elevation myocardial infarction (STEMI) is restless and anxious. The blood
,pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this
information, which patient problem is the priority?
a. Anxiety
b. Acute pain
c. Stress management
d. Decreased cardiac output
ANS: D
The hypotension and tachycardia indicate decreased cardiac output and shock from
the damaged myocardium. This will result in decreased perfusion to all vital organs
(e.g., brain, kidney, heart) and is a priority
The nurse is developing a teaching plan for a 64-year-old patient with coronary
artery disease (CAD). Which factor should the nurse focus on during the
teaching session?
a. Family history of coronary artery disease
b. Elevated low-density lipoprotein (LDL) level
c. Greater risk associated with the patient's gender
d. Increased risk of cardiovascular disease with aging
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.
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. Emphasize the increased cardiac risk unless the patient makes dietary
changes.
c. Help the patient modify favorite high-fat recipes by using monounsaturated
oils.
d. Give the patient a list of low-sodium-cholestrol foods include in the diet.
ANS: C
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.
The nurse is admitting a patient who has chest pain. Which assessment data
suggest that the pain is from an acute myocardial infarction?
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.
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.
Which patient statement indicates that the nurse's teaching about sublingual
nitroglycerin (Nitrostat) 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."
