Practice Questions and Answers

Week 2 - Ch. 34 Lewis - Evolve NCLEX Practice Questions and Answers The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic group would the nurse select as the highest priority for this intervention?

• White male
• Hispanic male
• African American male
• Native American female - Answer- A. White male

The incidence of CAD and myocardial infarction (MI) is highest among white, middle- aged men. Hispanic individuals have lower rates of CAD than non-Hispanic whites or African Americans. African Americans have an earlier age of onset and more severe CAD than whites and more than twice the mortality rate of whites of the same age.Native Americans have increased mortality in less than 35-year-olds and have major modifiable risk factors such as diabetes.Which individuals would the nurse identify as having the highest risk for CAD?

• A 45-year-old depressed male with a high-stress job
• A 60-year-old male with below normal homocysteine levels
• A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels
• A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23

kg/m2 - Answer- A. A 45-year-old depressed male with a high-stress job The 45-year-old depressed male with a high-stress job 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 actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD.When providing nutritional counseling for patients at risk for CAD, which foods would the nurse encourage patients to include in their diet (select all that apply)?

• Tofu
• Walnuts
• Tuna fish
• Whole milk
• Orange juice - Answer- A, B, C
• Tofu
• Walnuts This study source was downloaded by 100000897174347 from CourseHero.com on 03-10-2025 22:56:04 GMT -05:00

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• Tuna fish

Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly.Which antilipemic medications should the nurse question for a patient with cirrhosis of the liver (select all that apply)?

• Niacin (Nicobid)
• Ezetimibe (Zetia)
• Gemfibrozil (Lopid)
• Atorvastatin (Lipitor)
• Cholestyramine (Questran) - Answer- B, D
• Ezetimibe (Zetia)
• Atorvastatin (Lipitor)

Ezetimibe (Zetia) should not be used by patients with liver impairment. Adverse effects of atorvastatin (Lipitor), a statin drug, include liver damage and myopathy. Liver enzymes must be monitored frequently and the medication stopped if these enzymes increase. Niacin's side effects subside with time, although decreased liver function may occur with high doses. Cholestyramine is safe for long-term use.After teaching a patient with chronic stable angina about nitroglycerin, the nurse recognizes the need for further teaching when the patient makes which statement?

• "I will replace my nitroglycerin supply every 6 months."
• "I can take up to five tablets every 3 minutes for relief of my chest pain."
• "I will take acetaminophen (Tylenol) to treat the headache caused by nitroglycerin."
• "I will take the nitroglycerin 10 minutes before planned activity that usually causes

chest pain." - Answer- B. "I can take up to five tablets every 3 minutes for relief of my chest pain." The recommended dose of nitroglycerin is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should be instructed to activate the emergency medical services (EMS) system. If symptoms are improved, repeat the nitroglycerin every 5 minutes for a maximum of three doses and contact EMS if symptoms have not resolved completely.The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI) (select all that apply)?

• Flushing
• Ashen skin
• Diaphoresis
• Nausea and vomiting
• S3 or S4 heart sounds - Answer- B, C, D, E
• Ashen skin
• Diaphoresis
• Nausea and vomiting This study source was downloaded by 100000897174347 from CourseHero.com on 03-10-2025 22:56:04 GMT -05:00

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• S3 or S4 heart sounds

During the initial phase of an MI, catecholamines are released from the ischemic myocardial cells, causing increased sympathetic nervous system (SNS) stimulation.This results in the release of glycogen, diaphoresis, and vasoconstriction of peripheral blood vessels. The patient's skin may be ashen, cool, and clammy (not flushed) as a result of this response. Nausea and vomiting may result from reflex stimulation of the vomiting center by severe pain. Ventricular dysfunction resulting from the MI may lead to the presence of the abnormal S3 and S4 heart sounds.When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administrating?

• Oxygen, nitroglycerin, aspirin, and morphine
• Oxygen, furosemide (Lasix), nitroglycerin, and meperidine
• Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen
• Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin) - Answer- A.

Oxygen, nitroglycerin, aspirin, and morphine The American Heart Association's guidelines for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin, aspirin, and morphine.These interventions serve to relieve chest pain, improve oxygenation, decrease myocardial workload, and prevent further platelet aggregation. The other medications may be used later in the patient's treatment.When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food choice?

• Baked flounder
• Angel food cake
• Baked potato with margarine
• Canned chicken noodle soup - Answer- D. Canned chicken noodle soup

Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content.The nurse is providing teaching to a patient recovering from an MI. How should resumption of sexual activity be discussed?

• Delegated to the primary care provider
• Discussed along with other physical activities
• Avoided because it is embarrassing to the patient
• Accomplished by providing the patient with written material - Answer- B. Discussed

along with other physical activities Although some nurses may not feel comfortable discussing sexual activity with patients, it is a necessary component of patient teaching. It is helpful to consider sex as a physical activity and to discuss or explore feelings in this area when other physical This study source was downloaded by 100000897174347 from CourseHero.com on 03-10-2025 22:56:04 GMT -05:00 https://www.coursehero.com/file/245701766/Week-2-Ch-34-Lewis-Evolve-NCLEX-Practice-Questions-and-Answersdocx/

activities are discussed. Although providing the patient with written material is appropriate, it should not replace a verbal dialogue that can address the individual patient's questions and concerns.Postoperative care of a patient undergoing coronary artery bypass graft (CABG) surgery includes monitoring for what common complication?

• Dehydration
• Paralytic ileus
• Atrial dysrhythmias
• Acute respiratory distress syndrome - Answer- C. Atrial dysrhythmias

Postoperative dysrhythmias, specifically atrial dysrhythmias, are common in the first 3 days following CABG surgery. Although the other complications could occur, they are not common complications.A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate?

• Unstable angina
• Cardiac tamponade
• Sudden cardiac death
• Cardiac dysrhythmias - Answer- D. Cardiac dysrhythmias

The most common complication after MI is dysrhythmias, which are present in 80% of patients. Unstable angina is considered a precursor to MI rather than a complication.Cardiac tamponade is a rare event, and sudden cardiac death is defined as an unexpected death from cardiac causes. Cardiac dysfunction in the period following an MI would not be characterized as sudden cardiac death.The nurse is examining the ECG of a patient who has just been admitted with a suspected MI. Which ECG change is most indicative of prolonged or complete coronary occlusion?

• Sinus tachycardia
• Pathologic Q wave
• Fibrillatory P waves
• Prolonged PR interval - Answer- B. Pathologic Q wave

The presence of a pathologic Q wave, as often accompanies STEMI, is indicative of complete coronary occlusion. Sinus tachycardia, fibrillatory P waves (e.g., atrial fibrillation), or a prolonged PR interval (first-degree heart block) are not direct indicators of extensive occlusion.For which problem is percutaneous coronary intervention (PCI) most clearly indicated?

• Chronic stable angina
• Left-sided heart failure
• Coronary artery disease This study source was downloaded by 100000897174347 from CourseHero.com on 03-10-2025 22:56:04 GMT -05:00

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