PCCN EXAM ACTUAL 200 QUESTIONS
AND CORRECT ANSWERS
1. Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR): A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic pressure (LVEDP), the
pressure exerted on the ventricular muscle at the end of diastole when the ventricle is full. This enables
blood to flow from a higher pressure through open arteries to a lower pressure, a pressure gradient
known as coronary artery prefusion pressure. As diastolic pressure drops, there is a decrease in
coronary artery blood flow. Coronary artery perfusion is not affected by systolic pressure, afterload or
SVR, but they all increase the demand of oxygen in the heart.
2. A post-STEMI (ST elevation myocardial infarction) patient is
started on an angiotensin-converting enzyme (ACE) inhibitor during
his hospital stay.
Which of the following is the most common serious side effect that
may occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
,D. rhinorrhea: C. swelling of the tongue and face
Although all of the answers may occur, swelling og the tongue and face is the most serious and may require
intervention. Patients should be instructed to seek medical attention immediately for any signs of swelling
in the tongue or throat.
3. Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts: D. It occurs
during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left ventricle. An S4 is also
called an atrial heart sound since it occurs at the end of diastolic filling when the atria contracts and fully
fills the left ventricle. Known as "atrial kick", this filling is important to cardiac output. The increased end-
diastolic volume in the ventricle improves cardiac output. When the left ventricle is stiff (decreased
compliance with long term hypertension, aortic stenosis or with acute STEMI), the atrium has to pump
harder to move blood from the atrium to the ventricle, causing a turbulent blood flow and extra heart
sound. This heart sound is always pathologic. It occurs before ventricular contraction, is best heard with
the bell of the stethoscope and is never a normal heart sound, even in children.
4. Which pathologic changes found on the 12-lead ECG indicate
myocardial ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
,C. Q-wave formation
D. ST-segment depression and T-wave inversion: D. ST segment depression
and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle. That change is seen on the 12
lead ECG as ST-segment depression and T wave inversion, which demonstrate subendocardial
ischemia -- the innermost layer of muscle in the myocardium. ST-segment elevation indicates acute
injury or infarction, ST segment depression and T wave elevation may indicate an electrolyte
abnormality, while Q wave formation indicates total infarction.
5. Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
D. vasodilate vessels: A. improve cardiac output and tissue perfusion
The term "inotropic" refers to affecting the force of myocardial contraction. Improvement of cardiac muscle
contraction leads to improved cardiac output and tissue perfusion.
6. A patient in the ED is now being admitted to telemetry with
complaint of chest pain and has been judged to be a possible
candidate for therapy with alteplase (Activase). Which of the
following is not considered a contraindication for the use of this
medication?
A. current antibiotic use
B. recent abdominal surgery
, C. recent gastrointestinal bleed
D. recent intracranial bleed: A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other answers -- recent
abdominal surgery, recent gastrointestinal bleeding and a recent intracranial bleed -- are contraindications
for the use of any fibrinolytic.
7. The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload): A. SVR (afterload) and
cardiac output The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the SVR (afterload) is high
and the cardiac output low, the patient may still have a normal BP. the pulse pressure will be lower, but
this is a compensatory response by the heart to maintain BP. If the SVR (afterload) is low (as in early septic
shock), the cardiac output is very high, thereby trying to support BP.
8. The layer of the arterial vessel wall responsible for changes in
the diameter of the artery is the:
A. media
B. intima
C. externa
D. adventitia: A. media
The media layer of the arterial wall contains vascular smooth muscle cells and is responsible for arterial tone.
AND CORRECT ANSWERS
1. Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR): A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic pressure (LVEDP), the
pressure exerted on the ventricular muscle at the end of diastole when the ventricle is full. This enables
blood to flow from a higher pressure through open arteries to a lower pressure, a pressure gradient
known as coronary artery prefusion pressure. As diastolic pressure drops, there is a decrease in
coronary artery blood flow. Coronary artery perfusion is not affected by systolic pressure, afterload or
SVR, but they all increase the demand of oxygen in the heart.
2. A post-STEMI (ST elevation myocardial infarction) patient is
started on an angiotensin-converting enzyme (ACE) inhibitor during
his hospital stay.
Which of the following is the most common serious side effect that
may occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
,D. rhinorrhea: C. swelling of the tongue and face
Although all of the answers may occur, swelling og the tongue and face is the most serious and may require
intervention. Patients should be instructed to seek medical attention immediately for any signs of swelling
in the tongue or throat.
3. Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts: D. It occurs
during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left ventricle. An S4 is also
called an atrial heart sound since it occurs at the end of diastolic filling when the atria contracts and fully
fills the left ventricle. Known as "atrial kick", this filling is important to cardiac output. The increased end-
diastolic volume in the ventricle improves cardiac output. When the left ventricle is stiff (decreased
compliance with long term hypertension, aortic stenosis or with acute STEMI), the atrium has to pump
harder to move blood from the atrium to the ventricle, causing a turbulent blood flow and extra heart
sound. This heart sound is always pathologic. It occurs before ventricular contraction, is best heard with
the bell of the stethoscope and is never a normal heart sound, even in children.
4. Which pathologic changes found on the 12-lead ECG indicate
myocardial ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
,C. Q-wave formation
D. ST-segment depression and T-wave inversion: D. ST segment depression
and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle. That change is seen on the 12
lead ECG as ST-segment depression and T wave inversion, which demonstrate subendocardial
ischemia -- the innermost layer of muscle in the myocardium. ST-segment elevation indicates acute
injury or infarction, ST segment depression and T wave elevation may indicate an electrolyte
abnormality, while Q wave formation indicates total infarction.
5. Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
D. vasodilate vessels: A. improve cardiac output and tissue perfusion
The term "inotropic" refers to affecting the force of myocardial contraction. Improvement of cardiac muscle
contraction leads to improved cardiac output and tissue perfusion.
6. A patient in the ED is now being admitted to telemetry with
complaint of chest pain and has been judged to be a possible
candidate for therapy with alteplase (Activase). Which of the
following is not considered a contraindication for the use of this
medication?
A. current antibiotic use
B. recent abdominal surgery
, C. recent gastrointestinal bleed
D. recent intracranial bleed: A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other answers -- recent
abdominal surgery, recent gastrointestinal bleeding and a recent intracranial bleed -- are contraindications
for the use of any fibrinolytic.
7. The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload): A. SVR (afterload) and
cardiac output The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the SVR (afterload) is high
and the cardiac output low, the patient may still have a normal BP. the pulse pressure will be lower, but
this is a compensatory response by the heart to maintain BP. If the SVR (afterload) is low (as in early septic
shock), the cardiac output is very high, thereby trying to support BP.
8. The layer of the arterial vessel wall responsible for changes in
the diameter of the artery is the:
A. media
B. intima
C. externa
D. adventitia: A. media
The media layer of the arterial wall contains vascular smooth muscle cells and is responsible for arterial tone.
