A nurse is providing discharge instructions to a patient newly diagnosed with stable angina. The patient asks for advice on physical activity. Which statement by the nurse is most appropriate?

Appeared in: NORCET 1 - 2020

Explanation

For stable angina, a regular program of moderate isotonic exercise (like walking) is recommended to improve cardiovascular fitness and tolerance.
Isotonic exercise involves rhythmic movements of large muscle groups, which conditions the heart efficiently without causing a sudden, dangerous spike in blood pressure or oxygen demand.
This approach helps increase the threshold at which anginal symptoms occur, improving the patient's quality of life.
The exercise should be tailored to stay within the patient's ischemic threshold, typically not exceeding 80% of the heart rate associated with ischemia.

Option A: Complete inactivity is harmful, leading to physical deconditioning, which lowers the angina threshold and worsens overall cardiovascular health.
Option B: High-intensity activities like heavy shoveling (7-9 METs) cause a rapid, significant increase in myocardial oxygen demand, which can precipitate severe angina or a myocardial infarction.
Option D: This is an unnecessarily restrictive recommendation for most patients with stable angina. While these activities are safe, limiting a patient to only this level prevents them from gaining the cardiovascular benefits of moderate exercise.

Visual 1: Chart: MET (Metabolic Equivalent of Task) levels for common daily activities, categorizing them into light, moderate, and heavy intensity.
Visual 2: Infographic: 'Do's and Don'ts of Exercise with Angina', showing safe activities like walking and swimming versus unsafe ones like shoveling snow or lifting heavy weights.

Clinical Relevance

Nursing practice connection: Use the key finding related to Exercise guidelines for patients with stable angina to guide bedside assessment, documentation, and the next nursing action.
Patient education on safe activity levels is a critical nursing role to prevent symptom exacerbation, reduce anxiety, and improve quality of life in patients with coronary artery disease.
Nurses must teach patients to recognize their personal anginal threshold and how to use prophylactic nitroglycerin as prescribed before planned exertion to prevent pain.
It is crucial to differentiate advice for stable vs. unstable angina. Stable angina management focuses on controlled activity, while unstable angina requires immediate rest and medical intervention.

How to Approach the Question

Identify the core question: It asks for the most appropriate physical activity advice for a patient with stable angina.
Analyze the patient's condition: 'Stable angina' is key. This means symptoms are predictable and occur with a certain level of exertion, but the patient is not in an acute crisis. The goal is to improve tolerance without causing harm.
Evaluate each option based on the pathophysiology of angina. Angina is caused by an imbalance between myocardial oxygen supply and demand.
Option A (no exercise) is incorrect because conditioning is beneficial and inactivity is harmful.
Option B (high-intensity) is dangerous as it creates a large, sudden oxygen deficit that the diseased coronary arteries cannot meet.
Option D (too restrictive) is not ideal because it prevents the patient from achieving the conditioning benefits of moderate exercise.

Concept Tested & Keywords

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Practise the full NORCET 1 - 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.