PCCN CARDIAC STUDY EXAMS GUIDE QUESTIONS
AND ANSWERS SET A+
✔✔If the INR (international normalized ratio) is greater than 5.0, the pt is at a significant
risk for bleeding. A drug that can cause a significant rise in the INR is?
• Ethacrinic acid
• PCN
• Amiodarone
• Statins - ✔✔AMIODARONE
These cause a SIGNIFICANT rise in INR:
ASA
sulfonamides (ABXs)
cimetidine (Tagamet, an H2 antogonist receptor), fluoroquinolones (ABXs)
macrolide antibiotics
Those below all cause a MODERATE rise in INR:
Ethacrinic acid (loop diuretic, antihypertensive) PCN (ABX)
Statins (anticholesterol medications)
✔✔A drug that will significantly decrease the INR would be?
• Naficillin
• Vitamin K
• High-dose Vitamin C
• Cyclosporin - ✔✔VITAMIN K
Vitamin K is considered the antidote for warfarin, but can actually lower the INR too
much and increase warfarin resistance, so careful monitoring is needed.
These cause SIGNIFICANT decrease in INR:
Rifampin (ABX)
Phenobarbital (barbiturate anticonvulsant)
Glutethimide (hypnotic sedative)
,Those below cause a MODERATE decrease in INR:
Naficillin (narrow spectrum ABX)
High dose Vitamin C (cancer tx)
Cyclosporin (immunosuppressant)
✔✔Your pt has a temporary pacer and has been requiring adjustments to raise the
energy output (milliamps). This is probably due to?
• Hyperkalemia
• Necrotic tissue
• Lidocaine toxicity
• An atrioventricular block - ✔✔NECROTIC TISSUE
Dead meat don't beat. Necrotic tissue cannot conduct an impulse. Ischemic tissue may
impair conduction.
If the pt was Hypokalemic, the energy levels (mA) would have to be raised because the
low K level depresses the myocardium.
✔✔Mr K is a 54 YO dockworker who was admitted with a NSTEMI to the inferior wall.
He is c/o dyspnea, weakness, bilateral crackles, and demonstrates orthopnea. He has
developed an S3 heart sound. You suspect he has also developed?
• Pulmonary Embolus
• Pulmonary HTN
• A fat embolism
• Cardiogenic shock - ✔✔CARDIOGENIC SHOCK
The MI has impaired the heart's ability to pump effectively. The CO falls and the body
reacts by vasoconstricting peripheral circulation and increasing the HR.
Tachycardia is also the result of catecholamine release, and the myocardial O2
consumption increases.
The left ventricle works harder, but has been compromised by the MI.
Preload increases because fluid cannot be pumped out of the chambers effectively.
S3 is a signal of increased PREload.
Pulmonary congestion occurs because of increased LEFT heart pressures.
✔✔Your pt suddenly complains of chest pain. You auscultate a new holosystolic
murmur at the lower left sternal border. Your pt has probable experienced a
• Dissecting thoracic aneurysm
• Pulmonary embolus
• Ventricular septal rupture
• Lateral wall MI - ✔✔VENTRICULAR SEPTAL RUPTURE
A new holosystolic murmur at the lower left sternal border means that turbulent blood
flow is occurring there. The turbulence is caused by a hole that is allowing blood to flow
through a previously closed area. The SvO2 will increase due to the mixing of blood.
This condition must be corrected surgically.
,✔✔Mrs F was admitted for DVT management 3 days ago. During your initial
assessment, you found her sitting on the side of the bed leaning forward. Mrs. F states
that this position relieved her newly developed chest pain. She also states her pain is
worse on inspiration. You call the doc who orders a CXR and labs. The lab results show
that the pt's sed rate and WBCs are elevated. Mrs. F most likely has?
• Pericarditis
• Thoracic aneurysm
• Pulmonary embolus
• Pulmonary edema - ✔✔PERICARDITIS
The CXR will probably show a pericardial effusion.
The elevated sed rate and WBCs indicate infection.
Learning forward will relieve the chest pain whereas lying supine makes it worse.
If the pain worsens with inspiration, it's because the lungs expand and come in contact
with the pericardium.
The pt will also probably have a fever.
It's also important to assess for s/s of tamponade and to make certain that any
anticoagulants are d/c'd.
✔✔A probable candidate for a CABG (coronary artery bypass graft) might have?
• An EF of 55% and diabetes
• Right main artery disease
• An EF of 35% and CAD (coronary artery disease)
• A previous history of cardiac surgery - ✔✔An EF of 35% and CAD
✔✔You are performing CPR on a pt with an endotracheal tube (ET) in place. The
placement of the tube has been confirmed. THe pt should be ventilated every:
6 to 8 seconds
5 Compressions
15 Compressions
3 to 5 seconds - ✔✔6 to 8 seconds
The new AHA guidelines specify t hat ventilation should occur every 6 to 8 seconds.
The compressions should continue at a rate of 100 per minute. The recommended
ventilation rate approximates a normal adult rate and allows for cardiac refill. Ventilating
too fast raises intrathoracic pressure and interferes with cardiac fill.
✔✔If you are using a biphasic defibrillator on an adult, t he energy setting should be:
360 joules
50 to 100 joules
300 joules
200 joules - ✔✔200 joules
, 200 joules on a biphasic defibrillator is as effective as 360 joules on a monophasic
defibrillator. The purpose of defibrillation is to deliver enough electricity to cause a large
enough mass of myocardium to depolarize simultaneously. If that occurs, it is then
possible for a normal rhythm to reemerge or become the primary rhythm. It is important
to identify the initial cause of the dysrhythmia and treat it, if possible, to prevent
recurrence.
✔✔Maria has been diagnosed with pericarditis secondary to blunt chest trauma and
cardiac contusion after a motor vehicle accident. She asks you how long the pericarditis
may last. Your answer will be formulated based on the fact that:
Acute pericarditis will self resolve in 1 week
Acute pericarditis should self resolve in 2-6 weeks
Acute pericarditis will always result in chronic pericarditis
Chronic pericarditis is reoccuring and not associated with any other cardiac symptom -
✔✔Acute pericarditis should self resolve in 2-6 weeks.
Acute pericarditis is usually self limiting within 2 to 6 weeks after it's initial onset.
Treatment includes bedrest, O2 therapy, antivirals, antifungals, or antibacterials. In
addition, drainage and management of cardiac tamponade may be necessary. The
classic presentation of chronic pericarditis, also known as constrictive pericarditis,
demonstrates fibrous pericardial thickening. Treatment may include the extreme
measure of pericardiotomy (removal of the pericardium.)
✔✔Wellen's syndrome:
Is the same as Prinzmetal's angina
Occurs with the proximal stenosis of the LAD
Is also called cresendo angina
Is variant angina - ✔✔Occurs with the proximal stenosis of the LAD
Wellen's syndrome is a type of angina that occurs when the LAD is stenosed proximally.
The ST segment is not elevated more than 1mm in leads V1-V3, there is a mild T wave
inversion in leads V2-V3, and Q waves are not pathologic (greater than 25% of the total
length). Because of the location of the stenosis, surgery is emergently needed.
Prinzmetal angina is aka Variant angina -- in this type of angina, the pain occurs at rest
and is associated with a vasospasm.
Cresendo angina means that over time, it takes less to initiate the pain and the pain
lasts longer.
✔✔A vasodilator used in the treatment of anginal pain is:
Morphine
AND ANSWERS SET A+
✔✔If the INR (international normalized ratio) is greater than 5.0, the pt is at a significant
risk for bleeding. A drug that can cause a significant rise in the INR is?
• Ethacrinic acid
• PCN
• Amiodarone
• Statins - ✔✔AMIODARONE
These cause a SIGNIFICANT rise in INR:
ASA
sulfonamides (ABXs)
cimetidine (Tagamet, an H2 antogonist receptor), fluoroquinolones (ABXs)
macrolide antibiotics
Those below all cause a MODERATE rise in INR:
Ethacrinic acid (loop diuretic, antihypertensive) PCN (ABX)
Statins (anticholesterol medications)
✔✔A drug that will significantly decrease the INR would be?
• Naficillin
• Vitamin K
• High-dose Vitamin C
• Cyclosporin - ✔✔VITAMIN K
Vitamin K is considered the antidote for warfarin, but can actually lower the INR too
much and increase warfarin resistance, so careful monitoring is needed.
These cause SIGNIFICANT decrease in INR:
Rifampin (ABX)
Phenobarbital (barbiturate anticonvulsant)
Glutethimide (hypnotic sedative)
,Those below cause a MODERATE decrease in INR:
Naficillin (narrow spectrum ABX)
High dose Vitamin C (cancer tx)
Cyclosporin (immunosuppressant)
✔✔Your pt has a temporary pacer and has been requiring adjustments to raise the
energy output (milliamps). This is probably due to?
• Hyperkalemia
• Necrotic tissue
• Lidocaine toxicity
• An atrioventricular block - ✔✔NECROTIC TISSUE
Dead meat don't beat. Necrotic tissue cannot conduct an impulse. Ischemic tissue may
impair conduction.
If the pt was Hypokalemic, the energy levels (mA) would have to be raised because the
low K level depresses the myocardium.
✔✔Mr K is a 54 YO dockworker who was admitted with a NSTEMI to the inferior wall.
He is c/o dyspnea, weakness, bilateral crackles, and demonstrates orthopnea. He has
developed an S3 heart sound. You suspect he has also developed?
• Pulmonary Embolus
• Pulmonary HTN
• A fat embolism
• Cardiogenic shock - ✔✔CARDIOGENIC SHOCK
The MI has impaired the heart's ability to pump effectively. The CO falls and the body
reacts by vasoconstricting peripheral circulation and increasing the HR.
Tachycardia is also the result of catecholamine release, and the myocardial O2
consumption increases.
The left ventricle works harder, but has been compromised by the MI.
Preload increases because fluid cannot be pumped out of the chambers effectively.
S3 is a signal of increased PREload.
Pulmonary congestion occurs because of increased LEFT heart pressures.
✔✔Your pt suddenly complains of chest pain. You auscultate a new holosystolic
murmur at the lower left sternal border. Your pt has probable experienced a
• Dissecting thoracic aneurysm
• Pulmonary embolus
• Ventricular septal rupture
• Lateral wall MI - ✔✔VENTRICULAR SEPTAL RUPTURE
A new holosystolic murmur at the lower left sternal border means that turbulent blood
flow is occurring there. The turbulence is caused by a hole that is allowing blood to flow
through a previously closed area. The SvO2 will increase due to the mixing of blood.
This condition must be corrected surgically.
,✔✔Mrs F was admitted for DVT management 3 days ago. During your initial
assessment, you found her sitting on the side of the bed leaning forward. Mrs. F states
that this position relieved her newly developed chest pain. She also states her pain is
worse on inspiration. You call the doc who orders a CXR and labs. The lab results show
that the pt's sed rate and WBCs are elevated. Mrs. F most likely has?
• Pericarditis
• Thoracic aneurysm
• Pulmonary embolus
• Pulmonary edema - ✔✔PERICARDITIS
The CXR will probably show a pericardial effusion.
The elevated sed rate and WBCs indicate infection.
Learning forward will relieve the chest pain whereas lying supine makes it worse.
If the pain worsens with inspiration, it's because the lungs expand and come in contact
with the pericardium.
The pt will also probably have a fever.
It's also important to assess for s/s of tamponade and to make certain that any
anticoagulants are d/c'd.
✔✔A probable candidate for a CABG (coronary artery bypass graft) might have?
• An EF of 55% and diabetes
• Right main artery disease
• An EF of 35% and CAD (coronary artery disease)
• A previous history of cardiac surgery - ✔✔An EF of 35% and CAD
✔✔You are performing CPR on a pt with an endotracheal tube (ET) in place. The
placement of the tube has been confirmed. THe pt should be ventilated every:
6 to 8 seconds
5 Compressions
15 Compressions
3 to 5 seconds - ✔✔6 to 8 seconds
The new AHA guidelines specify t hat ventilation should occur every 6 to 8 seconds.
The compressions should continue at a rate of 100 per minute. The recommended
ventilation rate approximates a normal adult rate and allows for cardiac refill. Ventilating
too fast raises intrathoracic pressure and interferes with cardiac fill.
✔✔If you are using a biphasic defibrillator on an adult, t he energy setting should be:
360 joules
50 to 100 joules
300 joules
200 joules - ✔✔200 joules
, 200 joules on a biphasic defibrillator is as effective as 360 joules on a monophasic
defibrillator. The purpose of defibrillation is to deliver enough electricity to cause a large
enough mass of myocardium to depolarize simultaneously. If that occurs, it is then
possible for a normal rhythm to reemerge or become the primary rhythm. It is important
to identify the initial cause of the dysrhythmia and treat it, if possible, to prevent
recurrence.
✔✔Maria has been diagnosed with pericarditis secondary to blunt chest trauma and
cardiac contusion after a motor vehicle accident. She asks you how long the pericarditis
may last. Your answer will be formulated based on the fact that:
Acute pericarditis will self resolve in 1 week
Acute pericarditis should self resolve in 2-6 weeks
Acute pericarditis will always result in chronic pericarditis
Chronic pericarditis is reoccuring and not associated with any other cardiac symptom -
✔✔Acute pericarditis should self resolve in 2-6 weeks.
Acute pericarditis is usually self limiting within 2 to 6 weeks after it's initial onset.
Treatment includes bedrest, O2 therapy, antivirals, antifungals, or antibacterials. In
addition, drainage and management of cardiac tamponade may be necessary. The
classic presentation of chronic pericarditis, also known as constrictive pericarditis,
demonstrates fibrous pericardial thickening. Treatment may include the extreme
measure of pericardiotomy (removal of the pericardium.)
✔✔Wellen's syndrome:
Is the same as Prinzmetal's angina
Occurs with the proximal stenosis of the LAD
Is also called cresendo angina
Is variant angina - ✔✔Occurs with the proximal stenosis of the LAD
Wellen's syndrome is a type of angina that occurs when the LAD is stenosed proximally.
The ST segment is not elevated more than 1mm in leads V1-V3, there is a mild T wave
inversion in leads V2-V3, and Q waves are not pathologic (greater than 25% of the total
length). Because of the location of the stenosis, surgery is emergently needed.
Prinzmetal angina is aka Variant angina -- in this type of angina, the pain occurs at rest
and is associated with a vasospasm.
Cresendo angina means that over time, it takes less to initiate the pain and the pain
lasts longer.
✔✔A vasodilator used in the treatment of anginal pain is:
Morphine
