PCCN Review Cardiac Exam 238 Questions with Verified Answers
Calculate the cardiac output for a pt with a HR of 70 and a SV of 65 ml. - CORRECT ANSWER
... [Show More] HR X SV=CO
70 X 65= 4550
4.6 L/min
Calculate the cardiac output for a pt with a HR of 70 and a SV of 65 ml.
HR X SV=CO - CORRECT ANSWER HR X SV=CO
70 X 65= 4550
4.6 L/min
What % of the cardiac cycle is provided by the atrial kick?
• 15%
• 20%
• 30%
• 35% - CORRECT ANSWER 20%
Atrial kick is a term that represents the amount of the total CO that is supplied via atrial contraction.
If the pt has a condition or dysrhythmia that impairs or eliminates the atrial contraction, the pt may be compromised.
Atrial Kick - CORRECT ANSWER Atrial kick is a term that represents the amount of the total CO that is supplied via atrial contraction.
A normal value for an EF would be?
• 65%
• 40%
• 30%
• 25% - CORRECT ANSWER 65%
The EF should be more than 50%. It represents the amount of blood ejected from the left ventricle compared to the total amount available, expressed as a %. An EF of 35% or less indicates a problem with contractility, outflow or filling.
EXA: If the ventricle contains 90ml of blood and 50mls are ejected, the amount would be expressed as a %, in this case 55%.
A 67 year old male is admitted with chest pain after collapsing at home. He is arguing with his wife that he should not be admitted because he "just over did it" while working in the world. Lee's wife states to you that his chest pain is more frequent, severe and prolonged than before. You should anticipate what diagnosis?
• Exertional angina
• Unstable angina
• Variant angina
• Stable angina - CORRECT ANSWER UNSTABLE ANGINA
The change in quality, frequency, and duration indicates UNSTABLE ANGINA and may indicate that the pt is at increased risk for an MI. This pt should be closely monitored for EKG changes and rhythm disturbances. Pt/ family teaching should begin on how to identify an MI and basic CPR.
Stroke Volume is comprised of which of the following factors?
• Blood volume, viscosity, impedance
• Cardiac output, HR, compliance
• Contractility, preload, afterload
• Compliance, impedance, HR - CORRECT ANSWER Contractility, preload and afterload
A reflex tachycardia caused by the stretch of the right atrial receptors is known as the ____
• Herring-Sines law
• Renin-angiotensin system
• Starling's law
• Bainbridge reflex - CORRECT ANSWER BAINBRIDGE REFLEX
It is believed that this reflex exists to speed up the HR if the right side becomes overloaded, thereby helping equalize pressures on both sides
Diastole comprises what & of the cardiac cycle?
• ½
• 2/3
• ¼
• 1/3 - CORRECT ANSWER 2/3
Some people that the heart is virtually static during diastole.
During this period, the cardiac vessels and chambers fill—a process that takes up 2/3s of the time necessary to complete the cardiac cycle
What is the MAP (mean arterial pressure) for pt:
BP 120/70
HR 80 - CORRECT ANSWER MAP=2(DBP) + (SBP)/3
MAP=2(70) + 120/3
MAP=260/3
MAP=86.6
Pts should maintain a MAP of at least 60 to ensure adequate perfusion to the brain and kidneys.
What is the MAP (mean arterial pressure) for pt:
BP 120/70
HR 80
MAP=2(DBP) + (SBP)/3 - CORRECT ANSWER MAP=2(70) + 120/3
MAP=260/3
MAP=86.6
Pts should maintain a MAP of at least 60 to ensure adequate perfusion to the brain and kidneys.
Calculate CI (cardiac index)
HR 80
BP 110/70
SV 60
BSA 2.0 m2
Expressed in L/min/m2 - CORRECT ANSWER CI=CO/BSA
CO=HR X SV
CO=80 X 60
CI=4800/2.0
CI=2400
CI=2.4 L/min/m2
Calculate CI (cardiac index)
HR 80
BP 110/70
SV 60
BSA 2.0 m2
Expressed in L/min/m2
CI=CO/BSA - CORRECT ANSWER CI=CO/BSA
CO=HR X SV
CO=80 X 60
CI=4800/2.0
CI=2400
CI=2.4 L/min/m2
The resistance against which the right ventricle must work to eject its volume is known as
• Resting heart pressure
• Systemic vascular pressure
• Central venous pressure
• Pulmonary vascular resistance - CORRECT ANSWER Pulmonary Vascular Resistance
This pressure represents a mean pressure in the systemic vasculature. The higher the resistance, the harder the heart has to work against it.
EXA: Colder temperatures will cause vasoconstriction; the heart then has to pump harder to deliver blood through the narrowed vasculature.
Mr. Ironclaw lives on a nearby Indian Reservation. He is retired and on a fixed income with no insurance. He is being discharged today after an observational stay for Chest Pain. In planning his discharge care, which of the following should be considered FIRST to increase compliance with plan of care once home?
• Arrange for Home Health 1X/week
• Ask doc to consider an OTC antiplatelet medication
• Schedule his follow-up appt with the cardiologist in 3 months
• Suggest a gym membership - CORRECT ANSWER ASK DOC TO CONSIDER AN OTC ANTIPLATELET MEDICATION
Although he may wish to be compliant with plan of care at home, financial limitations may prohibit him from expensive treatments, meds, and support services.
William was diagnosed with unstable angina. He is scheduled for an exercise stress test. He tells you he has a "bad hip" and an old knee injury that makes it difficult for him to walk or stand for more than 20 minutes. You tell him:
• You only need to walk for 10 minutes
• You can ride a bike for 20 minutes instead
• I will call the doc and ask for the Weight-life test instead
• I will call the doc and ask for a stress echocardiography test instead - CORRECT ANSWER I WILL CALL THE DOC AND ASK FOR A STRESS ECHOCARDIOGRAPHY TEST INSTEAD
The exercise stress test requires the pt to walk on a treadmill or stationary bike for 30-60 minutes.
The Stress Echocardiography test uses Dobutamine to stress the cardiac tissues without requiring the pt to walk or ride.
The Weight lift test does not exist.
Approximately what % of coronary artery blockage is needed to cause angina?
• 45%
• 60%
• 75%
• 90% - CORRECT ANSWER 75%
Anginal pain usually occurs when approximately 75% of the artery's diameter becomes occluded. Pain is usually more pronounced with exertion or emotional distress, when O2 demand by cardiac tissue cannot be met by O2 supply via the occluded arteries. The severity of the pain may be compounded with vasospams that further restrict blood flow through the coronary arteries.
A heart murmur associated with acute valvular regurg would be?
• S3
• S2
• S1
• S4 - CORRECT ANSWER S4
S1 and S2 are normal heart sounds
S3 is associated with fluid status
S4 is associated with compliance.
Which is the best lead to monitor a RBBB?
• Lead II
Lead I
• Lead V1
• Lead V6 - CORRECT ANSWER Lead V1
Tall, peaked T waves on an EKG may be indicative of?
• Hypocalcemia
• A non-STEMI
• Hyperkalemia
• A LBBB - CORRECT ANSWER HYPERKALEMIA
The PR interval may become prolonged. Also, if the K is greater than 8, a wide-complex tachycardia may occur. Keep in mind that low levels of calcium or sodium may potentiate the cardiac effects, as can a low pH.
Mrs. P suffered a cardiac arrest at home. The family did not perform CPR and paramedics arrived 6 minutes after the arrest. The pt was found in pulseless V-tach. Defib and continuous CPR were provided during transport to the ED. The pt was tx-ed to tele. The doc initiated hypothermic measures and administered vecuronium. This med is for?
• Controlling ventral dysrhythmias
• Prevent shivering
• Sedative
• Pain control - CORRECT ANSWER PREVENT SHIVERING
Vecuronium is a paralytic and will prevent shivering. If a pt shivers, her temperature will rise.
Your pt was admitted for malaise, severe dyspnea and had a syncopal episode at work. He states he has a midline burning sensation in his chest that worsens when he is supine. You suspect?
• Pleural effusion
• Pericardial tamponade
• GERD
• Myocarditis - CORRECT ANSWER MYOCARDITIS
It can also present as inspiratory pain. The pain when supine is a cardinal sign of myocarditis. Other findings may include respiratory infection and an S3, S4, and pericardial friction rub.
A definitive diagnosis of myocarditis can be made via?
• Endomyocardial biopsy
• Transesophageal ultrasound
• Transmural catheterization
• Chest X-ray - CORRECT ANSWER ENDOMYOCARDIAL BIOPSY
A biopsy is the ONLY definitive way to diagnose myocarditis.
The volume of fluid required to cause a pericardial tamponade is?
• 25-50 ml
• 50-75 ml
• 100-150 ml
• 200-300 ml - CORRECT ANSWER 50-75 ml of blood
Although 50-75 mls is a small amount, the pressure in the intrapericardial space may equal or exceed atrial and vertricular pressures causing an acute tamponade.
Beck's triad is a combination of symptoms useful in diagnosing cardiac tamponade. They are?
• Pericardial friction rub, hypertension, RV failure
• Increased pulse pressure, increased JVD, tachycardia
• Tachycardia, hypertension, LV failure
• Distended neck veins, muffled heart sounds, hypotension - CORRECT ANSWER Distended neck veins
Muffled heart sounds
Hypotension
Tachycardia is an early sign of tamponade. A narrowed pulse pressure occurs, and fluid cannot be ejected from the heart. The muffled heart sounds occur because the fluid in the sac minimized the transmission of sound waves.
Which of the following hemodynamic changes will occur with cardiac tamponade?
• Increased cardiac output
• Stroke volume decrease
• Contractility increases
• Decreased heart rate - CORRECT ANSWER STROKE VOLUME DECREASE
Because the heart cannot adequately fill or eject its contents, stroke volume (SV) decreases and causes a decreased cardiac output (CO). Contractility decreases because the muscles cannot stretch and, therefore, cannot contract effectively.
If your pt had a cardiac tamponade, which of the following would you expect to see on a CXR?
• A dilated superior vena cava
• Increased JVD
• Narrowed mediastinum
• Delineation of the pericardium and epicardium - CORRECT ANSWER A DILATED SUPERIOR VENA CAVA
The vena cava is dilated because blood couldn't flow into the right atrium.
JVD would not be visible on a CXR.
The mediastinum would be widened.
Delineation of the pericardium or epicardium would not be visible on a CXR.
Your pt was admitted for severe dyspnea, dysphagia, palpitations and an intractable cough. On auscultation, you hear a loud S1 and a right sided S3 and S4. This pt probably has?
• Mitral insufficiency
• Myocarditis
• Atrial stenosis
• Mitral stenosis - CORRECT ANSWER MITRAL STENOSIS
These symptoms could be caused by mitral stenosis, an ischemic left ventricle, or failure of a left ventricle. The S3 and S4 sounds suggest both a fluid problem and a pressure problem.
Quincke's sign is usually seen in which of the following conditions?
• Mitral Stenosis
• Endocarditis
• Aortic insufficiency
• Pericarditis - CORRECT ANSWER AORTIC INSUFFICIENCY
Quincke's sign is elicited by pressing down on he finger top; a visible pulsation is seen in the nail bed. The sign results from a pulse with a rapid, initial hard pulsation, followed by a sudden collapse as blood flows back through the incompetent valve.
In pts with aortic insufficiency, the popliteal BP is often higher than the brachial BP by at least 40 mm HG. This discrepancy between the measurements is known as?
• DeMusset's Sign
• Hill's Sign
• Holmes' Sign
• Rochelle's Sign - CORRECT ANSWER HILL'S SIGN
Hills's sign reflects the rapid rise in pulsation.
DeMusset's sign is also found in aortic insufficiency; it consists of the bobbing of the head in time with the forceful pulse.
Holmes' and Rochelle's signs are not diagnostic signs.
In stable angina, which of the following is true?
• A positive treadmill test will indicate CAD
• A thallium test (myocardial scintigraphy) will not diagnose LV dysfunction
• The treadmill test will miss as many as 20% of cases of single-vessel disease
• CK-MB isoenzymes and troponins will not increase - CORRECT ANSWER CK-MB ISOENZYMES AND TROPONINS WILL NOT INCREASE
A positive treadmill test may not be positive for CAD.
LV dysfunction may be diagnosed with a thallium test (myocardial scintigraphy).
Treadmill stress tests miss as many as 40% of cases of single-vessel disease.
Actions of beta blockers include?
• Increased myocardial oxygen demand
• Increased heart rate
• Increased diastolic filling time
• Increased afterload - CORRECT ANSWER INCREASED DIASTOLIC FILLING TIME
If the inferior wall of the heart is infracted, the leads that will most directly reflect the injury are?
• II, aVF
• I, aVL
• V1 - V2
• V5 - V6 - CORRECT ANSWER II, a VF - inferior heart
I, aVL - lateral wall
V1 - V2 --septal wall
V5 - V6 - apical area
An anterior wall infarct may be seen in leads?
• V4, R
• V5, V6
• V7, V9
• V2, V4 - CORRECT ANSWER V2, V4 -anterior wall
V4, R -right ventricular damage
V5, V6 -apical injury
V7, V9 - posterior wall
Pulsus alternans is most often noted with?
• Mitral Stenosis
• Constrictive pericarditis
• Aortic stenosis
• LV failure - CORRECT ANSWER LV failure
Pulsus alternans occurs when a weakened myocardium cannot maintain an even pressure with each contraction. The pulses alternate between strong and weak. This phenomenon is also seen in CHF.
Which of the heart valves is most commonly affected by infective endocarditis?
• Aortic
• Pulmonic
• Mitral
• Tricuspid - CORRECT ANSWER MITRAL
Aortic valve - is the next most common affected
Pulmonic valve - least likely to be affected
Tricuspid valve - often involved secondarily as a result of IV drug abuse
Alpha-adrenergic effects of norepinephrine include?
• Increased force of myocardial contraction
• Increased SA node firing
• Increase AV conduction time
• Peripheral arteriolar vasoconstriction - CORRECT ANSWER Peripheral arteriolar vasoconstriction
Increased force of myocardial contraction
Increased SA node firing
Increase AV conduction time
• These are all affects of beta-adrenergic sympathetic stimulation
Stimulation of the vasomotor center in the medulla occurs when the partial pressure of O2 changes. This sequence is initiated by?
• Baroreceptors
• Chemoreceptors
• The Purkinje system
• The Bainbridge reflex - CORRECT ANSWER CHEMORECEPTORS
Minute changes in the partial pressure of O2, pH, and the partial pressure of CO2 result in changes in the heart and respiratory rates. These changes are initiated by the chemoreceptors located in the carotid and aortic bodies.
When attempting to auscultate the aortic area, the location of the stethoscope should be?
• At the 2nd intercostal space, left sternal border
• Over the apical area
• At the 2nd intercostal space, right stenal area
• At the 5th intercostal space, left sternal boarder - CORRECT ANSWER At the 2nd intercostal space, right stenal area
At the 2nd intercostal space, left sternal border
• Pulmonic area
Over the apical area
• Mitral valve
At the 5th intercostal space, left sternal boarder
• Tricuspid area
When preparing to teach your 30 YO female pt about goals for weight control, the BMI should be assessed. The BMI should be between?
• 12.6 - 15.0
• 11.2 - 15.8
• 18.0 - 24.9
• 28.6 - 24.7 - CORRECT ANSWER 18.0 - 24.9
BMI= [(wt in #) / (ht in inches)2] X 703
BMI greater than 30 = obesity
BMI of 25-29 = overweight
When preparing to teach your 30 YO female pt about goals for weight control, the BMI should be assessed. The BMI should be between?
• 12.6 - 15.0
• 11.2 - 15.8
• 18.0 - 24.9
• 28.6 - 24.7
BMI= [(wt in #) / (ht in inches)2] X 703 - CORRECT ANSWER 18.0 - 24.9
BMI= [(wt in #) / (ht in inches)2] X 703
BMI greater than 30 = obesity
BMI of 25-29 = overweight
Symptoms of right-sided heart failure include?
• Pulmonary edema
• Elevated pulmonary pressures
• Hepatomegaly
• Orthopnea - CORRECT ANSWER HEPATOMEGALY
Pulmonary edema, elevated pulmonary pressures and orthopnea are all signs of left-sided heart failure.
Often times when the right side of the heart fails it's because the left side has failed. The right ventricle cannot adequately pump blood out, so filling pressures rise and the blood backs up, resulting in HEPATOMEGALY. As a consequence, CVP is elevated.
Additional symptoms may include: SPLENOMEGALY, ASCITES, ABDOMINAL PAIN, S3, S4, AND WEIGHT GAIN.
NSAIDS are contraindicated in the treatment of pts with heart failure because they?
• Decrease myocardial contractibility
• Cause a-fib in pts with heart failure
• Promote fluid retention
• May cause hypocalcemia - CORRECT ANSWER PROMOTE FLUID RETENTION
And may also contribute to renal insufficiency
Mr. J underwent a CABG 4 days ago and was tx-ed to you yesterday. Today, he c/o dull aching around the sternum. You note increased tenderness to touch along the sternal edge and contracted intercostal muscles. You should?
• Call the doc for orders: EKG, cardiac enzymes, and morphine
• Culture the wound for infection
• Do nothing; his pain is normal
• Administer morphine and diazepam as ordered. - CORRECT ANSWER ADMINISTER MORPHINE AND DIAZEPAM AS ORDERD.
The chest wall pain is most likely from his open-heart surgery. Pain must be addressed. MS and diazepam will treat both pain and muscle spasms.
The pain the pt c/o is not indicative of another MI and EKG changes would not be seen.
There is no indication of infections, so no culture is indicated.
Pain must ALWAYS be addressed.
You are using the PQRST method of pain assessment for your pt c/o CP. The S stands for?
• Sensitivity
• Severity
• Standard
• Symptoms - CORRECT ANSWER SEVERITY
P - provokes (what makes it hurt?)
Q—quality (sharp, stabbing, dull, ache?)
R—radiation (does it start in one place and move to another?)
S - severity (1-10)
T - time - (duration of pain)
An absolute contraindication for use of a fibrinolytic would be?
• Traumatic CPR
• Cerebrovascular disease
• Subacute bacterial endocarditis
• Oral anticoagulants - CORRECT ANSWER TRAUMATIC CPR
Other absolute contraindications are:
HYPERTENSTION
BLEEDING DISORDERS
The other options are relative contraindications.
Which of the following statements are true about Lidocaine?
• Causes hypotension
• Has a moderate GI intolerance
• Has no impairment of normal contractility
• Can cause nystagmus - CORRECT ANSWER LIDOCAINE HAS NO IMPAIRMENT OF NORMAL CONTRACILITY
Lidocaine may shorten QT intervals.
Side effects usually involve the CNS - slurred speech, drowsiness, confusion, paresthesias, seizures, and convulsions.
The other selections are effects of phenytoin, another class 1B drug.
Which of the medications listed has a high iodine content?
• Flecanide
• Lidocaine
• Mexilitene
• Amiodarone - CORRECT ANSWER AMIODARONE
The high iodine content can actually exert an effect on the thyroid, thereby producing an antiarrhythmic action.
Flecanide - antiarrythmic
Lidocaine - antiarrythmic
Mexilitene - antiarrythmic
The drug of choice to treat AV nodal and atrioventricular re-entrant arrhythmias is?
• Amiodarone
• Clonidine
• Quinidine
• Adenoside - CORRECT ANSWER ADENOSINE
Adenosine is a naturally occurring substance in our bodies and has a very short half-life (only a few seconds). It slows AV nodal conduction or can stop the conduction process altogether, potentially causing a transient AV block (seen as asystole). The pt may experience mild to moderate chest discomfort, slight hypotension, bradycardia, and possibly flushing.
Amiodarone is an antiarrhythmic
Clonidine is an antihypertensive
Quinidine is an antiarrhythmic
Sometimes certain medications prolong the QT interval, potentially causing polymorphic ventricular tachycardia. The drug of choice to treat this rhythm is?
• Magnesium
• Calcium
• Digoxin
• Lidocaine - CORRECT ANSWER MAGNESIUM
Magnesium acts on the processes by which calcium is transferred both across the cell membrane and within the cell itself.
If high doses of Magnesium are given, it may slow AV conduction
The QT interval may be prolonged by use of tricyclic antidepressants, erythromycin (ABX), quinidine (antiarrhythmic) or terfenidine (antihistamine).
Calcium-channel blockers act primarily on?
• Reduction of CO (cardiac output)
• Arteries to arterioles
• Lung receptors only
• Venules to veins - CORRECT ANSWER ARTERIES TO ARTERIOLES
Large-lumen vessels in the arteriole system are affected. The advantage of this action is that both systolic and diastolic pressures are reduced and the pt will not have a precipitous drop in BP. The BP may be lowered slightly and cause a reflex baroreceptor response to increase HR to maintain CO (cardiac output).
The fourth heart sound, S4, is?
• Heard as the mitral valve opens
• A low-pitched murmur
• Heard during atrial contraction
• Produced in CHF - CORRECT ANSWER HEARD DURING ATRIAL CONTRACTION
AKA ATRIAL GALLOP
When the atria contract and fill the ventricle, there is naturally some resistance to that pressure, as the ventricle is already about 80% full.
If the pt has a problem such as HTN, had an MI, an anginal episode, or aortic stenosis, the S4 sound may become quite pronounced.
An example of a systolic murmur would be?
• Tricuspid stenosis
• Tricuspid insufficiency
• Mitral stenosis
• Pulmonic insufficiency - CORRECT ANSWER TRICUSPID INSUFFICIENCY
A heart murmur is the sound made by turbulent blood flow.
A SYSTOLIC murmur would be heard during systole, when the ventricles are contracting. The mitral and tricuspid valves should be closed during this phase of the cardiac cycle. If these valves are incompetent/ insufficient, the blood will flow back through the valve (regurgitation).
Pulmonic and Aortic STENOSIS=
Systolic murmurs
Mitral and Tricuspid INSUFFICIENY=
Systolic murmurs
An example of a pansystolic murmur is?
• Pulmonic insufficiency
• Tricuspid insufficiency
• Atrial stenosis
• Mitral stenosis - CORRECT ANSWER TRICUSPID INSUFFICIENCY
PANsystolic means that the murmur is heard throughout systole.
Pulomonic INSUFFICIENCY=
Diastolic murmur
Atrial and Mitral STENOSIS =
Diastolic murmur
Mrs E. was diagnosed with pericarditis on admit to PCU. She is c/o intermittent, sharp, knifelike pain in her chest. Which position would you place her in to help alleviate some of the pain?
• Flat with heels elevated
• Sit up and leaning forward on a stable bedside table
• Prone, Trendelenburg (head down, feet up)
• On her right side - CORRECT ANSWER SIT UP AND LEANING FORWARD ON A STABLE BEDSIDE TABLE
Pericarditis results in inflamed layers of the pericardial sac.
Upright and forward positioning pulls the heart away from the diaphragmatic pleura of the lungs and eases cardiac pain.
Deep respirations, trunk rotation and flat positioning allow the parietal and visceral layers of the pericardial sac greater ability to rub against each other.
Mrs. B was admitted for observation post falling 10 feet into a ravine. She was diagnosed with SLE (systemic lupus erythematosus) 2 yrs ago. She suffered a concussion, 3 fx-ed ribs, a fx-ed radius, and sprained ankle. She is on a Holter monitor and receiving IVF and ABX. Which of the following conditions would be exacerbated by the SLE?
• Hypotension
• Constipation
• Pericarditis
• Polycythemia - CORRECT ANSWER PERICARDITIS
SLE - systemic lupus erythematosus is a chronic inflammatory autoimmune disease that affects the vascular and connective tissues within any body system or organ.
As a result of the SLE, inflammation may be increased and the stress of injury would further exacerbate the disease.
S/S to monitor closely for include:
Pericarditis, HTN, diarrhea, thrombocytopenia, anemia, leucopenia, joint and muscle pain, vasculitis, proteinurea, seizures, depression, PNA, pleural effusions, nausea and ulcers.
If the INR (international normalized ratio) is greater than 5.0, the pt is at a significant risk for bleeding. A drug that can cause a significant rise in the INR is?
• Ethacrinic acid
• PCN
• Amiodarone
• Statins - CORRECT ANSWER AMIODARONE
These cause a SIGNIFICANT rise in INR:
ASA
sulfonamides (ABXs)
cimetidine (Tagamet, an H2 antogonist receptor), fluoroquinolones (ABXs)
macrolide antibiotics
Those below all cause a MODERATE rise in INR:
Ethacrinic acid (loop diuretic, antihypertensive) PCN (ABX)
Statins (anticholesterol medications)
A drug that will significantly decrease the INR would be?
• Naficillin
• Vitamin K
• High-dose Vitamin C
• Cyclosporin - CORRECT ANSWER VITAMIN K
Vitamin K is considered the antidote for warfarin, but can actually lower the INR too much and increase warfarin resistance, so careful monitoring is needed.
These cause SIGNIFICANT decrease in INR:
Rifampin (ABX)
Phenobarbital (barbiturate anticonvulsant)
Glutethimide (hypnotic sedative)
Those below cause a MODERATE decrease in INR:
Naficillin (narrow spectrum ABX)
High dose Vitamin C (cancer tx)
Cyclosporin (immunosuppressant)
Your pt has a temporary pacer and has been requiring adjustments to raise the energy output (milliamps). This is probably due to?
• Hyperkalemia
• Necrotic tissue
• Lidocaine toxicity
• An atrioventricular block - CORRECT ANSWER NECROTIC TISSUE
Dead meat don't beat. Necrotic tissue cannot conduct an impulse. Ischemic tissue may impair conduction.
If the pt was Hypokalemic, the energy levels (mA) would have to be raised because the low K level depresses the myocardium.
Mr K is a 54 YO dockworker who was admitted with a NSTEMI to the inferior wall. He is c/o dyspnea, weakness, bilateral crackles, and demonstrates orthopnea. He has developed an S3 heart sound. You suspect he has also developed?
• Pulmonary Embolus
• Pulmonary HTN
• A fat embolism
• Cardiogenic shock - CORRECT ANSWER CARDIOGENIC SHOCK
The MI has impaired the heart's ability to pump effectively. The CO falls and the body reacts by vasoconstricting peripheral circulation and increasing the HR.
Tachycardia is also the result of catecholamine release, and the myocardial O2 consumption increases.
The left ventricle works harder, but has been compromised by the MI.
Preload increases because fluid cannot be pumped out of the chambers effectively.
S3 is a signal of increased PREload.
Pulmonary congestion occurs because of increased LEFT heart pressures.
Your pt suddenly complains of chest pain. You auscultate a new holosystolic murmur at the lower left sternal border. Your pt has probable experienced a
• Dissecting thoracic aneurysm
• Pulmonary embolus
• Ventricular septal rupture
• Lateral wall MI - CORRECT ANSWER VENTRICULAR SEPTAL RUPTURE
A new holosystolic murmur at the lower left sternal border means that turbulent blood flow is occurring there. The turbulence is caused by a hole that is allowing blood to flow through a previously closed area. The SvO2 will increase due to the mixing of blood. This condition must be corrected surgically.
Mrs F was admitted for DVT management 3 days ago. During your initial assessment, you found her sitting on the side of the bed leaning forward. Mrs. F states that this position relieved her newly developed chest pain. She also states her pain is worse on inspiration. You call the doc who orders a CXR and labs. The lab results show that the pt's sed rate and WBCs are elevated. Mrs. F most likely has?
• Pericarditis
• Thoracic aneurysm
• Pulmonary embolus
• Pulmonary edema - CORRECT ANSWER PERICARDITIS
The CXR will probably show a pericardial effusion.
The elevated sed rate and WBCs indicate infection.
Learning forward will relieve the chest pain whereas lying supine makes it worse.
If the pain worsens with inspiration, it's because the lungs expand and come in contact with the pericardium.
The pt will also probably have a fever.
It's also important to assess for s/s of tamponade and to make certain that any anticoagulants are d/c'd.
A probable candidate for a CABG (coronary artery bypass graft) might have?
• An EF of 55% and diabetes
• Right main artery disease
• An EF of 35% and CAD (coronary artery disease)
• A previous history of cardiac surgery - CORRECT ANSWER An EF of 35% and CAD
You are performing CPR on a pt with an endotracheal tube (ET) in place. The placement of the tube has been confirmed. THe pt should be ventilated every:
6 to 8 seconds
5 Compressions
15 Compressions
3 to 5 seconds - CORRECT ANSWER 6 to 8 seconds
The new AHA guidelines specify t hat ventilation should occur every 6 to 8 seconds. The compressions should continue at a rate of 100 per minute. The recommended ventilation rate approximates a normal adult rate and allows for cardiac refill. Ventilating too fast raises intrathoracic pressure and interferes with cardiac fill.
If you are using a biphasic defibrillator on an adult, t he energy setting should be:
360 joules
50 to 100 joules
300 joules
200 joules - CORRECT ANSWER 200 joules
200 joules on a biphasic defibrillator is as effective as 360 joules on a monophasic defibrillator. The purpose of defibrillation is to deliver enough electricity to cause a large enough mass of myocardium to depolarize simultaneously. If that occurs, it is then possible for a normal rhythm to reemerge or become the primary rhythm. It is important to identify the initial cause of the dysrhythmia and treat it, if possible, to prevent recurrence.
Maria has been diagnosed with pericarditis secondary to blunt chest trauma and cardiac contusion after a motor vehicle accident. She asks you how long the pericarditis may last. Your answer will be formulated based on the fact that:
Acute pericarditis will self resolve in 1 week
Acute pericarditis should self resolve in 2-6 weeks
Acute pericarditis will always result in chronic pericarditis
Chronic pericarditis is reoccuring and not associated with any other cardiac symptom - CORRECT ANSWER Acute pericarditis should self resolve in 2-6 weeks.
Acute pericarditis is usually self limiting within 2 to 6 weeks after it's initial onset. Treatment includes bedrest, O2 therapy, antivirals, antifungals, or antibacterials. In addition, drainage and management of cardiac tamponade may be necessary. The classic presentation of chronic pericarditis, also known as constrictive pericarditis, demonstrates fibrous pericardial thickening. Treatment may include the extreme measure of pericardiotomy (removal of the pericardium.)
Wellen's syndrome:
Is the same as Prinzmetal's angina
Occurs with the proximal stenosis of the LAD
Is also called cresendo angina
Is variant angina - CORRECT ANSWER Occurs with the proximal stenosis of the LAD
Wellen's syndrome is a type of angina that occurs when the LAD is stenosed proximally. The ST segment is not elevated more than 1mm in leads V1-V3, there is a mild T wave inversion in leads V2-V3, and Q waves are not pathologic (greater than 25% of the total length). Because of the location of the stenosis, surgery is emergently needed.
Prinzmetal angina is aka Variant angina -- in this type of angina, the pain occurs at rest and is associated with a vasospasm.
Cresendo angina means that over time, it takes less to initiate the pain and the pain lasts longer.
A vasodilator used in the treatment of anginal pain is:
Morphine
Ticlid
Aspirin
NTG - CORRECT ANSWER Nitroglycerine
NTG is a vasodilator for both arterial and venous systems. Sometimes the decreased coronary vessels are stiff and calcified. If the patient has good collateral circulation, O2 and blood can reach the ischemic areas. NTG is now available in a metered-dose oral spray, in addition to pressed tabs, paste, and IV (nitroprusside) formulations.
A pt is at high risk for ventricular septal defect or rupture or even a ventricular aneurysm if an infarct occurs in the:
Left Anterior Descending artery
Left Main Coronary artery
Left Circumflex artery
Right Coronary artery - CORRECT ANSWER Left Main Coronary Artery
An infarct in the left main coronary artery is an ominous sign. Sudden death may occur, along with heart blocks and atrial and ventricular dysrhythmias.
If a chronic fluid accumulation occurs, the pericardial sac may hold as much as _____ before the signs of cardiac tamponade will appear.
200 ml
400 ml
1000 ml
2000 ml - CORRECT ANSWER 2000 ml
In a chronic condition, as much as 2000 ml of fluid may collect in the pericardial sac before symptoms appear. This fluid buildup is usually due to a chronic pleural effusion or uremia.
Acute tamponade may occur with as little as 50 ml of fluid collects in the pericardial sac.
Which of the following statements is true about pericardial effusion?
-Pericardial effusion is a painless, hard to diagnose condition.
-On CXR, a "water bottle" silhouette is noted.
-Diastolic filling is increased.
-The voltage of the QRS complex in increased. - CORRECT ANSWER On CXR, a "water bottle" silhouette is noted.
The classic description of the CXR associated with pericardial effusion is the "water bottle" silhouette.
QRS amplitude is decreased, as is diastolic filling.
Increased afterload would be seen with _____.
-Polycythemia
-Aortic insufficiency
-Hypovolemia
-Sepsis - CORRECT ANSWER Polycythemia
Hypovolemia and Sepsis decrease afterload as does Aortic insufficiency. Aortic stenosis increases afterload, as do peripheral vasoconstriction and hypertension.
Auto-regulatory control of caridac vessels becomes impaired if the coronary perfusion pressure drops below:
35 mm Hg
40 mm Hg
50 mm Hg
60 mm Hg - CORRECT ANSWER 50 mm Hg
A pressure of at least 50 mm Hg is required to maintain auto-regulatory control.
Renin is secreted by the _____.
-Pancreas
-Lungs
-Liver
-Kidneys - CORRECT ANSWER Kidneys
Renin, a protease, will be secreted if the sodium concentration falls, sympathetic output increases, or blood pressure decreases. Blood pressure may be lowered by diuretics, hemorrhage, dehydration, or sodium depletion. Something as simple as NG tube drainage can decrease blood pressure, so in any setting, it is critical to maintain accurate I/Os.
If blood pressure is lower by at least 10-11 mm Hg on inspiration than on expiration, this is known as _____.
-Pulsus alternans
-Pulse pressure
-Pulsus paradoxus
-Pulsus parvus - CORRECT ANSWER Pulsus paradoxus
Pulsus paradoxus may be present in conjunction with asthma, emphysema, cardiac tamponade, restrictive pericarditis, or hemorrhagic shock.
Pulse pressure is the difference between systolic and diastolic pressures.
Pulsus parvus means a small or weak pulse
Pulsus alternans means the upstroke is more powerful than the downstroke -- that is, the stokes alternate in strength.
Robert suffered an MI but is now in stable condition in the PCU. Seven family members arrive at the unit demanding to see the pt. Your best response would be:
-Notify social services
-Identify the responsible family spokesperson and contact him or her
-Refuse to admit more than one person]
-Call security to remove the visitors. - CORRECT ANSWER Identify the responsible family spokesperson and contact him or her.
Visitation policies cary by institution. However, it is best to identify one person as the point of contact. HIPAA regulations require limitations on the release of any medical information be set by the patient if the patient is able to communicate his or her wishes. If the patient is unable to make this decision, the next of kin can act as a contact person.
Robert suffered an MI but is now in stable contition in the PCU. After you have identified his significant other, his estranged wife arrives. Robert tells you that he does not want contact with her. He even writes a note to the effect to be placed on his chart. He also states he wants no information given to his estranged wife. She becomes belligerent when told of Robert's wishes and threatens the staff with a lawsuit. The most appropriate nursing action would be :
-Request an ethics/ multidisciplinary care conference to discuss communication and dissemination of the patient's medical status and to review the visitation policy
-Immediately call the hospial's attorney to speak to the estranged wife
-Give the wife any information she wants, but do not inform Robert that you have done so
-Request that the patient's physician write a non-visitation order for the wife. - CORRECT ANSWER Request an ethics/ multidisciplinary care conference to discuss communication and dissemination of the patient's medical status and to review the visitation policy
The best response would be to collaborate and interact with other professionals.
Rebecca, who is a Jehovah's Witness, has just undergone a cardiac surgical procedure. Her Hgb and Hct levels have been falling and are now 6.5 and 24. Her chest tubes have drained 1750 ml in the last 4 hours. The anticipated treatment would be to administer:
-One unit type specific whole blood
-500 ml albumin
-250 ml FFP
-Continuous-circuit auto-transfusion - CORRECT ANSWER Continuous-Circuit Auto-transfusion
The religious preference of the patient must be respected. The only acceptable form of transfusion is this case is via auto-transfusion.
The major advantage of using an internal mammary artery for cardiac bypass would be:
-Greater ease of harvesting
-Better postsurgical patency
-A lowered infection rate
-A lowered rate of reperfusion rhythms - CORRECT ANSWER Better postsurgical patency
Utilizing the internal mammary artery means grafts do not have to come from the saphenous veins in the legs, minimizing the risk for infection from another site.
In the graft procedure, the internal mammary artery is seperated at only one end and reanastomosed to the affected coronary artery distal to the affected area. The patency of the resulting graft is generally quite good. After 10 years, approximately 90% of the grafts are still patent.
Your patient just underwent a percutaneous intervention for stent placement, after which he was returned to your tele unit. You note a rash over the patient's trunk and arms. This is probably due to _____.
-An allergic reaction to contrast dye
-Petechiae from a fat emolism
-A reaction to the indwelling stent
-A rash secondary to a Candida infection - CORRECT ANSWER An allergic reaction to contrast dye.
Iodine dye is used and will cause a rash, itching, swelling and can also lead to laryngospasm and anaphylaxis in some patients. It is imperative to determine whether the patient is allergic to iodine, shellfish, or horses prior to initiating the procedure.
A sign of necrosis on an EKG would include:
-Acute ST elevation
-A Right BBB
-A Left BBB
-A Q wave in lead III - CORRECT ANSWER Acute ST elevation. [Show Less]