PCCN CARDIAC EXAMINATION SET QUESTIONS AND
ANSWERS SET A+
✔✔Under the Fontaine classification for peripheral vascular disease, intermittent
claudication occurs at:
-Stage I
-Stage II
-Stage III
-Stage IV - ✔✔Stage II
Stage I disease (pathological arterial changes) produces no symptoms.
Stage II is representative of a 75% occlusion and the patient will exhibit intermittent
claudication.
Stage III represents 90-95% occlusion and the patient will have pain at rest.
Stage IV is a 99-100% occulsion that will result in necrosis if not treated.
✔✔Which of the following nursing actions would be important in the care of a patient
with occlusive disease of the terminal aorta and a nonhealing wound on the left foot?
-Elevate the legs
-Place the patient in Fowler's position
-Maintain normothermia
-Fluid restriction - ✔✔Maintain normothermia
Patients with peripheral vascular disease are often hypothermic because of poor blood
circulation. The nurse should provide proper alignment without impeding circulation and
monitor the patient's peripheral pulses for presence and quality. The color and
temperature of the extremity should be monitored and results charted.
✔✔In a patient with cardiogenic shock, an undesirable outcome would produce:
-Increased cardiac output
,-Increased systemic vascular resistance
-Decreased ventricular preload
-Decreased pulmonary artery pressures - ✔✔Increased systemic vascular resistance
A primary goal in cardiogenic shock is to improve the pumping action of the heart
(improve myocardial contractility), reduce the workload of the heart, reduced O2
demand and improve cardiac output. If possible, systemic vascular resistance should be
decreased and the left ventricule augmented with an inotrope. Nitoprusside will reduce
preload and afterload. The cardiac workload and the myocardial O2 demand should
decrease.
✔✔Marvin has heard the staff talking about his mitral valve regurgitation; they also
mentioned that it could be mitral valve stenosis. He asks you how you can tell the
difference just by listening to his heart. Your best answer is:
-"Mitral stenosis produces a high-pitched murmur and mitral valve regurgitation
produces a low-pitched murmur."
-"Mitral stenosis produces a murmur during systole and mitral valve regurg produces a
murmur during diastole."
-"Mitral stenosis murmurs do not radiate their sound, whereas mitral valve regurg
murmurs will radiate towards the left arm. "
-"There is no difference between the presentation of mitral valve stenosis and the
presentation of mitral valve regurg." - ✔✔Mitral stenosis murmurs do not radiate their
sound, whereas mitral valve regurg murmurs will radiate towards the left arm.
Mitral valve stenosis presents with a low-pitched murmur that can be heard during
diastole and that does not radiate. Mitral valve regurgitation presents with a high-pitched
murmur that is hearding during systole that may radiate to the left arm. If severe, both
conditions present with symptoms of pulmonary edema, low cardiac output, and heart
failure.
✔✔If your patient's temporary pacemaker is not sensing, your first action should be to:
-Place patient on their right side
-Increase the mA output
-Check the sensitivity control for proper setting
-Immediately turn off the pacemaker and notify the physician - ✔✔Check the sensitivity
control for proper setting
The first step is to check the sensitivity control. Even though most of these pacemakers
have a cover, the dial may have been moved and indicate that a fixed rate is set. If the
pacer continues to fire, it may cause R-on-T phenomenon and cause ventricular
tachycardia or fibrillaation. If the patient has an adequate rhythm, you can turn off the
paver and notify the physician. If the patient has a non-sustaining rhythm, try positioning
the patient on the left side to see if the wire will come in contact with the myocardium.
,You can also try turning up the mA level. Either way, the physician must be notified and
vital signs carefully monitored until the physician can reposition the electrodes.
✔✔A diastolic murmur will occur as a result of regurgitant blood flow over which of the
following valves?
-Mitral and aortic
-Mitral and tricuspid
-Pulmonic and aortic
-Tricuspid and pulmonic - ✔✔Pulmonic and aortic
During ventricular diastole, both the aortic and pulmonic valves close. If a valve is
incompetent, the blood will flow backwards through the valve, creating turbulent blood
flow-- that is, a murmur.
✔✔Blood flow that moves forward through the stenotic valves can also dause a diastolic
murmur. The valves involved are the:
-Mitral and aortic
-Mitral and tricuspid
-Pulmonic and aortic
-Tricuspid and pulmonic - ✔✔Mitral and tricuspid
During diastole, the tricuspid and mitral valves close just prior to systole. If the valve is
stenotic, it will not close completely. When the atria contract, a murmur is heard as
blood goes through this narrow opening.
✔✔Sid is a 30 year old male who lost control of his motorcycle while riding in the rain.
At the time of the accident, he was wearing a helmet and protective gear. Sid suffered a
fractured left femur, a fractured rib, a cervical sprain, and road rash on his face and
neck. He is admitted with a BP of 84/44, HR 100, RR 26 and shallow, T 98.4'F. His 12
lead EKG shows ST elevation in the anterior leads. His CXR shows a normal cardiac
silhouette and no inflitrates. His H/H is 9.0/32. MB is 18%. Sid is restless and compains
of pain in the chest and left leg. Which condition would you anticipate?
-Systolic dysfuntion
-Hypovolemic shock
-Pulmonary hypertension
-Pulmonary edema - ✔✔Systolic dysfuntion
The injuries to the patient's chest may have caused a pulmonary artery laceration or a
cardiac contusion (the latter condition is more likely). His BP is low and the EKG shows
ST-segment elevation in the anterior leads. If the myocardium is contused, it will react
the same way as if an MI had occurred. The ST elevation may be the result of a
physiologic insult to a coronary artery, and an area of the myocardium may be ischemic.
If so, the pumping function of the myocardium will be compromised and may need
, additional support with inotropes. The patient may undergo angiography and/ or
surgery. Volume replacment may be necessary. This patient is probably in the first
stage of cardiogenic shock.
✔✔Four days ago, Gert, who is 70 years old, was admitted to your unit status post
laparotomy for an unknown abdominal mass. During surgery, Gert had minimal blood
loss and an uneventful course. The patient's history includes smoking since she was 15
(unknown number of ppd), DM, a permanent pacemaker, an anterior MI, and a right-
sided stroke 20 years ago with no deficits.
Three days ago, Gert had a hypotensive episode; her BP dropped to 82/48, HR 70. The
doctor ordered dobutamine and the BP increased until the MAP was 72.
Today, Gert remains on the dobutamine gtt at 2 mcg/kg/min. Her BP is 108/60, MAP 76,
HR 70. Attempts at weaning have failed-- her BP drops precipitously if the dobutamine
dosage is lowered.
What do you think is the cause Gert's inital hypotensive episode?
-Hypovolemic shock
-Previous MI
-Rapid rewarming postoperatively
-Cell mediated response - ✔✔Cell mediated response
Approximately 24 hours after a surgical procedure, the release of inflammatory cell
mediators can lead to casodilation. Gert has a permanent pacer, but apparently her
heart rate cannot compensate for the drop in BP. The caridac output did not increase as
a result of the reduced systemic resistance. Her pacer did not allow the HR to climb
above 70. The dobutamine acted on the pump and increased the heart's contractility.
Gert also has a history of a previous MI.
✔✔Four days ago, Gert, who is 70 years old, was admitted to your unit status post
laparotomy for an unknown abdominal mass. During surgery, Gert had minimal blood
loss and an uneventful course. The patient's history includes smoking since she was 15
(unknown number of ppd), DM, a permanent pacemaker, an anterior MI, and a right-
sided stroke 20 years ago with no deficits.
Three days ago, Gert had a hypotensive episode; her BP dropped to 82/48, HR 70. The
doctor ordered dobutamine and the BP increased until the MAP was 72.
Today, Gert remains on the dobutamine gtt at 2 mcg/kg/min. Her BP is 108/60, MAP 76,
HR 70. Attempts at weaning have failed-- her BP drops precipitously if the dobutamine
dosage is lowered.
Which additional action could be taken to improve Gert's cardiac output and help wean
her from dobutamine?
-Initiate a fluid challenge
-Start dopamine
-Place a pulmonary artery catheter
-Turn up the rate on - ✔✔Turn up the rate on the pacer
ANSWERS SET A+
✔✔Under the Fontaine classification for peripheral vascular disease, intermittent
claudication occurs at:
-Stage I
-Stage II
-Stage III
-Stage IV - ✔✔Stage II
Stage I disease (pathological arterial changes) produces no symptoms.
Stage II is representative of a 75% occlusion and the patient will exhibit intermittent
claudication.
Stage III represents 90-95% occlusion and the patient will have pain at rest.
Stage IV is a 99-100% occulsion that will result in necrosis if not treated.
✔✔Which of the following nursing actions would be important in the care of a patient
with occlusive disease of the terminal aorta and a nonhealing wound on the left foot?
-Elevate the legs
-Place the patient in Fowler's position
-Maintain normothermia
-Fluid restriction - ✔✔Maintain normothermia
Patients with peripheral vascular disease are often hypothermic because of poor blood
circulation. The nurse should provide proper alignment without impeding circulation and
monitor the patient's peripheral pulses for presence and quality. The color and
temperature of the extremity should be monitored and results charted.
✔✔In a patient with cardiogenic shock, an undesirable outcome would produce:
-Increased cardiac output
,-Increased systemic vascular resistance
-Decreased ventricular preload
-Decreased pulmonary artery pressures - ✔✔Increased systemic vascular resistance
A primary goal in cardiogenic shock is to improve the pumping action of the heart
(improve myocardial contractility), reduce the workload of the heart, reduced O2
demand and improve cardiac output. If possible, systemic vascular resistance should be
decreased and the left ventricule augmented with an inotrope. Nitoprusside will reduce
preload and afterload. The cardiac workload and the myocardial O2 demand should
decrease.
✔✔Marvin has heard the staff talking about his mitral valve regurgitation; they also
mentioned that it could be mitral valve stenosis. He asks you how you can tell the
difference just by listening to his heart. Your best answer is:
-"Mitral stenosis produces a high-pitched murmur and mitral valve regurgitation
produces a low-pitched murmur."
-"Mitral stenosis produces a murmur during systole and mitral valve regurg produces a
murmur during diastole."
-"Mitral stenosis murmurs do not radiate their sound, whereas mitral valve regurg
murmurs will radiate towards the left arm. "
-"There is no difference between the presentation of mitral valve stenosis and the
presentation of mitral valve regurg." - ✔✔Mitral stenosis murmurs do not radiate their
sound, whereas mitral valve regurg murmurs will radiate towards the left arm.
Mitral valve stenosis presents with a low-pitched murmur that can be heard during
diastole and that does not radiate. Mitral valve regurgitation presents with a high-pitched
murmur that is hearding during systole that may radiate to the left arm. If severe, both
conditions present with symptoms of pulmonary edema, low cardiac output, and heart
failure.
✔✔If your patient's temporary pacemaker is not sensing, your first action should be to:
-Place patient on their right side
-Increase the mA output
-Check the sensitivity control for proper setting
-Immediately turn off the pacemaker and notify the physician - ✔✔Check the sensitivity
control for proper setting
The first step is to check the sensitivity control. Even though most of these pacemakers
have a cover, the dial may have been moved and indicate that a fixed rate is set. If the
pacer continues to fire, it may cause R-on-T phenomenon and cause ventricular
tachycardia or fibrillaation. If the patient has an adequate rhythm, you can turn off the
paver and notify the physician. If the patient has a non-sustaining rhythm, try positioning
the patient on the left side to see if the wire will come in contact with the myocardium.
,You can also try turning up the mA level. Either way, the physician must be notified and
vital signs carefully monitored until the physician can reposition the electrodes.
✔✔A diastolic murmur will occur as a result of regurgitant blood flow over which of the
following valves?
-Mitral and aortic
-Mitral and tricuspid
-Pulmonic and aortic
-Tricuspid and pulmonic - ✔✔Pulmonic and aortic
During ventricular diastole, both the aortic and pulmonic valves close. If a valve is
incompetent, the blood will flow backwards through the valve, creating turbulent blood
flow-- that is, a murmur.
✔✔Blood flow that moves forward through the stenotic valves can also dause a diastolic
murmur. The valves involved are the:
-Mitral and aortic
-Mitral and tricuspid
-Pulmonic and aortic
-Tricuspid and pulmonic - ✔✔Mitral and tricuspid
During diastole, the tricuspid and mitral valves close just prior to systole. If the valve is
stenotic, it will not close completely. When the atria contract, a murmur is heard as
blood goes through this narrow opening.
✔✔Sid is a 30 year old male who lost control of his motorcycle while riding in the rain.
At the time of the accident, he was wearing a helmet and protective gear. Sid suffered a
fractured left femur, a fractured rib, a cervical sprain, and road rash on his face and
neck. He is admitted with a BP of 84/44, HR 100, RR 26 and shallow, T 98.4'F. His 12
lead EKG shows ST elevation in the anterior leads. His CXR shows a normal cardiac
silhouette and no inflitrates. His H/H is 9.0/32. MB is 18%. Sid is restless and compains
of pain in the chest and left leg. Which condition would you anticipate?
-Systolic dysfuntion
-Hypovolemic shock
-Pulmonary hypertension
-Pulmonary edema - ✔✔Systolic dysfuntion
The injuries to the patient's chest may have caused a pulmonary artery laceration or a
cardiac contusion (the latter condition is more likely). His BP is low and the EKG shows
ST-segment elevation in the anterior leads. If the myocardium is contused, it will react
the same way as if an MI had occurred. The ST elevation may be the result of a
physiologic insult to a coronary artery, and an area of the myocardium may be ischemic.
If so, the pumping function of the myocardium will be compromised and may need
, additional support with inotropes. The patient may undergo angiography and/ or
surgery. Volume replacment may be necessary. This patient is probably in the first
stage of cardiogenic shock.
✔✔Four days ago, Gert, who is 70 years old, was admitted to your unit status post
laparotomy for an unknown abdominal mass. During surgery, Gert had minimal blood
loss and an uneventful course. The patient's history includes smoking since she was 15
(unknown number of ppd), DM, a permanent pacemaker, an anterior MI, and a right-
sided stroke 20 years ago with no deficits.
Three days ago, Gert had a hypotensive episode; her BP dropped to 82/48, HR 70. The
doctor ordered dobutamine and the BP increased until the MAP was 72.
Today, Gert remains on the dobutamine gtt at 2 mcg/kg/min. Her BP is 108/60, MAP 76,
HR 70. Attempts at weaning have failed-- her BP drops precipitously if the dobutamine
dosage is lowered.
What do you think is the cause Gert's inital hypotensive episode?
-Hypovolemic shock
-Previous MI
-Rapid rewarming postoperatively
-Cell mediated response - ✔✔Cell mediated response
Approximately 24 hours after a surgical procedure, the release of inflammatory cell
mediators can lead to casodilation. Gert has a permanent pacer, but apparently her
heart rate cannot compensate for the drop in BP. The caridac output did not increase as
a result of the reduced systemic resistance. Her pacer did not allow the HR to climb
above 70. The dobutamine acted on the pump and increased the heart's contractility.
Gert also has a history of a previous MI.
✔✔Four days ago, Gert, who is 70 years old, was admitted to your unit status post
laparotomy for an unknown abdominal mass. During surgery, Gert had minimal blood
loss and an uneventful course. The patient's history includes smoking since she was 15
(unknown number of ppd), DM, a permanent pacemaker, an anterior MI, and a right-
sided stroke 20 years ago with no deficits.
Three days ago, Gert had a hypotensive episode; her BP dropped to 82/48, HR 70. The
doctor ordered dobutamine and the BP increased until the MAP was 72.
Today, Gert remains on the dobutamine gtt at 2 mcg/kg/min. Her BP is 108/60, MAP 76,
HR 70. Attempts at weaning have failed-- her BP drops precipitously if the dobutamine
dosage is lowered.
Which additional action could be taken to improve Gert's cardiac output and help wean
her from dobutamine?
-Initiate a fluid challenge
-Start dopamine
-Place a pulmonary artery catheter
-Turn up the rate on - ✔✔Turn up the rate on the pacer
