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Lewis Med-Surg Ch. 33 CAD and Acute Coronary Syndrome exam update
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Lewis Med-Surg Ch. 33 CAD and Acute Coronary Syndrome exam update
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Lewis Med-Surg Ch. 33 CAD and Acute Coronary Syndromeexam 2024 -2025 update
When caring for a patient who is recovering from a sudden cardiac death (SCD) event and has
no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the
patient that
a. sudden cardiac death events rarely reoccur.
b. additional diagnostic testing will be required.
c. long-term anticoagulation therapy will be needed.
d. limiting physical activity will prevent future SCD events. - answer>>>ANS: B
Diagnostic testing (e.g., stress test, Holter monitor, electrophysiologic studies, cardiac
catheterization) is used to determine the possible cause of the SCD and treatment options. SCD
is likely to recur. Anticoagulation therapy will not have any effect on the incidence of SCD, and
SCD can occur even when the patient is resting.
DIF: Cognitive Level: Apply (application)
A few days after experiencing a myocardial infarction (MI) and successful percutaneous
coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of
here, I'm going for my vacation as planned." Which reply would be most appropriate for the
nurse to make?
a. "What do you think caused your chest pain?"
b. "Where are you planning to go for your vacation?"
c. "Sometimes plans need to change after a heart attack."
d. "Recovery from a heart attack takes at least a few weeks." - answer>>>ANS: A
When the patient is experiencing denial, the nurse should assist the patient in testing reality
until the patient has progressed beyond this step of the emotional adjustment to MI. Asking the
patient about vacation plans reinforces the patient's plan, which is not appropriate in the
immediate post-MI period. Reminding the patient in denial about the MI is likely to make the
patient angry and lead to distrust of the nursing staff.
DIF: Cognitive Level: Apply (application)
,When evaluating the effectiveness of preoperative teaching with a patient scheduled for
coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse
determines that additional teaching is needed when the patient says which of the following?
a. "They will circulate my blood with a machine during surgery."
b. "I will have incisions in my leg where they will remove the vein."
c. "They will use an artery near my heart to go around the area that is blocked."
d. "I will need to take an aspirin every day after the surgery to keep the graft open." -
answer>>>ANS: B
When the internal mammary artery is used there is no need to have a saphenous vein removed
from the leg. The other statements by the patient are accurate and indicate that the teaching
has been effective.
DIF: Cognitive Level: Apply (application)
A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse when
sexual intercourse can be resumed. Which response by the nurse is best?
a. "Most patients are able to enjoy intercourse without any complications."
b. "Sexual activity uses about as much energy as climbing two flights of stairs."
c. "The doctor will provide sexual guidelines when your heart is strong enough."
d. "Holding and cuddling are good ways to maintain intimacy after a heart attack." -
answer>>>ANS: B
Sexual activity places about as much physical stress on the cardiovascular system as most
moderate-energy activities such as climbing two flights of stairs. The other responses do not
directly address the patient's question or may not be accurate for this patient.
DIF: Cognitive Level: Apply (application)
A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action
is appropriate when scheduling this medication?
, a. Administer the medication at the patient's usual bedtime.
b. Have the patient take the colesevelam 1 hour before breakfast.
c. Give the patient's other medications 2 hours after colesevelam.
d. Have the patient take the dose at the same time as the prescribed aspirin. - answer>>>ANS: C
The bile acid sequestrants interfere with the absorption of many other drugs and giving other
medications at the same time should be avoided. Taking an aspirin concurrently with the
colesevelam may increase the incidence of gastrointestinal side effects such as heartburn. For
maximum effect, colesevelam should be administered with meals.
DIF: Cognitive Level: Apply (application)
The nurse is caring for a patient who was admitted to the coronary care unit following an acute
myocardial infarction (AMI) and percutaneous coronary intervention the previous day. Teaching
for this patient would include
a. when cardiac rehabilitation will begin.
b. the typical emotional responses to AMI.
c. information regarding discharge medications.
d. the pathophysiology of coronary artery disease. - answer>>>ANS: A
Early after an AMI, the patient will want to know when resumption of usual activities can be
expected. At this time, the patient's anxiety level or denial will interfere with good
understanding of complex information such as the pathophysiology of coronary artery disease.
Teaching about discharge medications should be done closer to discharge. The nurse should
support the patient by decreasing anxiety rather than discussing the typical emotional
responses to myocardial infarction.
DIF: Cognitive Level: Apply (application)
A patient who has recently started taking pravastatin (Pravachol) and niacin reports several
symptoms to the nurse. Which information is most important to communicate to the health
care provider?
a. Generalized muscle aches and pains
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