PCCN QUESTIONS WITH ALL GRADED
A+ SOLUTIONS
Coronary wartery wperfusion wis wdependent wupon:
A. wdiastolic wpressure
B. wsystolic wpressure
C. wafterload
D. wsystemic wvascular wresistance w(SVR) w- wcorrect wanswers w-A. wdiastolic
wpressure
Diastolic wpressure win wthe waortic wroot wis whigher wthan wleft wventricular wend-
diastolic wpressure w(LVEDP), wthe wpressure wexerted won wthe wventricular wmuscle wat
wthe wend wof wdiastole wwhen wthe wventricle wis wfull. wThis wenables wblood wto wflow
wfrom wa whigher wpressure wthrough wopen warteries wto wa wlower wpressure, wa
wpressure wgradient wknown was wcoronary wartery wprefusion wpressure. wAs wdiastolic
wpressure wdrops, wthere wis wa wdecrease win wcoronary wartery wblood wflow. wCoronary
wartery wperfusion wis wnot waffected wby wsystolic wpressure, wafterload wor wSVR, wbut
wthey wall wincrease wthe wdemand wof woxygen win wthe wheart.
,A wpost-STEMI w(ST welevation wmyocardial winfarction) wpatient wis wstarted won wan
wangiotensin-converting wenzyme w(ACE) winhibitor wduring whis whospital wstay. wWhich
wof wthe wfollowing wis wthe wmost wcommon wserious wside weffect wthat wmay woccur?
A. wa wnonproductive wcough
B. wpedal wedema
C. wswelling wof wthe wtongue wand wface
D. wrhinorrhea w- wcorrect wanswers w-C. wswelling wof wthe wtongue wand wface
Although wall wof wthe wanswers wmay woccur, wswelling wog wthe wtongue wand wface wis
wthe wmost wserious wand wmay wrequire wintervention. wPatients wshould wbe winstructed
wto wseek wmedical wattention wimmediately wfor wany wsigns wof wswelling win wthe
wtongue wor wthroat.
Which wof wthe wfollowing wbest wdescribes wthe wfourth wheart wsound w(S4):
A. wIt woccurs wafter wventricular wcontraction
B. wIt wis wbest wheard wwith wthe wdiaphragm wof wthe wstethoscope
C. wIt wis wa wnormal wfinding win wchildren
D. wIt woccurs wduring wlate wdiastole wwhen wthe watria wcontracts w- wcorrect wanswers
w-D. wIt woccurs wduring wlate wdiastole wwhen wthe watria wcontracts
The wpresence wof wthe wextra wheart wsound wS4 wsignifies wa wpoorly wcompliant w(stiff)
wleft wventricle. wAn wS4 wis walso wcalled wan watrial wheart wsound wsince wit woccurs wat
wthe wend wof wdiastolic wfilling wwhen wthe watria wcontracts wand wfully wfills wthe wleft
wventricle. wKnown was w"atrial wkick", wthis wfilling wis wimportant wto wcardiac woutput.
wThe wincreased wend-diastolic wvolume win wthe wventricle wimproves wcardiac woutput.
wWhen wthe wleft wventricle wis wstiff w(decreased wcompliance wwith wlong wterm
whypertension, waortic wstenosis wor wwith wacute wSTEMI), wthe watrium whas wto wpump
wharder wto wmove wblood wfrom wthe watrium wto wthe wventricle, wcausing wa wturbulent
wblood wflow wand wextra wheart wsound. wThis wheart wsound wis walways wpathologic.
wIt woccurs wbefore wventricular wcontraction, wis wbest wheard wwith wthe wbell wof wthe
wstethoscope wand wis wnever wa wnormal wheart wsound, weven win wchildren.
Which wpathologic wchanges wfound won wthe w12-lead wECG windicate wmyocardial
wischemia?
A. wST-segment welevation
B. wST-segment wdepression wand wT-wave welevation
C. wQ-wave wformation
D. wST-segment wdepression wand wT-wave winversion w- wcorrect wanswers w-D. wST
wsegment wdepression wand wT wwave winversion
Myocardial wischemia wchanges wthe wrepolarization wof wthe wventricular wmuscle. wThat
wchange wis wseen won wthe w12 wlead wECG was wST-segment wdepression wand wT
wwave winversion, wwhich wdemonstrate wsubendocardial wischemia w-- wthe winnermost
wlayer wof wmuscle win wthe wmyocardium. wST-segment welevation windicates wacute
winjury wor winfarction, wST wsegment wdepression wand wT wwave welevation wmay
windicate wan welectrolyte wabnormality, wwhile wQ wwave wformation windicates wtotal
winfarction.
Positive winotropic wagents ware wused wto:
,A. wimprove wcardiac woutput wand wtissue wperfusion
B. wdecrease wwater wloss wthrough wthe wkidneys
C. wincrease wheart wrate
D. wvasodilate wvessels w- wcorrect wanswers w-A. wimprove wcardiac woutput wand
wtissue wperfusion
The wterm w"inotropic" wrefers wto waffecting wthe wforce wof wmyocardial wcontraction.
wImprovement wof wcardiac wmuscle wcontraction wleads wto wimproved wcardiac woutput
wand wtissue wperfusion.
A wpatient win wthe wED wis wnow wbeing wadmitted wto wtelemetry wbwith wcomplaint wof
wchest wpain wand whas wbeen wjudged wto wbe wa wpossible wcandidate wfor wtherapy
wwith walteplase w(Activase). wWhich wof wthe wfollowing wis wnot wconsidered wa
wcontraindication wfor wthe wuse wof wthis wmedication?
A. wcurrent wantibiotic wuse
B. wrecent wabdominal wsurgery
C. wrecent wgastrointestinal wbleed
D. wrecent wintracranial wbleed w- wcorrect wanswers w-A. wcurrent wantibiotic wuse
Use wof wantibiotics wis wnot wa wcontraindication wfor wthe wuse wof walteplase. wAll wthe
wother wanswers w-- wrecent wabdominal wsurgery, wrecent wgastrointestinal wbleeding
wand wa wrecent wintracranial wbleed w-- ware wcontraindications wfor wthe wuse wof wany
wfibrinolytic.
The wtwo wmajor wcomponents wthat wdetermine wblood wpressure ware:
A. wsystemic wvascular wresistance w(SVR) w(afterload) wand wcardiac woutput
B. wcontractility wand wSVR w(afterload)
C. wpreload wand wSVR w(afterload)
D. wcontractility wand wSVR w(afterload) w- wcorrect wanswers w-A. wSVR w(afterload)
wand wcardiac woutput
The wequation wfor wBP wis: wBP w= wSVR wx wcardiac woutput.
BP wis wdetermined wby wresistance wof wthe warterial wbed wand wthe wcardiac woutput.
wIf wthe wSVR w(afterload) wis whigh wand wthe wcardiac woutput wlow, wthe wpatient wmay
wstill whave wa wnormal wBP. wthe wpulse wpressure wwill wbe wlower, wbut wthis wis wa
wcompensatory wresponse wby wthe wheart wto wmaintain wBP. wIf wthe wSVR w(afterload)
wis wlow w(as win wearly wseptic wshock), wthe wcardiac woutput wis wvery whigh, wthereby
wtrying wto wsupport wBP.
The wlayer wof wthe warterial wvessel wwall wresponsible wfor wchanges win wthe wdiameter
wof wthe wartery wis wthe:
A. wmedia
B. wintima
C. wexterna
D. wadventitia w- wcorrect wanswers w-A. wmedia
The wmedia wlayer wof wthe warterial wwall wcontains wvascular wsmooth wmuscle wcells
wand wis wresponsible wfor warterial wtone. wVasoactive wsubstances wreleased win
wresponse wto wthe wsympathetic wnervous wsystem wand/or wthe wrenin-angiotensin
wsystem wdetermine warterial wtone. wIntima, wexterna wand wadventitia ware wincorrect.
, A wpatient wpresents win wacute wdistress wwith wrales whalfway wup wbilaterally; wcool
wand wclammy wextremities; welevated wjugular wvenous wdistention w(JVD); woxygen
wsaturations wat w95%, wdown wfrom w99%; wand wcomplaints wof wshortness wof
wbreath. wWhich wof wthe wfollowing wfindings wcorrespond wto wthe wpatient's wcardiac
wstatus?
A. wno wpulmonary wcongestion, wnormal wperfusion
B. wno wpulmonary wcongestion, wlow wperfusion
C. wpulmonary wcongestion, wnormal wperfusion
D. wpulmonary wcongestion, wlow wperfusion w- wcorrect wanswers w-D. wpulmonary
wcongestion, wlow wperfusion
Rales windicate wfluid win wthe walveolar wsacs, wpossibly wsecondary wto wpulmonary
wedema, wcausing wpulmonary wcongestion. wPneumonia wcan walso wcause wfluid win
wthe walveolar wsacs. wThe wpatient wis wcomplaining wof wshortness wof wbreath, wand
wthe woxygen wsaturations ware wlowering, walso windicating wthat wthe wpatient whas
wpulmonary wcongestion. wThe wpatient's wskin wis wcool wand wclammy, windicating wthat
wthe wskin wis wpoorly wperfused. wSkin wdoes wnot wrequire woxygen wand wshunts
wblood waway win wdecreased wcardiac wfunction; wtherefore, wthis wpatient whas
wpulmonary wcongestion wand wlow wperfusion wstate. wThe wother wanswers ware
wincorrect.
When wlistening wto wheart wsounds, wS1 wsignifies wwhich wof wthe wfollowing?
A. wthe wbeginning wof wventricular wsystole
B. wthe wbeginning wof wventricular wdiastole
C. wthe wpropulsion wof wblood winto wa wnon-compliant wventricle
D. wthe wblood wgoing win wthe wwrong wdirection w- wcorrect wanswers w-A. wthe
wbeginning wof wventricular wsystole
The wheart wsound wof wS1 windicates wthe wopening wof wthe waortic wand wpulmonic
wvalves wand wmarks wthe wbeginning wof wventricular wsystole wor wejection. wThe
wbeginning wof wdiastole wis wafter wS2, wpropulsion wof wblood winto wa wnoncompliant
wchamber wis wS4, wand wblood wgoing win wthe wwrong wdirection wwill wcause wa
wmurmur.
A wpatient wwith wpulmonary wedema whas wimpaired wdiffusion wdue wto:
A. wincreased wthickness wof wthe walveolar wcapillary wmembrane
B. wretaining wCO2
C. wan welevated wbody wtemperature wassociated wwith wpulmonary wedema
D. wlow wbarometric wpressure w- wcorrect wanswers w-A. wincreased wthickness wof wthe
walveolar wcapillary wmembrane
With wincreasing wleft wventricular wpressures, wblood wmoves wback winto wthe wleft
watrium, wthen wto wthe wpulmonary wveins. wWhen wthe wpressure win wthe wpulmonary
wveins wincreases, wcapillary wfunction wdecreases, wand wfluid wthen wshifts wto wthe
winterstitial wspace, wcausing winterstitial wedema, wthereby, wincreasing wthe wthickness
wof wthe wspace woxygen wmust wtravel. wWhen wleft wventricular wpressures wincrease,
wthe wfluid wthen wshifts wto wthe walveolar wspace, wcausing wpulmonary wedema. wThis
wfluid wacts was wa wdeterrent wto woxygen wdiffusion. wRetention wof wCO2 wdoes wnot
A+ SOLUTIONS
Coronary wartery wperfusion wis wdependent wupon:
A. wdiastolic wpressure
B. wsystolic wpressure
C. wafterload
D. wsystemic wvascular wresistance w(SVR) w- wcorrect wanswers w-A. wdiastolic
wpressure
Diastolic wpressure win wthe waortic wroot wis whigher wthan wleft wventricular wend-
diastolic wpressure w(LVEDP), wthe wpressure wexerted won wthe wventricular wmuscle wat
wthe wend wof wdiastole wwhen wthe wventricle wis wfull. wThis wenables wblood wto wflow
wfrom wa whigher wpressure wthrough wopen warteries wto wa wlower wpressure, wa
wpressure wgradient wknown was wcoronary wartery wprefusion wpressure. wAs wdiastolic
wpressure wdrops, wthere wis wa wdecrease win wcoronary wartery wblood wflow. wCoronary
wartery wperfusion wis wnot waffected wby wsystolic wpressure, wafterload wor wSVR, wbut
wthey wall wincrease wthe wdemand wof woxygen win wthe wheart.
,A wpost-STEMI w(ST welevation wmyocardial winfarction) wpatient wis wstarted won wan
wangiotensin-converting wenzyme w(ACE) winhibitor wduring whis whospital wstay. wWhich
wof wthe wfollowing wis wthe wmost wcommon wserious wside weffect wthat wmay woccur?
A. wa wnonproductive wcough
B. wpedal wedema
C. wswelling wof wthe wtongue wand wface
D. wrhinorrhea w- wcorrect wanswers w-C. wswelling wof wthe wtongue wand wface
Although wall wof wthe wanswers wmay woccur, wswelling wog wthe wtongue wand wface wis
wthe wmost wserious wand wmay wrequire wintervention. wPatients wshould wbe winstructed
wto wseek wmedical wattention wimmediately wfor wany wsigns wof wswelling win wthe
wtongue wor wthroat.
Which wof wthe wfollowing wbest wdescribes wthe wfourth wheart wsound w(S4):
A. wIt woccurs wafter wventricular wcontraction
B. wIt wis wbest wheard wwith wthe wdiaphragm wof wthe wstethoscope
C. wIt wis wa wnormal wfinding win wchildren
D. wIt woccurs wduring wlate wdiastole wwhen wthe watria wcontracts w- wcorrect wanswers
w-D. wIt woccurs wduring wlate wdiastole wwhen wthe watria wcontracts
The wpresence wof wthe wextra wheart wsound wS4 wsignifies wa wpoorly wcompliant w(stiff)
wleft wventricle. wAn wS4 wis walso wcalled wan watrial wheart wsound wsince wit woccurs wat
wthe wend wof wdiastolic wfilling wwhen wthe watria wcontracts wand wfully wfills wthe wleft
wventricle. wKnown was w"atrial wkick", wthis wfilling wis wimportant wto wcardiac woutput.
wThe wincreased wend-diastolic wvolume win wthe wventricle wimproves wcardiac woutput.
wWhen wthe wleft wventricle wis wstiff w(decreased wcompliance wwith wlong wterm
whypertension, waortic wstenosis wor wwith wacute wSTEMI), wthe watrium whas wto wpump
wharder wto wmove wblood wfrom wthe watrium wto wthe wventricle, wcausing wa wturbulent
wblood wflow wand wextra wheart wsound. wThis wheart wsound wis walways wpathologic.
wIt woccurs wbefore wventricular wcontraction, wis wbest wheard wwith wthe wbell wof wthe
wstethoscope wand wis wnever wa wnormal wheart wsound, weven win wchildren.
Which wpathologic wchanges wfound won wthe w12-lead wECG windicate wmyocardial
wischemia?
A. wST-segment welevation
B. wST-segment wdepression wand wT-wave welevation
C. wQ-wave wformation
D. wST-segment wdepression wand wT-wave winversion w- wcorrect wanswers w-D. wST
wsegment wdepression wand wT wwave winversion
Myocardial wischemia wchanges wthe wrepolarization wof wthe wventricular wmuscle. wThat
wchange wis wseen won wthe w12 wlead wECG was wST-segment wdepression wand wT
wwave winversion, wwhich wdemonstrate wsubendocardial wischemia w-- wthe winnermost
wlayer wof wmuscle win wthe wmyocardium. wST-segment welevation windicates wacute
winjury wor winfarction, wST wsegment wdepression wand wT wwave welevation wmay
windicate wan welectrolyte wabnormality, wwhile wQ wwave wformation windicates wtotal
winfarction.
Positive winotropic wagents ware wused wto:
,A. wimprove wcardiac woutput wand wtissue wperfusion
B. wdecrease wwater wloss wthrough wthe wkidneys
C. wincrease wheart wrate
D. wvasodilate wvessels w- wcorrect wanswers w-A. wimprove wcardiac woutput wand
wtissue wperfusion
The wterm w"inotropic" wrefers wto waffecting wthe wforce wof wmyocardial wcontraction.
wImprovement wof wcardiac wmuscle wcontraction wleads wto wimproved wcardiac woutput
wand wtissue wperfusion.
A wpatient win wthe wED wis wnow wbeing wadmitted wto wtelemetry wbwith wcomplaint wof
wchest wpain wand whas wbeen wjudged wto wbe wa wpossible wcandidate wfor wtherapy
wwith walteplase w(Activase). wWhich wof wthe wfollowing wis wnot wconsidered wa
wcontraindication wfor wthe wuse wof wthis wmedication?
A. wcurrent wantibiotic wuse
B. wrecent wabdominal wsurgery
C. wrecent wgastrointestinal wbleed
D. wrecent wintracranial wbleed w- wcorrect wanswers w-A. wcurrent wantibiotic wuse
Use wof wantibiotics wis wnot wa wcontraindication wfor wthe wuse wof walteplase. wAll wthe
wother wanswers w-- wrecent wabdominal wsurgery, wrecent wgastrointestinal wbleeding
wand wa wrecent wintracranial wbleed w-- ware wcontraindications wfor wthe wuse wof wany
wfibrinolytic.
The wtwo wmajor wcomponents wthat wdetermine wblood wpressure ware:
A. wsystemic wvascular wresistance w(SVR) w(afterload) wand wcardiac woutput
B. wcontractility wand wSVR w(afterload)
C. wpreload wand wSVR w(afterload)
D. wcontractility wand wSVR w(afterload) w- wcorrect wanswers w-A. wSVR w(afterload)
wand wcardiac woutput
The wequation wfor wBP wis: wBP w= wSVR wx wcardiac woutput.
BP wis wdetermined wby wresistance wof wthe warterial wbed wand wthe wcardiac woutput.
wIf wthe wSVR w(afterload) wis whigh wand wthe wcardiac woutput wlow, wthe wpatient wmay
wstill whave wa wnormal wBP. wthe wpulse wpressure wwill wbe wlower, wbut wthis wis wa
wcompensatory wresponse wby wthe wheart wto wmaintain wBP. wIf wthe wSVR w(afterload)
wis wlow w(as win wearly wseptic wshock), wthe wcardiac woutput wis wvery whigh, wthereby
wtrying wto wsupport wBP.
The wlayer wof wthe warterial wvessel wwall wresponsible wfor wchanges win wthe wdiameter
wof wthe wartery wis wthe:
A. wmedia
B. wintima
C. wexterna
D. wadventitia w- wcorrect wanswers w-A. wmedia
The wmedia wlayer wof wthe warterial wwall wcontains wvascular wsmooth wmuscle wcells
wand wis wresponsible wfor warterial wtone. wVasoactive wsubstances wreleased win
wresponse wto wthe wsympathetic wnervous wsystem wand/or wthe wrenin-angiotensin
wsystem wdetermine warterial wtone. wIntima, wexterna wand wadventitia ware wincorrect.
, A wpatient wpresents win wacute wdistress wwith wrales whalfway wup wbilaterally; wcool
wand wclammy wextremities; welevated wjugular wvenous wdistention w(JVD); woxygen
wsaturations wat w95%, wdown wfrom w99%; wand wcomplaints wof wshortness wof
wbreath. wWhich wof wthe wfollowing wfindings wcorrespond wto wthe wpatient's wcardiac
wstatus?
A. wno wpulmonary wcongestion, wnormal wperfusion
B. wno wpulmonary wcongestion, wlow wperfusion
C. wpulmonary wcongestion, wnormal wperfusion
D. wpulmonary wcongestion, wlow wperfusion w- wcorrect wanswers w-D. wpulmonary
wcongestion, wlow wperfusion
Rales windicate wfluid win wthe walveolar wsacs, wpossibly wsecondary wto wpulmonary
wedema, wcausing wpulmonary wcongestion. wPneumonia wcan walso wcause wfluid win
wthe walveolar wsacs. wThe wpatient wis wcomplaining wof wshortness wof wbreath, wand
wthe woxygen wsaturations ware wlowering, walso windicating wthat wthe wpatient whas
wpulmonary wcongestion. wThe wpatient's wskin wis wcool wand wclammy, windicating wthat
wthe wskin wis wpoorly wperfused. wSkin wdoes wnot wrequire woxygen wand wshunts
wblood waway win wdecreased wcardiac wfunction; wtherefore, wthis wpatient whas
wpulmonary wcongestion wand wlow wperfusion wstate. wThe wother wanswers ware
wincorrect.
When wlistening wto wheart wsounds, wS1 wsignifies wwhich wof wthe wfollowing?
A. wthe wbeginning wof wventricular wsystole
B. wthe wbeginning wof wventricular wdiastole
C. wthe wpropulsion wof wblood winto wa wnon-compliant wventricle
D. wthe wblood wgoing win wthe wwrong wdirection w- wcorrect wanswers w-A. wthe
wbeginning wof wventricular wsystole
The wheart wsound wof wS1 windicates wthe wopening wof wthe waortic wand wpulmonic
wvalves wand wmarks wthe wbeginning wof wventricular wsystole wor wejection. wThe
wbeginning wof wdiastole wis wafter wS2, wpropulsion wof wblood winto wa wnoncompliant
wchamber wis wS4, wand wblood wgoing win wthe wwrong wdirection wwill wcause wa
wmurmur.
A wpatient wwith wpulmonary wedema whas wimpaired wdiffusion wdue wto:
A. wincreased wthickness wof wthe walveolar wcapillary wmembrane
B. wretaining wCO2
C. wan welevated wbody wtemperature wassociated wwith wpulmonary wedema
D. wlow wbarometric wpressure w- wcorrect wanswers w-A. wincreased wthickness wof wthe
walveolar wcapillary wmembrane
With wincreasing wleft wventricular wpressures, wblood wmoves wback winto wthe wleft
watrium, wthen wto wthe wpulmonary wveins. wWhen wthe wpressure win wthe wpulmonary
wveins wincreases, wcapillary wfunction wdecreases, wand wfluid wthen wshifts wto wthe
winterstitial wspace, wcausing winterstitial wedema, wthereby, wincreasing wthe wthickness
wof wthe wspace woxygen wmust wtravel. wWhen wleft wventricular wpressures wincrease,
wthe wfluid wthen wshifts wto wthe walveolar wspace, wcausing wpulmonary wedema. wThis
wfluid wacts was wa wdeterrent wto woxygen wdiffusion. wRetention wof wCO2 wdoes wnot
