LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 30 Nursing Care of Patients with Coronary Heart Disease

1) The nurse is preparing a teaching tool about coronary heart disease risk factors. Which information should the nurse include about modifiable risk factors? Select all that apply.

1. Hypertension

2. Diabetes mellitus

3. Obesity

4. Age

5. Heredity

Page Ref: 1001

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

2) A patient is experiencing chest pain. What diagnostic test should the nurse anticipate being prescribed for this patient to determine coronary artery status?

1. Coronary angiography

2. Stress electrocardiography

3. Echocardiography

4. Radionuclide testing

Page Ref: 1007

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

3) Aspirin has been prescribed for a patient following a myocardial infarction. What should the nurse include when teaching about this drug?

1. Check with your healthcare provider before taking any herbal remedies.

2. Report any itching that develops after seven days of taking the drug.

3. Take at a different time of day than warfarin (Coumadin).

4. Do not skip any scheduled appointments to have blood drawn for labs.

Page Ref: 1013

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

4) A patient recovering from coronary artery bypass graft (CABG) surgery has a heart rate of 120 bmp, blood pressure 90/50 mmHg, decreased urine output, decreased chest tube output, muffled heart sounds, and weak peripheral pulses. What action should the nurse take first?

1. Notify the physician immediately.

2. Recheck vital signs in 15 minutes.

3. Reposition the patient.

4. Increase the intravenous fluids.

Page Ref: 1017

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

5) A middle-aged female patient asks why she has not been prescribed a daily dose of aspirin when her spouse of the same age has been. What should the nurse explain is the most likely reason for this?

1. The benefit of aspirin in women under age 65 is not clear.

2. Aspirin is not recommended for women.

3. This must have been an oversight.

4. She has other medications that could interfere.

Page Ref: 1004

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

6) A patient recovering from a myocardial infarction asks if it is appropriate to use garlic and drink red wine. Which response should the nurse make?

1. "Discuss your idea with the physician to see what would benefit you."

2. "That sounds fine. See how they work."

3. "I wouldn't do that if I were you."

4. "You should also add ginkgo biloba for cardiovascular health."

Page Ref: 1004

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

7) The nurse instructs a patient about cardiac risk factors. For which laboratory test should the patient be instructed to increase the intake of foods with folic acid and the B vitamins?

1. Homocysteine

2. Creatinine

3. High density lipoprotein (HDL)

4. INR

Page Ref: 1002

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

8) A patient is experiencing chest pain. Which should the nurse expect to assess if this patient is experiencing an acute myocardial infarction?

1. Substernal pressure type pain, radiating down the left arm

2. Colic-like epigastric pain

3. Sharp, well-localized unilateral chest and left arm pain

4. Sharp, burning chest pain moving from place to place

Page Ref: 1011

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with coronary heart disease.

9) The nurse is caring for a patient diagnosed with variant angina. What should this diagnosis indicate to the nurse?

1. Presence of coronary artery spasm

2. Associated with renal disease

3. Associated with pulmonary disease

4. Presence of a myocardial infarction

Page Ref: 1006

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Practice-Know-How; Apply evidence to support decision making in situations characterized by ambiguity and uncertainty | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with coronary heart disease.

10) A patient enters the emergency department complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this patient should include which nursing action? Select all that apply.

1. Morphine intravenously and oxygen

2. Aspirin 325 mg orally

3. Open heart surgery

4. Heparin drip at 100 units per hour

5. Insert indwelling urinary catheter

Page Ref: 1024, 1026

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

11) The nurse suspects that a patient experienced a transmural myocardial infarction. What electrocardiogram finding did the nurse use to make this clinical decision?

1. Q wave deepening

2. ST segment elevation

3. ST segment depression

4. P wave inversion

Page Ref: 1020

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

12) A patient reports chest pain, nausea, and vomiting off and on for the last 4 days, which the patient interpreted as the flu. What laboratory test will provide information about acute cardiac damage for this patient?

1. Troponin I and T

2. Red blood cells

3. CK-MB

4. Homocysteine and platelets

Page Ref: 1012

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

13) Fifteen hours after admission, a patient's CK-MB level is markedly increased. What should this indicate to the treatment team?

1. Cellular necrosis of myocardial tissue has occurred.

2. Lactic acid is present.

3. Thrombolytic therapy is indicated.

4. Cardiac function has returned to normal.

Page Ref: 1012

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

14) The nurse is caring for a patient experiencing acute myocardial infarction. What electrocardiogram change should the nurse expect for this patient's health problem?

1. ST-segment elevation

2. Loss of P waves

3. Bradycardia

4. Widening of the QRS complex

Page Ref: 1012

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

15) The nurse is caring for a patient recovering from fibrinolytic therapy. For which common complication should the nurse focus care for this patient?

1. Bleeding

2. Hypotension

3. Lethargy

4. Heart block

Page Ref: 1025

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

16) Upon auscultating the chest of an older patient who recently experienced a myocardial infarction (MI), the nurse hears an S3 and lung crackles. Because of these findings, the nurse should assess for what other condition?

1. Heart failure

2. Extension of the MI

3. Renal failure

4. Liver failure

Page Ref: 1017

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with coronary heart disease.

17) A patient recovering from cardiovascular surgery has a chest tube output of 110 mL/hr. What should the nurse do? Select all that apply.

1. Report to the surgeon.

2. Check the hemoglobin and hematocrit.

3. Administer a blood transfusion.

4. Notify the family.

5. Strip and vent the chest tube.

Page Ref: 1017

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

18) The family of a patient who experienced a stroke after percutaneous coronary revascularization asks the nurse what caused the stroke to occur. How should the nurse respond to the family?

1. "A stroke could have been caused by clot particles from the procedure."

2. "Stroke is usually caused by ruptured plaque inside the coronary artery."

3. "Stroke is caused by heart failure."

4. "No one knows what causes strokes."

Page Ref: 1015

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

19) The nurse is participating in a screening program for coronary heart disease (CHD). For which information should the nurse evaluate a patient for CHD? Select all that apply.

1. Diabetes

2. Hyperlipidemia

3. Positive family history

4. A premenopausal woman

5. Hypotension

Page Ref: 997

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with coronary heart disease.

20) The nurse is conducting teaching about risk factor management for cardiovascular disease (CVD) at a senior center. What is the most important information for the nurse to include?

1. Stop smoking.

2. Eat in moderation.

3. Exercise when able.

4. Reduce saturated fats in the diet.

Page Ref: 1001

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with coronary heart disease.

21) The nurse is preparing medications for a patient with hyperlipidemia. What information should the nurse consider when administering these medications?

1. Such medications include the statins, which act by lowering LDL levels.

2. These medications act by increasing the LDL levels and decreasing the HDL levels.

3. These medications do not include angiotensin-converting enzyme (ACE) inhibitors.

4. Such medications include bile acid sequestrants as first-line drugs to lower cholesterol levels.

Page Ref: 1002

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

22) A patient is prescribed atorvastatin (Lipitor). For which adverse effect should the nurse monitor this patient?

1. Liver enzyme alteration

2. Blood glucose and uric acid level alteration

3. Renal function alteration

4. Sudden back pain and constipation

Page Ref: 1003

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

23) The nurse has completed teaching related to dietary management of coronary heart disease (CHD). Which patient statement indicates that teaching has been effective?

1. "I can lower my trans fatty acids by switching to the soft margarines and vegetable spreads."

2. "I will watch my fiber intake so I don't get too much."

3. "Well, I'll just have to go buy some of that coconut oil to cook with."

4. "Drinking a couple of glasses of milk each day will give me better protein."

Page Ref: 1001

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

24) A middle-aged obese male patient with elevated triglycerides and a history of smoking two packs of cigarettes a day for 20 years asks about the risk for coronary artery disease. What information should the nurse provide?

1. He is at risk for coronary artery disease.

2. He is not at risk for coronary artery disease.

3. He has nothing but nonmodifiable risk factors for coronary artery disease.

4. He has nothing but modifiable risk factors for coronary artery disease.

Page Ref: 1000

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Assessment/Communication and Documentation

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with coronary heart disease.

25) The nurse is caring for an adult patient who is admitted with chest pain that began four hours ago. Which test will be most specific in identifying acute heart damage?

1. Troponin

2. CK

3. CK-MB

4. Cholesterol

Page Ref: 1012

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

26) The nurse is caring for a patient with ventricular tachycardia. Which care should the nurse prepare to provide to this patient? Select all that apply.

1. Immediate assessment and probable emergency intervention by the nurse

2. Cardioversion, if sustained and symptomatic

3. Administration of a potassium channel blocker

4. Close observation for one hour prior to calling the physician

5. Defibrillation to convert the rhythm in the awake patient

Page Ref: 1034

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

27) A patient has a junctional escape rhythm. Which action should the nurse make a priority?

1. Assess the patient for symptoms associated with this rhythm.

2. Contact the physician immediately for emergency orders.

3. Eliminate caffeine from the diet.

4. Prepare for a pacemaker insertion.

Page Ref: 1034

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

28) The nurse is instructing a patient on nitroglycerin tablets prescribed to treat angina. Which statement should be included in the nurse's instructions? Select all that apply.

1. "Take a second dose if the angina is not relieved within five minutes."

2. "The drug should remain in this brown bottle since it is sensitive to light."

3. "Store this medication in your bathroom medicine cabinet so it is readily available to you."

4. "Eating or drinking will not interfere when taking the medication."

5. "Call your doctor immediately if you develop a headache when taking this drug."

Page Ref: 1008

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

29) Sinus bradycardia with a rate 56 beats per minute is identified in a sleeping patient on telemetry. Which action should the nurse take first?

1. Awaken the patient and see how the heart rate responds.

2. Call the physician and report this dysrhythmia.

3. Check the medication administration record and see if there is a PRN medication that will improve this rhythm.

4. Call for an immediate 12-lead electrocardiogram (ECG).

Page Ref: 1036

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

30) A patient is in sinus tachycardia. Which nursing interventions are appropriate? Select all that apply.

1. Observe the patient for effects on cardiac function.

2. Administer two tablets of acetaminophen (Tylenol) per physician prescription if an elevated temperature is present.

3. Administer normal saline 0.9% IV at the prescribed rate of 200 mL per hour if hypovolemia is suspected as the cause.

4. Give pain medications as prescribed if pain is present.

5. Give atropine per physician prescription to slow the heart rate.

Page Ref: 1033, 1047

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

31) A patient with a pacemaker has one pacing spike before every QRS complex and the rhythm does not change with rest or activity. For which type of pacemaker should the nurse plan care for this patient?

1. Asynchronous pacing

2. Demand pacing

3. Dual-chamber pacing

4. Atrial single-chamber pacing

Page Ref: 1043

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

32) A patient on continuous cardiac monitoring is in no apparent distress, sitting in the chair and eating. Which action should the nurse take? Select all that apply.

1. Confirm that lead wires are properly connected.

2. Assess placement of electrodes.

3. Remove and reapply new electrodes if nonadherent.

4. Assess skin sites and move an electrode if the skin appears irritated.

5. Call for assistance.

Page Ref: 1047

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

33) A patient is experiencing nausea, loss of appetite, blurred and double vision, green yellow halos, vomiting and "feeling uneasy." What drug toxicity should the nurse suspect is occurring with this patient?

1. Digoxin

2. Lidocaine

3. Amiodarone

4. Procainamide

Page Ref: 1041

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

34) The nurse is caring for a patient with premature ventricular contractions (PVCs). What should the nurse keep in mind about this heart rhythm?

1. PVCs are insignificant in people with no history of heart disease.

2. PVCs typically have no pattern.

3. The frequency of PVCs is not associated with specific events.

4. Their incidence and significance have no relevance to the patient having had a myocardial infarction.

Page Ref: 1037

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with coronary heart disease.

35) A patient is recovering from implantable cardioverter-defibrillator (ICD) insertion. Which teaching should the nurse provide to the patient during discharge?

1. "If a family member is in direct contact with you when the ICD discharges, he or she may experience a shock or tingling sensation."

2. "You can activate the ICD whenever you feel a change in your heart rhythm."

3. "The batteries of the ICD won't need to be replaced if the ICD never shocks the heart."

4. "There should be no discomfort if the ICD discharges, and you probably won't notice it."

Page Ref: 1046

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

36) The nurse is preparing a presentation on coronary heart disease (CHD) for a community women's club. Which statement should the nurse include in the presentation? Select all that apply.

1. The epigastric pain and nausea experienced with a heart attack are often attributed to heartburn.

2. Common symptoms of myocardial infarction (MI) include shortness of breath and fatigue.

3. Women are more likely to have an unrecognized myocardial infarction.

4. Weakness of the legs and back often precede a heart attack.

5. The mortality rate of young women having an MI is 50% lower than that of men.

Page Ref: 1021

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Context and Environment; Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with coronary heart disease.

37) A patient with coronary heart disease (CHD) is prescribed propranolol (Inderal). For which information in the patient's history should the nurse question this prescription?

1. Asthma and chronic obstructive pulmonary disease (COPD)

2. Taking antioxidants

3. Taking simvastatin (Zocor)

4. Bleeding disorders

Page Ref: 1008

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.

38) A patient identified as being at risk for coronary heart disease does not understand why exercise is important. What should the nurse explain to this patient? Select all that apply.

1. Exercise decreases blood pressure.

2. Exercise increases oxygen to the heart.

3. Exercise potentiates platelet aggregation.

4. Exercise decreases the workload of the heart.

5. Exercise improves the electrical ability of the heart.

Page Ref: 1002, 1005

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Context and Environment; Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

39) A patient with a high risk for coronary heart disease is prescribed a 1750-kcal diet in which 55% of the diet is to be carbohydrates and 20% fat. How many calories should the nurse instruct the patient consume as protein each day? Record your answer rounding up to the nearest whole number.

Page Ref: 1004

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

40) A patient with coronary heart disease is prescribed niacin (Nicobid). What should the nurse instruct the patient about this medication? Select all that apply.

1. Take with meals and a cold beverage.

2. Take with prescribed statin medication.

3. Keep routine appointments for blood work.

4. Report facial flushing to the healthcare provider.

5. Drink 4 ounces of alcohol if facial flushing occurs.

Page Ref: 1003

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 30.1 Describe the pathophysiology and manifestations of disorders of myocardial perfusion, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with coronary heart disease.

41) A patient is experiencing supraventricular tachycardia. Which medications should the nurse prepare to administer to this patient? Select all that apply.

1. Verapamil (Calan)

2. Diltiazem (Cardizem)

3. Amlodipine (Norvasc)

4. Propafenone (Rythmol)

5. Adenosine (Adenocard)

Page Ref: 1041

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 30.2 Describe the pathophysiology and manifestations of cardiac dysrhythmias, and outline the interprofessional care and nursing care of patients with these disorders.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with coronary heart disease.