Barron's CCRN Cardiac Questions and Answers well Explained Latest 2024/2025 Update 100% Correct.

Which clinical sign might patients with both systolic and diastolic heart failure have in common? a) Peripheral edema b) Enlarged heart size on chest radiograph c) Lung crackles d) Ejection fraction less than 40% - Answer: C Both a problem with ejection (systolic failure) and a problem with filling (diastolic failure) will increase left heart pressure and cause cardiogenic pulmonary edema (lung crackles). The remaining three choices are associated with systolic heart failure rather than diastolic heart failure. The patient with a temporary transvenous pacemaker develops pacemaker malfunction. The orientee is instructed to reposition the patient to try to correct the problem. The cardiac monitor most likely demonstrates: a) Periods of asystole without pacemaker activity b) Runs of ventricular tachycardia c) Pacemaker spikes without a QRS d) Pacemaker spikes on the T-wave of the patient's own beats - Answer: C Failure to capture (spikes present without QRS) may be corrected by repositioning the patient to the side. The remaining problems would not be helped by repositioning the patient. The patient with aortic regurgitation will have which of the following on auscultation? a) Diastolic murmur, loudest at the 5th intercostal space, midclavicular b) Systolic murmur, loudest at the apex of the heart c) Diastolic murmur, loudest at the second intercostal space, right sternal border d) Systolic murmur, loudest at the base of the heart - Answer: C Aortic insufficiency (regurgitation) is backflow of blood during the time the aortic valve should be closed. When is the aortic valve closed? During diastole — therefore it is a diastolic murmur. The aortic area of auscultation is at the base of the heart, second intercostal space, right sternal border.Cardiogenic shock secondary to left ventricular failure will generally result in: a) Decreased afterload b) narrow pulse pressure c) decreased preload d) Widening pulse pressure - Answer: B The systolic pressure decreases due to a drop in cardiac output; however, the diastolic pressure either stays the same or increases due to a compensatory increase of the systemic vascular resistance. The remaining choices are not found in cardiogenic shock. The patient was admitted with acute inferior wall STEMI; the physician advises the nurse to monitor the patient for signs of right ventricular (RV) infarction. Which of the following are signs of RV infarction? a) S2 heart sounds, lung crackles b) Hypotension, flat neck veins c) Hypertension, systolic murmur d) Distended neck veins, clear lungs - Answer: D If the RV contractility decreases, pressure proximal to the right ventricle (which is the right atrium) increases, resulting in distended neck veins. As the right heart fails, left heart preload decreases, lung sounds clear. The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the patient closely for which of the following? a) Tachycardia, lung crackles b) Sinus bradycardia, acute systolic murmur in the fifth intercostal space, midclavicular c) Second-degree heart block Type 2, hypotension d) Hypoxemia, acute systolic murmur, 5th intercostal space left sternal border - Answer: B Complications likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA and/or AV node, and papillary muscle rupture or dysfunction due to the anatomical distance between the right coronary artery and the papillary muscle. The remaining choices are not common complications of inferior MI. Pulmonary hypertension may result in which of the following? a) Left heart failureb) Right heart failure c) Increased lung compliance d) Arterial hypertension - Answer: B The right ventricular wall normally is thinner than the left because the RV generally ejects into a low pressure pulmonary system with a mean pulmonary pressure of approximately 20 mmHg. An increase in pulmonary pressure may result in failure of the RV. The patient with diastolic heart failure develops supraventricular tachycardia, heart rate 220/min. The most dangerous hemodynamic effect is a decrease in: a) Myocardial contractility b) Coronary artery perfusion c) ejection fraction d) Arterial oxygenation - Answer: B Diastolic heart failure results in a problem with left ventricular FILLING secondary to ventricular thickening, and contractility and ejection are maintained in diastolic failure. The rapid heart rate will decrease filling time, worsen left ventricular filling and because coronary artery perfusion occurs during diastole, this arrhythmia may be life-threatening. The nurse is caring for a patient with acute inferior wall MI, post-coronary artery stent deployment. For optimal care of the patient, the nurse should: a) administer an analgesic for acute back pain b) Apply pressure dressing to groin c) Continuously monitor the patient in lead II d) Maintain the patient in a supine position - Answer: C It is best practice to continuously monitor the patient status post PCI with stent, in the lead that was most abnormal during the acute occlusion. Lead II would most likely meet this criterion for the patient with an inferior wall MI. The remaining interventions are NOT indicated for the patient post PCI. The 75-year-old patient develops frequent 6 to 10 second episodes of asystole, interspersed with normal sinus rhythm that is associated with hypotension. The priority intervention is: a) Trans-cutaneous pacingb) Fluid bolus c) Trans-venous pacing d) Vasopressors - Answer: A The rhythm described is sinus arrest. Because the patient is having serious signs and symptoms, the immediate treatment is transcutaneous pacing. Transvenous pacing may be done once the patient is stabilized. The remaining two choices are not indicated for sinus arrest. One hemodynamic benefit of intra-aortic balloon therapy is: a) Balloon inflation prevents right to left shunt b) Balloon deflation increases coronary artery perfusion c) Balloon inflation optimizes aortic valve performance d) Balloon deflation decreases left ventricular afterload - Answer: D Balloon deflation in the descending aortic arch right before systole creates a drop in afterload. When the balloon inflates during diastole, blood is displaced into the coronary arteries, increasing coronary artery perfusion. Which of the following is indicated to maintain patency of a coronary artery stent? a) Nitrates b) Metoproplol (Lopressor) c) Aspirin d) clopidogrel (Plavix) - Answer: D The patient requires anti-platelet therapy post-procedure (and for some patients up to one year) to prevent thrombus formation at the site of a stent. While the patient may require the remaining three choices, they are prescribed for other reasons.