PCCN 2023/2024 Complete Rationale Questions

1. A 49-year-old male was recently admitted with an inferior wall MI resulting from 100% occlusion of the right coronary artery (RCA). The 12-lead ECG reveals ST elevation in leads II, III, and a VF. You would expect to see reciprocal changes in which leads? A. I, a VR B. V1, V2 C. V3, V4 D. I, a VL D. I, aVL. The RCA perfuses the inferior wall and the mirror image or reciprocal change will be seen in the high lateral wall, which is reflected in leads I, and aVL on the 12-Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate with the anterior area of the heart. The aVR lead does not provide much diagnostic value as all energy is depolarizing away from this lead. 2. You are summoned to the room of a 30 year old female who is experiencing sustained tonic-clonic convulsions while sitting in a chair. A family member states:"She was just talking to us and suddenly she let out a shriek and started flopping like a fish out of water." What is your initial priority of care? A. Call for help and safety guide the patient to the floor. B. Call for help and administer a prescribed antiepileptic. C. Call for help and administer a prescribed benzodiazepine D. Call for help and monitor the course of the seizure. A. Call for help and safely guide the patient to the floor. Patient safety is the first priority. Once the patient is safe from immediate harm or injury, the seizure activity must be terminated. Seizure abatement is accomplished by the administration of a benzodiazepine. Antiepileptic medications are useful in the prevention of seizure of activity. 3. A 46 year old patient presents with pneumonia and sepsis. He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath and is now on 100% FiO2 via non-rebreather mask. You obtain an ABG with the following results: pH 7.20 / PaCO2 68 / PaO2 102 / HCO3 28. A chest x-ray reveals bilateral pulmonary infiltrates. The patient is likely developing: A. Worsening pneumonia B. Acute Respiratory Distress Syndrome C. Pulmonary embolus D. Atelectasis B. Acute Respiratory Distress Syndrome. Criteria for ARDS include bilateral pulmonary infiltrates on chest x-ray and a P/F ratio ≤ 300; it is further rated as mild-moderate-severe ARDS based on the P/F ratio. To calculate the P/F ratio, divide the PaO2 from an ABG by the FiO2. In this case 102 (PaO2) ÷ 1.0 (100% FiO2) = 102, making it borderline severe ARDS. Other criteria for ARDS include decreased compliance, refractory hypoxemia and low expired minute volume. The patient needs to be transferred to the ICU and will likely require intubation & mechanical ventilation. 4. A 56 year old male is admitted to the PCU with a hypertensive crisis. His blood pressure is now 205/125 mm Hg and his is complaining of a headache with nausea. He reports he ran out of blood pressure medication three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach? A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication, then gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medication. B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications, then switch to oral antihypertensive medications for maintenance C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medications. D. Slowly lower the diastolic pressure to 85 mm Hg wi C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications, and then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medications. The patient is experiencing a hypertensive crisis with associated hypertensive encephalopathy. This requires emergent treatment by rapidly decreasing the diastolic blood pressure to around 100 mm Hg using intravenous antihypertensive medications. The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure. The initial decrease should take place over 2-6 hours. Once the BP is controlled and symptoms have resolved the patient should be transitioned to oral antihypertensive medications with a goal to reduce the diastolic pressure gradually to 85 mm Hg over the next 2-3 months. 5. Which of the following labs must be closely monitored when administering Lisinopril to a patient with systolic heart failure? A. Sodium B. Phosphate C. Magnesium D. Potassium D. Potassium. Patients taking angiotensin converting enzyme inhibitors may experience hyperkalemia. ACE inhibitors block angiotensin II, which may lead to decreased aldosterone. Aldosterone is responsible for excreting potassium from the kidneys. Therefore, ACE inhibitors can cause potassium retention and potassium levels should be monitored closely. In addition, renal labs such as BUN and creatinine should be monitored. If the patient develops more than a 20% increase in the creatinine, the medication should be discontinued.