CAD/CHF Exam Questions PDF

3. The nurse is caring for a patient recovering from a coronaryangioplasty with stent placement. Which intervention is a priority for...

3. The nurse is caring for a patient recovering from a coronaryangioplasty with stent placement. Which intervention is a priority for the patient at this time? CAD/CHF A. Securing chest tubes to bedding B. Maintaining leg extension on the affected side 1. The nurse is caring for a client with a history ofatherosclerosis. The client has chest pain that occurs with physical exertion or C. Discontinuing intravenous lines when taking oral fluids stress and is relieved with sublingual nitroglycerin. Which disorder should the nurse recognize the client is most likely experiencing? D. Treating chest pain with intravenous morphine as needed A. Prinzmetal angina B. Acute coronary syndrome C. Myocardial infarction Asnwer: B D. Stable angina Rationale: The cardiac catheter used to insert the stent is usuallyinserted via the femoral artery, a large, high-pressure vessel. Answer: Stable angina The leg is maintained in extension for a prescribed period after the procedure to reduce the risk of bleeding, hematoma formation, or clot formation at the insertion site. Rationale: Stable angina is a predictable form of angina, whichusually occurs when the work of the heart is increased by physical exertion, exposure to cold, or stress. Prinzmetal(variant) angina occurs unpredictably and often at night. Theclient is currently experiencing a predictable form of angina. Clinical 4. Which patient(s) are most at risk for developing coronary arterydisease? Select-all-that-apply: manifestations of myocardial infarction include pain that is less A. A 25 year old patient who exercises 3 times per week for 30minutes a day and has a history of cervical cancer. predictable, more prolonged, and unrelieved bysublingual nitroglycerin. Clinical manifestations of acute coronary syndrome include B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day. pain that is more severe and longer than previously experienced. The pain is not predictable and is unrelieved by sublingual C. A 45 year old female that reports her father died at the age of42 from a myocardial infraction. nitroglycerin. D. A 29 year old that has type I diabetes. 2. The nurse instructs a patient about modifiable risk factors forcoronary artery disease. Which statements indicate that teaching has been effective? (Select all that apply) Answers: B,C, D. A. I should stop smoking to reduce my risk of heart disease Rationale: Remember risk factors for developing CAD include:smoking, family history, diabetes, being overweight or obese, and high B. Restricting my activity reduces the onset of heart disease cholesterol. C. I should drink alcohol because this prevents hearts disease D. There is not much that can be done to prevent heart disease E. Obesity is a risk actor that I can change to reduce the onset ofheart disease 5. Which client reaction should the nurse expect during acoronary artery spasm? A. Acute reduction in level of consciousness B. Gradual increase in peripheral edema Answer: A, E C. Gradual increase in systolic blood pressure D. Sudden onset of acute chest pain Rationale: Modifiable risk factors for the development ofcoronary artery disease include obesity, smoking, and physical inactivity  Answer: A. "I will take salicylic acid every day to increase blood flow to my heart." Answer: Sudden onset of acute chest pain Rationale: To increase the client's blood flow, one goal is toprevent the aggregation of platelets in the arteries. Salicylic acid Rationale: The nurse should expect a sudden onset of acute chest pain from a coronary artery spasm, which is characteristic (aspirin) is a pharmacologic measure to control the aggregation. of Prinzmetal angina, in which there is an acute reduction in coronary blood flow. An acute reduction in level of consciousness Statins such as atorvastatin (Lipitor) are used to decrease cholesterol and would be a part of the indicates neurologic involvement. A gradualincrease in peripheral edema is a sign of heart failure. A gradualincrease in systolic client's protocol unless theclient experienced side effects. Analgesics are not given for chestpain blood pressure can have multiple causes. since they do not increase blood flow. Nitrates for angina wouldincrease blood flow. Ibuprofen is not recommended to increase blood flow to the coronary arteries. 6. A client has constant crushing chest pain rated at 9 out of 10that began 30 minutes ago and is increasing in intensity. The nurse should recognize the client is at risk for which disorder? 8. The nurse is caring for a mildly obese older adult client withcoronary artery disease. Which action should the nurse take to A. Atherosclerosis encourage additional physical activity in this client? B. Coronary artery disease (CAD) A. Teaching the client to warm up, stretch, and cool down beforeand after all physical activities C. Stable angina B. Asking the client what kind of exercise or activities she likesto do D. Myocardial infarction (MI) C. Telling the client that moderate exercise can lead to 2 poundsof weight loss per week D. Telling the client that older adults should exercise no morethan 15 minutes at a time Answer: Myocardial infarction (MI) Answer: B. Asking the client what kind of exercise or activitiesshe likes to do Rationale: Stable angina is the predictable form of chest pain that occurs when the heart is exerted or is exposed to cold orstress. In this case, the angina is unstable, and therefore theclient is at increased risk for MI. Atherosclerosis is a long-term illness Rationale: Clients are more likely to be motivated to increasephysical activities that they already like to do, so the nurse should ask that would not cause the increasing pain and intensity described by the client. CAD is the cause of chest pain but is not a disorder about their preferences. The benefits of weight loss should be emphasized instead of how much weight will be lost, especially in an that develops as a result of it. older, obese client. Older adults should get 30 minutes of moderate activity on most days, and they should always stretch, warm up, and cool down before and after activity. 7. The nurse is teaching a client about best practices inmanaging symptoms of coronary artery disease. Which client statement suggests that the nurse's teaching has been successful? 9. Which individuals would the nurse identify as having thehighest risk for CAD? A. "I will take salicylic acid every day to increase blood flow to my heart." A. A 45-year-old depressed male with a high-stress job B. "I will stop taking Lipitor every day in order to decrease mycholesterol." B. A 60-year-old male with below normal homocysteine levels C. "Ibuprofen will help to increase blood flow to my heart." C. A 54-year-old female vegetarian with elevated high-densitylipoprotein (HDL) levels D. "I should take a pain reliever every day for my chest pain." D. A 62-year-old female who has a sedentary lifestyle and bodymass index (BMI) of 23 kg/m2  Answer: A. A 45-year-old depressed male with a high-stress job Rationale: The 45-year-old depressed male with a high-stressjob is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels 12. A patient is being discharged home after hospitalization of left ventricular systolic actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus dysfunction. As the nurse providingdischarge teaching to the patient, which statement is NOT a correct statement about this the patient with two risk factors is at greatest risk for developing CAD. condition? A. "Signs and symptoms of this type of heart failure caninclude: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." 10. When providing nutritional counseling for patients at riskfor CAD, which foods would the nurse encourage patients to include in C. "Left-sided heart failure can lead to right-sided heart failure, ifleft untreated." their diet (select all that apply)? D. "This type of heart failure can build up pressure in thehepatic veins and cause them to become congested with fluid which leads to A. Tofu peripheral edema." B. Walnuts C. Tuna fish Ratioale: This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic D. Whole milk dysfunction is where the left side of the heart is unable E. Orange juice toCONTRACT efficiently which causes blood to back-up into thelungs...leading to pulmonary edema. Answer: A, B, C. 13. A patient is diagnosed with left-sided systolicdysfunction heart failure. Which of the following are expected findings with this condition? Rationale: Tuna fish, tofu, and walnuts are all rich in omega-3fatty acids, which have been shown to reduce the risks associated A. Echocardiogram shows an ejection fraction of 38%. with CAD when consumed regularly. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmaldyspnea. D. Options A and C are both expected findings with left-sidedsystolic dysfunction heart failure. 11. Which of the following patients are MOST at risk fordeveloping heart failure? Select-all- that-apply: Rationale: Both Options A and C are correct. Option B is afinding expected in left-sided DIASTOLIC dysfunction heart failure A. A 69 year old male with a history of alcohol abuse and isrecovering from a myocardial infarction. because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. Remember a normal EF is >60% in a healthy heart. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and isbeing treated for influenza. 14. A patient has a history of heart failure. Which of thefollowing statements by the patient indicates the patient may be Rationale: These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember experiencing heart failure exacerbation? the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, A. “I’ve noticed that I’ve gain 6 lbs in one week.” Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza) B. “While I sleep I have to prop myself up with a pillow so I can breathe.” C. “I haven’t noticed any swelling in my feet or hands lately.” C. BUN 9 D. Options B and C are correct. D. Troponin 600 pg/mL >moderate, 900 pg/mL severe 17. A patient with left-sided heart failure is having difficultybreathing. Which of the following is the most appropriate nursing intervention? A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy. Rationale: Due to the patient being in fluid overload (especiallywith left-sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing 15. Patients with heart failure can experience episodes of exacerbation. All of the patients below easier. have a history of heartfailure. Which of the following patients are at MOST risk forheart failure exacerbation? 18. You're providing diet discharge teaching to a patient with ahistory of heart failure. Which of the following statements made by the patient represents they understood the diet teaching? A. A 55 year old female who limits sodium and fluid intakeregularly. A. "I will limit my sodium intake to 5-6 grams a day." B. A 73 year old male who reports not taking Amiodarone forone month and is experiencing atrial fibrillation. B. "I will be sure to incorporate canned vegetables and fish into my diet." C. A 67 year old female who is being discharged home fromheart valve replacement surgery. C. "I'm glad I can still eat sandwiches because I love bologna andcheese sandwiches." D. A 78 year old male who has a health history of eczema andcystic fibrosis. D. "I will limit my consumption of frozen meals." Raionale: Patients who are in an arrhythmia (especially a-fib) areat risk for developing heart failure because the heart is not Rationale: Patients with heart failure should limit sodium intake to 2 to 3 grams per day contracting properly and blood is pooling in the chambers. (not 5-6 grams), avoid cannedvegetable/fish, and avoid sandwich meats and cheeses becauseof their high sodium content. Frozen meals are high in sodium,therefore the patient is correct in saying they should limit their consumption of them. 16. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout 19. You are assisting a patient up from the bed to the bathroom.The patient has swelling in the feet and legs. The patient is the lung fields, respiratory rate of 25, and an oxygensaturation of 90% on room air. Which of the following lab results confirm your receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient suspicions of heart failure? while assisting them to the bathroom? A. K+ 5.6 A. Measure and record the urine voided. B. BNP 820 B. Assist the patient up slowing and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient. Rationale: The best answer for this particular question is option B. All the options are important for the nurse to perform.However, Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension. The patient should transfer slowly and gradually to decrease dizziness and the risk of falling. 20. A patient is taking Digoxin. Prior to administration youcheck the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action? A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient’s potassium level is normal. Rationale: The patient is Digoxin toxic. A normal Digoxin levelis