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1. True or False: The left anterior descending coronary artery provides blood supply to the left ventricle, front of the septum and part of the right ventricle.
- True
- False
Answer: True...the LAD (left anterior descending artery) provides blood supply to the left ventricle, front of the septum and collateral circulation to the right ventricle.
2. Which coronary artery provides blood to the left atrium and left ventricle:
- A. Right marginal artery
- B. Posterior descending artery
- C. Left circumflex artery
- D. Right coronary artery
Answer: C. The LCA provides blood to the left atrium and left ventricle.
3. Which patient(s) are most at risk for developing coronary artery disease? Select-all-that-apply:
- A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer.
- B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day.
- C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction.
- D. A 29 year old that has type I diabetes.
Answers: B,C, D. Remember risk factors for developing CAD include: smoking, family history, diabetes, being overweight or obese, and high cholesterol.
4. A patient reports during a routine check-up that he is experiencing chest pain and shortness of breath while performing activities. He states the pain goes away when he rests. This is known as:
- A. Unstable angina
- B. Variant angina
- C. Stable angina
- D. Prinzmetal angina
Answer: C. Stable angina occurs during activities but goes away when the patient rests. Variant and Prinzmetal angina are the same and occur at rest during cycles. Unstable angina is chest pain felt during rest and is more severe.
5. Keeping the patient in question 4 in mind: What type of diagnostic tests will the physician most likely order (at first) for this patient to evaluate the cause of the patient’s symptoms? Select-all-that-apply:
- A. EKG
- B. Stress test
- C. Heart catheterization
- D. Balloon angioplasty
Answers: A and B. If the patient is experiencing STABLE angina (which in question 4 the patient's symptoms are stable) an EKG or stress test would be ordered to investigate if there are any EKG changes (ST depression) during exercise. These tests are usually ordered first and then the doctor may proceed with a heart catheterization. A balloon angioplasty is sometimes performed during a heart cath.
6. You're providing education to a patient who will be undergoing a heart catheterization. Which statement by the patient requires you to re-educate the patient about this procedure?
- A. “The brachial artery is most commonly used for this procedure.”
- B. “A dye is injected into the coronary arteries to assess for blockages."
- C. “Not all patients who have a heart catheterization will need a stent placement.”
- D. “I will not be completely asleep and will be able to breathe on my own during the procedure.”
Answers: A. The femoral or radial artery is used during a heart cath...not the brachial.
7. A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction?
- A. absent Q wave
- B. QRS widening
- C. absent P-wave
- D. ST segment elevation
Answer: D This is a common finding on an EKG when a patient is having a myocardial infraction due to muscle damage.
8. A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix. What important information will you include in the patient's teaching? Select-all-that-apply:
- A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure.
- B. A normal side effect of this medication is a dry cough.
- C. Avoid green leafy vegetables while taking Plavix.
- D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.
Answers: A and D. Patients on Plavix should let their doctor know that they are taking Plavix because it should be discontinued 5 to 7 days before a surgical procedure due to increased risk of bleeding. Also, option D represents signs and symptoms of Thrombotic Thrombocytopenic Purpura a clotting disorder where clots form in the vessels of the body which is a complication of Plavix.
9. A patient calls the cardiac clinic you are working at and reports that they have taken 3 sublingual doses of Nitroglycerin as prescribed for chest pain, but the chest pain is not relieved. What do you educate the patient to do next?
- A. Take another dose of Nitroglycerin in 5 minutes.
- B. Call 911 immediately
- C. Lie down and rest to see if that helps with relieving the pain
- D. Take two doses of Nitroglycerin in 5 minutes
Answer: B. If a patient's chest pain is not relieved with 3 doses of Nitroglycerin, taken 5 minutes apart, they should call 911 immediately. The patient should never exceed more than 3 doses of Nitroglycerin or take 2 doses at one time.
10. Lipitor is prescribed for a patient with a high cholesterol level. As the nurse, how do you educate the patient on how this drugs works on the body?
- A. Lipitor increases LDL levels and decreases HDL levels, total cholesterol, and triglyceride levels.
- B. Lipitor decreases LDL, HDL levels, total cholesterol, and triglyceride levels.
- C. Lipitor increases HDL levels, total cholesterol, and triglyceride levels.
- D. Lipitor increases HDL levels and decreases LDL, total cholesterol, and triglyceride levels.
Answer: D. Lipitor is a common "statin" medication used to lower cholesterol in CAD. It works by increasing HDL levels (the "good" cholesterol") and decreases LDL (the "bad" cholesterol"), total cholesterol, and triglyceride levels.
11. A patient taking Zocor is reporting muscle pain. You are evaluating the patient’s lab work and note that which of the following findings could cause muscle pain?
- A. Elevated potassium level
- B. Elevated CPK (creatine kinase level)
- C. Decreased potassium level
- D. Decreased CPK (creatine kinase level)
Answer: B. Zocor (a statin medication used for lowering cholestorl) can cause increased CPK levels which will lead to a patient experiencing muscle pain. Therefore, CPK levels must be monitored while a patient is taking this medication.
12. A patient who has diabetes will be started on Metoprolol for medical management of coronary artery disease. Which of the following will you include in your discharge teaching about this medication?
- A. Check your heart rate regularly because Metoprolol can cause an irregular heart rate.
- B. Check your glucose regularly because this medication can cause hyperglycemia.
- C. Check your blood pressure regularly because this medication can cause hypertension.
- D. Check your glucose regularly because this medication can mask the typical signs and symptoms of hypoglycemia.
Answer: D. This patient needs to be educated to check their glucose levels regularly because this medication can mask the typical signs and symptoms of hypoglycemia. This is very important since the patient is diabetic.
13. True or False: ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin II to Angiotensin I which causes vasodilation.
- True
- False
Answer: False. ACE inhibitors work to decrease the workload on the heart by blocking the conversion of Angiotensin I to Angiotensin II (not Angiotensin II to Angiotensin I as stated in the question) which causes vasodilation.
