PCCN 2027 CORE REVIEWS ANSWERS AND
QUESTIONS SET A+
✔✔A patient is discharged with the diagnosis of severe peripheral vascular disease
(PVD). In addition to medication and a walking regime, if applicable, which of the
following is essential education at time of discharge?
A. nutritional counseling
B. smoking cessation counseling
C. social work consult
D. speech therapy consult - ✔✔B. smoking cessation counseling
Cessation of tobacco use is the most important non-pharmacological intervention that
can be done to improve signs and symptoms of peripheral bvascular disease. Social
work consult and speech therapy may not be indicated in this patient. All patients may
benefit from nutrition counseling; however, this is not a primary concern for this patient.
✔✔A medication that dilates both the venous and arterial beds will cause which of the
following results?
A. increased preload, decreased afterload
B. increased preload, increased afterload
C. decreased preload, decreased afterload
D. decreased preload, increased afterload - ✔✔C. decreased preload, decreased
afterload
When both the venous and arterial beds are dilated, there will be less venous return,
causing a decreased preload (ex. nitroglycerin). With arterial vasodilation, the afterload
will decrease (ex nitroprusside, ACE-I). Afterload in this case is resistant to LV pumping.
✔✔Stable angina is best defined as:
A. pain that increases in severity
B. pain that is new
C. pain that occurs at rest
D. pain that has a predictable pattern over time - ✔✔D. pain that has a predictable
pattern over time
Stable angina is predictable -- the patient can describe the pain and how it is initiated
accurately each time -- and occurs with exertion. Ex: The patient knows every time he
or she climbs stairs, it will be accompanied by chest pain. The pain is relieved with rest
,and nitroglycerin (Nitrolingual). Pain that is new or occurs at rest is not stable angina. If
the pain increases in severity, it is no longer stable.
✔✔The gold standard diagnostic tool for the identification, location of disease and
severity of coronary artery disease is:
A. a stress test
B. an echocardiography
C. cardiac catheterization
D. a spiral computer tomography (CT scan) - ✔✔C. cardiac catheterization
The gold standard, or best diagnostic tool, for the diagnosis, location and severity of
coronary artery disease is the cardiac catheterization performed in the cath laboratory.
Echocardiography is excellent in revealing structure changes, but not coronary artery
disease. A stress test may be a good screening tool, but again, is not the gold standard,
nor is CT scanning
✔✔The most common complication after a STEMI is:
A. heart failure
B. dysrhythmia
C. ventricular septal rupture
D. ventricular wall rupture - ✔✔B. dysrhythmia
The most common complication after a STEMI is dysrhthmia due to irritability of the
ischemic myocardium and the dead myocardium that does not transmit electrical stimuli.
With interior-wall STEMI, the most common dysrhythmia is bradycardia and heart block.
With anterior-wall STEMI, tachydysrhythmias such as ventricular tachycardia and/or
ventricular fibrillation are most common. Heart failure, ventricular septal wall rupture and
ventricular rupture are infrequent complications after STEMI and carry a very poor
prognosis.
✔✔The most common cause of heart failure in the US is:
A. valvular disease
B. ischemic heart disease
C. renal failure
D. hepatitis - ✔✔B. ischemic heart disease
In the US, the most common cause of heart failure is ischemic heart disease. After
STEMI or NSTEMI with damage to the myocardium, ventricular failure may result
secondary to decreased ejection fraction. Each insult to the myocardium may make the
heart failure worse. For many years, valvular disease, caused by untreated strep throat,
was one of the most common causes of heart failure. However, that has changed since
the newer strep tests provide rapid results, preventing delayed treatments. Renal failure
and hepatitis are serious illnesses but are not common causes of heart failure.
✔✔Systolic left ventricular dysfunction is best defined as:
A. the impaired ability of the left ventricle to contract and effectively eject blood
B. the impaired ability of the left ventricle to fill and relax
C. heart failure with an elevated systolic blood pressure
,D. heart failure in which the heart stops beating - ✔✔A. the impaired ability of the left
ventricle to contract and effectively eject blood
Systolic failure occurs when the ventricle has lower contractility and produces a lower
ejection fraction and cardiac output. The ventricle dilates and loses the ability to contract
as a unit. Depending on the severity of the dysfunction, the patient may present in
cardiogenic shock. Impaired ability to fill the ventricle is a problem with diastolic
dysfunction; heart failure with an elevated systolic pressure may more often cause
diastolic dysfunction by causing a thickened ventricle that cannot fill properly. Heart
failure caused by asystole is not heart failure but electrical standstill.
✔✔Neurohormonal response in heart failure with long-term consequences include:
A. increased liver release of glycogen stores
B. increased activation of the sympathetic nervous system and the renin-angiotensin
system
C. increased production of hemoglobin
D. increased production of cholesterol to make hormones - ✔✔B. increased activation
of the sympathetic nervous system and the renin-angiotensin system
With continued heart failure, the body compensates for the low cardiac output by
stimulating the sympathetic nervous system and the renin-angiotensin system. This
increases preload and afterload in an already poorly functioning heart. Neurohormonal
blockers are the treatment. Activation of increased liver release of glycogen stores
increases blood sugar, but not heart failure. Increased production of hemoglobin is a
response to hypoxia, and increased production of cholesterol does not have a relation
to the neurohormonal response to heart failure.
✔✔Medications commonly used in the treatment of heart failure include:
A. ACE inhibitors, beta blockers
B. calcium channel blockers
C. nitrates
D. calcium channel blockers and digoxin (Lanoxicaps) - ✔✔A. ACE inhibitors, beta
blockers
The most effective and evidence-based practice treatment of heart failure is
neurohormonal blockade. These medications include beta blockers and ACE inhibitors.
They reduce preload and afterload as well as controlling heart rate and BP. Calcium
channel blockers are not used in heart failure since they tend to increase the absorption
of sodium and water. Nitrates are used for treatment in conjunction with other drugs.
Beta blockers are ACE-I are the foundation of treatments. Digoxin is also used but only
after the beta blockers and ACE-I are started.
✔✔The heart's primary compensatory response to chronic aortic stenosis includes:
A. left arterial hypertrophy
B. left ventricular hypertrophy
C. left ventricular dilation
D. right ventricular dysfunction - ✔✔B. left ventricular hypertrophy
, With chronic aortic stenosis, the left ventricle hypertrophies over time due to the
increased workload of pumping blood through a narrowed opening. This leads to
diastolic dysfunction as well as hypertrophy. The left atrium will enlarge over time, but
the primary result is left ventricular hypertrophy, not dilation. The right ventricle remains
normal for a period of time.
✔✔Patients with pericardial effusions should be assessed for the development of which
of the following complications:
A. thrombocytopenia
B. tamponade
C. low hemoglobin and hematocrit
D. endocarditis - ✔✔B. tamponade
Any patient with a pericardial effusion should be assessed for cardiac tamponade
physiology. Any accumulation of fluid in the pericardial sac can compress the
myocardium, producing tamponade signs and symptoms. All patients are assessed for
thrombocytopenia, low H+H and endocarditis; they are not the focus of complications
with effusions but could be additional signs of tamponade (low H+H and
thrombocytopenia).
✔✔Nursing interventions in the patient with pericarditis include all the following except:
A. providing comfort by administering pain medications and proper positioning
B. auscultating heart sounds to assess for muffled heart sounds
C. administering anticoagulants to prevent thrombus in the pericardium
D. monitoring for jugular venous distention (JVD) and hypotension - ✔✔C. administering
anticoagulants to prevent thrombus in the pericardium
A patient with pericarditis should have pain-relief medication. The nurse should
auscultate heart sounds and assess if they are muffled (a sign of possible tamponade),
and monitor for JVD and hypotension (more signs of tamponade physiology). Do not
give anticoagulants to the patient since they may cause bloody pericardial effusions and
tamponade.
✔✔Epinephrine is indicated as the first-line drug for any pulseless condition because it
has the following actions:
A. inotropic and selectively shunts blood to brain and heart
B. converts ventricular fibrillation to sinus rhythm
C. slows the heart rate and improves contractility
D. causes decreased contractility, - ✔✔A. inotropic and selectively shunts blood to brain
and heart
Epinephrine is a pure catecholamine that increases contractility and causes
vasoconstriction that shunts blood to the heart, brain, and diaphragm. According to
ACLS, it is the drug of choice for any pulseless arrest. Epinephrine does not convert VF
to any rhythm, slow heart rates or cause decreased contractility.
✔✔The most common postoperative complication of coronary artery bypass (CABG)
surgery is:
QUESTIONS SET A+
✔✔A patient is discharged with the diagnosis of severe peripheral vascular disease
(PVD). In addition to medication and a walking regime, if applicable, which of the
following is essential education at time of discharge?
A. nutritional counseling
B. smoking cessation counseling
C. social work consult
D. speech therapy consult - ✔✔B. smoking cessation counseling
Cessation of tobacco use is the most important non-pharmacological intervention that
can be done to improve signs and symptoms of peripheral bvascular disease. Social
work consult and speech therapy may not be indicated in this patient. All patients may
benefit from nutrition counseling; however, this is not a primary concern for this patient.
✔✔A medication that dilates both the venous and arterial beds will cause which of the
following results?
A. increased preload, decreased afterload
B. increased preload, increased afterload
C. decreased preload, decreased afterload
D. decreased preload, increased afterload - ✔✔C. decreased preload, decreased
afterload
When both the venous and arterial beds are dilated, there will be less venous return,
causing a decreased preload (ex. nitroglycerin). With arterial vasodilation, the afterload
will decrease (ex nitroprusside, ACE-I). Afterload in this case is resistant to LV pumping.
✔✔Stable angina is best defined as:
A. pain that increases in severity
B. pain that is new
C. pain that occurs at rest
D. pain that has a predictable pattern over time - ✔✔D. pain that has a predictable
pattern over time
Stable angina is predictable -- the patient can describe the pain and how it is initiated
accurately each time -- and occurs with exertion. Ex: The patient knows every time he
or she climbs stairs, it will be accompanied by chest pain. The pain is relieved with rest
,and nitroglycerin (Nitrolingual). Pain that is new or occurs at rest is not stable angina. If
the pain increases in severity, it is no longer stable.
✔✔The gold standard diagnostic tool for the identification, location of disease and
severity of coronary artery disease is:
A. a stress test
B. an echocardiography
C. cardiac catheterization
D. a spiral computer tomography (CT scan) - ✔✔C. cardiac catheterization
The gold standard, or best diagnostic tool, for the diagnosis, location and severity of
coronary artery disease is the cardiac catheterization performed in the cath laboratory.
Echocardiography is excellent in revealing structure changes, but not coronary artery
disease. A stress test may be a good screening tool, but again, is not the gold standard,
nor is CT scanning
✔✔The most common complication after a STEMI is:
A. heart failure
B. dysrhythmia
C. ventricular septal rupture
D. ventricular wall rupture - ✔✔B. dysrhythmia
The most common complication after a STEMI is dysrhthmia due to irritability of the
ischemic myocardium and the dead myocardium that does not transmit electrical stimuli.
With interior-wall STEMI, the most common dysrhythmia is bradycardia and heart block.
With anterior-wall STEMI, tachydysrhythmias such as ventricular tachycardia and/or
ventricular fibrillation are most common. Heart failure, ventricular septal wall rupture and
ventricular rupture are infrequent complications after STEMI and carry a very poor
prognosis.
✔✔The most common cause of heart failure in the US is:
A. valvular disease
B. ischemic heart disease
C. renal failure
D. hepatitis - ✔✔B. ischemic heart disease
In the US, the most common cause of heart failure is ischemic heart disease. After
STEMI or NSTEMI with damage to the myocardium, ventricular failure may result
secondary to decreased ejection fraction. Each insult to the myocardium may make the
heart failure worse. For many years, valvular disease, caused by untreated strep throat,
was one of the most common causes of heart failure. However, that has changed since
the newer strep tests provide rapid results, preventing delayed treatments. Renal failure
and hepatitis are serious illnesses but are not common causes of heart failure.
✔✔Systolic left ventricular dysfunction is best defined as:
A. the impaired ability of the left ventricle to contract and effectively eject blood
B. the impaired ability of the left ventricle to fill and relax
C. heart failure with an elevated systolic blood pressure
,D. heart failure in which the heart stops beating - ✔✔A. the impaired ability of the left
ventricle to contract and effectively eject blood
Systolic failure occurs when the ventricle has lower contractility and produces a lower
ejection fraction and cardiac output. The ventricle dilates and loses the ability to contract
as a unit. Depending on the severity of the dysfunction, the patient may present in
cardiogenic shock. Impaired ability to fill the ventricle is a problem with diastolic
dysfunction; heart failure with an elevated systolic pressure may more often cause
diastolic dysfunction by causing a thickened ventricle that cannot fill properly. Heart
failure caused by asystole is not heart failure but electrical standstill.
✔✔Neurohormonal response in heart failure with long-term consequences include:
A. increased liver release of glycogen stores
B. increased activation of the sympathetic nervous system and the renin-angiotensin
system
C. increased production of hemoglobin
D. increased production of cholesterol to make hormones - ✔✔B. increased activation
of the sympathetic nervous system and the renin-angiotensin system
With continued heart failure, the body compensates for the low cardiac output by
stimulating the sympathetic nervous system and the renin-angiotensin system. This
increases preload and afterload in an already poorly functioning heart. Neurohormonal
blockers are the treatment. Activation of increased liver release of glycogen stores
increases blood sugar, but not heart failure. Increased production of hemoglobin is a
response to hypoxia, and increased production of cholesterol does not have a relation
to the neurohormonal response to heart failure.
✔✔Medications commonly used in the treatment of heart failure include:
A. ACE inhibitors, beta blockers
B. calcium channel blockers
C. nitrates
D. calcium channel blockers and digoxin (Lanoxicaps) - ✔✔A. ACE inhibitors, beta
blockers
The most effective and evidence-based practice treatment of heart failure is
neurohormonal blockade. These medications include beta blockers and ACE inhibitors.
They reduce preload and afterload as well as controlling heart rate and BP. Calcium
channel blockers are not used in heart failure since they tend to increase the absorption
of sodium and water. Nitrates are used for treatment in conjunction with other drugs.
Beta blockers are ACE-I are the foundation of treatments. Digoxin is also used but only
after the beta blockers and ACE-I are started.
✔✔The heart's primary compensatory response to chronic aortic stenosis includes:
A. left arterial hypertrophy
B. left ventricular hypertrophy
C. left ventricular dilation
D. right ventricular dysfunction - ✔✔B. left ventricular hypertrophy
, With chronic aortic stenosis, the left ventricle hypertrophies over time due to the
increased workload of pumping blood through a narrowed opening. This leads to
diastolic dysfunction as well as hypertrophy. The left atrium will enlarge over time, but
the primary result is left ventricular hypertrophy, not dilation. The right ventricle remains
normal for a period of time.
✔✔Patients with pericardial effusions should be assessed for the development of which
of the following complications:
A. thrombocytopenia
B. tamponade
C. low hemoglobin and hematocrit
D. endocarditis - ✔✔B. tamponade
Any patient with a pericardial effusion should be assessed for cardiac tamponade
physiology. Any accumulation of fluid in the pericardial sac can compress the
myocardium, producing tamponade signs and symptoms. All patients are assessed for
thrombocytopenia, low H+H and endocarditis; they are not the focus of complications
with effusions but could be additional signs of tamponade (low H+H and
thrombocytopenia).
✔✔Nursing interventions in the patient with pericarditis include all the following except:
A. providing comfort by administering pain medications and proper positioning
B. auscultating heart sounds to assess for muffled heart sounds
C. administering anticoagulants to prevent thrombus in the pericardium
D. monitoring for jugular venous distention (JVD) and hypotension - ✔✔C. administering
anticoagulants to prevent thrombus in the pericardium
A patient with pericarditis should have pain-relief medication. The nurse should
auscultate heart sounds and assess if they are muffled (a sign of possible tamponade),
and monitor for JVD and hypotension (more signs of tamponade physiology). Do not
give anticoagulants to the patient since they may cause bloody pericardial effusions and
tamponade.
✔✔Epinephrine is indicated as the first-line drug for any pulseless condition because it
has the following actions:
A. inotropic and selectively shunts blood to brain and heart
B. converts ventricular fibrillation to sinus rhythm
C. slows the heart rate and improves contractility
D. causes decreased contractility, - ✔✔A. inotropic and selectively shunts blood to brain
and heart
Epinephrine is a pure catecholamine that increases contractility and causes
vasoconstriction that shunts blood to the heart, brain, and diaphragm. According to
ACLS, it is the drug of choice for any pulseless arrest. Epinephrine does not convert VF
to any rhythm, slow heart rates or cause decreased contractility.
✔✔The most common postoperative complication of coronary artery bypass (CABG)
surgery is:
