ATI Care of Patients with Acute Coronary Syndromes, Questions and Answers with Explanations, 100% Correct, Download to Score A

Test Bank

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)

6. Eight hours after presentation to the emergency department with reports of substernal chest pain, a client’s laboratory results demonstrate myoglobin levels of 55 ng/mL. What does the nurse do next?

a.            Prepare the client for an emergency coronary bypass graft surgery.

b.            Administer nitroglycerin to prevent further myocardial cell death.

c.             Assess the client to identify another potential cause of the chest pain.

d.            Provide client education related to complications of myocardial infarctions.

ANS: C

Myoglobin is a heme protein found in skeletal and cardiac muscle. With myocardial injury, myoglobin levels rise within 3 to 6 hours. If myoglobin levels have not risen within that time, the client has not experienced a myocardial infarction. The nurse should assess the client to identify a potential cause for the chest pain, besides an MI.

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

TOP: Client Needs Category: Physiological Integrity (Reduction in Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Analysis)

7. The nurse evaluates diagnostic results for a client who has chest pain. Which laboratory test is most specific for acute coronary syndromes?

a.            Troponin markers

b.            Serum lactate dehydrogenase (LDH)

c.             Serum myoglobin

d.            Creatine kinase (CK)-MB isoenzyme

ANS: A

Although all these laboratory tests are appropriate to confirm or rule out a myocardial infarction, the one most specific for acute coronary syndromes is troponin T. When elevated, it serves to identify the development of unstable angina, subendocardial MI, or MI.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 829

TOP: Client Needs Category: Physiological Integrity (Reduction in Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Analysis)

8. While evaluating a client’s electrocardiogram (ECG) before surgery, the preoperative nurse identifies large, wide Q waves. What is the nurse’s best interpretation of this finding?

a.            An acute myocardial infarction is occurring.

b.            The client had a myocardial infarction in the past.

c.             The ventricles are enlarged and failing.

d.            The ECG is a common variation of normal sinus rhythm.

ANS: B

A wide and large Q wave develops as a result of myocardial infarction and necrotic ventricular cells that do not conduct electrical impulses. This change is usually permanent. When it appears alone, it indicates a past MI. The other interpretations are not correct.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 836

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

MSC: Integrated Process: Nursing Process (Analysis