MSN 377 ACTUAL 2026 EXAM QUESTIONS AND
SOLUTIONS RATED A+
✔✔Age of Terrorism: Biologic Agents - ✔✔Anthrax -> vaccine, antibiotics
Smallpox -> vaccine
Botulism -> antitoxin
Plague -> antibiotics
Tularemia
Hemorrhagic fever
✔✔Age of Terrorism: Chemical Agents - ✔✔Sarin
Phosgene
Mustard gas
✔✔Age of Terrorism: Radiologic or nuclear agents - ✔✔Radiologic dispersal devices
(RDDs) or dirty bombs
Ionizing radiation
Acute radiation syndrome (ARS)
✔✔Age of Terrorism: Explosive devices - ✔✔TNT, dynamite, blast, crush, or penetrating
injuries
✔✔Emergency Incident Preparedness - ✔✔Multi-vehicle crash
✔✔Mass Casualty Incident (MCI) - ✔✔Man-made or natural
Overwhelms a community's ability o respond
Large number of victims
Requires assistance from outside resources
✔✔Triage: Colored Tag System - ✔✔Green: minor injuries (sprains)
Yellow: urgent, but non-life threatening (open fracture)
Red: life threatening requiring immediate intervention (shocK)
Blue: Expected to die (massive head trauma)
Black: dead
✔✔Triage - ✔✔Conducted in 15 seconds
Treat, stabilize, and decontaminate if necessary
Transport to hospital, some go directly to hospital on their own if able
Total number of victims at the hospital: double the number who arrive in the first hour -
30% need admission, and half need surgery in first 8hrs
✔✔Community Emergency Response Team (CERTs) - ✔✔Trains citizens to safely help
themselves, their families, and their neighbors after a disaster until professional services
arrive
,✔✔Hospital Emergency Room Response Plan - ✔✔Roles and responsibilities of the
HCPs and staff
Preparedness drills, computer simulations
✔✔National Incident Management System (DHS) - ✔✔Coordinates federal, state, and
local responses
Special training required to participate
✔✔Acute Pericarditis: Pathophysiology - ✔✔Inflammation of pericardial sac
Normally 10-15ml of fluid
Results in: venous supply has a hard time getting into the right atrium and LV isn't going
to be able to pump out
✔✔Acute Pericarditis: Etiologies - ✔✔Infection
(Toxins - lack of dialysis, inflammation, chemotherapy)
Non-infectious: renal failure, neoplasms, acute MI, trauma, post cardiac surgery,
radiation
Autoimmune: Dressler syndrome, PPS, rheumatologic diseases, drug run
✔✔Acute Pericarditis: Clinical Manifestations - ✔✔Progressive and severe sharp chest
pain
Worsens with movement
Radiates to neck, arms, or leg shoulder, referred to shoulder and upper back
Dyspnea
Hallmark sign: pericardial friction rub
✔✔Acute Pericarditis: Complications: Pericardial Effusion - ✔✔Build-up of fluid in the
pericardium
Rapid or slow accumulation
Cough, dyspnea, tachypnea
May experience hiccups, hoarseness - pressing on nerves that lead to these symptoms)
Distant or muffled heart sounds (aka change in heart sounds)
BP usually maintained (initially)
✔✔Acute Pericarditis: Complications: Cardiac Tamponade - ✔✔Increased pericardial
effusion compresses the heart
Acute or subacute (gradual onset)
S/S: chest pain, confusion, resltlessness, anxiety - blood/O2 isn't perfusing the brain
Decreased CO with muffled heart sounds - blood isn't getting into or out of the heart
Markedly dissented neck veins (JVD)
,Narrowed pulse pressure
✔✔Pulsus Paradoxus - ✔✔Looking for change in the blood pressure whether the
patient is inhaling or exhaling because the change in intrapleural pressures
Systolic pressure drop of >10mmHg during inspiration
Have pt in a semi recumbent position
Use manual cuff - use 2 step method
*FINISH*
✔✔Acute Pericarditis: Diagnostic Studies - ✔✔12-lead ECG -> diffuse ST segment
elevations (because of inflammation)
Echocardiogram - shows blood flow through the heart
CT/MRI - can show fluid around the heart, identify neoplasms
CXR - can show enlarged heart
Lab studies - CBC (elevated WBC), CRP (inflammation, nonspecific for CAD), ESR,
troponin (MI), fluid analysis (pericardiocentesis)
✔✔Acute Pericarditis: Interprofessional Care - ✔✔Identify and treat underlying cause
and symptoms - antibiotics, NSAIDS, corticosteroids, colchicine (used for pts with
ESRD that is causing inflammation of pericardium)
Pericardiocentesis
-watch ECG monitor - blips mean you touched the myocardium
-possible complications: myocardial laceration, coronary artery laceration,
pneumothorax, further tamponade, dysrhythmias
May leave a small catheter in for continuous drainage if end stage disease - consider
who person
Pericardial window - cuts out part of the visceral pericardium and allows fluid to drain
into the body so it won't continue to accumulate
✔✔Acute Pericarditis: Nursing Management - ✔✔Pain - NSAIDs with food or milk
(watch GI bleeding), PPIs
Relieve anxiety
Bedrest with HOB 45, overbed table for support, may be more comfortable leaning
forward
Monitor S/S of tamponade - severely decreased CO, pulses paradoxes, increased JVD,
confusion, narrowed pulse pressure
, Prepare for pericardiocentesis
✔✔Chronic Constrictive Pericarditis - ✔✔Results from scarring of the pericardium -
makes it less compliant, less "give"
Usually begins with an initial episode of acute pericarditis
S/S are gradual: DOE, peripheral edema, ascites, JVD, fatigue, anorexia, weight loss,
pulsus paradoxus not common, nonspecific ECG changes
Tx: pericardectomy - median sternotomy, remove visceral pericardium/parietal
pericardium
✔✔Infective Endocarditis: Pathophysiology - ✔✔An infection of the endocardium, or
innermost layer of the heart and heart valves
Currently classified according to cause and site of involvement - bacteria, drug, viruses,
fungal
✔✔Infective Endocarditis: Etiology - ✔✔Bacteria are the most common causative
organism: staphylococcus aureus (most common from IV drug abuse), streptococcus
viridans (found in mouth and teeth)
Vegetatiosn are the primary lesions of IE; many patients experience systemic
embolization
✔✔Vegetations - ✔✔Form little nodules on the valves and when they break off, they're
shedding the bacteria throughout the blood stream and can become an embolus
Happens because of inflammatory process
Adhere to valves, endocardial surface
Tricuspid or pulmonic valve emboli - cause pulmonary embolism
Mitral or aortic valve emboli - can go into arterial system, causes stroke, embolization
down the arm, organs and other extremities
✔✔Infective Endocarditis: Risk Factors - ✔✔Prior endocarditis
Prosthetic heart valves - antibiotics prophylactically before any type of procedure
Acquired valve disease
Cardiac lesions
Rheumatic heart disease
Congenital heart disease
Pacemakers
Marfan's syndrome
Cardiomyopathy
Noncardiac
SOLUTIONS RATED A+
✔✔Age of Terrorism: Biologic Agents - ✔✔Anthrax -> vaccine, antibiotics
Smallpox -> vaccine
Botulism -> antitoxin
Plague -> antibiotics
Tularemia
Hemorrhagic fever
✔✔Age of Terrorism: Chemical Agents - ✔✔Sarin
Phosgene
Mustard gas
✔✔Age of Terrorism: Radiologic or nuclear agents - ✔✔Radiologic dispersal devices
(RDDs) or dirty bombs
Ionizing radiation
Acute radiation syndrome (ARS)
✔✔Age of Terrorism: Explosive devices - ✔✔TNT, dynamite, blast, crush, or penetrating
injuries
✔✔Emergency Incident Preparedness - ✔✔Multi-vehicle crash
✔✔Mass Casualty Incident (MCI) - ✔✔Man-made or natural
Overwhelms a community's ability o respond
Large number of victims
Requires assistance from outside resources
✔✔Triage: Colored Tag System - ✔✔Green: minor injuries (sprains)
Yellow: urgent, but non-life threatening (open fracture)
Red: life threatening requiring immediate intervention (shocK)
Blue: Expected to die (massive head trauma)
Black: dead
✔✔Triage - ✔✔Conducted in 15 seconds
Treat, stabilize, and decontaminate if necessary
Transport to hospital, some go directly to hospital on their own if able
Total number of victims at the hospital: double the number who arrive in the first hour -
30% need admission, and half need surgery in first 8hrs
✔✔Community Emergency Response Team (CERTs) - ✔✔Trains citizens to safely help
themselves, their families, and their neighbors after a disaster until professional services
arrive
,✔✔Hospital Emergency Room Response Plan - ✔✔Roles and responsibilities of the
HCPs and staff
Preparedness drills, computer simulations
✔✔National Incident Management System (DHS) - ✔✔Coordinates federal, state, and
local responses
Special training required to participate
✔✔Acute Pericarditis: Pathophysiology - ✔✔Inflammation of pericardial sac
Normally 10-15ml of fluid
Results in: venous supply has a hard time getting into the right atrium and LV isn't going
to be able to pump out
✔✔Acute Pericarditis: Etiologies - ✔✔Infection
(Toxins - lack of dialysis, inflammation, chemotherapy)
Non-infectious: renal failure, neoplasms, acute MI, trauma, post cardiac surgery,
radiation
Autoimmune: Dressler syndrome, PPS, rheumatologic diseases, drug run
✔✔Acute Pericarditis: Clinical Manifestations - ✔✔Progressive and severe sharp chest
pain
Worsens with movement
Radiates to neck, arms, or leg shoulder, referred to shoulder and upper back
Dyspnea
Hallmark sign: pericardial friction rub
✔✔Acute Pericarditis: Complications: Pericardial Effusion - ✔✔Build-up of fluid in the
pericardium
Rapid or slow accumulation
Cough, dyspnea, tachypnea
May experience hiccups, hoarseness - pressing on nerves that lead to these symptoms)
Distant or muffled heart sounds (aka change in heart sounds)
BP usually maintained (initially)
✔✔Acute Pericarditis: Complications: Cardiac Tamponade - ✔✔Increased pericardial
effusion compresses the heart
Acute or subacute (gradual onset)
S/S: chest pain, confusion, resltlessness, anxiety - blood/O2 isn't perfusing the brain
Decreased CO with muffled heart sounds - blood isn't getting into or out of the heart
Markedly dissented neck veins (JVD)
,Narrowed pulse pressure
✔✔Pulsus Paradoxus - ✔✔Looking for change in the blood pressure whether the
patient is inhaling or exhaling because the change in intrapleural pressures
Systolic pressure drop of >10mmHg during inspiration
Have pt in a semi recumbent position
Use manual cuff - use 2 step method
*FINISH*
✔✔Acute Pericarditis: Diagnostic Studies - ✔✔12-lead ECG -> diffuse ST segment
elevations (because of inflammation)
Echocardiogram - shows blood flow through the heart
CT/MRI - can show fluid around the heart, identify neoplasms
CXR - can show enlarged heart
Lab studies - CBC (elevated WBC), CRP (inflammation, nonspecific for CAD), ESR,
troponin (MI), fluid analysis (pericardiocentesis)
✔✔Acute Pericarditis: Interprofessional Care - ✔✔Identify and treat underlying cause
and symptoms - antibiotics, NSAIDS, corticosteroids, colchicine (used for pts with
ESRD that is causing inflammation of pericardium)
Pericardiocentesis
-watch ECG monitor - blips mean you touched the myocardium
-possible complications: myocardial laceration, coronary artery laceration,
pneumothorax, further tamponade, dysrhythmias
May leave a small catheter in for continuous drainage if end stage disease - consider
who person
Pericardial window - cuts out part of the visceral pericardium and allows fluid to drain
into the body so it won't continue to accumulate
✔✔Acute Pericarditis: Nursing Management - ✔✔Pain - NSAIDs with food or milk
(watch GI bleeding), PPIs
Relieve anxiety
Bedrest with HOB 45, overbed table for support, may be more comfortable leaning
forward
Monitor S/S of tamponade - severely decreased CO, pulses paradoxes, increased JVD,
confusion, narrowed pulse pressure
, Prepare for pericardiocentesis
✔✔Chronic Constrictive Pericarditis - ✔✔Results from scarring of the pericardium -
makes it less compliant, less "give"
Usually begins with an initial episode of acute pericarditis
S/S are gradual: DOE, peripheral edema, ascites, JVD, fatigue, anorexia, weight loss,
pulsus paradoxus not common, nonspecific ECG changes
Tx: pericardectomy - median sternotomy, remove visceral pericardium/parietal
pericardium
✔✔Infective Endocarditis: Pathophysiology - ✔✔An infection of the endocardium, or
innermost layer of the heart and heart valves
Currently classified according to cause and site of involvement - bacteria, drug, viruses,
fungal
✔✔Infective Endocarditis: Etiology - ✔✔Bacteria are the most common causative
organism: staphylococcus aureus (most common from IV drug abuse), streptococcus
viridans (found in mouth and teeth)
Vegetatiosn are the primary lesions of IE; many patients experience systemic
embolization
✔✔Vegetations - ✔✔Form little nodules on the valves and when they break off, they're
shedding the bacteria throughout the blood stream and can become an embolus
Happens because of inflammatory process
Adhere to valves, endocardial surface
Tricuspid or pulmonic valve emboli - cause pulmonary embolism
Mitral or aortic valve emboli - can go into arterial system, causes stroke, embolization
down the arm, organs and other extremities
✔✔Infective Endocarditis: Risk Factors - ✔✔Prior endocarditis
Prosthetic heart valves - antibiotics prophylactically before any type of procedure
Acquired valve disease
Cardiac lesions
Rheumatic heart disease
Congenital heart disease
Pacemakers
Marfan's syndrome
Cardiomyopathy
Noncardiac
