Chapter 40: Care of Patients with Acute Coronary Syndromes

Chapter 40: Care of Patients with Acute Coronary Syndromes

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is taking the history of a client with suspected coronary artery disease (CAD). Which situation correlates with stable angina?

a.	Chest discomfort at rest and inability to tolerate mowing the lawn
b.	Chest discomfort when mowing the lawn and subsiding with rest
c.	Indigestion and a choking sensation when mowing the lawn
d.	Jaw pain that radiates to the shoulder after mowing the lawn

 

 

ANS:  B

The client with stable angina reports chest discomfort that occurs with moderate, prolonged exertion. This discomfort is typically relieved with nitroglycerin or rest. The other experiences do not correlate with stable angina.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Analysis)

 

2. The nurse is assessing a client who has a history of stable angina. The client describes a recent increase in the number of attacks and in the intensity of the pain. Which question does the nurse ask to assess the client’s change in condition?

a.	“How many cigarettes do you smoke daily?”
b.	“Do you have pain when you are resting?”
c.	“Do you have abdominal pain or nausea?”
d.	“How frequently are you having chest pain?”

 

 

ANS:  B

An increase in the number of anginal attacks and an increase in the intensity of pain characterize unstable angina. Chest pain or discomfort also occurs at rest. The nurse should assess for this characteristic of unstable angina. The other questions would not be helpful in assessing for unstable angina.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Analysis)

 

3. The community health nurse assesses clients at a health fair. Which statement assists the nurse to identify modifiable risk factors in clients with coronary artery disease?

a.	“Would you please state your full name and birth date?”
b.	“Have you ever had an exercise tolerance stress test?”
c.	“In what activities do you participate on a daily basis?”
d.	“Does anyone in your family have a history of heart disease?”

 

 

ANS:  C

Modifiable risk factors can be altered or controlled. Cigarette smoking and a sedentary lifestyle are examples of behaviors that are modifiable. Nonmodifiable factors are personal elements that cannot be altered or controlled (e.g., age, gender, family history). A stress test would not provide any information about risk factors.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Alterations in Body Systems)                   MSC:  Integrated Process: Nursing Process (Assessment)

 

4. The nurse teaches a client who is newly diagnosed with coronary artery disease. Which instruction does the nurse include to minimize complications of this disease?

a.	“Rest is the best medicine at this time. Do not start an exercise program.”
b.	“You are a man; therefore there is nothing you can do to minimize your risks.”
c.	“You should talk to your provider about medications to help you quit smoking.”
d.	“Decreasing the carbohydrates in your diet will help you lose weight.”

 

 

ANS:  C

Modifiable risk factors can be altered or controlled. Cigarette smoking and a sedentary lifestyle are examples of behaviors that are modifiable. Nonmodifiable factors are personal elements that cannot be altered or controlled (e.g., age, gender, family history). The nurse needs to encourage the client to stop smoking because this is a proven risk factor for coronary artery disease development. The nurse should also encourage weight loss and moderate exercise.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC:  Integrated Process: Nursing Process (Assessment)

 

5. The emergency department nurse is assessing an 82-year-old client for a potential myocardial infarction. Which clinical manifestation does the nurse monitor for?

a.	Pain on inspiration
b.	Posterior wall chest pain
c.	Disorientation or confusion
d.	Numbness and tingling of the arm

 

 

ANS:  C

In older adults, disorientation or confusion may be the major manifestation of myocardial infarction caused by poor cardiac output. Pain manifestations could also be related to the myocardial infarction. However, the nurse is more concerned about the new onset of disorientation or confusion caused by decreased perfusion.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Health Promotion and Maintenance (Aging Process)

MSC:  Integrated Process: Nursing Process (Assessment)