CCRN CRITICAL CARE REGISTERED NURSE EXAM VERSION 1
AND 2/ DOWNLOAD TO SCORE A+….ALREADY PASSED
What are the three types of angina?
1. Stable
2. Unstable
3. Prinzmetal's/Variant
What is stable angina?
Excerise induced chest pain relieved by rest or nitroglycerin (non-
emergent)
What is unstable angina?
Chest pain that occurs at rest. Symptoms more significant
(emergent, call 911 right away)
What is Prinzmetal's angina? What is the patient at risk for?
Spasms of coronary arteries that occur at rest.
High risk for ventricular arrhythmias that can lead to sudden
cardiac death
Where is the myocardial oxygen supplied from? What are 2
things that can affect oxygen supply?
Coronary vessels
1. Blockage (atherosclerosis) & 2. Vasospasm's
What are 4 things that can affect oxygen demand of the
coronary vessels?
1. HR
2. Preload
3. After-load
4. Contractility
What is the 4 step process for treating classic angina?
1. Nitrates
2. Nitrates & beta blockers
3. Nitrates, beta blockers, & calcium channel blockers
4. Coronary artery bypass graft
What is the 3 step process for treating prinzmetal's angina?
,1. Nitrates OR calcium channel blockers
2. Nitrates & calcium channel blockers
3. Coronary artery bypass graft
Why are beta blockers not given to treat prinzmetals angina?
Can drop BP which can worsen spasms
A myocardial infarction is ____ of the myocardial cells, _____
is the most common cause, and ___ of the heart effects the
outcome
1. Necrosis (irreversible)
2. Atherosclerosis
3. Location
What vessel is responsible for infarctions on the anterior and
antero-septal sides of the heart?
Left anterior descending (LAD)
Highest mortality (widow maker)
Which 2 vessels are responsible for the infarctions on the
inferior & posterior sides of the heart?
Right coronary artery (RCA) or Left circumflex
What vessel is responsible for the infarctions on the lateral
side of the heart?
Left circumflex
What is an transmural infarction?
STEMI
Infraction involving all 3 layers of the heart
What is an subendocardial and subepicardial infarct?
NSTEMI
1. Affecting the endocardium (outer) and partial wall of
myocardium
2. Affecting the epicardium (inner) and partial wall of myocardium
What is the number one atypical symptom of an acute MI?
Unexplained dyspnea
What is the PQRST assessment stand for?
Precipitation, Quality, Radiation, Severity, & Time
What is the main purpose of a 12 lead EKG?
,Looking at the heart from different views. The different leads are
telling about the different surfaces of the heart
When would a 18 lead EKG be used?
If a right sided MI is suspected
Which lead indicates the location of the infarction?
V lead
If there is ST elevation where should the leads be placed?
Over the area of infraction
If there is no ST elevation or suspected ischemia which 2
leads are used?
V3 and III ( Double 3's)
If there is ST elevation, what kind of MI is suspected?
STEMI
If there is ST depression, what kind of MI is suspected?
Non-STEMI
What 3 EKG changes are seen in a STEMI's?
1. ST elevation
2. New LBBB
3. Pathological Q waves
What 2 EKG changes are seen in a Non-STEMI?
1. ST depression
2. T wave inversion
What is the cardiac marker myoglobin used for when
diagnosing MI's?
Used a rule out for any ACS
Can be a false positive bc present in all muscles
What is the cardiac marker troponin used for when
diagnosing MI's?
Used to see if any damage to the heart
Has a quick onset & long duration
What is cardiac marker CPK-MB used for when diagnosing
MI's?
Used because it is specific to the heart but only last about 24
hours to test for damage
Which 2 lab tests are most accurate to diagnosis acute MI?
, Troponin & CPK-MB
Which diagnostic test is MOST important in a patient workup
for ACS who delayed ER for 24 hr?
Troponin
What 2 inflammatory makers are used to look for ACS
inflammation?
1. WBC's
2. CRP (C reactive protein)
What hemodynamic marker is used as indication of elevated
muscle stretch and seen in CHF? What is the normal value?
BNP (B-type natriuretic peptide)
<100
What CAD screening tool is a predictor of morbidity/mortality
of CV event? What are the 3 primary prevention treatments?
Homocysteine
Increase intake of B6, B12, & folate
What is the treatment window for a patient having chest
pain?
12 hours
In what order should MONA be received related to treatment
of an acute MI?
1. Oxygen 2. Nitro 3. Morphine 4. Aspirin
Why is morphine the choice narcotic analgesic for ACS?
Lowers preload (venous dilation)
When is the best time to do a 12 lead EKG?
During chest pain
What 2 medications are given to lower demand/de-stress the
heart during chest pain?
1. Beta blockers
2. Calcium channel blockers
What is the action of beta blockers(ol)? When is it held?
Action: Decreases workload of the heart: supply & demand of O2
(decreases HR & contractility)
Hold: when HR & BP low, pt has asthma (bronchospasm)
What is the action of calcium channel blockers?
AND 2/ DOWNLOAD TO SCORE A+….ALREADY PASSED
What are the three types of angina?
1. Stable
2. Unstable
3. Prinzmetal's/Variant
What is stable angina?
Excerise induced chest pain relieved by rest or nitroglycerin (non-
emergent)
What is unstable angina?
Chest pain that occurs at rest. Symptoms more significant
(emergent, call 911 right away)
What is Prinzmetal's angina? What is the patient at risk for?
Spasms of coronary arteries that occur at rest.
High risk for ventricular arrhythmias that can lead to sudden
cardiac death
Where is the myocardial oxygen supplied from? What are 2
things that can affect oxygen supply?
Coronary vessels
1. Blockage (atherosclerosis) & 2. Vasospasm's
What are 4 things that can affect oxygen demand of the
coronary vessels?
1. HR
2. Preload
3. After-load
4. Contractility
What is the 4 step process for treating classic angina?
1. Nitrates
2. Nitrates & beta blockers
3. Nitrates, beta blockers, & calcium channel blockers
4. Coronary artery bypass graft
What is the 3 step process for treating prinzmetal's angina?
,1. Nitrates OR calcium channel blockers
2. Nitrates & calcium channel blockers
3. Coronary artery bypass graft
Why are beta blockers not given to treat prinzmetals angina?
Can drop BP which can worsen spasms
A myocardial infarction is ____ of the myocardial cells, _____
is the most common cause, and ___ of the heart effects the
outcome
1. Necrosis (irreversible)
2. Atherosclerosis
3. Location
What vessel is responsible for infarctions on the anterior and
antero-septal sides of the heart?
Left anterior descending (LAD)
Highest mortality (widow maker)
Which 2 vessels are responsible for the infarctions on the
inferior & posterior sides of the heart?
Right coronary artery (RCA) or Left circumflex
What vessel is responsible for the infarctions on the lateral
side of the heart?
Left circumflex
What is an transmural infarction?
STEMI
Infraction involving all 3 layers of the heart
What is an subendocardial and subepicardial infarct?
NSTEMI
1. Affecting the endocardium (outer) and partial wall of
myocardium
2. Affecting the epicardium (inner) and partial wall of myocardium
What is the number one atypical symptom of an acute MI?
Unexplained dyspnea
What is the PQRST assessment stand for?
Precipitation, Quality, Radiation, Severity, & Time
What is the main purpose of a 12 lead EKG?
,Looking at the heart from different views. The different leads are
telling about the different surfaces of the heart
When would a 18 lead EKG be used?
If a right sided MI is suspected
Which lead indicates the location of the infarction?
V lead
If there is ST elevation where should the leads be placed?
Over the area of infraction
If there is no ST elevation or suspected ischemia which 2
leads are used?
V3 and III ( Double 3's)
If there is ST elevation, what kind of MI is suspected?
STEMI
If there is ST depression, what kind of MI is suspected?
Non-STEMI
What 3 EKG changes are seen in a STEMI's?
1. ST elevation
2. New LBBB
3. Pathological Q waves
What 2 EKG changes are seen in a Non-STEMI?
1. ST depression
2. T wave inversion
What is the cardiac marker myoglobin used for when
diagnosing MI's?
Used a rule out for any ACS
Can be a false positive bc present in all muscles
What is the cardiac marker troponin used for when
diagnosing MI's?
Used to see if any damage to the heart
Has a quick onset & long duration
What is cardiac marker CPK-MB used for when diagnosing
MI's?
Used because it is specific to the heart but only last about 24
hours to test for damage
Which 2 lab tests are most accurate to diagnosis acute MI?
, Troponin & CPK-MB
Which diagnostic test is MOST important in a patient workup
for ACS who delayed ER for 24 hr?
Troponin
What 2 inflammatory makers are used to look for ACS
inflammation?
1. WBC's
2. CRP (C reactive protein)
What hemodynamic marker is used as indication of elevated
muscle stretch and seen in CHF? What is the normal value?
BNP (B-type natriuretic peptide)
<100
What CAD screening tool is a predictor of morbidity/mortality
of CV event? What are the 3 primary prevention treatments?
Homocysteine
Increase intake of B6, B12, & folate
What is the treatment window for a patient having chest
pain?
12 hours
In what order should MONA be received related to treatment
of an acute MI?
1. Oxygen 2. Nitro 3. Morphine 4. Aspirin
Why is morphine the choice narcotic analgesic for ACS?
Lowers preload (venous dilation)
When is the best time to do a 12 lead EKG?
During chest pain
What 2 medications are given to lower demand/de-stress the
heart during chest pain?
1. Beta blockers
2. Calcium channel blockers
What is the action of beta blockers(ol)? When is it held?
Action: Decreases workload of the heart: supply & demand of O2
(decreases HR & contractility)
Hold: when HR & BP low, pt has asthma (bronchospasm)
What is the action of calcium channel blockers?
