NURS 100|CORONARY ARTERIES EXAM STUDY GUIDE
2022
The left anterior descending artery is the primary source of blood for the anterior wall
of the heart.
The circumflex artery supplies the lateral wall.
The internal mammary artery supplies the mammary.
The right coronary artery supplies the right ventricle and the inferior wall of the heart.
Most of the blood flow to coronary arteries is supplied during diastole.
Coronary artery disease (CAD) is the leading cause of death in the U.S. (accounts for
over 50% of all deaths)
Atherosclerosis, or plaque formation, is the leading cause of Coronary artery
disease (CAD).
Myocardial infarction is commonly a result of CAD.
Enhance myocardial oxygenation is the first priority of care for a client exhibiting S&S
of coronary artery disease.
Enhance myocardial oxygenation is always the first priority when a client exhibits S&S of
cardiac compromise.
Prolonged occlusion of the right coronary artery produces an infarction in which of he
following areas of the heart?
Inferior
The right coronary artery supplies the right ventricle, or the inferior portion of the heart.
Therefore, prolonged occlusion could produce an infarction in that area. The right coronary
artery doesn't supply the anterior portion ( left ventricle ), lateral portion ( some of the left
ventricle and the left atrium ), or the apical portion ( left ventricle ) of the heart.
Atherosclerosis
1. Arteries supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a
direct result of plaque formation in the artery. Hardened vessels cannot dilate properly and,
therefore, constrict blood flow.
Myocardial infarction (MI)
The most common symptom of an MI is chest pain, resulting from deprivation of oxygen
to the heart. Dyspnea is the second most common symptom, related to an increase in the
metabolic needs of the body during an MI.
Which condition is most commonly responsible for myocardial infarction (MI)?
Coronary artery thrombosis
Coronary artery thrombosis causes an occlusion of the artery, leading to myocardial death.
The FIRST intervention for a client experiencing MI?
Administer oxygen
Rationals: the myocardium is deprived of oxygen during an infarction, so additional oxygen is
administered to assist in oxygenation and prevent further damage. Morphine and sublingual
nitroglycerin are also used to treat MI, but they are more commonly administered after the
oxygen. An ECG is the most common diagnostic tool used to evaluate MI.
,NURS 100|CORONARY ARTERIES EXAM STUDY GUIDE
2022
Heart Sounds
Abnormalities of the Pulmonic valve is heard at the second left intercostal space along
the left sternal border).
Aortic valve: second intercostal space, to the right of the sternum.
Mitral valve: fifth intercostal space in the midclavicular line.
Tricuspid valve: third and fourth intercostal spaces along the sternal border.
Which complication is indicated by a third heart sound (S3)?
Ventricular dilation
Rationales: Rapid filling of the ventricular causes vasodilation that is auscultated as S3.
Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic
valve malfunction is heard as a murmur.
The nurse is assessing a client with heart failure. The breath sounds commonly auscultated
in clients with heart failure are:
fine crackles
RATIONALES: Fine crackles are caused by fluid in the alveoli and commonly occur in
clients with heart failure. Tracheal breath sounds are auscultated over the trachea. Coarse
crackles are caused by secretion accumulation in the airways. Friction rubs occur with pleural
, NURS 100|CORONARY ARTERIES EXAM STUDY GUIDE
2022
inflammation.
Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
Failure of the ventricle to eject all the blood during systole
An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction.
This increased resistance is related to decrease compliance of the ventricle. A dilated aorta
doesn’t cause an extra heart sound, though it does cause a murmur. Decreased myocardial
contractility is heard as a third heart sound. An s4 isn’t heard in a normally functioning heart.
Test & tools
Which blood tests is most indicative of cardiac damage?
Troponin I
Rationales: Troponin I levels rise rapidly and are detectable within 1 hour of myocardial
injury. Triponin I levels are not detectable in people without cardiac injury.
Which diagnostic tools is most commonly used to determine the location of
myocardial damage?
Electrocardiogram (ECG)
The ECG is the quickest, most accurate, and most widely used tool to determine the location
of MI, Cardiac enzymes are used to diagnose MI but cannot determine the location. An
echocardiogram is used mostly widely to view myocardial wall function after an MI has been
diagnosed. Cardiac catheterization is an invasive study for determining coronary artery
disease and may also indicate the location of myocardial damage, but the study may not be
performed immediately.
A client comes to the emergency department with chest pain, dyspnea, and an irregular
heartbeat. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia)
with frequent premature ventricular contractions. Shortly after admission, the client
has ventricular tachycardia and becomes unresponsive. After successful resuscitation, the
client is taken to the intensive care unit (ICU). Which nursing diagnosis is appropriate
at this time?
Anxiety related to the threat of death
RATIONALES: Anxiety related to the threat of death is an appropriate nursing diagnosis because
anxiety can adversely affect the heart rate and rhythm by stimulating the autonomic nervous
system. Also, because the client required resuscitation, the threat of death is a real and immediate
concern. Unless anxiety is dealt with first, the client's emotional state will impede learning. Client
teaching should be limited to clear, concise explanations that reduce anxiety and promote
cooperation. An anxious client has difficulty learning, so a knowledge deficit would continue
despite teaching attempts. Impaired physical mobility and Social isolation are necessitated by the
2022
The left anterior descending artery is the primary source of blood for the anterior wall
of the heart.
The circumflex artery supplies the lateral wall.
The internal mammary artery supplies the mammary.
The right coronary artery supplies the right ventricle and the inferior wall of the heart.
Most of the blood flow to coronary arteries is supplied during diastole.
Coronary artery disease (CAD) is the leading cause of death in the U.S. (accounts for
over 50% of all deaths)
Atherosclerosis, or plaque formation, is the leading cause of Coronary artery
disease (CAD).
Myocardial infarction is commonly a result of CAD.
Enhance myocardial oxygenation is the first priority of care for a client exhibiting S&S
of coronary artery disease.
Enhance myocardial oxygenation is always the first priority when a client exhibits S&S of
cardiac compromise.
Prolonged occlusion of the right coronary artery produces an infarction in which of he
following areas of the heart?
Inferior
The right coronary artery supplies the right ventricle, or the inferior portion of the heart.
Therefore, prolonged occlusion could produce an infarction in that area. The right coronary
artery doesn't supply the anterior portion ( left ventricle ), lateral portion ( some of the left
ventricle and the left atrium ), or the apical portion ( left ventricle ) of the heart.
Atherosclerosis
1. Arteries supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a
direct result of plaque formation in the artery. Hardened vessels cannot dilate properly and,
therefore, constrict blood flow.
Myocardial infarction (MI)
The most common symptom of an MI is chest pain, resulting from deprivation of oxygen
to the heart. Dyspnea is the second most common symptom, related to an increase in the
metabolic needs of the body during an MI.
Which condition is most commonly responsible for myocardial infarction (MI)?
Coronary artery thrombosis
Coronary artery thrombosis causes an occlusion of the artery, leading to myocardial death.
The FIRST intervention for a client experiencing MI?
Administer oxygen
Rationals: the myocardium is deprived of oxygen during an infarction, so additional oxygen is
administered to assist in oxygenation and prevent further damage. Morphine and sublingual
nitroglycerin are also used to treat MI, but they are more commonly administered after the
oxygen. An ECG is the most common diagnostic tool used to evaluate MI.
,NURS 100|CORONARY ARTERIES EXAM STUDY GUIDE
2022
Heart Sounds
Abnormalities of the Pulmonic valve is heard at the second left intercostal space along
the left sternal border).
Aortic valve: second intercostal space, to the right of the sternum.
Mitral valve: fifth intercostal space in the midclavicular line.
Tricuspid valve: third and fourth intercostal spaces along the sternal border.
Which complication is indicated by a third heart sound (S3)?
Ventricular dilation
Rationales: Rapid filling of the ventricular causes vasodilation that is auscultated as S3.
Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic
valve malfunction is heard as a murmur.
The nurse is assessing a client with heart failure. The breath sounds commonly auscultated
in clients with heart failure are:
fine crackles
RATIONALES: Fine crackles are caused by fluid in the alveoli and commonly occur in
clients with heart failure. Tracheal breath sounds are auscultated over the trachea. Coarse
crackles are caused by secretion accumulation in the airways. Friction rubs occur with pleural
, NURS 100|CORONARY ARTERIES EXAM STUDY GUIDE
2022
inflammation.
Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
Failure of the ventricle to eject all the blood during systole
An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction.
This increased resistance is related to decrease compliance of the ventricle. A dilated aorta
doesn’t cause an extra heart sound, though it does cause a murmur. Decreased myocardial
contractility is heard as a third heart sound. An s4 isn’t heard in a normally functioning heart.
Test & tools
Which blood tests is most indicative of cardiac damage?
Troponin I
Rationales: Troponin I levels rise rapidly and are detectable within 1 hour of myocardial
injury. Triponin I levels are not detectable in people without cardiac injury.
Which diagnostic tools is most commonly used to determine the location of
myocardial damage?
Electrocardiogram (ECG)
The ECG is the quickest, most accurate, and most widely used tool to determine the location
of MI, Cardiac enzymes are used to diagnose MI but cannot determine the location. An
echocardiogram is used mostly widely to view myocardial wall function after an MI has been
diagnosed. Cardiac catheterization is an invasive study for determining coronary artery
disease and may also indicate the location of myocardial damage, but the study may not be
performed immediately.
A client comes to the emergency department with chest pain, dyspnea, and an irregular
heartbeat. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia)
with frequent premature ventricular contractions. Shortly after admission, the client
has ventricular tachycardia and becomes unresponsive. After successful resuscitation, the
client is taken to the intensive care unit (ICU). Which nursing diagnosis is appropriate
at this time?
Anxiety related to the threat of death
RATIONALES: Anxiety related to the threat of death is an appropriate nursing diagnosis because
anxiety can adversely affect the heart rate and rhythm by stimulating the autonomic nervous
system. Also, because the client required resuscitation, the threat of death is a real and immediate
concern. Unless anxiety is dealt with first, the client's emotional state will impede learning. Client
teaching should be limited to clear, concise explanations that reduce anxiety and promote
cooperation. An anxious client has difficulty learning, so a knowledge deficit would continue
despite teaching attempts. Impaired physical mobility and Social isolation are necessitated by the
