NCLEX-Style Coronary Artery Disease (CAD) Questions
Question 1: A 58-year-old male presents with chest pain on exertion and shortness of breath. He has a history of hypertension and high cholesterol. Which pathophysiological process is most responsible for his symptoms of coronary artery disease?
- A. Myocardial hypertrophy without ischemia
- B. Narrowing of coronary arteries due to atherosclerotic plaque
- C. Pericardial effusion compressing the heart
- D. Pulmonary embolism obstructing pulmonary arteries
Answer: B
Explanation: Coronary artery disease occurs primarily due to atherosclerotic plaque narrowing the coronary arteries, reducing blood flow and oxygen supply to the myocardium, which causes chest pain and shortness of breath.
Question 2: A 65-year-old female with coronary artery disease reports severe chest pressure at rest. Which complication is she most at risk for if prompt treatment is not provided?
- A. Chronic bronchitis
- B. Acute myocardial infarction
- C. Pulmonary hypertension
- D. Stroke from carotid artery stenosis
Answer: B
Explanation: Unstable angina or severe ischemia in CAD can progress to acute myocardial infarction if blood flow is completely blocked, making early recognition and intervention critical.
Question 3: A patient with CAD is prescribed a beta-blocker. What is the primary therapeutic effect of this medication?
- A. Dissolve existing atherosclerotic plaques
- B. Reduce myocardial oxygen demand by lowering heart rate and contractility
- C. Increase platelet aggregation to stabilize plaques
- D. Dilate peripheral veins to reduce preload only
Answer: B
Explanation: Beta-blockers reduce heart rate and myocardial contractility, lowering oxygen demand, which helps prevent ischemia and angina in patients with coronary artery disease.
Question 4: A nurse monitors a patient with CAD and notes ST-segment depression on the ECG. What does this finding indicate?
- A. Acute myocardial infarction with full-thickness injury
- B. Myocardial ischemia due to reduced coronary perfusion
- C. Normal variant with no clinical significance
- D. Pericarditis causing diffuse ST changes
Answer: B
Explanation: ST-segment depression on an ECG is a classic sign of myocardial ischemia, indicating insufficient blood flow to part of the heart muscle without full-thickness infarction.
Question 5: A patient with coronary artery disease is instructed to follow a low-cholesterol diet. Which outcome is the nurse reinforcing by this intervention?
- A. Prevent arrhythmias
- B. Reduce atherosclerotic plaque progression
- C. Cure coronary artery disease completely
- D. Eliminate the need for medications
Answer: B
Explanation: A low-cholesterol diet helps reduce LDL cholesterol levels, slowing the progression of atherosclerotic plaques and reducing the risk of further ischemic events.
Question 6: A patient with CAD experiences shortness of breath and fatigue during minimal activity. What is the most likely underlying pathophysiology?
- A. Heart failure due to decreased cardiac output from ischemic myocardium
- B. Pulmonary embolism obstructing blood flow to lungs
- C. Asthma causing bronchoconstriction
- D. Liver cirrhosis reducing oxygen delivery
Answer: A
Explanation: In CAD, reduced coronary blood flow can impair cardiac muscle function, decreasing cardiac output and causing fatigue and dyspnea on exertion.
Question 7: A 70-year-old patient with CAD is prescribed aspirin daily. What is the primary purpose of this therapy?
- A. Reduce heart rate
- B. Prevent thrombus formation by inhibiting platelet aggregation
- C. Dilate coronary arteries
- D. Lower cholesterol levels
Answer: B
Explanation: Aspirin inhibits platelet aggregation, reducing the risk of thrombus formation on unstable atherosclerotic plaques, which prevents acute coronary events.
Question 8: A patient with CAD reports atypical chest discomfort but has diabetes. Why might symptoms be less obvious in this patient?
- A. Diabetes enhances pain sensitivity
- B. Diabetic neuropathy can reduce perception of ischemic pain
- C. Diabetes prevents atherosclerosis
- D. Diabetic patients cannot develop angina
Answer: B
Explanation: Diabetic neuropathy can impair sensory nerve function, leading to atypical or silent ischemia, which makes early detection of CAD symptoms more challenging.
Question 9: A nurse evaluates a patient with CAD who has a family history of heart disease. Which statement best explains the role of family history?
- A. Genetics can predispose to endothelial dysfunction and early atherosclerosis
- B. Family history has no effect on CAD risk
- C. Family history only affects cholesterol levels in women
- D. Genetics determines response to beta-blockers only
Answer: A
Explanation: Genetic factors can influence lipid metabolism, blood pressure regulation, and endothelial function, increasing the risk of early atherosclerosis and coronary artery disease.
Question 10: A nurse teaches a patient with CAD about the importance of regular exercise. Which physiologic benefit supports this recommendation?
- A. Exercise increases oxygen demand without benefit
- B. Exercise improves endothelial function and reduces cardiac risk factors
- C. Exercise dissolves existing atherosclerotic plaques instantly
- D. Exercise eliminates the need for medications
Answer: B
Explanation: Regular moderate exercise improves endothelial function, reduces blood pressure and cholesterol, enhances cardiac efficiency, and helps prevent progression of coronary artery disease.
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