Cardiovascular System: Atherosclerosis — Nursing Guide + NORCET MCQs

Cardiovascular System: Atherosclerosis — Nursing Guide + NORCET MCQs

Understand plaque formation, risk factors, symptoms by system (heart, brain, limbs), essential diagnostics (incl. ABI), nursing management, prevention for the public, and exam-focused highlights.

NORCET AIIMS Nursing Quiz Informative Blog

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Introduction

Atherosclerosis is a chronic disease where fatty deposits (plaques) build up in the inner lining of medium and large arteries. Over time, plaques can narrow or suddenly block blood flow, leading to heart attack, stroke, or limb ischemia. Nurses play a key role in risk assessment, education, early detection, medication adherence, and referral.

What Happens in Atherosclerosis?

• Endothelial injury (from smoking, high BP, diabetes, etc.) → LDL enters vessel wall and oxidizes.
• Immune cells ingest oxidized LDL → foam cells → fatty streaks → fibrous cap forms over lipid core.
• Stable plaque: thick cap, slower narrowing → exertional symptoms (e.g., stable angina, claudication).
• Vulnerable/unstable plaque: thin cap, rupture-prone → thrombosis → acute events (MI, stroke).

Risk Factors

Non-modifiable

• Age, male sex (until menopause), family history of premature ASCVD.

Modifiable

• Tobacco exposure, high BP, diabetes, dyslipidemia (↑LDL, low HDL), obesity/central adiposity, physical inactivity, unhealthy diet, psychosocial stress, alcohol excess.

Where It Occurs (Types by Territory)

• Coronary arteries (CAD): angina, acute coronary syndrome (ACS).
• Carotid/cerebral: transient ischemic attack (TIA), stroke.
• Peripheral arteries (PAD): leg claudication, rest pain, non-healing ulcers.
• Renal artery stenosis: resistant hypertension, renal dysfunction.
• Mesenteric: post-prandial abdominal pain, weight loss (intestinal angina).

Signs & Symptoms (by Territory)

• CAD: chest discomfort/pressure with exertion, relieved by rest; dyspnea; acute severe chest pain with nausea/sweating suggests MI → emergency.
• Carotid/CNS: sudden unilateral weakness, facial droop, speech/vision difficulty → stroke/TIA warning; immediate care.
• PAD: calf/thigh pain on walking (claudication), hair loss/shiny skin, cool limb, weak/absent pulses; rest pain/ulcers = severe ischemia.
• Renal: difficult-to-control BP, rise in creatinine after ACEi/ARB may suggest stenosis → evaluation.
• Mesenteric: abdominal pain after meals, food fear, weight loss.

Diagnosis (Overview)

• History & exam: BP, BMI/waist, pulses, bruits; foot inspection in PAD.
• Labs: lipid profile, glucose/HbA1c; others as advised.
• ABI (Ankle-Brachial Index): ratio of ankle to arm systolic pressure. Interpretation commonly used: normal ~1.0–1.3; <0.9 suggests PAD; >1.3 may indicate calcified non-compressible vessels (interpret with caution).
• Imaging/tests: ECG ± stress testing for CAD (as advised), echocardiography, duplex Doppler (carotid/PAD), CT/MR angiography, or invasive angiography per specialist.

Management & Nursing Care (Essentials)

• Lifestyle: stop tobacco, heart-healthy diet (more fruits/veg/whole grains; less salt, sugar, trans-fats), regular physical activity as advised, weight management, adequate sleep & stress control.
• Medicines (as prescribed): statins (lipids), antiplatelets (e.g., aspirin when indicated), BP & sugar control, symptom relief (e.g., anti-anginal), vaccines (e.g., influenza) as per policy.
• Nursing tasks: monitor vitals & adherence, check feet/skin in PAD, teach warning signs (chest pain, stroke symptoms), medication education, referral pathways, documentation.
• Procedures: some patients need angioplasty/stent or bypass; post-procedure care: site checks, antiplatelet adherence, activity advice, follow-ups.

Note: This article is educational. Follow local protocols and clinician orders.

Prevention Tips (For Everyone)

• Know your numbers: BP, sugar, lipids, BMI/waist.
• Quit tobacco; avoid second-hand smoke.
• Eat smart; move more; manage stress; limit alcohol.
• Take prescribed medicines regularly; keep follow-up visits.
• Seek urgent care for chest pain, stroke signs, or sudden leg pain/coldness.

High-Yield NORCET Points

• Definition: lipid-rich plaque in intima → narrowing/acute thrombosis.
• Stable vs vulnerable plaque concept and clinical patterns.
• Major risks: smoking, HTN, DM, ↑LDL, low HDL, obesity, inactivity.
• ABI: normal ~1.0–1.3; <0.9 PAD; >1.3 → consider calcification.
• PAD clues: claudication, diminished pulses, trophic skin changes, ulcers.
• Carotid/TIA signs: sudden neuro deficits → immediate referral.
• CAD: exertional chest pain → stable angina; rest/unstable pain → ACS suspicion.
• First-line prevention: lifestyle + statins/BP/DM control where indicated.

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NORCET-Style MCQs — Atherosclerosis

Click “Show Answer” to reveal the correct option and rationale.

1) Atherosclerosis primarily affects which vessel layer?

1. Adventitia
2. Intima
3. Media
4. Vasa vasorum

Correct: B. Plaques form in the intimal layer.

2) Which is a major modifiable risk factor?

1. Age
2. Family history
3. Tobacco use
4. Male sex

Correct: C. Smoking accelerates endothelial injury.

3) Vulnerable plaques are more likely to:

1. Remain asymptomatic
2. Calcify heavily
3. Rupture and cause thrombosis
4. Resolve spontaneously

Correct: C. Thin-cap plaques can rupture and trigger clots.

4) Classic PAD symptom on exertion is:

1. Chest tightness
2. Intermittent claudication (leg pain on walking)
3. Orthopnea
4. Productive cough

Correct: B. PAD often causes calf/thigh pain with walking.

5) ABI value suggesting PAD is:

1. 1.10
2. 1.25
3. 0.80
4. 1.35

Correct: C. ABI <0.9 generally indicates PAD.

6) Sudden facial droop and slurred speech suggest:

1. Asthma
2. Stroke/TIA
3. Appendicitis
4. Renal colic

Correct: B. Carotid/cerebral atherosclerosis can cause TIA/stroke.

7) Initial lifestyle advice for dyslipidemia includes all EXCEPT:

1. Reduce trans-fats and refined sugars
2. Increase physical activity as advised
3. Start smoking to reduce stress
4. More fruits, vegetables, whole grains

Correct: C. Smoking is harmful and must be stopped.

8) A bruit over the carotid artery indicates:

1. Normal flow
2. Turbulent flow, possible stenosis
3. Venous insufficiency
4. Asthma

Correct: B. Atherosclerotic narrowing may cause bruits.

9) Which test directly screens for PAD at bedside?

1. Echocardiography
2. Ankle-Brachial Index (ABI)
3. Liver function tests
4. Spirometry

Correct: B. ABI compares ankle to brachial systolic pressures.

10) Typical angina is classically described as:

1. Sharp pin-point pain on inspiration
2. Pressure/heaviness behind sternum with exertion, relieved by rest
3. Rash with itching
4. Right upper quadrant pain after meals

Correct: B. Represents demand–supply mismatch in CAD.

11) Which finding favors critical limb ischemia?

1. Mild calf ache after a marathon
2. Rest pain and non-healing foot ulcer
3. Knee swelling after injury
4. Itchy eczema patch

Correct: B. Rest pain/ulcers suggest severe PAD.

12) A patient on statin therapy needs reinforcement about:

1. Regular intake and liver function checks as advised
2. Stopping if no symptoms
3. Doubling dose without advice
4. Statins raise BP

Correct: A. Adherence and periodic monitoring are important.

13) Which diet choice best supports vascular health?

1. More vegetables, fruits, whole grains, legumes, nuts; less trans-fats/sugars
2. Only red meat daily
3. Only fruit juice diet
4. Unlimited fried snacks

Correct: A. Pattern matters more than single foods.

14) Which is NOT a typical atherosclerotic site?

1. Coronary arteries
2. Carotid arteries
3. Pulmonary veins
4. Femoral arteries

Correct: C. Systemic arterial beds are typical sites.

15) Nurse advice for PAD foot care includes:

1. Walk barefoot outdoors
2. Daily inspection, moisturize (not between toes), proper footwear
3. Hot water bottle on numb feet
4. Ignore minor injuries

Correct: B. Foot protection prevents ulcers/infections.

16) Resistant hypertension with renal bruit suggests:

1. IBS
2. Renal artery stenosis
3. Asthma
4. Varicose veins

Correct: B. Consider renovascular disease.

17) Which is TRUE for stable angina?

1. Occurs randomly at rest only
2. Occurs with exertion/stress and improves with rest
3. Always causes syncope
4. Never relieved by nitrates

Correct: B. Demand-related ischemia pattern.

18) Key nursing counseling for antiplatelet therapy is:

1. Stop without advice if bruising occurs
2. Report unusual bleeding; do not stop medicine without clinician advice
3. Take only when symptomatic
4. Combine with NSAIDs freely

Correct: B. Safety counseling and adherence are essential.

19) Mesenteric ischemia commonly presents with:

1. Cough and wheeze
2. Post-prandial abdominal pain and weight loss
3. Urinary frequency
4. Rash

Correct: B. “Intestinal angina” after meals.

20) Immediate action for suspected stroke symptoms is to:

1. Advise home rest
2. Activate emergency care and refer urgently
3. Schedule routine appointment
4. Give only vitamins

Correct: B. Time-sensitive emergency.

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Frequently Asked Questions (FAQ)

Fatty plaques build inside arteries and reduce blood flow; sometimes a plaque ruptures and causes a sudden clot, leading to heart attack or stroke.

Risk can be reduced and progression slowed with lifestyle changes and medicines. Some plaque features improve, but prevention and control are key.

Commonly, an ABI around 1.0–1.3 is considered normal. Values <0.9 suggest PAD; >1.3 may indicate calcified vessels—interpret clinically.

More vegetables, fruits, whole grains, legumes, nuts; choose healthy oils; reduce salt, sugar, and trans-fats. Follow local diet advice if you have other conditions.

New chest pressure, severe breathlessness, sudden face/arm weakness or speech/vision trouble, or a cold/painful leg—call emergency services and get urgent care.

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