Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 33 - Coronary Artery Disease and Acute Coronary Syndrome
1. When developing a teaching plan for a 61-year-old man with the following risk
factors for coronary artery disease (CAD), the nurse should focus on the
A. family history of coronary artery disease.
B. increased risk associated with the patients gender.
C. increased risk of cardiovascular disease as people age.
D. elevation of the patients low-density lipoprotein (LDL) level.
Answer: D
Explanation: Because family history, gender, and age are nonmodifiable risk factors, the
nurse should focus on the patients LDL level. Decreases in LDL will help reduce the patients
risk for developing CAD.
2. Which nursing intervention will be most effective when assisting the patient with
coronary artery disease (CAD) to make appropriate dietary changes?
A. Give the patient a list of low-sodium, low-cholesterol foods that should be
included in the diet.
B. Emphasize the increased risk for heart problems unless the patient makes the
dietary changes.
C. Help the patient modify favorite high-fat recipes by using monosaturated oils when
possible.
D. Inform the patient that a diet containing no saturated fat and minimal salt will be
necessary.
Answer: C
Explanation: Lifestyle changes are more likely to be successful when consideration is given
to the patients values and preferences. The highest percentage of calories from fat should
come from monosaturated 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.
3. Which assessment data collected by the nurse who is admitting a patient with
chest pain 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.
Answer: B
Explanation: 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.
4. Which information given by a patient admitted with chronic stable angina will
help the nurse confirm this diagnosis?
A. The patient states that the pain wakes me up at night.
B. The patient rates the pain at a level 3 to 5 (0 to 10 scale).
C. The patient states that the pain has increased in frequency over the last week.
D. The patient states that the pain goes away with one sublingual nitroglycerin tablet.
Answer: D
Explanation: 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.
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 some nausea as a side effect of nitroglycerin.
B. I should only take the nitroglycerin if I start to have chest pain.
C. I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes
apart.
D. Nitroglycerin helps prevent a clot from forming and blocking blood flow to my
heart.
Answer: C
Explanation: The emergency medical services (EMS) system should be activated when chest
pain or other symptoms are not completely relieved after 3 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.
, 6. Which statement made by a patient with coronary artery disease after the nurse
has completed teaching about therapeutic lifestyle changes (TLC) diet indicates
that further teaching is needed?
A. I will switch from whole milk to 1% milk.
B. I like salmon and I will plan to eat it more often.
C. I can have a glass of wine with dinner if I want one.
D. I will miss being able to eat peanut butter sandwiches.
Answer: D
Explanation: Although only 30% of the daily calories should come from fats, most of the fat
in the TLC diet should come from monoasturated fats such as are found in nuts, olive oil, and
canola oil. The patient can include peanut butter sandwiches as part of the TLC diet. The
other patient comments indicate a good understanding of the TLC diet.
7. After the nurse teaches the patient about the use of carvedilol (Coreg) in
preventing anginal episodes, which statement by a patient indicates that the
teaching has been effective?
A. Carvedilol will help my heart muscle work harder.
B. It is important not to suddenly stop taking the carvedilol.
C. I can expect to feel short of breath when taking carvedilol.
D. Carvedilol will increase the blood flow to my heart muscle.
Answer: B
Explanation: Patients who have been taking b-adrenergic blockers can develop intense and
frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases
myocardial contractility. Shortness of breath that occurs when taking b-adrenergic blockers
for angina may be due to bronchospasm and should be reported to the health care provider.
Carvedilol works by decreasing myocardial oxygen demand, not by increasing blood flow to
the coronary arteries.
8. A patient who has had chest pain for several hours is admitted with a diagnosis
of rule out acute myocardial infarction (AMI). Which laboratory test should the
nurse monitor to help determine whether the patient has had an AMI?
A. Myoglobin
B. Homocysteine
C. C-reactive protein
D. Cardiac-specific troponin
Answer: D
Explanation: Troponin levels increase about 4 to 6 hours after the onset of myocardial
infarction (MI) and are highly specific indicators for MI. Myoglobin is released within 2
, hours of MI, but it lacks specificity and its use is limited. The other laboratory data are useful
in determining the patients risk for developing coronary artery disease (CAD) but are not
helpful in determining whether an acute MI is in progress.
9. Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetals
(variant) angina. When teaching the patient, the nurse will include the
information that diltiazem will
A. reduce heart palpitations.
B. decrease spasm of the coronary arteries.
C. increase the force of the heart contractions.
D. help prevent plaque from forming in the coronary arteries.
Answer: B
Explanation: Prinzmetals angina is caused by coronary artery spasm. Calcium channel
blockers (e.g., diltiazem, amlodipine [Norvasc]) are a first-line therapy for this type of
angina. Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), and b-
adrenergic blockers decrease sympathetic stimulation of the heart (i.e., palpitations).
Medications or activities that increase myocardial contractility will increase the incidence of
angina by increasing oxygen demand.
10. The nurse will suspect that the patient with stable angina is experiencing a side
effect of the prescribed metoprolol (Lopressor) if the
A. patient is restless and agitated.
B. blood pressure is 90/54 mm Hg.
C. patient complains about feeling anxious.
D. cardiac monitor shows a heart rate of 61 beats/minute.
Answer: B
Explanation: Patients taking b-adrenergic blockers should be monitored for hypotension and
bradycardia. Because this class of medication inhibits the sympathetic nervous system,
restlessness, agitation, hypertension, and anxiety will not be side effects.
11. Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left
ventricular dysfunction. To determine whether the drug is effective, the nurse
will monitor for
A. decreased blood pressure and heart rate.
B. fewer complaints of having cold hands and feet.
C. improvement in the strength of the distal pulses.
D. the ability to do daily activities without chest pain.
Answer: D
Chapter 33 - Coronary Artery Disease and Acute Coronary Syndrome
1. When developing a teaching plan for a 61-year-old man with the following risk
factors for coronary artery disease (CAD), the nurse should focus on the
A. family history of coronary artery disease.
B. increased risk associated with the patients gender.
C. increased risk of cardiovascular disease as people age.
D. elevation of the patients low-density lipoprotein (LDL) level.
Answer: D
Explanation: Because family history, gender, and age are nonmodifiable risk factors, the
nurse should focus on the patients LDL level. Decreases in LDL will help reduce the patients
risk for developing CAD.
2. Which nursing intervention will be most effective when assisting the patient with
coronary artery disease (CAD) to make appropriate dietary changes?
A. Give the patient a list of low-sodium, low-cholesterol foods that should be
included in the diet.
B. Emphasize the increased risk for heart problems unless the patient makes the
dietary changes.
C. Help the patient modify favorite high-fat recipes by using monosaturated oils when
possible.
D. Inform the patient that a diet containing no saturated fat and minimal salt will be
necessary.
Answer: C
Explanation: Lifestyle changes are more likely to be successful when consideration is given
to the patients values and preferences. The highest percentage of calories from fat should
come from monosaturated 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.
3. Which assessment data collected by the nurse who is admitting a patient with
chest pain 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.
Answer: B
Explanation: 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.
4. Which information given by a patient admitted with chronic stable angina will
help the nurse confirm this diagnosis?
A. The patient states that the pain wakes me up at night.
B. The patient rates the pain at a level 3 to 5 (0 to 10 scale).
C. The patient states that the pain has increased in frequency over the last week.
D. The patient states that the pain goes away with one sublingual nitroglycerin tablet.
Answer: D
Explanation: 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.
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 some nausea as a side effect of nitroglycerin.
B. I should only take the nitroglycerin if I start to have chest pain.
C. I will call an ambulance if I still have pain after taking 3 nitroglycerin 5 minutes
apart.
D. Nitroglycerin helps prevent a clot from forming and blocking blood flow to my
heart.
Answer: C
Explanation: The emergency medical services (EMS) system should be activated when chest
pain or other symptoms are not completely relieved after 3 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.
, 6. Which statement made by a patient with coronary artery disease after the nurse
has completed teaching about therapeutic lifestyle changes (TLC) diet indicates
that further teaching is needed?
A. I will switch from whole milk to 1% milk.
B. I like salmon and I will plan to eat it more often.
C. I can have a glass of wine with dinner if I want one.
D. I will miss being able to eat peanut butter sandwiches.
Answer: D
Explanation: Although only 30% of the daily calories should come from fats, most of the fat
in the TLC diet should come from monoasturated fats such as are found in nuts, olive oil, and
canola oil. The patient can include peanut butter sandwiches as part of the TLC diet. The
other patient comments indicate a good understanding of the TLC diet.
7. After the nurse teaches the patient about the use of carvedilol (Coreg) in
preventing anginal episodes, which statement by a patient indicates that the
teaching has been effective?
A. Carvedilol will help my heart muscle work harder.
B. It is important not to suddenly stop taking the carvedilol.
C. I can expect to feel short of breath when taking carvedilol.
D. Carvedilol will increase the blood flow to my heart muscle.
Answer: B
Explanation: Patients who have been taking b-adrenergic blockers can develop intense and
frequent angina if the medication is suddenly discontinued. Carvedilol (Coreg) decreases
myocardial contractility. Shortness of breath that occurs when taking b-adrenergic blockers
for angina may be due to bronchospasm and should be reported to the health care provider.
Carvedilol works by decreasing myocardial oxygen demand, not by increasing blood flow to
the coronary arteries.
8. A patient who has had chest pain for several hours is admitted with a diagnosis
of rule out acute myocardial infarction (AMI). Which laboratory test should the
nurse monitor to help determine whether the patient has had an AMI?
A. Myoglobin
B. Homocysteine
C. C-reactive protein
D. Cardiac-specific troponin
Answer: D
Explanation: Troponin levels increase about 4 to 6 hours after the onset of myocardial
infarction (MI) and are highly specific indicators for MI. Myoglobin is released within 2
, hours of MI, but it lacks specificity and its use is limited. The other laboratory data are useful
in determining the patients risk for developing coronary artery disease (CAD) but are not
helpful in determining whether an acute MI is in progress.
9. Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetals
(variant) angina. When teaching the patient, the nurse will include the
information that diltiazem will
A. reduce heart palpitations.
B. decrease spasm of the coronary arteries.
C. increase the force of the heart contractions.
D. help prevent plaque from forming in the coronary arteries.
Answer: B
Explanation: Prinzmetals angina is caused by coronary artery spasm. Calcium channel
blockers (e.g., diltiazem, amlodipine [Norvasc]) are a first-line therapy for this type of
angina. Lipid-lowering drugs help reduce atherosclerosis (i.e., plaque formation), and b-
adrenergic blockers decrease sympathetic stimulation of the heart (i.e., palpitations).
Medications or activities that increase myocardial contractility will increase the incidence of
angina by increasing oxygen demand.
10. The nurse will suspect that the patient with stable angina is experiencing a side
effect of the prescribed metoprolol (Lopressor) if the
A. patient is restless and agitated.
B. blood pressure is 90/54 mm Hg.
C. patient complains about feeling anxious.
D. cardiac monitor shows a heart rate of 61 beats/minute.
Answer: B
Explanation: Patients taking b-adrenergic blockers should be monitored for hypotension and
bradycardia. Because this class of medication inhibits the sympathetic nervous system,
restlessness, agitation, hypertension, and anxiety will not be side effects.
11. Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left
ventricular dysfunction. To determine whether the drug is effective, the nurse
will monitor for
A. decreased blood pressure and heart rate.
B. fewer complaints of having cold hands and feet.
C. improvement in the strength of the distal pulses.
D. the ability to do daily activities without chest pain.
Answer: D
