While assessing a client diagnosed with angina, the patient asks, “What causes this pain in my heart?” What is the nurse’s BEST response?

Increased afterload

Inadequate myocardial oxygenation

Coronary artery system

Increased preload

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Increased afterload refers to the resistance against which the heart must pump to eject blood into the aorta.

While increased afterload can contribute to angina by increasing the heart's workload, it is not the primary cause of the pain.

Increased afterload is more commonly associated with heart failure, hypertension, and aortic stenosis.

Choice C rationale:

The coronary artery system is the network of blood vessels that supply oxygen and nutrients to the heart muscle.

While coronary artery disease (CAD), a narrowing or blockage of these arteries, is the underlying cause of angina, it is not the direct cause of the pain.

The pain of angina is caused by the heart muscle not receiving enough oxygen, which can occur even if the coronary arteries are not completely blocked.

Choice D rationale:

Increased preload refers to the volume of blood that fills the ventricles before they contract.

While increased preload can also contribute to angina by increasing the heart's workload, it is not the primary cause of the pain.

Increased preload is more commonly associated with heart failure, valvular regurgitation, and fluid overload.

Choice B rationale:

Inadequate myocardial oxygenation is the most direct and accurate explanation for the pain of angina.

When the heart muscle does not receive enough oxygen, it experiences ischemia, which is a lack of blood flow and oxygen.

Ischemia triggers the release of chemicals that stimulate pain receptors in the heart, leading to the characteristic chest pain of angina.

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Correct Answer is A

Explanation

Cardiac tamponade is a life-threatening condition that occurs when fluid accumulates in the pericardial sac, the thin, doublelayered membrane that surrounds the heart. This fluid buildup compresses the heart, preventing it from filling properly and pumping blood effectively.

The classic triad of symptoms of cardiac tamponade is muffled heart sounds, jugular vein distention (JVD), and hypotension.

Muffled heart sounds occur because the fluid in the pericardial sac dampens the sound of the heart's valves closing. JVD occurs because the fluid in the pericardial sac compresses the superior vena cava, which is a large vein that carries blood from the upper body back to the heart. Hypotension occurs because the compressed heart is unable to pump blood effectively.

Other signs and symptoms of cardiac tamponade may include:

Tachycardia (rapid heart rate)

Dyspnea (shortness of breath)

Chest pain

Pulsus paradoxus (a drop in blood pressure during inspiration)

Anxiety or restlessness

Altered mental status

Cardiac tamponade is a medical emergency that requires immediate treatment. The goal of treatment is to relieve the pressure on the heart by removing the fluid from the pericardial sac. This is typically done through a procedure called pericardiocentesis, which involves inserting a needle into the pericardial sac and draining the fluid.

Choice B rationale:

Artery dissection is a condition that occurs when the inner layer of an artery tears, allowing blood to flow between the layers of the artery wall. This can lead to a number of complications, including aneurysm formation, rupture, and ischemia (lack of blood flow) to the organs and tissues supplied by the affected artery.

The signs and symptoms of artery dissection vary depending on the location of the dissection. Common symptoms include sudden, severe pain; weakness or numbness; and a difference in blood pressure between the arms or legs.

Artery dissection is a serious condition that requires prompt medical attention. Treatment options may include medication, surgery, or a combination of both.

Choice C rationale:

It is not normal to have muffled heart sounds, JVD, and hypotension following stent placement. These are signs of a serious complication, such as cardiac tamponade or artery dissection.

Choice D rationale:

Myocardial infarction (MI), also known as a heart attack, occurs when blood flow to a portion of the heart is blocked, causing damage to the heart muscle. The classic symptom of an MI is chest pain, but other symptoms may include shortness of breath, nausea, vomiting, sweating, and lightheadedness.

The signs and symptoms of cardiac tamponade and MI can overlap, but there are some key differences. For example, chest pain is more common in MI, while JVD is more common in cardiac tamponade.

A. Enlarged waist circumference. B. Systolic Blood pressure greater than 130. C. Decreased triglyceride level. D. Elevated HDL levels.

Correct Answer is ["A","B"]

Explanation

Choice A rationale:

Enlarged waist circumference is a significant risk factor for metabolic syndrome. Excess abdominal fat, particularly visceral fat that accumulates around the organs, is strongly linked to insulin resistance, a hallmark of metabolic syndrome.

Visceral fat cells are metabolically active, releasing inflammatory substances and free fatty acids that can impair insulin's ability to regulate blood sugar levels. This leads to elevated blood glucose levels, a key feature of metabolic syndrome.

Research consistently demonstrates a strong correlation between waist circumference and metabolic syndrome. Studies have shown that even a modest increase in waist circumference can significantly increase the risk of developing metabolic syndrome.

Waist circumference is a simple and non-invasive measurement that can be used to assess abdominal obesity and identify individuals at risk for metabolic syndrome.

Choice B rationale:

Elevated systolic blood pressure (greater than 130 mmHg) is another key risk factor for metabolic syndrome. High blood pressure, also known as hypertension, is a major risk factor for heart disease, stroke, and other cardiovascular complications.

Multiple mechanisms contribute to the link between hypertension and metabolic syndrome:

Insulin resistance can lead to increased sodium retention by the kidneys, which can raise blood pressure.

Excess weight and obesity can also contribute to hypertension by increasing blood volume and placing strain on the heart.

Metabolic syndrome is often associated with chronic inflammation, which can damage blood vessels and further contribute to hypertension. Choice C rationale:

Decreased triglyceride level is not a risk factor for metabolic syndrome. In fact, elevated triglycerides are one of the diagnostic criteria for metabolic syndrome.

Triglycerides are a type of fat found in the blood. High levels of triglycerides can contribute to the buildup of plaque in the arteries, increasing the risk of heart disease and stroke.

Choice D rationale:

Elevated HDL levels are not a risk factor for metabolic syndrome. HDL cholesterol, often referred to as "good" cholesterol, helps to remove excess cholesterol from the bloodstream and protect against heart disease.

Low HDL levels are a common feature of metabolic syndrome and contribute to its associated cardiovascular risks.

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While assessing a client diagnosed with angina, the patient asks, “What causes this pain in my heart?” What is the nurse’s BEST response?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is ["A","B"]

Explanation

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