Test Bank Chapter 19- Disorders of Cardiac Function NURS 3365

1. The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses? A) Stable angina B) Non–ST-segment elevation MI C) ST-segment elevation MI D) Unstable angina Ans: A Feedback: The fixed or stable plaque is commonly associated with stable angina, and the unstable plaque is implicated in unstable angina and myocardial infarction (MI). 2. Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A) Red thrombus B) Large lipid core C) Calcified lesion D) Vessel wall injury Ans: B Feedback: Plaque disruption causes thrombus formation, with white platelet-containing thrombi being associated with unstable angina. The major determinants of plaque vulnerability to disruption include the size of its lipid-rich core, lack of stabilizing smooth muscle cells, presence of inflammation with plaque degradation, and stability and thickness of its fibrous cap. Plaques with a thin fibrous cap overlaying a large lipid core are at high risk for rupture. Plaque tends to be stable or fixed unevenly in any area of the coronary arteries. Calcified plaque tends to be stable and encased in a thrombus, until it begins to degrade. 3. Clients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: A) Heart murmurs B) ECG changes C) Pulmonary disease D) Pericardial effusion Ans: B Feedback: Persons with ischemic coronary vessel disease and ACS are routinely classified as low or high risk for acute myocardial infarction based on clinical history, ECG variables, and serum cardiac biomarkers. Chronic pulmonary disease increases pulmonary vascular resistance, leading to right or left heart failure. Pericardial effusion increases intracardiac pressure and venous pressure. Heart murmurs result from turbulent blood flow through a diseased valve. 4. Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)? A) A client whose most recent ECG indicates that silent myocardial ischemia has occurred B) A client who occasionally experiences persistent and severe chest pain when at rest C) A client who sometimes experiences chest pain when climbing stairs D) A client who has recently been diagnosed with variant (vasospastic) angina Ans: B Feedback: The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin. Silent MI, stable angina, and variant, or vasospastic, angina are subtypes of chronic ischemic coronary artery disease.