CMC Practice Questions – AACN with correct answers (100%)
1. While caring for a patient with an IABP at 3:1, the nurse notes:
A. decreasing urine output as well as increasing BUN and CR levels; the nurse
should increase timing to 2:1
B. absent pulses in the proximal extremity; the nurse should apply pressure
at the insertion site.
C. blood in the IABP tubing; the nurse should disconnect the balloon catheter
from the IABP.
D. blood oozing from the insertion site; the nurse should anticipate the need
for an emergency fasciotomy.: A. incorrect. decreasing urine output with increas-
ing BUN and CR levels with an IABP in place indicates obstruction of the renal
arteries. The nurse should plan for removal.
B. incorrect. absent pulses distal to the insertion site indicates complete occlusion
of the femoral artery. application of pressure to the insertion site will worsen the
obstruction.
C. correct. blood in the IABP tubing indicates a rupture of the balloon. Continuing to
allow the IABP to inflate and deflate will increase the size of the rupture, causing
more bleeding. the nurse should plan for removal or exchange of the IABP catheter.
D. incorrect. a fasciotomy would be indicated if the patient had an increase in fluid
accumulation in the extremities causing significant injury to the limb.
2. An IABP is currently at 3:1 when the patient suddenly goes into ventricular
fibrillation. In addition to resuscitative measures, the nurse should:
A. change the trigger to internal or pressure support resuscitative measures.
B. increase timing back to 1:1 to increase coronary artery perfusion pressure.
C. put the pump on standby until the return of spontaneous circulation.
D. assess the IABP timing to chest compressions at 1:2.: A. correct. the IABP
will not be able to time correctly when a patient is in V-Fib. by placing the system
to trigger on internal or pressure support, it will generate off the pressure created
during compressions.
B. incorrect. attempting to time the IABP back to 1:1 will be counterproductive, as it
will not be able to trigger correctly.
C. incorrect. there is significant risk of clot forming on the IABP when placed in stand
for an indeterminate amount of time.
D. incorrect. the primary goal during resuscitative measures is to attempt to circulate
,blood volume as effectively as possible. assessing the timing of the IABP is unnec-
essary.
3. The nurse is reviewing the home medications list for a patient admitted c/o
severe chest pain. serial EKGs and blood testing are negative, so an exercise
stress test is scheduled. which of the following medications may result in a
false-positive finding on the stress test?
,A. digitalis (Digoxin)
B. potassium chloride (K-Dur)
C. sotalol (Betapace)
D. diltiazem (Cardiazem): A. correct. digitalis can cause false-positive EKG
changes during a stress test. there is an association between the development of
ST segment depression during stress testing. the mechanism of this EKG change
is not clear. further, digitalis should be withheld on the day of the test because of its
negative chronotropic effects.
B. incorrect.
C & D. incorrect. beta-blockers and calcium channel blockers blunt the heart rate
response to exercise and may prevent achievement of maximum predicted heart
rate. they should be withheld on the day of the test.
4. A patient is admitted with elevated troponin levels and ST segment elevation
in leads II, III, and aVF. Administration of which of the following should the
nurse anticipate initially?
A. enoxaparin (Lovenox)
B. streptokinase (Strepase)
C. alteplase (Activase)
D. reteplase (Retavase): A. incorrect. enoxaparin is an alternative to heparin in
patients with unstable angina, NSTEMI or DVT.
B. incorrect. streptokinase is indicated for acute arterial thrombosis or embolism, or
occluded AV cannulas.
C. incorrect. alteplase in indicated for acute ischemic stroke or acute massive
pulmonary embolism.
D. correct. reteplase is indicated for AMI when fibrinolytics are indicated.
5. Which of the following is a characteristic of diastolic heart failure?
A. inability of the heart muscle to relax.
B. dilation of the ventricular chambers.
C. increased filling of the left ventricle.
D. decreased ability of the ventricle to contract.: A. correct. with diastolic heart
failure the left ventricle is unable to relax, leading to signs and symptoms of heart
failure, but the patient maintains a preserved EF as the muscle retains its ability to
contract.
B. incorrect. dilation of the ventricular chambers is a characteristic of systolic heart
failure.
C. incorrect. diastolic heart failure is an abnormality with heart filling. the heart
muscle does not relax normally, and the heart may fill too slowly or asynchronously.
if the left ventricle does not relax properly or is thick and stiff, it does not fill in the
usual manner and blood is drawn back into the left atrium and eventually into the
, lungs.
D. incorrect. decreased ability of the ventricle to contract is a symptom of overexten-
sion of the heart muscle in patients with cardiomyopathy.
6. Following a STEMI, the nurse auscultates a late systolic murmur at the apex.
The nurse should suspect the finding is r/t the new onset of a:
A. right bundle branch block
B. left bundle branch block
C. papillary muscle rupture
D. calcific plaque rupture: A. incorrect. a RBBB would cause an electrical delay in
conduction for a wide split S2.
B. incorrect. a LBBB would cause and electrical delay in ventricular conduction for
a paroxical split S2.
C. correct. a papillary muscle chord rupture results from ischemia to the tissue
supplying the mitral valve. a systolic murmur is heard due to mitral regurgitation.
D. incorrect. plaque rupture would cause an occlusion of the coronary artery that
would not directly cause a new systolic murmur.
7. The nurse is reviewing the plan of care for a patient with systolic heart fail-
ure who has enalapril (Vasotec), furosemide (Lasix), metoprolol (Lopressor),
and carvedilol (Coreg) ordered. Which of the following will provide the most
accurate assessment of the regimen?
A. daily weights
B. strict I&O
C. BMP every morning
D. serial CXRYs: A. correct. assessing daily weights is a noninvasive and easy
method to assess compliance with the effectiveness of a medical regimen in patients
with heart failure, observing the patient's ability to maintain a consistent weight
indicates compliance as well as the effectiveness of the medical regimen.
B. incorrect. strict I&O is only one component of a plan of care but does not assess
if a patient adheres to the medical regimen or if the regimen is effective.
C. incorrect. a daily BMP would not help assess the effectiveness of the medical
regimen as the majority of the panel components are not affected by the drugs listed.
D. incorrect. serial CXRYs could reveal worsening heart failure, but assessing daily
weights is far easier, noninvasive and cost-effective.
8. Which of the following patient situations might be best treated with the maze
procedure?
A. recurrent ventricular tachycardia refractory to cardioversion
B. recurrent atrial fibrillation refractory to drug therapy
C. cardiomyopathy with an EF <20%
D. coronary artery restenosis following PCI: A. incorrect. recurrent ventricular
1. While caring for a patient with an IABP at 3:1, the nurse notes:
A. decreasing urine output as well as increasing BUN and CR levels; the nurse
should increase timing to 2:1
B. absent pulses in the proximal extremity; the nurse should apply pressure
at the insertion site.
C. blood in the IABP tubing; the nurse should disconnect the balloon catheter
from the IABP.
D. blood oozing from the insertion site; the nurse should anticipate the need
for an emergency fasciotomy.: A. incorrect. decreasing urine output with increas-
ing BUN and CR levels with an IABP in place indicates obstruction of the renal
arteries. The nurse should plan for removal.
B. incorrect. absent pulses distal to the insertion site indicates complete occlusion
of the femoral artery. application of pressure to the insertion site will worsen the
obstruction.
C. correct. blood in the IABP tubing indicates a rupture of the balloon. Continuing to
allow the IABP to inflate and deflate will increase the size of the rupture, causing
more bleeding. the nurse should plan for removal or exchange of the IABP catheter.
D. incorrect. a fasciotomy would be indicated if the patient had an increase in fluid
accumulation in the extremities causing significant injury to the limb.
2. An IABP is currently at 3:1 when the patient suddenly goes into ventricular
fibrillation. In addition to resuscitative measures, the nurse should:
A. change the trigger to internal or pressure support resuscitative measures.
B. increase timing back to 1:1 to increase coronary artery perfusion pressure.
C. put the pump on standby until the return of spontaneous circulation.
D. assess the IABP timing to chest compressions at 1:2.: A. correct. the IABP
will not be able to time correctly when a patient is in V-Fib. by placing the system
to trigger on internal or pressure support, it will generate off the pressure created
during compressions.
B. incorrect. attempting to time the IABP back to 1:1 will be counterproductive, as it
will not be able to trigger correctly.
C. incorrect. there is significant risk of clot forming on the IABP when placed in stand
for an indeterminate amount of time.
D. incorrect. the primary goal during resuscitative measures is to attempt to circulate
,blood volume as effectively as possible. assessing the timing of the IABP is unnec-
essary.
3. The nurse is reviewing the home medications list for a patient admitted c/o
severe chest pain. serial EKGs and blood testing are negative, so an exercise
stress test is scheduled. which of the following medications may result in a
false-positive finding on the stress test?
,A. digitalis (Digoxin)
B. potassium chloride (K-Dur)
C. sotalol (Betapace)
D. diltiazem (Cardiazem): A. correct. digitalis can cause false-positive EKG
changes during a stress test. there is an association between the development of
ST segment depression during stress testing. the mechanism of this EKG change
is not clear. further, digitalis should be withheld on the day of the test because of its
negative chronotropic effects.
B. incorrect.
C & D. incorrect. beta-blockers and calcium channel blockers blunt the heart rate
response to exercise and may prevent achievement of maximum predicted heart
rate. they should be withheld on the day of the test.
4. A patient is admitted with elevated troponin levels and ST segment elevation
in leads II, III, and aVF. Administration of which of the following should the
nurse anticipate initially?
A. enoxaparin (Lovenox)
B. streptokinase (Strepase)
C. alteplase (Activase)
D. reteplase (Retavase): A. incorrect. enoxaparin is an alternative to heparin in
patients with unstable angina, NSTEMI or DVT.
B. incorrect. streptokinase is indicated for acute arterial thrombosis or embolism, or
occluded AV cannulas.
C. incorrect. alteplase in indicated for acute ischemic stroke or acute massive
pulmonary embolism.
D. correct. reteplase is indicated for AMI when fibrinolytics are indicated.
5. Which of the following is a characteristic of diastolic heart failure?
A. inability of the heart muscle to relax.
B. dilation of the ventricular chambers.
C. increased filling of the left ventricle.
D. decreased ability of the ventricle to contract.: A. correct. with diastolic heart
failure the left ventricle is unable to relax, leading to signs and symptoms of heart
failure, but the patient maintains a preserved EF as the muscle retains its ability to
contract.
B. incorrect. dilation of the ventricular chambers is a characteristic of systolic heart
failure.
C. incorrect. diastolic heart failure is an abnormality with heart filling. the heart
muscle does not relax normally, and the heart may fill too slowly or asynchronously.
if the left ventricle does not relax properly or is thick and stiff, it does not fill in the
usual manner and blood is drawn back into the left atrium and eventually into the
, lungs.
D. incorrect. decreased ability of the ventricle to contract is a symptom of overexten-
sion of the heart muscle in patients with cardiomyopathy.
6. Following a STEMI, the nurse auscultates a late systolic murmur at the apex.
The nurse should suspect the finding is r/t the new onset of a:
A. right bundle branch block
B. left bundle branch block
C. papillary muscle rupture
D. calcific plaque rupture: A. incorrect. a RBBB would cause an electrical delay in
conduction for a wide split S2.
B. incorrect. a LBBB would cause and electrical delay in ventricular conduction for
a paroxical split S2.
C. correct. a papillary muscle chord rupture results from ischemia to the tissue
supplying the mitral valve. a systolic murmur is heard due to mitral regurgitation.
D. incorrect. plaque rupture would cause an occlusion of the coronary artery that
would not directly cause a new systolic murmur.
7. The nurse is reviewing the plan of care for a patient with systolic heart fail-
ure who has enalapril (Vasotec), furosemide (Lasix), metoprolol (Lopressor),
and carvedilol (Coreg) ordered. Which of the following will provide the most
accurate assessment of the regimen?
A. daily weights
B. strict I&O
C. BMP every morning
D. serial CXRYs: A. correct. assessing daily weights is a noninvasive and easy
method to assess compliance with the effectiveness of a medical regimen in patients
with heart failure, observing the patient's ability to maintain a consistent weight
indicates compliance as well as the effectiveness of the medical regimen.
B. incorrect. strict I&O is only one component of a plan of care but does not assess
if a patient adheres to the medical regimen or if the regimen is effective.
C. incorrect. a daily BMP would not help assess the effectiveness of the medical
regimen as the majority of the panel components are not affected by the drugs listed.
D. incorrect. serial CXRYs could reveal worsening heart failure, but assessing daily
weights is far easier, noninvasive and cost-effective.
8. Which of the following patient situations might be best treated with the maze
procedure?
A. recurrent ventricular tachycardia refractory to cardioversion
B. recurrent atrial fibrillation refractory to drug therapy
C. cardiomyopathy with an EF <20%
D. coronary artery restenosis following PCI: A. incorrect. recurrent ventricular
