CCRN PRACTICE QUESTIONS

A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system?

A. Sinoatrial (SA) node

B. Bachmann's bundle

C. Atrioventricular (AV) node

D. Bundle of His

LAD so D. bundle of his

Which of the following is the preferred lead for ST segment monitoring for a patient with a suspected RCA occlusion?

A.I

B. aVR

C. III

D. V1

c. III

Which of the following is not a manifestation of hypertrophic cardiomyopathy?

A. Syncope

B. Murmur that increases with squatting

C. Chest pain

D. Sudden cardiac death

*B

Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an aortic stenosis type of murmur that decreases when the patient is in a squatting position. The first manifestation of this condition is occasionally sudden cardiac death during exercise.

In which quadrant is the mean QRS complex axis located if the QRS complex is predominantly positive in lead I and negative in lead aVF?

A. Normal quadrant

B. Left axis deviation quadrant

C. Right axis deviation quadrant

D. Indeterminant quadrant

*B

Because the positive of lead I is the left arm, if the QRS complex is upright in lead I, the mean QRS axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the foot, if the QRS complex is negative in lead aVF, the mean QRS axis is upward away from the foot. This axis would be in the upper left quadrant, described as left axis deviation.

A patient becomes apneic and pulseless. CPR has been initiated, and the monitor shows asystole in two leads. Which of the following drugs would be used initially?

A. Calcium gluconate

B. Atropine

C. Epinephrine

D. Amiodarone (Cordarone)

C

After CPR is initiated and an intravenous access is established, epinephrine should be given. Calcium was used in the past in asystole but is used today only for hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia. Atropine is no longer recommended for asystole. Amiodarone is not indicated in asystole because asystole is the absolute absence of irritability.

What is associated w/ Mitral Stenosis

A. Pinkish discoloration of the cheeks

B. Systolic murmur

C. Widened pulse pressure

D. Narrow pulse pressure

A

Patients with mitral stenosis may exhibit a pinkish discoloration of the cheeks (i.e., malar blush). Mitral stenosis causes a diastolic murmur. Widened pulse pressure is associated with aortic regurgitation. Narrowed pulse pressure is associated with mitral regurgitation.

Four days after a mitral valve replacement, the patient develops atrial fibrillation. The nurse initially would:

A. order a 12-lead EKG

B. evaluate the patient for clinical indications of hypoperfusion.

C. notify the physician.

D. ask the patient to bear down as if having a bowel movement.

B

The onset of atrial fibrillation results in the loss of atrial kick. Loss of atrial kick may reduce the cardiac output by as much as 20-30%. This is especially true in patients whose cardiac output may be affected by long-standing cardiac disease, such as mitral valve disease. Assess the patient for clinical indications of hypoperfusion (e.g., cool skin, decreased urine output, narrowed pulse pressure, and hypotension).

A patient has just returned from the cath lab. She had an angioplasty for occlusion of her RCA. She still has femoral artery and vein sheaths in place. The patient complains of chest pain that she rates 9/10 about an hour after she returns from the cath lab. Which of the following is indicated?

A. Administer morphine IV.

B. Administer nitroglycerin sublingual spray.

C. Stop the heparin.

D. Notify the physician

D

New-onset severe chest pain after percutaneous coronary intervention suggests acute closure of the dilated coronary artery. The patient needs to be returned to the cardiac catheterization laboratory for repeat dilation and probable insertion of stent.

A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What other data would indicate the development of cardiac tamponade?

A. Increased venous oxygen saturation (SvO2)

B. Decreased UO

C. Muffled heart sounds

D. New holosystolic murmur at the sternum

C

Muffled heart sounds are a classic finding in cardiac tamponade. Remember the classic indications of cardiac tamponade referred to as Beck's triad: muffled heart sounds, jugular venous distention, and hypotension. Even though urine output is a sensitive indicator of cardiac output and in cardiac tamponade a decreased stroke volume results in a decreased cardiac output, by the time a nurse would notice the decreased urine output, the patient may have already had a cardiopulmonary arrest. The SvO2 actually would decrease because of the decrease in cardiac output. New holosystolic murmur at the lower left sternal border is a sign of ventricular septal rupture.

A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following complications most likely is occurring in this patient?

A. Acute mitral regurgitation

B. Rupture of left ventricular free wall

C. Ventricular septal rupture

D. Acute aortic stenosis

A

With an inferior MI, the risk of the papillary muscles being affected is greater. The papillary muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral regurgitation occurs and is manifested by a new holosystolic murmur at the apex, acute pulmonary edema, and decreased cardiac output/index

A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type of drug is carvedilol?

A. Calcium channel blocker

B. Angiotensin-converting enzyme inhibitor

C. Alpha- and noncardioselective beta-blocker

D. Cardioselective beta-blocker

C. Alpha- and noncardioselective beta-blocker

A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute MI. EKG shows ST elevation and T wave inversion in leads V2, V3, and V4. His history includes HTN, 80 pack-years of smoking, COPD, and HLD.

An IV and fibrinolytic therapy were initiated in the ED. Which of the following would not be an indication of successful reperfusion?

A. Pain cessation

B. Absence of creatine kinase (CK) enzyme elevation

C. Reversal of ST segment elevation with return of ST segment to baseline

D. Short runs of ventricular tachycardia

B. Absence of creatine kinase (CK) enzyme elevation

Substernal chest pain, low-grade fever, and pericardial friction rub are clinical indications of which of the following?

A. Pericarditis

B. Pericardial tamponade

C. Pneumothorax

D. Pleurisy

A. Pericarditis

A patient sustains a myocardial contusion as a result of a MVC. Which of the following signs and symptoms would be most likely?

A. Jugular venous distention

B. Crackles

C. Bradycardia

D. S3 at the apex

A. Jugular venous distention

A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV block with a ventricular rate of 52 and no pacing spikes. This indicates which of the following?

A. Failure to capture

B. Failure to pace

C. Competition between pacemaker and intrinsic rhythm

D. Failure to sense

B. Failure to pace

Which one of the following structures is at greatest risk for trauma in myocardial contusion?

A. Right atrium

B. Right ventricle

C. Aorta

D. Left ventricle

B. RV

Leads V8 and V9 are used to evaluate which of the following?

A. Left ventricular failure

B. Posterior myocardial infarction (MI)

C. Lateral MI

D. Left bundle branch block

B. posterior MI

Which of the following is the major advantage of minimally invasive direct coronary artery bypass grafting (MIDCABG)?

A. Decreased cost

B. Decreased length of stay

C. Avoidance of cardiopulmonary bypass

D. Less patient pain

C. avoidance of cardiopulmonary bypass

A patient arrives to the ED with a knife sticking out of his chest. He is stable at this time but complaining of pain at the knife insertion site. The physician is busy resuscitating another patient. What should be done?

A. Remove the knife so that the wound can be cleansed.

B. Remove the knife and apply a sterile, occlusive dressing.

C. Leave the knife in but stabilize it with adhesive tape.

D. Leave the knife in but apply a pressure dressing over it.

C. Leave the knife in but stabilize it with adhesive tape.

A 57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal MI. A PA catheter was inserted, and initial readings were within normal limits. BP 140/92, HR 110 and regular, RR 24. Breath sounds equal and clear. 3 hrs after admission, the pt becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR 28 and labored. Crackles are audible at the lung bases BL. The patient is given furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of the following would be the most appropriate intervention at this time?

A. Administer saline bolus.

B. Decrease dobutamine drip rate.

C. Increase nitroglycerin drip rate.

D. Replace potassium.

A. Administer saline bolus.

What type of AV block is characterized by a progressive prolongation of the PR interval followed by a nonconducted P wave?

A. First-degree AV block

B. Second-degree AV block, type I

C. Second-degree AV block, type II

D. Third-degree AV block

B.

Second-degree AV block, type I

A premature P wave buried in the T wave before a run of wide QRS complex tachycardia indicates that the wide QRS complex tachycardia is most likely which of the following?

A. Supraventricular tachycardia with aberrancy

B. Ventricular tachycardia

C. Bundle branch block

D. Wolff-Parkinson-White syndrome

A.

Supraventricular tachycardia with aberrancy

Which of the following drugs are used for first-line therapy for chronic management of hypertension?

A. ACE inhibitors and vasodilators

B. Vasodilators and beta-blockers

C. Diuretics and beta-blockers

D. Diuretics and ACE inhibitors

C.

Diuretics and beta-blockers

A 61-year-old man is admitted to the critical care unit from the cath lab. He has just had a PCI and stent insertion to the RCA. His leg is immobilized, and the HOB 30 degrees. Six hours later the patient is restless and complaining of back pain. The femoral sheath is intact in the right femoral area, and there is no evidence of bleeding or hematoma. Neck veins are flat with the HOB 30 degrees, and heart sounds are normal. Vital signs are BP 80/50, HR 120, and RR 24. Which of the following is the priority issue for patient education for this patient?

A. The need for lifestyle changes to decelerate the atherosclerotic process

B. To avoid magnetic resonance imaging

C. The need for taking a platelet aggregation inhibitor daily

D. How to take nitroglycerin

C. The need for taking a platelet aggregation inhibitor daily

Unstable angina that presents as pain at rest is likely to be due to progression of CAD or which of the following?

A. Dysrhythmias

B. Hypertension

C. Coronary artery spasm

D. Anxiety

C. Coronary artery spasm

Which of the following is the major disadvantage of the use of serum myoglobin for the diagnosis of an acute MI?

A. Low specificity and false-positive results

B. High specificity and false-negative results

C. High sensitivity and false-positive results

D. Low sensitivity and false-negative results

C. High sensitivity and false-positive results

Which of the following is the most likely mechanism for atrial tachycardias?

A. Reentry

B. Triggered activity

C. Accessory pathways

D. Enhanced automaticity

A. re-entry

Which of the following would be a contraindication to the use of fibrinolytic drugs, such as recombinant tissue plasminogen activator?

A. Hypotension

B. Heart block

C. Uncontrolled hypertension

D. Pain lasting more than 6 hours

C. uncontrolled hypertension

A patient returns to the critical care unit after insertion of a transvenous pacemaker. There are pacing spikes not followed by a QRS. Which of the following is a method to facilitate capture during pacing?

A. Increase the pacing rate.

B. Increase the milliamperage.

C. Suppress the competitive rhythm.

D. Increase the sensitivity

B. Increase the milliamperage.

eduction in peripheral circulation and shifting of the oxyhemoglobin dissociation curve can affect the accuracy of which of the following?

A. Arterial blood gases

B. Capnography

C. Hemoglobin and hematocrit

D. Pulse oximetry

D. Pulse oximetry

Which of the following would not be recommended for diastolic dysfunction?

A. Angiotensin receptor blockers

B. Beta-blockers

C. Inotropes

D. Angiotensin-converting enzyme inhibitors

C. inotropes

Why does nitroprusside (Nipride) cause tachycardia?

A. Stimulation of cardioacceleratory center

B. Stimulation of alpha receptors

C. Stimulation of baroreceptors

D. Stimulation of renin-angiotensin-aldosterone system

C. Stimulation of baroreceptors

Aortic stenosis would elevate which of the following?

A. Left ventricular systolic pressure

B. Pulmonary artery systolic pressure

C. Arterial systolic pressure

D. Arterial diastolic pressure

A. Left ventricular systolic pressure

Which of the following does not predispose the patient to digitalis toxicity?

A. Hypokalemia

B. Hypercalcemia

C. Hypomagnesemia

D. Hyponatremia

D. Hyponatremia

Which of the following types of drugs can cause hypotension, hyperkalemia, angioedema, proteinuria, and cough?

A. Beta-blockers

B. Loop diuretics

C. Calcium channel blockers

D. Angiotensin-converting enzyme (ACE) inhibitors

D. Angiotensin-converting enzyme (ACE) inhibitors

Ashman's phenomenon is most likely to be evident in which of the following electrocardiogram changes?

A. Second-degree atrioventricular block, type I (Wenckebach)

B. Atrial fibrillation

C. Sinus dysrhythmia

D. Premature ventricular contraction

B. A-fib

Ashman's phenomenon is more likely to be evident in rhythms that are irregular; therefore having more short cycles after long cycles. The most likely rhythm to demonstrate Ashman's phenomenon is atrial fibrillation because it is irregularly irregular. Ashman's phenomenon is also evident in early premature atrial complexes. Again, Ashman's phenomenon occurs when a short cycle follows a long cycle.

Which of the following is a clinical indication of diastolic dysfunction?

A. S3

B. S4

C. Murmur

D. Midsystolic click

B. S4

Which of the following type of drug would be prescribed after a MI to aid in prevention of remodeling?

A. Beta-blockers

B. Calcium channel blockers

C. Angiotensin-converting enzyme (ACE) inhibitors

D. Anticoagulants

C. ACE inhibitors

Which of the following are clinical indications of bacterial endocarditis?

A. Fever and new murmur

B. Chest pain and pericardial friction rub

C. Dyspnea and crackles

D. Chest pain and syncope

A. fever and new murmur

While monitoring the patient's PAP, a damped waveform is noted. Which of the following would not be an appropriate action?

A. Ensure that the valve on the balloon lumen is open and that no air is trapped in the balloon.

B. Reposition the patient.

C. Fast flush the distal lumen.

D. Check for a possible clot in the catheter by aspiration of the distal lumen.

C. Fast flush the distal lumen.

Which of the following is not characteristic of the clinical presentation of dissecting thoracic aortic aneurysm?

A. Crushing substernal chest pain

B. Hypotension

C. Widened mediastinum on chest x-ray film

D. Syncope

A. Crushing substernal chest pain

Which of the following is an important group of drugs used to block a maladaptive compensatory mechanism in HF?

A. Cardiac glycosides

B. Angiotensin-converting enzyme (ACE) inhibitors

C. Diuretics

D. Vasodilators

B. Angiotensin-converting enzyme (ACE) inhibitors

A 55-year-old man with a long history of alcoholism continues to drink alcohol and now has alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of the following would this patient not be expected to receive?

A. Angiotensin-converting enzyme inhibitors

B. Cardiac transplant referral

C. Diuretics

D. Inotropes

B. Cardiac transplant referral

The reciprocal changes of a posterior MI are evident in which leads?

A. II, III, aVF

B. V1, V2

C. V5, V6

D. I, aVL

B. V1, V2

A 52-year-old woman arrives in the ED. started having fluttering in her chest about 1 hour ago and now is having chest pain. She has a history of HTN. The EKG monitor shows paroxysmal atrial tachycardia with HR 150, BP 130/88. Verapamil 5 mg is given via slow IV push. What would be a desirable therapeutic outcome?

A. Decrease in blood pressure

B. Decrease in heart rate

C. Change in rhythm to atrial fibrillation

D. A decrease in the fluttering feeling in her chest

B. Decrease in heart rate

Which of the following is the most common cause of death associated with an acute MI?

A. Heart failure

B. Ventricular dysrhythmias

C. Pulmonary edema

D. Thromboembolism

B. Ventricular dysrhythmias

If a murmur is audible at the same time that the carotid pulse is felt, the murmur is:

A. systolic.

B. diastolic.

C. always normal.

D. always pathologic.

A. systolic

Which drug has Class II and Class III properties?

A. Verapamil (Calan)

B. Propranolol (Inderal)

C. Sotalol (Betapace)

D. Tocainide (Tonocard)

C. Sotalol (Betapace)

The skin changes associated with chronic peripheral arterial disease are:

A. thickened with brownish discoloration at the ankles.

B. pale and shiny.

C. ulcerations at the sides of the ankles.

D. rubor when in dependent position.

B. pale and shiny.

If the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system is 2 inches below the phlebostatic axis, what effect would it have on pressure measurements?

A. The pressures recorded would be falsely high by about 2 mm Hg.

B. The pressures recorded would be falsely low by about 2 mm Hg.

C. The pressures recorded would be falsely high by about 4 mm Hg.

D. The pressures recorded would be falsely low by about 4 mm Hg.

C. The pressures recorded would be falsely high by about 4 mm Hg.

A patient is admitted to the coronary care unit in third-degree AV heart block with syncopal episodes. Which of the following defines syncope?

A. Dizziness

B. Ataxia

C. Vertigo

D. Transient loss of consciousness

D. Transient loss of consciousness

Clinical indications of a right tension pneumothorax include which of the following?

A. Tracheal shift toward the right with diminished or absent breath sounds on the left

B. Tracheal shift toward the left with diminished or absent breath sounds on the right

C. Tracheal shift toward the left with diminished or absent breath sounds on the left

D. Tracheal shift toward the right with diminished or absent breath sounds on the right

B. Tracheal shift toward the left with diminished or absent breath sounds on the right

A 70-year-old woman, weighing 50 kg, comes to the ED complaining of chest pain and shortness of breath. EKG shows ventricular tachycardia HR 150. Which treatment is appropriate in this situation?

A. Amiodarone (Cordarone) IV

B. Verapamil HCl (Calan) IV

C. Defibrillation beginning at 200 J

D. Synchronized cardioversion beginning at 100 J

D.

Synchronized cardioversion beginning at 100 J

A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV heart block with a ventricular rate of 52 beats/min and no pacing spikes. This indicates failure to pace, and the patient is taken to surgery for insertion of a DVI permanent pacemaker. Which of the following describes the function of a DVI pacemaker?

A. Senses atrium and ventricle; paces ventricle; inhibited by QRS complex

B. Senses atrium and ventricle; paces ventricle; triggered by QRS complex

C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex

D. Paces and senses atrium and ventricle; inhibited by the P wave

C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex

Shortly after returning from PCI, a patient begins to complain of chest pain similar in intensity and character to the pre-PCI pain. The pain is unresponsive to nitroglycerin infusion titration. The patient should be prepared for:

A. return to cardiac catheterization for an additional procedure.

B. emergency coronary artery bypass grafting.

C. intraaortic balloon pump therapy.

D. a catheterization of the right side of the heart.

A. return to cardiac catheterization for an additional procedure.

Which of the following would not be associated with a false-positive result for an acute MI using the total creatine kinase (CK)?

A. Hypothyroidism

B. Hemorrhagic stroke

C. Cardioversion

D. Ulcerative colitis

D. Ulcerative colitis

While auscultating the patient's heart, an S3 is noted. What does this heart sound indicate?

A. Atrial contraction and propulsion of blood into a noncompliant ventricle

B. Inflammation of the pericardium

C. Opening of a defective semilunar valve

D. Rapid ventricular filling into an already distended ventricle

D. Rapid ventricular filling into an already distended ventricle

Which of the following is the best hemodynamic parameter for assessing LV function?

A. Pulmonary artery occlusive pressure (PAOP)

B. Pulmonary artery diastolic pressure (PAd)

C. Cardiac index (CI)

D. Pulmonary artery systolic pressure (PAs)

A. PAOP

Which of the following are therapeutic goals for drug therapy for dilated cardiomyopathy?

A. Decreasing contractility, decreasing afterload and preload

B. Decreasing contractility, increasing afterload and preload

C. Increasing contractility, decreasing afterload and preload

D. Increasing contractility, increasing afterload and preload

C. Increasing contractility, decreasing afterload and preload

A 65-year-old black man comes to the ER with complaints of headache. His admission BP 220/150. A nitroprusside (Nipride) drip is initiated. Which of the following would not be an important aspect of care for a patient receiving nitroprusside?

A. Closely assessing the patient for clinical indications of hypoxia

B. Monitoring the patient's blood pressure every 1-2 minutes until it stabilizes and dosage is established

C. Checking the patient's serum glucose every 6 hours

D. Monitoring the patient for signs of thiocyanate poisoning

C. Checking the patient's serum glucose every 6 hours

A patient has just arrived in the ED with severe dyspnea. His history includes an inferior MI approximately 1 week ago. Physical assessment reveals a loud, blowing holosystolic murmur that is loudest at the apex and radiates to the axilla. Crackles are audible throughout the lung fields, and pulse oximetry reveals hypoxemia. What is the most likely cause of the patient's deterioration?

A. Ruptured ventricular septum

B. Acute left ventricular failure

C. Reinfarction

D. Ruptured papillary muscle

D. Ruptured papillary muscle

A patient has developed a 2:1 AV block. Which of the following two factors would be helpful in deciding that it is most likely type II second-degree AV block?

A. The QRS complex is 0.1 second wide, and the patient has had an anterior myocardial infarction (MI).

B. The QRS complex is 0.14 second wide, and the patient has had an anterior MI.

C. The QRS complex is 0.1 second wide, and the patient has had an inferior MI.

D. The QRS complex is 0.14 second wide, and the patient has had an inferior MI.

B. The QRS complex is 0.14 second wide, and the patient has had an anterior MI.

Occlusion of the RCA would cause ST elevation in which leads?

A. I, aVL

B. II, III, aVF

C. V1, V2

D. V5, V6

B. II, III, aVF

Which of the following correlates with brain natriuretic peptide (BNP) levels?

A. Venous oxygen saturation

B. Pulmonary artery pressure

C. Pulmonary artery occlusive pressure (PAOP)

D. Systemic vascular resistance

C. Pulmonary artery occlusive pressure (PAOP)

A patient is receiving low-molecular-weight dextran after an aortofemoral bypass graft. What is the purpose of this therapy for this patient?

A. Increase circulating volume

B. Increase blood thrombogenicity

C. Decrease platelet aggregation

D. Decrease inflammation

C. Decrease platelet aggregation

Which of the following findings would occur in dilated cardiomyopathy?

A. Murmur of mitral regurgitation

B. Hypertension

C. Elevated sedimentation rate

D. Syncope

A. Murmur of mitral regurgitation

Which of the following would be contraindicated in a patient with Wolff-Parkinson-White (WPW) syndrome?

A. Amiodarone (Cordarone)

B. Lidocaine (Xylocaine)

C. Adenosine (Adenocard)

D. Verapamil (Calan)

D. Verapamil (Calan)

A 67-year-old woman with unstable angina is admitted to the cardiac unit. She has a history of DM and reports having had chest pain intermittently for 4 days. The EKG shows nonspecific ST changes. Which of the following studies is most diagnostic in identifying a MI in this patient?

A. Elevated creatine kinase-myocardial bound (CK-MB)

B. Elevated creatine kinase-muscle type (CK-MM)

C. Elevated troponin I

D. Lactate dehydrogenase 1 (LDH-1) greater than LDH-2

C. Elevated troponin I

A patient is in cardiogenic shock and requires careful volume titration to enhance contractility. Which of the following ranges describes the most likely optimal PAOP in this patient?

A. 0-5 mm Hg

B. 10-15 mm Hg

C. 15-20 mm Hg

D. 20-25 mm Hg

C. 15-20 mm Hg

Which of the following drugs prescribed for a patient with stable angina does not decrease myocardial oxygen consumption?

A. Beta-blocker

B. Calcium channel blocker

C. Nitrate

D. Aspirin

D. Aspirin

Which of the following is the most common complication of infective endocarditis?

A. Heart failure

B. Emboli

C. Myocarditis

D. Pericarditis

B. Emboli

Which of the following is likely to correlate most directly with the need for electrical cardioversion for a tachydysrhythmia?

A. Degree of instability

B. Presence of heart failure

C. Heart rate

D. Origin of the rhythm

A. Degree of instability

What is the most frequently identified primary mechanism of cardiac arrest?

A. Asystole

B. Ventricular tachycardia

C. Third-degree atrioventricular block

D. Ventricular fibrillation

D. Ventricular fibrillation

Which are the two most common dysrhythmias associated with Wolff-Parkinson-White syndrome?

A. Atrial fibrillation and supraventricular tachycardia

B. Atrial fibrillation and ventricular tachycardia

C. Supraventricular and ventricular tachycardia

D. Atrioventricular nodal blocks and ventricular fibrillation

A. Atrial fibrillation and supraventricular tachycardia

patient in ED with complaints of severe headache. She states that she has been out of her BP pills for 3 weeks and cannot afford to buy more. BP ranges from 250/128 to 200/110. Nitroprusside (Nipride) is being titrated, and the patient is on O2 by NC. In considering the risk for cardiac failure and pulmonary edema, consideration should be made to the physiologic principle that the majority of myocardial oxygen consumption occurs during which phase of the cardiac cycle?

A. Ventricular ejection

B. Isovolumetric contraction

C. Ventricular filling

D. Isovolumetric relaxation

B. Isovolumetric contraction

A postoperative cardiac surgery patient's blood pressure suddenly drops to 70 mm Hg palpable, with a loss of the a wave in the PAOP waveform. What change in his cardiac rhythm would cause this change in his PAOP waveform?

A. Sinus tachycardia

B. Sinus dysrhythmia

C. Atrial tachycardia

D. Atrial fibrillation

D. afib

A 40-year-old patient has been admitted to the critical care unit after sustaining multiple injuries from a cave-in accident this morning. X-ray confirm multiple fractures, including the left femur. During the afternoon he was taken to surgery for internal fixation of the left femur. It is now 10 pm, and the patient is complaining of severe throbbing pain in his thigh. The patient received 5 mg of morphine sulfate IV 30 minutes ago. The anterior left thigh is firm to touch, and the pain increases when the patient flexes his left leg. The nurse should suspect which of the following?

A. Normal pain related to fractured femur

B. Abnormal pain related to compartment syndrome

C. Abnormal pain related to infection

D. Abnormal pain related to lumbosacral plexus injury

B. Abnormal pain related to compartment syndrome

Which of the following medications is associated with thiocyanate toxicity?

A. Nicardipine (Cardene)

B. Captopril (Capoten)

C. Metoprolol (Lopressor)

D. Nitroprusside (Nipride)

D. Nitroprusside (Nipride)

patient is in cardiac and respiratory arrest. The selection of medications to reestablish cardiac function would stimulate the sympathetic nervous system beta1 receptors. This stimulation would result in increased automaticity and which of the following?

A. Increased myocardial contractility

B. Decreased left ventricular stroke work

C. Decreased myocardial oxygen consumption

D. Increased left ventricular afterload

A. Increased myocardial contractility

A 55-year-old man had a heart transplant 10 hours ago. Present assessment includes cold, clammy skin, jugular venous distention, bilateral crackles, and tachycardia. Vital signs are temperature 98.6° F, BP 80/60, HR 120 and RR 24 . Mediastinal tube drainage is approximately 50 mL/hr. He is diagnosed with decreased cardiac contractility. Which of the following would be an appropriate treatment for this patient?

A. Beta-adrenergic stimulant (e.g., dobutamine)

B. Diuretic (e.g., furosemide)

C. Normal saline bolus

D. Antibiotics

A. Beta-adrenergic stimulant (e.g., dobutamine)

Which vessel is used as a graft when the minimally invasive direct coronary artery bypass grafting (MIDCABG) procedure is performed?

A. Internal thoracic artery

B. Radial artery

C. Gastroepiploic artery

D. Saphenous vein

A. Internal thoracic artery

Which of the following may be useful in systolic dysfunction but may be detrimental in diastolic dysfunction?

A. Beta-blockers

B. Angiotensin-converting enzyme inhibitors

C. Aldosterone antagonists

D. Vasodilators

D. Vasodilators

A 90-year-old patient is admitted with acute respiratory distress. Vital signs are blood pressure 92/66 mm Hg, heart rate 132 beats/min and regular rhythm, and respiratory rate 36 breaths/min and labored. Auscultation of breath sounds reveals crackles to the scapular level bilaterally. Which of the following is the most likely pathophysiologic problem in this patient?

A. Acute myocardial infarction

B. Mild heart failure

C. Massive pulmonary embolus

D. Acute pulmonary edema

D.

Acute pulmonary edema

Which of the following are two significant adverse effects of angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril [Capoten])?

A. Heart failure and hypokalemia

B. Proteinuria and hyperkalemia

C. Thrombocytopenia and hepatotoxicity

D. Dysrhythmias and hyponatremia

B.

Proteinuria and hyperkalemia

A patient has just returned to the critical care unit from the operating room. He has a VDD pacemaker. Which of the following is an accurate description of this type of pacemaker?

A. atrium and ventricle are paced and sensed, atrial pacing can be inhibited by an intrinsic atrial impulse, and ventricular pacing can be triggered by an intrinsic atrial impulse or inhibited by an intrinsic ventricular impulse.

B. ventricle is paced in response to a sensed intrinsic atrial impulse.

C. atrium and ventricle are paced, but only ventricular pacing can be inhibited by a sensed intrinsic ventricular impulse.

D. ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by a sensed intrinsic ventricular impulse.

D.

The ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by a sensed intrinsic ventricular impulse

While placing a patient on the monitor during admission, a wide-notched P wave is noted in lead II. What does this most likely indicate?

A. Chronic obstructive pulmonary disease (COPD)

B. Myocardial infarction

C. Pulmonary embolism

D. Mitral valve disease

D. Mitral valve disease

When pulmonary arterial diastolic pressure (PAd) is more than 5 mm Hg higher than pulmonary artery occlusive pressure (PAOP), it signals which abnormal condition?

A.Right ventricular failure

B.Left ventricular failure

C.Pulmonary hypertension

D.Systemic hypertension

C. Pulmonary HTN

*When the PAd is more than 5 mm Hg higher than the PAOP, it is an indication of pulmonary hypertension. Possible causes of pulmonary hypertension are passive (e.g., mitral valve disease) or active (e.g., causes of hypoxemic pulmonary vasoconstriction such as acute respiratory distress syndrome, chronic obstructive pulmonary disease, or pulmonary embolism). Pulmonary embolism causes pulmonary hypertension by mechanical obstruction and by hypoxemic pulmonary vasoconstriction.