PCCN questions And Well Updated Answers
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR) - ANSWER>>A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic
pressure (LVEDP), the pressure exerted on the ventricular muscle at the end of
diastole when the ventricle is full. This enables blood to flow from a higher
pressure through open arteries to a lower pressure, a pressure gradient known
as coronary artery prefusion pressure. As diastolic pressure drops, there is a
decrease in coronary artery blood flow. Coronary artery perfusion is not
affected by systolic pressure, afterload or SVR, but they all increase the demand
of oxygen in the heart.
A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay. Which of
the following is the most common serious side effect that may occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
D. rhinorrhea - ANSWER>>C. swelling of the tongue and face
Although all of the ANSWERs may occur, swelling og the tongue and face is the
most serious and may require intervention. Patients should be instructed to
seek medical attention immediately for any signs of swelling in the tongue or
throat.
Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
,C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts - ANSWER>>D. It occurs
during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left
ventricle. An S4 is also called an atrial heart sound since it occurs at the end of
diastolic filling when the atria contracts and fully fills the left ventricle. Known
as "atrial kick", this filling is important to cardiac output. The increased end-
diastolic volume in the ventricle improves cardiac output. When the left
ventricle is stiff (decreased compliance with long term hypertension, aortic
stenosis or with acute STEMI), the atrium has to pump harder to move blood
from the atrium to the ventricle, causing a turbulent blood flow and extra heart
sound. This heart sound is always pathologic. It occurs before ventricular
contraction, is best heard with the bell of the stethoscope and is never a normal
heart sound, even in children.
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
C. Q-wave formation
D. ST-segment depression and T-wave inversion - ANSWER>>D. ST segment
depression and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle. That
change is seen on the 12 lead ECG as ST-segment depression and T wave
inversion, which demonstrate subendocardial ischemia -- the innermost layer of
muscle in the myocardium. ST-segment elevation indicates acute injury or
infarction, ST segment depression and T wave elevation may indicate an
electrolyte abnormality, while Q wave formation indicates total infarction.
Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
,D. vasodilate vessels - ANSWER>>A. improve cardiac output and tissue
perfusion
The term "inotropic" refers to affecting the force of myocardial contraction.
Improvement of cardiac muscle contraction leads to improved cardiac output
and tissue perfusion.
A patient in the ED is now being admitted to telemetry bwith complaint of chest
pain and has been judged to be a possible candidate for therapy with alteplase
(Activase). Which of the following is not considered a contraindication for the
use of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed - ANSWER>>A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other
ANSWERs -- recent abdominal surgery, recent gastrointestinal bleeding and a
recent intracranial bleed -- are contraindications for the use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload) - ANSWER>>A. SVR (afterload) and cardiac
output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the
SVR (afterload) is high and the cardiac output low, the patient may still have a
normal BP. the pulse pressure will be lower, but this is a compensatory
response by the heart to maintain BP. If the SVR (afterload) is low (as in early
septic shock), the cardiac output is very high, thereby trying to support BP.
The layer of the arterial vessel wall responsible for changes in the diameter of
the artery is the:
, A. media
B. intima
C. externa
D. adventitia - ANSWER>>A. media
The media layer of the arterial wall contains vascular smooth muscle cells and is
responsible for arterial tone. Vasoactive substances released in response to the
sympathetic nervous system and/or the renin-angiotensin system determine
arterial tone. Intima, externa and adventitia are incorrect.
A patient presents in acute distress with rales halfway up bilaterally; cool and
clammy extremities; elevated jugular venous distention (JVD); oxygen
saturations at 95%, down from 99%; and complaints of shortness of breath.
Which of the following findings correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion - ANSWER>>D. pulmonary congestion,
low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary
edema, causing pulmonary congestion. Pneumonia can also cause fluid in the
alveolar sacs. The patient is complaining of shortness of breath, and the oxygen
saturations are lowering, also indicating that the patient has pulmonary
congestion. The patient's skin is cool and clammy, indicating that the skin is
poorly perfused. Skin does not require oxygen and shunts blood away in
decreased cardiac function; therefore, this patient has pulmonary congestion
and low perfusion state. The other ANSWERs are incorrect.
When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction - ANSWER>>A. the beginning of
ventricular systole
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR) - ANSWER>>A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic
pressure (LVEDP), the pressure exerted on the ventricular muscle at the end of
diastole when the ventricle is full. This enables blood to flow from a higher
pressure through open arteries to a lower pressure, a pressure gradient known
as coronary artery prefusion pressure. As diastolic pressure drops, there is a
decrease in coronary artery blood flow. Coronary artery perfusion is not
affected by systolic pressure, afterload or SVR, but they all increase the demand
of oxygen in the heart.
A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay. Which of
the following is the most common serious side effect that may occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
D. rhinorrhea - ANSWER>>C. swelling of the tongue and face
Although all of the ANSWERs may occur, swelling og the tongue and face is the
most serious and may require intervention. Patients should be instructed to
seek medical attention immediately for any signs of swelling in the tongue or
throat.
Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
,C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts - ANSWER>>D. It occurs
during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left
ventricle. An S4 is also called an atrial heart sound since it occurs at the end of
diastolic filling when the atria contracts and fully fills the left ventricle. Known
as "atrial kick", this filling is important to cardiac output. The increased end-
diastolic volume in the ventricle improves cardiac output. When the left
ventricle is stiff (decreased compliance with long term hypertension, aortic
stenosis or with acute STEMI), the atrium has to pump harder to move blood
from the atrium to the ventricle, causing a turbulent blood flow and extra heart
sound. This heart sound is always pathologic. It occurs before ventricular
contraction, is best heard with the bell of the stethoscope and is never a normal
heart sound, even in children.
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
C. Q-wave formation
D. ST-segment depression and T-wave inversion - ANSWER>>D. ST segment
depression and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle. That
change is seen on the 12 lead ECG as ST-segment depression and T wave
inversion, which demonstrate subendocardial ischemia -- the innermost layer of
muscle in the myocardium. ST-segment elevation indicates acute injury or
infarction, ST segment depression and T wave elevation may indicate an
electrolyte abnormality, while Q wave formation indicates total infarction.
Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
,D. vasodilate vessels - ANSWER>>A. improve cardiac output and tissue
perfusion
The term "inotropic" refers to affecting the force of myocardial contraction.
Improvement of cardiac muscle contraction leads to improved cardiac output
and tissue perfusion.
A patient in the ED is now being admitted to telemetry bwith complaint of chest
pain and has been judged to be a possible candidate for therapy with alteplase
(Activase). Which of the following is not considered a contraindication for the
use of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed - ANSWER>>A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other
ANSWERs -- recent abdominal surgery, recent gastrointestinal bleeding and a
recent intracranial bleed -- are contraindications for the use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload) - ANSWER>>A. SVR (afterload) and cardiac
output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the
SVR (afterload) is high and the cardiac output low, the patient may still have a
normal BP. the pulse pressure will be lower, but this is a compensatory
response by the heart to maintain BP. If the SVR (afterload) is low (as in early
septic shock), the cardiac output is very high, thereby trying to support BP.
The layer of the arterial vessel wall responsible for changes in the diameter of
the artery is the:
, A. media
B. intima
C. externa
D. adventitia - ANSWER>>A. media
The media layer of the arterial wall contains vascular smooth muscle cells and is
responsible for arterial tone. Vasoactive substances released in response to the
sympathetic nervous system and/or the renin-angiotensin system determine
arterial tone. Intima, externa and adventitia are incorrect.
A patient presents in acute distress with rales halfway up bilaterally; cool and
clammy extremities; elevated jugular venous distention (JVD); oxygen
saturations at 95%, down from 99%; and complaints of shortness of breath.
Which of the following findings correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion - ANSWER>>D. pulmonary congestion,
low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary
edema, causing pulmonary congestion. Pneumonia can also cause fluid in the
alveolar sacs. The patient is complaining of shortness of breath, and the oxygen
saturations are lowering, also indicating that the patient has pulmonary
congestion. The patient's skin is cool and clammy, indicating that the skin is
poorly perfused. Skin does not require oxygen and shunts blood away in
decreased cardiac function; therefore, this patient has pulmonary congestion
and low perfusion state. The other ANSWERs are incorrect.
When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction - ANSWER>>A. the beginning of
ventricular systole
