A client is recently diagnosed with stable angina. The LPN is reinforcing teaching for the patient. The LPN knows which statement about stable angina is correct?
Troponin levels will always be elevated.
The pain is sharp and last for hours, usually radiating down the left leg.
The pain is predictable with exertion and is relieved by rest or nitroglycerin.
Pain occurs at rest and is relieved by nitroglycerin.
The Correct Answer is C
A. Troponin levels will always be elevated: Troponin is a biomarker for myocardial necrosis and cell death, which does not occur in stable angina. In stable angina, the ischemia is transient and reversible, meaning cardiac enzymes typically remain within normal limits. Elevated troponin levels are diagnostic of an acute myocardial infarction rather than angina.
B. The pain is sharp and last for hours, usually radiating down the left leg: Anginal pain is characteristically described as a dull, crushing, or squeezing pressure in the substernal region. It typically lasts only a few minutes and may radiate to the left arm, neck, or jaw, but not the leg. Prolonged pain lasting for hours suggests a more serious acute coronary syndrome.
C. The pain is predictable with exertion and is relieved by rest or nitroglycerin: Stable angina follows a consistent pattern where chest discomfort is triggered by specific levels of physical activity or emotional stress. The increased myocardial demand is eased once the activity stops or when nitroglycerin causes coronary vasodilation. This predictability is the defining feature that differentiates it from unstable angina.
D. Pain occurs at rest and is relieved by nitroglycerin: Pain that occurs without exertion or while the patient is resting is classified as unstable angina or Prinzmetal's angina. This represents a more dangerous clinical state where blood flow is compromised even at baseline. Stable angina requires an external stressor to trigger the imbalance in oxygen supply.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Myocardial infarction: While this patient has significant cardiovascular risk factors, the clinical presentation does not describe acute substernal chest pain or EKG changes. The presence of 4+ peripheral edema and jugular venous distention points toward a chronic congestive process rather than acute coronary occlusion. Weight gain and exhaustion are symptoms of volume overload.
B. Left-sided heart failure: Left-sided failure typically presents with pulmonary congestion, characterized by crackles, orthopnea, and paroxysmal nocturnal dyspnea. While it often precedes right-sided failure, the specific findings of jugular distention and lower extremity edema are hallmarks of systemic venous congestion. This choice does not align with the predominant systemic symptoms described.
C. Acute pericarditis: Pericarditis usually presents with sharp, pleuritic chest pain that improves when leaning forward, often accompanied by a pericardial friction rub. It does not typically cause massive peripheral edema or rapid weight gain unless it progresses to cardiac tamponade. The clinical signs in the stem indicate high systemic venous pressure.
D. Right-sided heart failure: This condition results in the inability of the right ventricle to pump blood into the pulmonary circulation, causing systemic backup. Jugular venous distention, 4+ pitting edema, and rapid weight gain are classic signs of systemic venous hypertension. The exhaustion stems from decreased cardiac output during physical exertion.
Correct Answer is C
Explanation
A. Pulmonary embolism: While shortness of breath is a symptom, the presence of jugular vein distention (JVD) and 2+ bilateral lower extremity edema points more toward a volume overload state. Atrial fibrillation often leads to decreased cardiac output and subsequent congestive symptoms. The physical findings specifically support a diagnosis of systemic venous congestion.
B. Gastritis: Nausea can occur with cardiac issues, but the primary symptoms of racing heart, JVD, and peripheral edema are not associated with gastric inflammation. Gastritis does not cause irregular heart rhythms or shortness of breath. The clinical picture is overwhelmingly cardiovascular rather than gastrointestinal in origin.
C. Heart failure: The combination of an irregular rhythm, shortness of breath, JVD, and 2+ bilateral lower extremity edema are classic indicators of heart failure. Atrial fibrillation reduces the "atrial kick," leading to decreased ventricular filling and backup of fluid into the systemic circulation. These findings characterize the patient's current clinical decompensation.
D. Pneumonia: Lungs sounding clear in all fields effectively rules out active pneumonia as the cause of the client's current respiratory distress. Pneumonia typically presents with cough, fever, and adventitious breath sounds such as crackles or wheezing. The client's symptoms are better explained by cardiac-driven fluid volume excess.
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