CMC PRACTICE QUESTIONS – AACN
COMPLETE DETAILED CASE STUDY
u While caring for a patient with an IABP at 3:1, the nurse notes:
A. decreasing urine output as well as increasing BUN and CR levels; the nurse should increase timing to
2:1
B. absent pulses in the proximal extremity; the nurse should apply pressure at the insertion site.
C. blood in the IABP tubing; the nurse should disconnect the balloon catheter from the IABP.
D. blood oozing from the insertion site; the nurse should anticipate the need for an emergency
fasciotomy. - Correct answer.A. incorrect. decreasing urine output with increasing BUN and CR levels
with an IABP in place indicates obstruction of the renal arteries. The nurse should plan for removal.
B. incorrect. absent pulses distal to the insertion site indicates complete occlusion of the femoral artery.
application of pressure to the insertion site will worsen the obstruction.
C. correct. blood in the IABP tubing indicates a rupture of the balloon. Continuing to allow the IABP to
inflate and deflate will increase the size of the rupture, causing more bleeding. the nurse should plan for
removal or exchange of the IABP catheter.
D. incorrect. a fasciotomy would be indicated if the patient had an increase in fluid accumulation in the
extremities causing significant injury to the limb.
An IABP is currently at 3:1 when the patient suddenly goes into ventricular fibrillation. In addition to
resuscitative measures, the nurse should:
A. change the trigger to internal or pressure support resuscitative measures.
B. increase timing back to 1:1 to increase coronary artery perfusion pressure.
C. put the pump on standby until the return of spontaneous circulation.
D. assess the IABP timing to chest compressions at 1:2. - Correct answer.A. correct. the IABP will not be
able to time correctly when a patient is in V-Fib. by placing the system to trigger on internal or pressure
support, it will generate off the pressure created during compressions.
B. incorrect. attempting to time the IABP back to 1:1 will be counterproductive, as it will not be able to
trigger correctly.
C. incorrect. there is significant risk of clot forming on the IABP when placed in stand for an
indeterminate amount of time.
D. incorrect. the primary goal during resuscitative measures is to attempt to circulate blood volume as
effectively as possible. assessing the timing of the IABP is unnecessary.
,The nurse is reviewing the home medications list for a patient admitted c/o severe chest pain. serial EKGs
and blood testing are negative, so an exercise stress test is scheduled. which of the following
medications may result in a false-positive finding on the stress test?
A. digitalis (Digoxin)
B. potassium chloride (K-Dur)
C. sotalol (Betapace)
D. diltiazem (Cardiazem) - Correct answer.A. correct. digitalis can cause false-positive EKG changes
during a stress test. there is an association between the development of ST segment depression during
stress testing. the mechanism of this EKG change is not clear. further, digitalis should be withheld on the
day of the test because of its negative chronotropic effects.
B. incorrect.
C & D. incorrect. beta-blockers and calcium channel blockers blunt the heart rate response to exercise
and may prevent achievement of maximum predicted heart rate. they should be withheld on the day of
the test.
A patient is admitted with elevated troponin levels and ST segment elevation in leads II, III, and aVF.
Administration of which of the following should the nurse anticipate initially?
A. enoxaparin (Lovenox)
B. streptokinase (Strepase)
C. alteplase (Activase)
D. reteplase (Retavase) - Correct answer.A. incorrect. enoxaparin is an alternative to heparin in patients
with unstable angina, NSTEMI or DVT.
B. incorrect. streptokinase is indicated for acute arterial thrombosis or embolism, or occluded AV
cannulas.
C. incorrect. alteplase in indicated for acute ischemic stroke or acute massive pulmonary embolism.
D. correct. reteplase is indicated for AMI when fibrinolytics are indicated.
Which of the following is a characteristic of diastolic heart failure?
A. inability of the heart muscle to relax.
B. dilation of the ventricular chambers.
C. increased filling of the left ventricle.
,D. decreased ability of the ventricle to contract. - Correct answer.A. correct. with diastolic heart failure
the left ventricle is unable to relax, leading to signs and symptoms of heart failure, but the patient
maintains a preserved EF as the muscle retains its ability to contract.
B. incorrect. dilation of the ventricular chambers is a characteristic of systolic heart failure.
C. incorrect. diastolic heart failure is an abnormality with heart filling. the heart muscle does not relax
normally, and the heart may fill too slowly or asynchronously. if the left ventricle does not relax properly
or is thick and stiff, it does not fill in the usual manner and blood is drawn back into the left atrium and
eventually into the lungs.
D. incorrect. decreased ability of the ventricle to contract is a symptom of overextension of the heart
muscle in patients with cardiomyopathy.
Following a STEMI, the nurse auscultates a late systolic murmur at the apex. The nurse should suspect
the finding is r/t the new onset of a:
A. right bundle branch block
B. left bundle branch block
C. papillary muscle rupture
D. calcific plaque rupture - Correct answer.A. incorrect. a RBBB would cause an electrical delay in
conduction for a wide split S2.
B. incorrect. a LBBB would cause and electrical delay in ventricular conduction for a paroxical split S2.
C. correct. a papillary muscle chord rupture results from ischemia to the tissue supplying the mitral
valve. a systolic murmur is heard due to mitral regurgitation.
D. incorrect. plaque rupture would cause an occlusion of the coronary artery that would not directly
cause a new systolic murmur.
The nurse is reviewing the plan of care for a patient with systolic heart failure who has enalapril
(Vasotec), furosemide (Lasix), metoprolol (Lopressor), and carvedilol (Coreg) ordered. Which of the
following will provide the most accurate assessment of the regimen?
A. daily weights
B. strict I&O
C. BMP every morning
D. serial CXRYs - Correct answer.A. correct. assessing daily weights is a noninvasive and easy method to
assess compliance with the effectiveness of a medical regimen in patients with heart failure, observing
the patient's ability to maintain a consistent weight indicates compliance as well as the effectiveness of
the medical regimen.
, B. incorrect. strict I&O is only one component of a plan of care but does not assess if a patient adheres
to the medical regimen or if the regimen is effective.
C. incorrect. a daily BMP would not help assess the effectiveness of the medical regimen as the majority
of the panel components are not affected by the drugs listed.
D. incorrect. serial CXRYs could reveal worsening heart failure, but assessing daily weights is far easier,
noninvasive and cost-effective.
Which of the following patient situations might be best treated with the maze procedure?
A. recurrent ventricular tachycardia refractory to cardioversion
B. recurrent atrial fibrillation refractory to drug therapy
C. cardiomyopathy with an EF <20%
D. coronary artery restenosis following PCI - Correct answer.A. incorrect. recurrent ventricular
tachycardia refractory to cardioversion would be best treated with the insertion of an automatic
implantable cardioverter defibrillator.
B. correct. in a maze procedure, numerous incisions are made on the left and right atrium so that scar
tissue forms. this scar tissue does not conduct electricity, which disrupts the path of abnormal electrical
impulses.
C. incorrect. cardiomyopathy with an EF <20% would be best treated with either inotropic or mechanical
circulatory support.
D. incorrect. coronary artery restenosis following PCI would be best treated with antiplatelet therapy.
A patient develops chest pain, nausea, vomiting and diaphoresis. the 12-lead EKG is normal. a further
cardiac assessment is warranted, as it is common for ST segment elevation to be absent in:
A. an anterior wall MI
B. a posterior wall MI
C. a lateral wall MI
D. an inferior wall MI - Correct answer.A. incorrect. an anterior wall MI would have EKG changes in leads
V1-V4
B. correct. in the standard lead setup, the EKG typically does not look at the posterior wall; because of
the location of the occlusion, ECG changes would not be apparent.
C. incorrect. a lateral wall MI would present changes in leads I, aVL, V5, and V6.
D. incorrect. an inferior wall MI would present changes in leads II, III, aVF.
COMPLETE DETAILED CASE STUDY
u While caring for a patient with an IABP at 3:1, the nurse notes:
A. decreasing urine output as well as increasing BUN and CR levels; the nurse should increase timing to
2:1
B. absent pulses in the proximal extremity; the nurse should apply pressure at the insertion site.
C. blood in the IABP tubing; the nurse should disconnect the balloon catheter from the IABP.
D. blood oozing from the insertion site; the nurse should anticipate the need for an emergency
fasciotomy. - Correct answer.A. incorrect. decreasing urine output with increasing BUN and CR levels
with an IABP in place indicates obstruction of the renal arteries. The nurse should plan for removal.
B. incorrect. absent pulses distal to the insertion site indicates complete occlusion of the femoral artery.
application of pressure to the insertion site will worsen the obstruction.
C. correct. blood in the IABP tubing indicates a rupture of the balloon. Continuing to allow the IABP to
inflate and deflate will increase the size of the rupture, causing more bleeding. the nurse should plan for
removal or exchange of the IABP catheter.
D. incorrect. a fasciotomy would be indicated if the patient had an increase in fluid accumulation in the
extremities causing significant injury to the limb.
An IABP is currently at 3:1 when the patient suddenly goes into ventricular fibrillation. In addition to
resuscitative measures, the nurse should:
A. change the trigger to internal or pressure support resuscitative measures.
B. increase timing back to 1:1 to increase coronary artery perfusion pressure.
C. put the pump on standby until the return of spontaneous circulation.
D. assess the IABP timing to chest compressions at 1:2. - Correct answer.A. correct. the IABP will not be
able to time correctly when a patient is in V-Fib. by placing the system to trigger on internal or pressure
support, it will generate off the pressure created during compressions.
B. incorrect. attempting to time the IABP back to 1:1 will be counterproductive, as it will not be able to
trigger correctly.
C. incorrect. there is significant risk of clot forming on the IABP when placed in stand for an
indeterminate amount of time.
D. incorrect. the primary goal during resuscitative measures is to attempt to circulate blood volume as
effectively as possible. assessing the timing of the IABP is unnecessary.
,The nurse is reviewing the home medications list for a patient admitted c/o severe chest pain. serial EKGs
and blood testing are negative, so an exercise stress test is scheduled. which of the following
medications may result in a false-positive finding on the stress test?
A. digitalis (Digoxin)
B. potassium chloride (K-Dur)
C. sotalol (Betapace)
D. diltiazem (Cardiazem) - Correct answer.A. correct. digitalis can cause false-positive EKG changes
during a stress test. there is an association between the development of ST segment depression during
stress testing. the mechanism of this EKG change is not clear. further, digitalis should be withheld on the
day of the test because of its negative chronotropic effects.
B. incorrect.
C & D. incorrect. beta-blockers and calcium channel blockers blunt the heart rate response to exercise
and may prevent achievement of maximum predicted heart rate. they should be withheld on the day of
the test.
A patient is admitted with elevated troponin levels and ST segment elevation in leads II, III, and aVF.
Administration of which of the following should the nurse anticipate initially?
A. enoxaparin (Lovenox)
B. streptokinase (Strepase)
C. alteplase (Activase)
D. reteplase (Retavase) - Correct answer.A. incorrect. enoxaparin is an alternative to heparin in patients
with unstable angina, NSTEMI or DVT.
B. incorrect. streptokinase is indicated for acute arterial thrombosis or embolism, or occluded AV
cannulas.
C. incorrect. alteplase in indicated for acute ischemic stroke or acute massive pulmonary embolism.
D. correct. reteplase is indicated for AMI when fibrinolytics are indicated.
Which of the following is a characteristic of diastolic heart failure?
A. inability of the heart muscle to relax.
B. dilation of the ventricular chambers.
C. increased filling of the left ventricle.
,D. decreased ability of the ventricle to contract. - Correct answer.A. correct. with diastolic heart failure
the left ventricle is unable to relax, leading to signs and symptoms of heart failure, but the patient
maintains a preserved EF as the muscle retains its ability to contract.
B. incorrect. dilation of the ventricular chambers is a characteristic of systolic heart failure.
C. incorrect. diastolic heart failure is an abnormality with heart filling. the heart muscle does not relax
normally, and the heart may fill too slowly or asynchronously. if the left ventricle does not relax properly
or is thick and stiff, it does not fill in the usual manner and blood is drawn back into the left atrium and
eventually into the lungs.
D. incorrect. decreased ability of the ventricle to contract is a symptom of overextension of the heart
muscle in patients with cardiomyopathy.
Following a STEMI, the nurse auscultates a late systolic murmur at the apex. The nurse should suspect
the finding is r/t the new onset of a:
A. right bundle branch block
B. left bundle branch block
C. papillary muscle rupture
D. calcific plaque rupture - Correct answer.A. incorrect. a RBBB would cause an electrical delay in
conduction for a wide split S2.
B. incorrect. a LBBB would cause and electrical delay in ventricular conduction for a paroxical split S2.
C. correct. a papillary muscle chord rupture results from ischemia to the tissue supplying the mitral
valve. a systolic murmur is heard due to mitral regurgitation.
D. incorrect. plaque rupture would cause an occlusion of the coronary artery that would not directly
cause a new systolic murmur.
The nurse is reviewing the plan of care for a patient with systolic heart failure who has enalapril
(Vasotec), furosemide (Lasix), metoprolol (Lopressor), and carvedilol (Coreg) ordered. Which of the
following will provide the most accurate assessment of the regimen?
A. daily weights
B. strict I&O
C. BMP every morning
D. serial CXRYs - Correct answer.A. correct. assessing daily weights is a noninvasive and easy method to
assess compliance with the effectiveness of a medical regimen in patients with heart failure, observing
the patient's ability to maintain a consistent weight indicates compliance as well as the effectiveness of
the medical regimen.
, B. incorrect. strict I&O is only one component of a plan of care but does not assess if a patient adheres
to the medical regimen or if the regimen is effective.
C. incorrect. a daily BMP would not help assess the effectiveness of the medical regimen as the majority
of the panel components are not affected by the drugs listed.
D. incorrect. serial CXRYs could reveal worsening heart failure, but assessing daily weights is far easier,
noninvasive and cost-effective.
Which of the following patient situations might be best treated with the maze procedure?
A. recurrent ventricular tachycardia refractory to cardioversion
B. recurrent atrial fibrillation refractory to drug therapy
C. cardiomyopathy with an EF <20%
D. coronary artery restenosis following PCI - Correct answer.A. incorrect. recurrent ventricular
tachycardia refractory to cardioversion would be best treated with the insertion of an automatic
implantable cardioverter defibrillator.
B. correct. in a maze procedure, numerous incisions are made on the left and right atrium so that scar
tissue forms. this scar tissue does not conduct electricity, which disrupts the path of abnormal electrical
impulses.
C. incorrect. cardiomyopathy with an EF <20% would be best treated with either inotropic or mechanical
circulatory support.
D. incorrect. coronary artery restenosis following PCI would be best treated with antiplatelet therapy.
A patient develops chest pain, nausea, vomiting and diaphoresis. the 12-lead EKG is normal. a further
cardiac assessment is warranted, as it is common for ST segment elevation to be absent in:
A. an anterior wall MI
B. a posterior wall MI
C. a lateral wall MI
D. an inferior wall MI - Correct answer.A. incorrect. an anterior wall MI would have EKG changes in leads
V1-V4
B. correct. in the standard lead setup, the EKG typically does not look at the posterior wall; because of
the location of the occlusion, ECG changes would not be apparent.
C. incorrect. a lateral wall MI would present changes in leads I, aVL, V5, and V6.
D. incorrect. an inferior wall MI would present changes in leads II, III, aVF.
