Chapter 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery

Chapter 20: Care of Patients with Coronary Artery Disease and Cardiac Surgery

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is caring for a patient with agina pectoris who asks what happens to make his body experience pain. The nurse explains that pain results from which underlying causative factor?

a.	Congestion that backs up into the lungs
b.	Inadequate blood flow and poor oxygen supply
c.	Edema from fluid overload
d.	Inflammation in the vessels

 

 

ANS:  B

Angina pectoris (chest pain) occurs when blood supply to the heart is decreased or totally obstructed. Pain results from ischemia (inadequate blood and oxygen supply).

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   450

OBJ:   2 (theory)       TOP:   CAD: Pain      KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

2. How does a myocardial infarction (MI) alter the pumping efficiency of the heart?

a.	An MI reduces the impulse from the sinoatrial node.
b.	An MI causes myocardial necrosis.
c.	An MI shunts all myocardial blood flow to a specific cardiac region.
d.	An MI causes myocardial swelling and inflammation.

 

 

ANS:  B

Myocardial necrosis (damaged or dead heart muscle tissue) cannot contract effectively, which decreases pumping efficiency (cardiac output).

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   450

OBJ:   2 (theory)       TOP:   MI: Pathophysiology

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

3. The nurse is caring for a patient admitted with chest pain to rule out a myocardial infarction (MI). The nurse observes that the patient is experiencing electrocardiogram (ECG) changes and reviews new laboratory results. Which laboratory value should the nurse report immediately?

a.	Troponin of 2.4 mcg/L
b.	Potassium of 3.4 mEq/L
c.	Creatine phosphokinase of 134 IU/L
d.	Sodium of 133 mEq/L

 

 

ANS:  A

The patient has a significantly elevated troponin. The abnormal troponin, along with ECG changes, indicates that the patient is likely experiencing an MI. (Elevated troponin levels are most indicative of an MI as these enzymes are specific to heart muscle damage.) While the nurse should report the abnormally low potassium of 3.4 (low normal) sodium, these findings are of lesser priority than the elevated troponin.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   458

OBJ:   5 (theory)       TOP:   MI: Cardiac Enzymes

KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

4. The nurse is caring for a post–myocardial infarction (MI) patient who has been started on daily simvastatin (Zocor) and a low-fat diet. Which statement best indicates that the nurse’s teaching has been successful?

a.	“I will need to have blood work every month while taking Zocor.”
b.	“I should take my Zocor with grapefruit juice to help absorption.
c.	“I should call my doctor if I experience unexplained muscle pain.”
d.	“I should take Zocor an hour before my biggest meal of the day.”

 

 

ANS:  C

Statins can injure muscle tissue and are toxic to the liver in some patients. Patients should report any unexplained muscle tenderness or pain persisting for more than a few days. Laboratory tests for liver enzymes are recommended at the start of therapy and only when clinically indicated. Grapefruit juice interferes with drug metabolism and should be avoided to prevent increased risk of toxicity. Zocor can be taken without regard to meals.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   454, Clinical Cues

OBJ:   2 (clinical)      TOP:   Statins: Precaution

KEY:  Nursing Process Step: Evaluation

MSC:  NCLEX: Physiological Integrity: Pharmacological Therapies

 

5. The nurse is educating a patient on a low-fat, low-cholesterol diet after a myocardial infarction (MI). Which food choice should the nurse recommend?

a.	“Avoid eating frozen foods.”
b.	“Replace a serving of red meat with a serving of fish.”
c.	“Use nondairy creamer in your decaffeinated coffee.”
d.	“Drink a serving of grapefruit juice each day.”

 

 

ANS:  B

Fish have a high content of omega-3 fatty acids, which are helpful in reducing cholesterol. Not all frozen foods are unhealthy. Frozen vegetables with no sodium added are a good choice for a low-fat, low-cholesterol diet. Nondairy creamer is high in trans fat and saturated fat. Grapefruit juice often interferes with metabolism of a variety of medications.

 

PTS:   1                    DIF:    Cognitive Level: Application

REF:   454, Nutrition Considerations          OBJ:   3 (clinical)      TOP:   Low-Fat Diet: Omega-3

KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease