Please provide complete, thorough, and detailed answers to all questions in the case study. Multiple-choice answers should include the correct choice and rationale for that choice and/or rationale why other choices are incorrect.

Case Study
Coronary Artery Disease and Pacemakers

Difficulty: Intermediate

Setting: Hospital, outpatient cardiac rehabilitation

Index Words: coronary artery disease (CAD), hypertension (HTN), angina, lifestyle modification, medications, laboratory values, assessment, risk factors, pacemaker, ECG strip, atrial fibrillation, graded exercise (stress) test

Giddens Concepts: Caregiving, Perfusion, Patient Education

HESI Concepts: Assessment, Caregiving, Perfusion, Patient Education

It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P. is a 60-year- old retired businessman who is married and has three grown children. As you take his health history, he tells you that he began feeling changes in his chest about 10 days ago. He has hypertension (HTN) and a 5-year history of angina pectoris. During the past week, he has had frequent episodes of mid-chest discomfort. The chest pain responds to nitroglycerin (NTG), which he has taken sublingually about 8 to 10 times over the past week. During the week, he has also experienced increased fatigue. He states, “I just feel crappy all the time.” A cardiac catheterization done several years ago revealed 50% stenosis of the right coronary artery (RCA) and 50% stenosis of the left anterior descending (LAD) coronary artery. He tells you that both his mother and his father had coronary artery disease (CAD). He is currently taking amlodipine (Norvasc), metoprolol (Lopressor), atorvastatin (Lipitor), and aspirin 81 mg/day.


1. What other information are you going to obtain about his episodes of chest pain?

2. What are common sites for radiation of ischemic cardiac pain?

3. You know that G.P. has atherosclerosis of the coronary arteries. You need to know his risk factors for CAD to plan teaching for lifestyle modifications. What will you ask him about?

4. Although he has been taking sublingual nitroglycerin (SL NTG) for a long time, you want to be certain he is using it correctly. Which actions are correct when taking SL NTG for chest pain? (Select all that apply.)

a. Stop the activity and lie or sit down.

b. Call 911 immediately.

c. Call 911 if the pain is not relieved after taking one SL tablet.

d. Call 911 if the pain is not relieved after taking three SL tablets, 5 minutes apart.

e. Chew the tablet slowly then swallow.

f. Place the NTG tablet under the tongue.

5. You revie