Chapter 28 Pharmacology For Nurses A Pathophysiologic Approach 5th Edition

Chapter 28 Pharmacology For Nurses A Pathophysiologic Approach 5th Edition

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

The patient says to the nurse, “My doctor said I can’t have fried chicken anymore because I have heart disease. I’ve eaten it all my life and am fine except for some indigestion lately.” What is the best response by the nurse?

1. “Did your doctor mention exercise? That is the most important lifestyle change to slow the progression of your heart disease.”
2. “Your indigestion is an indication that your body cannot tolerate fatty foods; this causes an increased workload for your heart.”
3. “Fried chicken is actually okay, but you must be very careful with the type of fat that you fry the chicken in.”
4. “Your indigestion could actually be chest pain caused by narrowed coronary arteries; you will need a low-fat diet.”

Correct Answer: 4

Rationale 1: Exercise is only one of several important healthy lifestyle habits to prevent or slow the progression of coronary artery disease (CAD).

Rationale 2: Some patients experience angina pain in the midepigastrium, which is an indication of coronary artery disease (CAD), not an intolerance of fatty foods.

Rationale 3: The patient should not consume chicken fried in any type of fat since foods that are high in saturated fats should be avoided.

Rationale 4: The most common etiology of coronary artery disease (CAD) in adults is atherosclerosis, the presence of plaque within coronary artery walls. To decrease this, patients should eliminate foods high in cholesterol or saturated fats.

Global Rationale: The most common etiology of coronary artery disease (CAD) in adults is atherosclerosis, the presence of plaque within coronary artery walls. To decrease this, patients should eliminate foods high in cholesterol or saturated fats. Some patients experience angina pain in the midepigastrium, which is an indication of coronary artery disease (CAD), not an intolerance of fatty foods. Exercise is only one of several important healthy lifestyle habits to prevent or slow the progression of coronary artery disease (CAD). The patient should not consume chicken fried in any type of fat since foods that are high in saturated fats should be avoided.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 28-1 Explain the pathogenesis of coronary artery disease.

MNL Learning Outcome: 4.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 413

 

Question 2

Type: MCMA

The nurse is conducting an education class about myocardial blood supply for patients with coronary artery disease (CAD). The nurse determines that learning has occurred when the patients make which statements.

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “The heart has right and left arteries that arise from the aorta.”
2. “The coronary arteries carry blood away from the heart to the right atrium.”
3. “The heart receives its oxygen through the blood that fills it.”
4. “Coronary arteries primarily carry blood to the left ventricle.”
5. “The right and left arteries have smaller branches that go around the heart.”

Correct Answer: 1,5

Rationale 1: The myocardium receives blood from the right and left coronary arteries that arise from aortic sinuses at the base of the aorta.

Rationale 2: The coronary veins, not arteries, carry blood to the right atrium.

Rationale 3: Although the heart is filled with blood, this is not its source of oxygen.

Rationale 4: The coronary arteries supply blood to all areas of the heart, not primarily the left ventricle.

Rationale 5: The right and left coronary arteries diverge into smaller branches that encircle the heart.

Global Rationale: The myocardium receives blood from the right and left coronary arteries that arise from aortic sinuses at the base of the aorta. These diverge into smaller branches that encircle the heart. The coronary veins, not arteries, carry blood to the right atrium. The coronary arteries supply blood to all areas of the heart, not primarily the left ventricle. Although the heart is filled with blood, this is not its source of oxygen.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 28-1 Explain the pathogenesis of coronary artery disease.

MNL Learning Outcome: 4.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 413

 

Question 3

Type: MCSA

The patient is being treated for angina. He asks the nurse if angina is the same thing as having a heart attack. What is the best response by the nurse?

1. “They have some things in common, for example, severe emotional distress and panic can accompany both angina and myocardial infarction.”
2. “Angina means heart muscle is not getting enough oxygen, while heart attack, or myocardial infarction, means part of your heart has died.”
3. “Actually, it depends on what type of angina you mean; there are several types.”
4. “They are basically the same.”

Correct Answer: 2

Rationale 1: This is a true statement but is not the best explanation for the patient.

Rationale 2: A myocardial infarction indicates ischemia and necrosis have occurred to the affected part of the myocardium. Angina results from ischemia without necrosis.

Rationale 3: There are several types of angina; however, this response does not answer the patient’s question.

Rationale 4: There are differences between angina and myocardial infarction.

Global Rationale: Angina pectoris is acute chest pain caused by insufficient oxygen reaching a portion of the myocardium. Accompanying the discomfort is severe emotional distress, a feeling of panic with fear of impending death. A myocardial infarction indicates ischemia and necrosis have occurred to the affected part of the myocardium. Angina and myocardial infarction are different in that with myocardial infarction ischemia and necrosis occur to a portion of the myocardium. There are several types of angina; however, this response does not answer the patient’s question.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 28-1 Explain the pathogenesis of coronary artery disease.

MNL Learning Outcome: 4.2.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 413

 

Question 4

Type: MCSA

The nurse is providing care to a patient who has experienced several episodes of angina. What is the primary desired outcome for this patient?

1. The patient will experience relief of chest pain with anticoagulant therapy.
2. The patient will experience relief of chest pain with nitrate therapy.
3. The patient will experience relief of chest pain with aspirin therapy.
4. The patient will experience relief of chest pain with therapeutic lifestyle changes.

Correct Answer: 2

Rationale 1: Anticoagulant therapy is used to prevent additional thrombi from forming post–myocardial infarction; it will not relieve angina pain.

Rationale 2: A primary goal in the treatment of angina is to reduce the intensity and frequency of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode.

Rationale 3: Aspirin therapy following an acute myocardial infarction dramatically reduces mortality due to its antiplatelet function; it will not relieve angina pain.

Rationale 4: Therapeutic lifestyle changes are significant if the patient is to maintain a healthy heart, but they will not relieve chest pain; this is accomplished with medications.

Global Rationale: A primary goal in the treatment of angina is to reduce the intensity and frequency of angina episodes. Rapid-acting organic nitrates are the drugs of choice for terminating an acute angina episode. Anticoagulant therapy is used to prevent additional thrombi from forming post–myocardial infarction; it will not relieve angina pain. Therapeutic lifestyle changes are significant if the patient is to maintain a healthy heart, but they will not relieve chest pain; this is accomplished with medications. Aspirin therapy following an acute myocardial infarction dramatically reduces mortality due to its antiplatelet function; it will not relieve angina pain.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28-4 Explain mechanisms of drugs used to manage angina.

MNL Learning Outcome: 4.2.2 Compare the classes of medications used in pharmacologic management: Angina pectoris.

Page Number: 413