Barron's CCRN || + Certified.
What is the primary hemodynamic effect of:
Dopamine >10 mcg/kg/min
(A) Increase preload
(B) Decrease preload
(C) Increase afterload
(D) Decreased afterload
(E) Increase contractility
(D) Decrease contractility correct answers "high dose" dopamine causes vasoconstriction and
(C) Increase afterload
What causes the S3 sound? correct answers Pulmonary HTN and cor pulmonale;
Mitral, aortic, or tricuspid insufficiency
When are coronary arteries perfused? correct answers during diastole
What may you hear before crackles when a patient is going into heart failure? correct answers S3
heart sound
What is this called?
Unstable angina with transient ST segment elevation
Can occur at rest or may be cyclic (occurring at the same time daily)
troponin negative
Can be precipitated by nicotine, coke, or ETOH correct answers Variant or Prinzmetal's Angina
There are changes in leads II, III, aVF....what type of MI? correct answers RCA, inferior LV
There are changes in leads V1, V3 V3, V4 correct answers LAD, anterior LV
There are changes in leads V5, V6, I, aVL correct answers circumflex, lateral LV
There are changes in leads V5, V6 correct answers Low lateral LB
,There are changes in leads I aVL correct answers high lateral LB
There are changes in leads V1 and V2 correct answers RCA, posterior LV
There are changes in leads V3R, V4R correct answers RCA, right ventricular infarct
What are some signs of reperfusion following fibrinolytic treatment of a STEMI? correct
answers Marked ELEVATION of troponin/CK-MB: due to miocardial stunning when vessel
opens
reperfusion arrhythmias: VT, Vfib, accelerated idioventricular rhythm (due to stunning)
resolution of ST segment deviations
Chest pain relief
Your patient just had a percutaneous coronary intervention (PCI) (stenting) less than 24 hours
ago:
He is experiencing unrelenting chest pain, his EKG shows ST elevation. What should you do?
What could be happening? correct answers contact the physician. Could be coronary artery re-
occlusion/stent thrombosis.
Your patient just had a percutaneous coronary intervention (PCI) (stenting) less than 24 hours
ago:
He is experiencing sudden low severe back pain and becomes hypotensive. What is happening?
correct answers retroperitoneal bleeding is most likely. Give fluids/blood
what is a normal ankle-brachial index (ABI)? correct answers >1 (get by dividing ankle pressure
by brachial pressure on the same side)
Your patient has PAD and just had a bypass graft. How should you care for the extremity? How
should the HOB be? correct answers do not elevate the affected extremity, it will decrease
perfusion
Put bed in reverse trendelenburg
prolonged QT can lead to what deadly rhythm? correct answers torsades
Causes of prolonged QT correct answers Amiodarone
Haldol
Quinidine
, Procainamide
Low mag, calcium, or potassium
Your patient has a pacemaker and has gone into Vtach. The pacemaker does not correct the
rhythm and your patient goes unresponsive. What do you do? correct answers Amiodarone 150
mg IV over 10 min; Prepare for elective synchronized cardioversion.
right sided heart failure correct answers 1. Jungular Vein Distention
2. Ascending Dependent Edema
3. Weight Gain
4. Hepatomegaly (Liver Enlargement)
Left sided heart failure correct answers 1. SOB
2. Crackles
3. Oliguria
4. Frothy Sputum
5. Displaced Apical Pulse (Hypertrophy)
*left goes away from lungs...takes your breath away
Ventricular assist device (VAD) correct answers A mechanical pump that helps the ventricles
pump blood, easing the workload of the heart in patients with left ventricular heart failure,
cardiogenic shock, and cardiac myopathies.
IABP correct answers inflates (INCREASES CORONARY ARTERY PERFUSION)
and deflates ( DECREASES AFTERLOAD)
Inflates at dicrotic notch of the arterial waveform, beginning of diastole
Deflates before systole begins, determined by set trigger for deflation, R-wave of ECG or
upstroke of arterial pressure wave
CABG (Coronary Artery Bypass Graft) complications correct answers tamponade
pericarditis
long CABG can increase bleeding risk due to increased heparin dose in surgery
Signs of cardiac tamponade correct answers Narrowed pulse pressure (IE 82/68)
Pulsus paradoxus: excessive drop is SBP (>12mmgh during inspiration). Cardiac muscle
restriction due to tamponade with inspiration, intrathoracic pressure increases thus decreasing
venous return
Restlessness and agitation.
What is the primary hemodynamic effect of:
Dopamine >10 mcg/kg/min
(A) Increase preload
(B) Decrease preload
(C) Increase afterload
(D) Decreased afterload
(E) Increase contractility
(D) Decrease contractility correct answers "high dose" dopamine causes vasoconstriction and
(C) Increase afterload
What causes the S3 sound? correct answers Pulmonary HTN and cor pulmonale;
Mitral, aortic, or tricuspid insufficiency
When are coronary arteries perfused? correct answers during diastole
What may you hear before crackles when a patient is going into heart failure? correct answers S3
heart sound
What is this called?
Unstable angina with transient ST segment elevation
Can occur at rest or may be cyclic (occurring at the same time daily)
troponin negative
Can be precipitated by nicotine, coke, or ETOH correct answers Variant or Prinzmetal's Angina
There are changes in leads II, III, aVF....what type of MI? correct answers RCA, inferior LV
There are changes in leads V1, V3 V3, V4 correct answers LAD, anterior LV
There are changes in leads V5, V6, I, aVL correct answers circumflex, lateral LV
There are changes in leads V5, V6 correct answers Low lateral LB
,There are changes in leads I aVL correct answers high lateral LB
There are changes in leads V1 and V2 correct answers RCA, posterior LV
There are changes in leads V3R, V4R correct answers RCA, right ventricular infarct
What are some signs of reperfusion following fibrinolytic treatment of a STEMI? correct
answers Marked ELEVATION of troponin/CK-MB: due to miocardial stunning when vessel
opens
reperfusion arrhythmias: VT, Vfib, accelerated idioventricular rhythm (due to stunning)
resolution of ST segment deviations
Chest pain relief
Your patient just had a percutaneous coronary intervention (PCI) (stenting) less than 24 hours
ago:
He is experiencing unrelenting chest pain, his EKG shows ST elevation. What should you do?
What could be happening? correct answers contact the physician. Could be coronary artery re-
occlusion/stent thrombosis.
Your patient just had a percutaneous coronary intervention (PCI) (stenting) less than 24 hours
ago:
He is experiencing sudden low severe back pain and becomes hypotensive. What is happening?
correct answers retroperitoneal bleeding is most likely. Give fluids/blood
what is a normal ankle-brachial index (ABI)? correct answers >1 (get by dividing ankle pressure
by brachial pressure on the same side)
Your patient has PAD and just had a bypass graft. How should you care for the extremity? How
should the HOB be? correct answers do not elevate the affected extremity, it will decrease
perfusion
Put bed in reverse trendelenburg
prolonged QT can lead to what deadly rhythm? correct answers torsades
Causes of prolonged QT correct answers Amiodarone
Haldol
Quinidine
, Procainamide
Low mag, calcium, or potassium
Your patient has a pacemaker and has gone into Vtach. The pacemaker does not correct the
rhythm and your patient goes unresponsive. What do you do? correct answers Amiodarone 150
mg IV over 10 min; Prepare for elective synchronized cardioversion.
right sided heart failure correct answers 1. Jungular Vein Distention
2. Ascending Dependent Edema
3. Weight Gain
4. Hepatomegaly (Liver Enlargement)
Left sided heart failure correct answers 1. SOB
2. Crackles
3. Oliguria
4. Frothy Sputum
5. Displaced Apical Pulse (Hypertrophy)
*left goes away from lungs...takes your breath away
Ventricular assist device (VAD) correct answers A mechanical pump that helps the ventricles
pump blood, easing the workload of the heart in patients with left ventricular heart failure,
cardiogenic shock, and cardiac myopathies.
IABP correct answers inflates (INCREASES CORONARY ARTERY PERFUSION)
and deflates ( DECREASES AFTERLOAD)
Inflates at dicrotic notch of the arterial waveform, beginning of diastole
Deflates before systole begins, determined by set trigger for deflation, R-wave of ECG or
upstroke of arterial pressure wave
CABG (Coronary Artery Bypass Graft) complications correct answers tamponade
pericarditis
long CABG can increase bleeding risk due to increased heparin dose in surgery
Signs of cardiac tamponade correct answers Narrowed pulse pressure (IE 82/68)
Pulsus paradoxus: excessive drop is SBP (>12mmgh during inspiration). Cardiac muscle
restriction due to tamponade with inspiration, intrathoracic pressure increases thus decreasing
venous return
Restlessness and agitation.
