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Med Surge Ch. 30: Coronary Heart
Disease NCLEX Questions and Answers
Rated A+
The nurse instructs a patient about modifiable risk factors for coronary artery disease. Which statements indicate that teaching has been effective? (Select all that apply)
- I should stop smoking to reduce my risk of heart disease
- Restricting my activity reduces the onset of heart disease
- I should drink alcohol because this prevents hearts disease
- There is not much that can be done to prevent heart disease
- Obesity is a risk actor that I can change to reduce the onset of heart disease ✔✔1, 5
Modifiable risk factors for the development of coronary artery disease include obesity, smoking, and physical inactivity
A patient is prescribed lovastatin (Mevacor) for hyperlipidemia. What should the nurse instruct the patient about this medication?
- Abstain from alcohol use while taking this drug
- Take the drug with meals to minimize gastric distress
- Promptly report muscle pain or tenderness to the physician
- Consume a diet that includes no more than 20% of calories from saturated fat. ✔✔3.
Lovastatin is a first line drug for treating hyperlipidemia and can cause myopathy. All patients should be instructed to report muscle pain and weakness or brown urine, which is an indication of muscle breakdown.
The nurse is caring for a patient with stable angina. Which assessment finding would be consistent with this medical diagnosis?
- Persistent ECG changes
- Increasing nocturnal pain
- Correlation between activity level and pain
- Evidence of impaired cardiac output such as weak peripheral pulses. ✔✔3. Stable angina is
the most common and predictable form of angina. It occurs with a predictable amount of activity or stress and usually occurs when the work of the heart is increased by physical exertion, exposure to the cold, or by stress.
The nurse is caring for a patient with acute coronary syndrome. Which nursing diagnosis should be the priority for this patient?
The nurse is planning care for a patient with acute myocardial infarction. What goals should the nurse use to guide this patient's care? (Select all that apply)
- Relieve chest pain
- Prevent complications
- Reduce blood viscosity
- Decrease cardiac workload
- Reduce myocardial damage ✔✔1,2,4,
Immediate treatment goals for the patient with an acute myocardial infarction are to reduce chest pain, myocardial damage, decrease cardiac workload, and prevent complication. Blood viscosity is not implicated in the development of an acute MI, but plays a role in peripheral vascular resistance.
The nurse is determining nursing diagnoses appropriate for a patient scheduled for fibrinolytic therapy. Which nursing diagnosis would a priority for this patient?
- Anxiety
- Ineffective protection
- Risk for powerlessness
- Ineffective health maintenance ✔✔2. Fibrinolytic therapy, administered to restore myocardial
perfusion, disruts the clotting cascade and can lead to potentially serious bleeding. Establishing bleeding precautions is vital to preserve physiologic integrity. The diagnosis Ineffective protection would be the priority for this patient.
The nurse is reviewing laboratory results for a patient admitted with acute chest pain. Which laboratory value should cause the nurse the most concern?
- AST 65 units/L
- CK 320 units/L
- Hematocrit 35%
- APTT 35 seconds ✔✔2. Creatine kinase is an important enzyme for celar function found
principally in cardiac and skeletal muscle and the brain. CK levels rise rapidly with damage to these tissues, appearing in the serum 4-6 hours after an acute MI, peaking within 12-14 hours and then declining. The CK level correlates with the size of the infarction; the greater the amount of infarcted tissue, the higher the serum CK level.
AST is a liver enzyme
- Assess peripheral pulses on all four extremities
- Determine if an apical-radial pulse deficit is present ✔✔1. Sinus bradycardia may be well
tolerated in some patients and assessment is needed before treating. If decreased mental status and hypotension are presentIV atropine may be indicated.
