PCCN questions AND ANSWERS 2025
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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
Coronary artery perfusion is dependent diastole when the ventricle is full. This
upon: enables blood to flow from a higher pres-
A. diastolic pressure sure through open arteries to a low-
B. systolic pressure er pressure, a pressure gradient known
C. afterload as coronary artery prefusion pressure.
D. systemic vascular resistance (SVR) 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 oxy-
gen in the heart.
A post-STEMI (ST elevation myocardial
infarction) patient is started on an an- C. swelling of the tongue and face
giotensin-converting enzyme (ACE) in- Although all of the answers may oc-
hibitor during his hospital stay. Which of cur, swelling og the tongue and face is
the following is the most common seri- the most serious and may require inter-
ous side effect that may occur? vention. Patients should be instructed to
A. a nonproductive cough seek medical attention immediately for
B. pedal edema any signs of swelling in the tongue or
C. swelling of the tongue and face throat.
D. rhinorrhea
D. It occurs during late diastole when the
atria contracts
The presence of the extra heart sound
S4 signifies a poorly compliant (stiff) left
Which of the following best describes the
ventricle. An S4 is also called an atrial
fourth heart sound (S4):
heart sound since it occurs at the end of
A. It occurs after ventricular contraction
diastolic filling when the atria contracts
B. It is best heard with the diaphragm of
and fully fills the left ventricle. Known as
the stethoscope
"atrial kick", this filling is important to car-
diac output. The increased end-diastolic
volume in the ventricle improves cardiac
output. When the left ventricle is stiff (de-
, PCCN questions AND ANSWERS 2025
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creased compliance with long term hy-
pertension, aortic stenosis or with acute
STEMI), the atrium has to pump harder
to move blood from the atrium to the ven-
C. It is a normal finding in children
tricle, causing a turbulent blood flow and
D. It occurs during late diastole when the
extra heart sound. This heart sound is
atria contracts
always pathologic. It occurs before ven-
tricular contraction, is best heard with the
bell of the stethoscope and is never a
normal heart sound, even in children.
D. ST segment depression and T wave
inversion
Myocardial ischemia changes the repo-
Which pathologic changes found on the
larization of the ventricular muscle. That
12-lead ECG indicate myocardial is-
change is seen on the 12 lead ECG as
chemia?
ST-segment depression and T wave in-
A. ST-segment elevation
version, which demonstrate subendocar-
B. ST-segment depression and T-wave
dial ischemia -- the innermost layer of
elevation
muscle in the myocardium. ST-segment
C. Q-wave formation
elevation indicates acute injury or infarc-
D. ST-segment depression and T-wave
tion, ST segment depression and T wave
inversion
elevation may indicate an electrolyte ab-
normality, while Q wave formation indi-
cates total infarction.
Positive inotropic agents are used to: A. improve cardiac output and tissue per-
A. improve cardiac output and tissue per- fusion
fusion The term "inotropic" refers to affecting
B. decrease water loss through the kid- the force of myocardial contraction. Im-
neys provement of cardiac muscle contraction
C. increase heart rate leads to improved cardiac output and tis-
D. vasodilate vessels sue perfusion.
A patient in the ED is now being admit-
ted to telemetry bwith complaint of chest A. current antibiotic use
pain and has been judged to be a possi- Use of antibiotics is not a contraindica-
ble candidate for therapy with alteplase tion for the use of alteplase. All the other
(Activase). Which of the following is not answers -- recent abdominal surgery, re-
considered a contraindication for the use cent gastrointestinal bleeding and a re-
of this medication?
, PCCN questions AND ANSWERS 2025
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A. current antibiotic use
B. recent abdominal surgery cent intracranial bleed -- are contraindi-
C. recent gastrointestinal bleed cations for the use of any fibrinolytic.
D. recent intracranial bleed
A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x car-
diac output.
The two major components that deter- BP is determined by resistance of the
mine blood pressure are: arterial bed and the cardiac output. If the
A. systemic vascular resistance (SVR) SVR (afterload) is high and the cardiac
(afterload) and cardiac output output low, the patient may still have a
B. contractility and SVR (afterload) normal BP. the pulse pressure will be
C. preload and SVR (afterload) lower, but this is a compensatory re-
D. contractility and SVR (afterload) sponse 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.
A. media
The layer of the arterial vessel wall re- The media layer of the arterial wall con-
sponsible for changes in the diameter of tains vascular smooth muscle cells and is
the artery is the: responsible for arterial tone. Vasoactive
A. media substances released in response to the
B. intima sympathetic nervous system and/or the
C. externa renin-angiotensin system determine ar-
D. adventitia terial tone. Intima, externa and adventitia
are incorrect.
A patient presents in acute distress with D. pulmonary congestion, low perfusion
rales halfway up bilaterally; cool and Rales indicate fluid in the alveolar
clammy extremities; elevated jugular ve- sacs, possibly secondary to pulmonary
nous distention (JVD); oxygen satura- edema, causing pulmonary congestion.
tions at 95%, down from 99%; and com- Pneumonia can also cause fluid in the
plaints of shortness of breath. Which of alveolar sacs. The patient is complain-
the following findings correspond to the ing of shortness of breath, and the oxy-
patient's cardiac status? gen saturations are lowering, also indi-
A. no pulmonary congestion, normal per- cating that the patient has pulmonary
fusion congestion. The patient's skin is cool and
B. no pulmonary congestion, low perfu- clammy, indicating that the skin is poorly
sion perfused. Skin does not require oxygen
, PCCN questions AND ANSWERS 2025
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and shunts blood away in decreased car-
C. pulmonary congestion, normal perfu-
diac function; therefore, this patient has
sion
pulmonary congestion and low perfusion
D. pulmonary congestion, low perfusion
state. The other answers are incorrect.
A. the beginning of ventricular systole
When listening to heart sounds, S1 sig- The heart sound of S1 indicates the
nifies which of the following? opening of the aortic and pulmonic
A. the beginning of ventricular systole valves and marks the beginning of ven-
B. the beginning of ventricular diastole tricular systole or ejection. The beginning
C. the propulsion of blood into a of diastole is after S2, propulsion of blood
non-compliant ventricle into a noncompliant chamber is S4, and
D. the blood going in the wrong direction blood going in the wrong direction will
cause a murmur.
A. increased thickness of the alveolar
capillary membrane
With increasing left ventricular pres-
sures, blood moves back into the left atri-
um, then to the pulmonary veins. When
the pressure in the pulmonary veins in-
creases, capillary function decreases,
and fluid then shifts to the interstitial
A patient with pulmonary edema has im-
space, causing interstitial edema, there-
paired diffusion due to:
by, increasing the thickness of the space
A. increased thickness of the alveolar
oxygen must travel. When left ventricular
capillary membrane
pressures increase, the fluid then shifts
B. retaining CO2
to the alveolar space, causing pulmonary
C. an elevated body temperature associ-
edema. This fluid acts as a deterrent to
ated with pulmonary edema
oxygen diffusion. Retention of CO2 does
D. low barometric pressure
not impair diffusion. An elevated body
temperature associated with pulmonary
edema is not causing a diffusion abnor-
mality; increased temperature shifts the
oxyhemoglobin curve to the right, more
quickly releasing oxygen to the tissues.
Low barometric pressure has no effect
on diffusion of gases in the lung.
A patient with an anterior-wall STEMI is
in cardiogenic shock. What would be the
hemodynamic profile assessment?
A. decreased cardiac index, increased
preload, increased afterload
B. decreased cardiac index, decreased
preload, increased afterload
Study online at https://quizlet.com/_h934j0
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
Coronary artery perfusion is dependent diastole when the ventricle is full. This
upon: enables blood to flow from a higher pres-
A. diastolic pressure sure through open arteries to a low-
B. systolic pressure er pressure, a pressure gradient known
C. afterload as coronary artery prefusion pressure.
D. systemic vascular resistance (SVR) 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 oxy-
gen in the heart.
A post-STEMI (ST elevation myocardial
infarction) patient is started on an an- C. swelling of the tongue and face
giotensin-converting enzyme (ACE) in- Although all of the answers may oc-
hibitor during his hospital stay. Which of cur, swelling og the tongue and face is
the following is the most common seri- the most serious and may require inter-
ous side effect that may occur? vention. Patients should be instructed to
A. a nonproductive cough seek medical attention immediately for
B. pedal edema any signs of swelling in the tongue or
C. swelling of the tongue and face throat.
D. rhinorrhea
D. It occurs during late diastole when the
atria contracts
The presence of the extra heart sound
S4 signifies a poorly compliant (stiff) left
Which of the following best describes the
ventricle. An S4 is also called an atrial
fourth heart sound (S4):
heart sound since it occurs at the end of
A. It occurs after ventricular contraction
diastolic filling when the atria contracts
B. It is best heard with the diaphragm of
and fully fills the left ventricle. Known as
the stethoscope
"atrial kick", this filling is important to car-
diac output. The increased end-diastolic
volume in the ventricle improves cardiac
output. When the left ventricle is stiff (de-
, PCCN questions AND ANSWERS 2025
Study online at https://quizlet.com/_h934j0
creased compliance with long term hy-
pertension, aortic stenosis or with acute
STEMI), the atrium has to pump harder
to move blood from the atrium to the ven-
C. It is a normal finding in children
tricle, causing a turbulent blood flow and
D. It occurs during late diastole when the
extra heart sound. This heart sound is
atria contracts
always pathologic. It occurs before ven-
tricular contraction, is best heard with the
bell of the stethoscope and is never a
normal heart sound, even in children.
D. ST segment depression and T wave
inversion
Myocardial ischemia changes the repo-
Which pathologic changes found on the
larization of the ventricular muscle. That
12-lead ECG indicate myocardial is-
change is seen on the 12 lead ECG as
chemia?
ST-segment depression and T wave in-
A. ST-segment elevation
version, which demonstrate subendocar-
B. ST-segment depression and T-wave
dial ischemia -- the innermost layer of
elevation
muscle in the myocardium. ST-segment
C. Q-wave formation
elevation indicates acute injury or infarc-
D. ST-segment depression and T-wave
tion, ST segment depression and T wave
inversion
elevation may indicate an electrolyte ab-
normality, while Q wave formation indi-
cates total infarction.
Positive inotropic agents are used to: A. improve cardiac output and tissue per-
A. improve cardiac output and tissue per- fusion
fusion The term "inotropic" refers to affecting
B. decrease water loss through the kid- the force of myocardial contraction. Im-
neys provement of cardiac muscle contraction
C. increase heart rate leads to improved cardiac output and tis-
D. vasodilate vessels sue perfusion.
A patient in the ED is now being admit-
ted to telemetry bwith complaint of chest A. current antibiotic use
pain and has been judged to be a possi- Use of antibiotics is not a contraindica-
ble candidate for therapy with alteplase tion for the use of alteplase. All the other
(Activase). Which of the following is not answers -- recent abdominal surgery, re-
considered a contraindication for the use cent gastrointestinal bleeding and a re-
of this medication?
, PCCN questions AND ANSWERS 2025
Study online at https://quizlet.com/_h934j0
A. current antibiotic use
B. recent abdominal surgery cent intracranial bleed -- are contraindi-
C. recent gastrointestinal bleed cations for the use of any fibrinolytic.
D. recent intracranial bleed
A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x car-
diac output.
The two major components that deter- BP is determined by resistance of the
mine blood pressure are: arterial bed and the cardiac output. If the
A. systemic vascular resistance (SVR) SVR (afterload) is high and the cardiac
(afterload) and cardiac output output low, the patient may still have a
B. contractility and SVR (afterload) normal BP. the pulse pressure will be
C. preload and SVR (afterload) lower, but this is a compensatory re-
D. contractility and SVR (afterload) sponse 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.
A. media
The layer of the arterial vessel wall re- The media layer of the arterial wall con-
sponsible for changes in the diameter of tains vascular smooth muscle cells and is
the artery is the: responsible for arterial tone. Vasoactive
A. media substances released in response to the
B. intima sympathetic nervous system and/or the
C. externa renin-angiotensin system determine ar-
D. adventitia terial tone. Intima, externa and adventitia
are incorrect.
A patient presents in acute distress with D. pulmonary congestion, low perfusion
rales halfway up bilaterally; cool and Rales indicate fluid in the alveolar
clammy extremities; elevated jugular ve- sacs, possibly secondary to pulmonary
nous distention (JVD); oxygen satura- edema, causing pulmonary congestion.
tions at 95%, down from 99%; and com- Pneumonia can also cause fluid in the
plaints of shortness of breath. Which of alveolar sacs. The patient is complain-
the following findings correspond to the ing of shortness of breath, and the oxy-
patient's cardiac status? gen saturations are lowering, also indi-
A. no pulmonary congestion, normal per- cating that the patient has pulmonary
fusion congestion. The patient's skin is cool and
B. no pulmonary congestion, low perfu- clammy, indicating that the skin is poorly
sion perfused. Skin does not require oxygen
, PCCN questions AND ANSWERS 2025
Study online at https://quizlet.com/_h934j0
and shunts blood away in decreased car-
C. pulmonary congestion, normal perfu-
diac function; therefore, this patient has
sion
pulmonary congestion and low perfusion
D. pulmonary congestion, low perfusion
state. The other answers are incorrect.
A. the beginning of ventricular systole
When listening to heart sounds, S1 sig- The heart sound of S1 indicates the
nifies which of the following? opening of the aortic and pulmonic
A. the beginning of ventricular systole valves and marks the beginning of ven-
B. the beginning of ventricular diastole tricular systole or ejection. The beginning
C. the propulsion of blood into a of diastole is after S2, propulsion of blood
non-compliant ventricle into a noncompliant chamber is S4, and
D. the blood going in the wrong direction blood going in the wrong direction will
cause a murmur.
A. increased thickness of the alveolar
capillary membrane
With increasing left ventricular pres-
sures, blood moves back into the left atri-
um, then to the pulmonary veins. When
the pressure in the pulmonary veins in-
creases, capillary function decreases,
and fluid then shifts to the interstitial
A patient with pulmonary edema has im-
space, causing interstitial edema, there-
paired diffusion due to:
by, increasing the thickness of the space
A. increased thickness of the alveolar
oxygen must travel. When left ventricular
capillary membrane
pressures increase, the fluid then shifts
B. retaining CO2
to the alveolar space, causing pulmonary
C. an elevated body temperature associ-
edema. This fluid acts as a deterrent to
ated with pulmonary edema
oxygen diffusion. Retention of CO2 does
D. low barometric pressure
not impair diffusion. An elevated body
temperature associated with pulmonary
edema is not causing a diffusion abnor-
mality; increased temperature shifts the
oxyhemoglobin curve to the right, more
quickly releasing oxygen to the tissues.
Low barometric pressure has no effect
on diffusion of gases in the lung.
A patient with an anterior-wall STEMI is
in cardiogenic shock. What would be the
hemodynamic profile assessment?
A. decreased cardiac index, increased
preload, increased afterload
B. decreased cardiac index, decreased
preload, increased afterload
