Lewis: Medical-Surgical Nursing, 9th Edition

Chapter 34
Rationales for Bridge to NCLEX Examination questions
1. Correct answers: b, c, d
Rationale: Atherosclerosis is the major cause of coronary artery disease (CAD) and is
characterized by a focal deposit of cholesterol and lipids, primarily within the intimal wall of the
artery. The endothelial lining of the coronary arteries becomes inflamed from the presence of
unstable plaques and the oxidation of low-density lipoprotein (LDL) cholesterol. Fibrous plaque
causes progressive changes in the endothelium of the arterial wall. The result is a narrowing of
the vessel lumen and a reduction in blood flow to the myocardial tissue.
2. Correct answer: a
Rationale: Risk factors for coronary artery disease include elevated serum levels of lipids,
elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome,
certain psychologic states, and elevated homocysteine levels. Weight lifting is not a
cardioprotective exercise. An example of health-promoting regular physical activity is brisk
walking (3 to 4 miles/hr) for at least 30 minutes five or more times each week.
3. Correct answer: b
Rationale: Chronic stable angina is chest pain that occurs intermittently over a long period with
the same pattern of onset, duration, and intensity of symptoms. The chest pain is relieved by rest
or by rest and medication (e.g., nitroglycerin). The ischemia is transient and does not cause
myocardial damage.
4. Correct answer: b
Rationale: Acute pericarditis is inflammation of the visceral and/or parietal pericardium; it often
occurs 2 to 3 days after an acute myocardial infarction. Chest pain may vary from mild to severe
and is aggravated by inspiration, coughing, and movement of the upper body. Sitting in a forward
position often relieves the pain. The pain is usually different from pain associated with a
myocardial infarction. Assessment of the patient with pericarditis may reveal a friction rub over
the pericardium.
5. Correct answers: a, b, e
Rationale: In addition to oxygen, several medications may be used to treat unstable angina
(UA): nitroglycerin, aspirin (chewable), and morphine. For patients with UA with negative
cardiac markers and ongoing angina, a combination of aspirin, heparin, and a glycoprotein
IIb/IIIa inhibitor (e.g., eptifibatide [Integrilin]) is recommended. Angiotensin-converting enzyme
(ACE) inhibitors decrease myocardial oxygen demand by producing vasodilation, reducing
blood volume, and slowing or reversing cardiac remodeling.
6. Correct answer: c
Rationale: Physical activity should be regular, rhythmic, and repetitive, with the use of large
muscles to build up endurance (e.g., walking, cycling, swimming, rowing). Physical activity
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Rationales for Bridge to NCLEX Examination questions

sessions should be at least 30 minutes long. Instruct the patient to begin slowly at personal
tolerance (perhaps only 5 to 10 minutes) and build up to 30 minutes.
7. Correct answer: c
Rationale: Left ventricular dysfunction (ejection fraction less than 30%) and ventricular
dysrhythmias after myocardial infarction are the strongest predictors of sudden cardiac death
(SCD).

Copyright 2014 by Mosby, an imprint of Elsevier Inc.