NBCRNA CERTIFICATION FINAL EXAM ACTUAL
QUESTIONS AND SOLUTIONS RATED A+
✔✔How does methylene blue work? max dose? - ✔✔inhibits the NO pathway and
causes widespread vasoconstriction
Dose should not exceed 7mg/kg
✔✔What drug can increase IOP in the patient with narrow angle glaucoma? -
✔✔scopolamine
✔✔Normal IOP and how is it determined - ✔✔10-22 mmHg, determined by amount of
aqueous humor in the eye, choroidal blood volume, CVP and extra ocular muscle tone
Most important = volume of aqueous humor
✔✔Ciliary muscle is innervated by?
Stimulation causes? - ✔✔oculomotor nerve (CN 3)
mydriasis, which thickens iris and narrows the iridocorneal angle. This decreases
outflow and increases IOP esp, with narrow angle glaucoma
✔✔Rank each drug according to its ability to increase myocardial O2 demand: (potent -
> least potent)
scopolamine
Robinul
Atropine - ✔✔Atropine
Glycopyrrolate
Scopolamine
✔✔S/Sx central anticholinergic syndrome
What drugs cause this?
How is it treated? - ✔✔sedation, stupor, coma, sz, restlessness, anxiety, hallucinations,
delirium
- dry mouth, blurred vision, flushed skin, fever
Diphenhydramine
Promethazine
Treated by physostigmine - tertiary amine, crosses BBB
✔✔What beta blockers are primarily eliminated by the kidney? - ✔✔Atenolol
- can accumulate with renal failure
,✔✔labetalol - ✔✔intrinsic sympathomimetic effects
✔✔Propanolol has what type of properties: - ✔✔membrane stabilizing properties
- LA-like effects, this effect reduces the rate of rise of cardiac action potential, but
usually when toxic levels reached
- also acebutolol
✔✔What beta blockers are cardioselective? B-1 selective... - ✔✔Acebutolol
Atenolol
Betaxolol
bisprolol
esmolol
metoprolol
✔✔Non-selective beta antagonists include? - ✔✔carvedilol
labetalol
nadolol
pindolol
propanolol
timolol
✔✔In the SA node, what increases the heart rate regarding RMP and TP? ( 3 things) -
✔✔1. Increase the slop of spontaneous phase 4 depolarization
2. Make TP more negative (shortens distance btw RMP and TP)
3. Make RMP more positive (shorter distance)
✔✔PNS stimulation increases what electrolyte conductance?
- what is the result regarding HR? - ✔✔potassium
- since more exits the myocyte, its interior becomes more negative, this increases the
distance between RMP and TP, so it takes longer for the cell to reach TP
This slows the HR
✔✔How do you calculate the arteriovenous oxygen difference? - ✔✔(1.34 x Hgb x
SpO2) - (1.34 x Hgb x SvO2)
✔✔What is normal CaO2? - ✔✔20 ml O2/dL blood
✔✔What is normal CvO2? - ✔✔15 ml O2/dL blood
✔✔What is normal Ca-v difference? - ✔✔5 ml O2/dL blood
,✔✔What is the AvO2 difference? arteriovenous oxygen difference? - ✔✔global
measure of the volume of oxygen that is consumed by the body. It is the difference
between the O2 content in the arterioles and the O2 content in the venules
✔✔In the ventricular action potential, name what phase and where each electrolyte
conductance is greatest.
Phase 0-3 - ✔✔Phase 0 - Na+
Phase 1 - Cl-
Phase 2 - Ca2+
Phase 3 - K+
✔✔What conversion factor is used to change L/min to dynes/sec/-5? - ✔✔80
✔✔How do you calculate SVR? - ✔✔SVR = (MAP-CVP/CO) x 80
✔✔What is the solubility coefficient for dissolved oxygen? - ✔✔0.003
✔✔Contractility is dependent on what variables?
What is contractility? - ✔✔NEITHER preload or afterload
- it is the ability of the sarcomeres to shorten and perform work; independent of both of
the above
✔✔What is the way to remember what affects contractility? - ✔✔Chemicals affect
contractility, especially Calcium!
✔✔Increased contractility reflects what?
Decreased contractility? - ✔✔Increased reflects a greater ventricular output for a given
LVEDV
- Decreased = lower ventricular output for given LVEDV
✔✔What phases of the cardiac cycle are associated with an open mitral valve and a
closed aortic valve? (3) - ✔✔Rapid ventricular filling
Diastasis
Atrial systole
✔✔What are the two phases during systole? What is open/closed? - ✔✔Isovolumetric
ventricular contraction: M & A closed
Ventricular ejection: M closed, A open
✔✔What are the 4 phases of diastole? What is open/closed? - ✔✔Isovolumic ventricular
relaxation: M&A closed
, Rapid ventricular filling: M open, A closed
Diastasis/Reduced ventricular filling: M open, A closed
Atrial systole: M open, A closed
✔✔What part of the volume loop represents diastole? - ✔✔left and bottom of the loop
represent diastole
✔✔What are the 2 coronary arteries that arise as the first branches off the aorta? -
✔✔LCA and RCA
✔✔What do we mean by dominance as far as cardiac vessels?
What is 80% of the population? - ✔✔which supplies the posterior descending artery
80% of the population is RIGHT dominant
✔✔What does the posterior descending artery supply? - ✔✔SA and AV nodes
✔✔If a person has left dominant circulation, what supplies the SA and AV nodes? -
✔✔LCA
✔✔What perfuses the left bundle and the apex? - ✔✔LAD
✔✔II, III, aVF is supplied by? - ✔✔RCA
✔✔What perfused the anterior 2/3 of the septum? - ✔✔LAD
✔✔How much CO does the myocardium receive at rest?
What is that in ml/min? - ✔✔5% or about 225 ml/min
✔✔What is the most potent local vasodilator substance released by cardiac myocytes?
What are some other vasodilators? - ✔✔adenosine
NO, CO2, prostacyclin
✔✔What electrolyte disturbance increases RMP? - ✔✔Hyperkalemia
✔✔How is RMP determined?
What is it at rest? - ✔✔by the difference in electrical potential inside and outside of the
cell
At rest, inside is negative, in the myocyte, the RMP is -90 mV
QUESTIONS AND SOLUTIONS RATED A+
✔✔How does methylene blue work? max dose? - ✔✔inhibits the NO pathway and
causes widespread vasoconstriction
Dose should not exceed 7mg/kg
✔✔What drug can increase IOP in the patient with narrow angle glaucoma? -
✔✔scopolamine
✔✔Normal IOP and how is it determined - ✔✔10-22 mmHg, determined by amount of
aqueous humor in the eye, choroidal blood volume, CVP and extra ocular muscle tone
Most important = volume of aqueous humor
✔✔Ciliary muscle is innervated by?
Stimulation causes? - ✔✔oculomotor nerve (CN 3)
mydriasis, which thickens iris and narrows the iridocorneal angle. This decreases
outflow and increases IOP esp, with narrow angle glaucoma
✔✔Rank each drug according to its ability to increase myocardial O2 demand: (potent -
> least potent)
scopolamine
Robinul
Atropine - ✔✔Atropine
Glycopyrrolate
Scopolamine
✔✔S/Sx central anticholinergic syndrome
What drugs cause this?
How is it treated? - ✔✔sedation, stupor, coma, sz, restlessness, anxiety, hallucinations,
delirium
- dry mouth, blurred vision, flushed skin, fever
Diphenhydramine
Promethazine
Treated by physostigmine - tertiary amine, crosses BBB
✔✔What beta blockers are primarily eliminated by the kidney? - ✔✔Atenolol
- can accumulate with renal failure
,✔✔labetalol - ✔✔intrinsic sympathomimetic effects
✔✔Propanolol has what type of properties: - ✔✔membrane stabilizing properties
- LA-like effects, this effect reduces the rate of rise of cardiac action potential, but
usually when toxic levels reached
- also acebutolol
✔✔What beta blockers are cardioselective? B-1 selective... - ✔✔Acebutolol
Atenolol
Betaxolol
bisprolol
esmolol
metoprolol
✔✔Non-selective beta antagonists include? - ✔✔carvedilol
labetalol
nadolol
pindolol
propanolol
timolol
✔✔In the SA node, what increases the heart rate regarding RMP and TP? ( 3 things) -
✔✔1. Increase the slop of spontaneous phase 4 depolarization
2. Make TP more negative (shortens distance btw RMP and TP)
3. Make RMP more positive (shorter distance)
✔✔PNS stimulation increases what electrolyte conductance?
- what is the result regarding HR? - ✔✔potassium
- since more exits the myocyte, its interior becomes more negative, this increases the
distance between RMP and TP, so it takes longer for the cell to reach TP
This slows the HR
✔✔How do you calculate the arteriovenous oxygen difference? - ✔✔(1.34 x Hgb x
SpO2) - (1.34 x Hgb x SvO2)
✔✔What is normal CaO2? - ✔✔20 ml O2/dL blood
✔✔What is normal CvO2? - ✔✔15 ml O2/dL blood
✔✔What is normal Ca-v difference? - ✔✔5 ml O2/dL blood
,✔✔What is the AvO2 difference? arteriovenous oxygen difference? - ✔✔global
measure of the volume of oxygen that is consumed by the body. It is the difference
between the O2 content in the arterioles and the O2 content in the venules
✔✔In the ventricular action potential, name what phase and where each electrolyte
conductance is greatest.
Phase 0-3 - ✔✔Phase 0 - Na+
Phase 1 - Cl-
Phase 2 - Ca2+
Phase 3 - K+
✔✔What conversion factor is used to change L/min to dynes/sec/-5? - ✔✔80
✔✔How do you calculate SVR? - ✔✔SVR = (MAP-CVP/CO) x 80
✔✔What is the solubility coefficient for dissolved oxygen? - ✔✔0.003
✔✔Contractility is dependent on what variables?
What is contractility? - ✔✔NEITHER preload or afterload
- it is the ability of the sarcomeres to shorten and perform work; independent of both of
the above
✔✔What is the way to remember what affects contractility? - ✔✔Chemicals affect
contractility, especially Calcium!
✔✔Increased contractility reflects what?
Decreased contractility? - ✔✔Increased reflects a greater ventricular output for a given
LVEDV
- Decreased = lower ventricular output for given LVEDV
✔✔What phases of the cardiac cycle are associated with an open mitral valve and a
closed aortic valve? (3) - ✔✔Rapid ventricular filling
Diastasis
Atrial systole
✔✔What are the two phases during systole? What is open/closed? - ✔✔Isovolumetric
ventricular contraction: M & A closed
Ventricular ejection: M closed, A open
✔✔What are the 4 phases of diastole? What is open/closed? - ✔✔Isovolumic ventricular
relaxation: M&A closed
, Rapid ventricular filling: M open, A closed
Diastasis/Reduced ventricular filling: M open, A closed
Atrial systole: M open, A closed
✔✔What part of the volume loop represents diastole? - ✔✔left and bottom of the loop
represent diastole
✔✔What are the 2 coronary arteries that arise as the first branches off the aorta? -
✔✔LCA and RCA
✔✔What do we mean by dominance as far as cardiac vessels?
What is 80% of the population? - ✔✔which supplies the posterior descending artery
80% of the population is RIGHT dominant
✔✔What does the posterior descending artery supply? - ✔✔SA and AV nodes
✔✔If a person has left dominant circulation, what supplies the SA and AV nodes? -
✔✔LCA
✔✔What perfuses the left bundle and the apex? - ✔✔LAD
✔✔II, III, aVF is supplied by? - ✔✔RCA
✔✔What perfused the anterior 2/3 of the septum? - ✔✔LAD
✔✔How much CO does the myocardium receive at rest?
What is that in ml/min? - ✔✔5% or about 225 ml/min
✔✔What is the most potent local vasodilator substance released by cardiac myocytes?
What are some other vasodilators? - ✔✔adenosine
NO, CO2, prostacyclin
✔✔What electrolyte disturbance increases RMP? - ✔✔Hyperkalemia
✔✔How is RMP determined?
What is it at rest? - ✔✔by the difference in electrical potential inside and outside of the
cell
At rest, inside is negative, in the myocyte, the RMP is -90 mV
