Page 1 of 140
“BOOK: ADULT-GERONTOLOGY ACUTE CARE
NURSE PRACTITIONER CERTIFICATION REVIEW
CARDIOLOGY”LATEST EXAM SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION) WELL REVISED
100% GUARANTEE PASS
1. A 45-year-old man presented to the emergency department after he suffered
from syncope. He has no significant history except for an upper respiratory
tract infection 1 week ago. Physical exam revealed temperature 98.9°F, pulse
90 beats/min, blood pressure 100/60 mmHg, and respiratory rate 13
breaths/min. His neck veins are distended, and his heart sounds are muffled
and distant. Auscultation of the lungs reveals bilateral vesicular breathing with
no added sounds and chest x-ray showed small bilateral pleural effusion with
enlarged cardiac silhouette. Electrocardiography was done and it showed
varied QRS complex from beat to beat. Which of the following complications is
obviously developing in this patient?
1. Cardiac tamponade.
2. Cardiomyopathy.
3. Pulmonary embolism.
4. Myocardial infarction.
1. Cardiac Tamponade
Rationale: This patient with a previous history of upper respiratory tract infection
probably suffered from a developing cardiac tamponade. This resulted in a
pericardial effusion that formed as a complication of the previous upper respiratory
infection. The electrocardiogram findings described the typical electrical alternans
, Page 2 of 140
that is seen in cardiac tamponade as a result of the heart swinging back and forth
within the increased amount of fluid in the pericardial cavity.
2. Which of the following are the main components of the Beck triad in cardiac
tamponade?
1. Hypotension, electrical alternans, prominent x-descent in neck veins.
2. Muffled heart sounds, friction rub, hypotension.
3. Jugular venous distension, Kussmaul sign, electrical alternans.
4. Hypotension, muffled heart sounds, jugular venous distension.
4. Hypotension, muffled heart sounds, jugular venous distension.
Rationale: Beck's triad alerts clinicians that cardiac tamponade is potentially present.
The main components of cardiac tamponade are hypotension, muffled heart sounds,
and jugular venous distension. This triad is often associated with prominent x-
descent and absent y-descent and pulsus paradoxus. These features are caused by
failure of ventricular filling and limited cardiac output. The Kussmaul sign is seen in
restrictive cardiomyopathy and constrictive pericarditis. A friction rub can be seen in
any condition associated with pericardial inflammation.
3. A 66-year-old man, known to have melanoma, presents to the emergency
department with dizziness and shortness of breath for that last 3 days. On
exam his blood pressure is 80/50 mmHg. He has muffled heart sounds and
pedal edema. Chest x-ray revealed an enlarged cardiac silhouette. Which of
the following is most likely true of his physical exam?
1. Clear lungs with decreased jugular venous pressure (JVP).
2. Increased JVP with inspiration.
3. A greater than 10 mmHg drop in his systolic blood pressure with inspiration.
4. Pericardial knock.
3. A greater than 10 mmHg drop in his systolic blood pressure with inspiration.
Rationale: This patient most likely has a developing cardiac tamponade from a
previously formed pericardial effusion. Melanoma is a known tumor to infiltrate the
pericardium. Cardiac tamponade is characterized by increased jugular venous
pressure, muffled heart sounds, hypotension, and pulsus paradoxus (greater than 10
mmHg drop in systolic blood pressure with inspiration). Answer 1 is not correct
because the JVP increases. A pericardial knock is more likely to be noted in
constrictive pericarditis.
, Page 3 of 140
4. A 70-year-old woman, known to have breast cancer, presents to the
emergency department with a sudden attack of syncope. On exam she is
hypotensive, blood pressure (BP) is 75/50 mmHg, bilateral vesicular breathing
with no added sounds are heard on auscultation of the chest, distant heart
sounds, and more than 10 mmHg drop of systolic BP with inspiration. Which
of the following findings is most probably seen on electrocardiogram when
requested?
1. Prolonged PR interval with dropped P-wave.
2. Widespread ST elevation.
3. Varied QRS complex from beat to beat.
4. Delta wave in almost all leads.
3. Varied QRS complex from beat to beat.
Rationale: This patient most likely has cardiac tamponade, which is characterized by
altered and varied QRS complexes from beat to beat caused by the heart swinging
in the accumulating fluid in the pericardial cavity.
5. All of the following physical findings could be found in cardiac tamponade,
except:
1. Sinus bradycardia.
2. Sinus tachycardia.
3. Increased jugular venous pressure.
4. None of the above.
4. None of the above.
Rationale: Cardiac tamponade is associated with sinus tachycardia in almost all
cases, but sinus bradycardia could be found in subacute cardiac tamponade
associated with hypothyroidism. The Beck triad (hypotension, increased jugular
venous pressure, muffled heart sounds), pulsus paradoxus, and peripheral edema
also are present in patients with cardiac tamponade.
6. All of the following sentences are true about cardiac tamponade, except:
1. Acute cardiac tamponade occurs within minutes and it can be caused by
trauma.
2. Subacute cardiac tamponade occurs within days to weeks and it can be
caused by neoplasm.
3. Beck triad (hypotension, increased jugular venous pressure, muffled heart
sounds) is present in almost all patients with cardiac tamponade.
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4. Cardiomegaly associated with acute cardiac tamponade is not usually seen
on a chest x-ray until 200 mL fluid accumulates in the pericardial sac.
3. Beck triad (hypotension, increased jugular venous pressure, muffled heart
sounds) is present in almost all patients with cardiac tamponade.
Rationale: All the previous facts are true about cardiac tamponade except that the
Beck triad, which consists of hypotension, elevated jugular venous pressure, and
muffled heart sounds, is present in only a minority of patients.
7. Which of the following drugs is involved in cardiac tamponade formation?
1. Corticosteroids.
2. Ranitidine.
3. Amiodarone.
4. Procainamide.
4. Procainamide.
Rationale: Drug-induced cardiac tamponade is rare. Procainamide, isoniazid, and
hydralazine (drug-induced lupus) are involved in cardiac tamponade formation.
Others drugs found in drug-induced cardiac tamponade include dantrolene,
anticoagulants, thrombolytics, phenytoin, penicillin, and doxorubicin.
8. A 69-year-old man presents to the emergency department with a sudden
attack of syncope. On exam, his blood pressure is 70/45 mmHg. He has
muffled heart sounds, pulsus paradoxus, and peripheral edema. The chest x-
ray reveals an enlarged cardiac silhouette. He was diagnosed with lung cancer
3 years ago. Which of the following is most correct management step for this
patient?
1. Giving streptokinase immediately.
2. Urgent catheter pericardiocentesis.
3. Percutaneous coronary intervention within minutes.
4. Immediate open cardiac surgery.
2. Urgent catheter pericardiocentesis.
Rationale: This patient with suspected acute cardiac tamponade is hemodynamically
unstable. Both catheter pericardiocentesis and surgical drainage of a pericardial
effusion are highly effective at removal of pericardial fluid. Catheter
pericardiocentesis is the treatment of choice because it is less invasive, less
expensive, and does not need general anesthesia, which may worsen the
“BOOK: ADULT-GERONTOLOGY ACUTE CARE
NURSE PRACTITIONER CERTIFICATION REVIEW
CARDIOLOGY”LATEST EXAM SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION) WELL REVISED
100% GUARANTEE PASS
1. A 45-year-old man presented to the emergency department after he suffered
from syncope. He has no significant history except for an upper respiratory
tract infection 1 week ago. Physical exam revealed temperature 98.9°F, pulse
90 beats/min, blood pressure 100/60 mmHg, and respiratory rate 13
breaths/min. His neck veins are distended, and his heart sounds are muffled
and distant. Auscultation of the lungs reveals bilateral vesicular breathing with
no added sounds and chest x-ray showed small bilateral pleural effusion with
enlarged cardiac silhouette. Electrocardiography was done and it showed
varied QRS complex from beat to beat. Which of the following complications is
obviously developing in this patient?
1. Cardiac tamponade.
2. Cardiomyopathy.
3. Pulmonary embolism.
4. Myocardial infarction.
1. Cardiac Tamponade
Rationale: This patient with a previous history of upper respiratory tract infection
probably suffered from a developing cardiac tamponade. This resulted in a
pericardial effusion that formed as a complication of the previous upper respiratory
infection. The electrocardiogram findings described the typical electrical alternans
, Page 2 of 140
that is seen in cardiac tamponade as a result of the heart swinging back and forth
within the increased amount of fluid in the pericardial cavity.
2. Which of the following are the main components of the Beck triad in cardiac
tamponade?
1. Hypotension, electrical alternans, prominent x-descent in neck veins.
2. Muffled heart sounds, friction rub, hypotension.
3. Jugular venous distension, Kussmaul sign, electrical alternans.
4. Hypotension, muffled heart sounds, jugular venous distension.
4. Hypotension, muffled heart sounds, jugular venous distension.
Rationale: Beck's triad alerts clinicians that cardiac tamponade is potentially present.
The main components of cardiac tamponade are hypotension, muffled heart sounds,
and jugular venous distension. This triad is often associated with prominent x-
descent and absent y-descent and pulsus paradoxus. These features are caused by
failure of ventricular filling and limited cardiac output. The Kussmaul sign is seen in
restrictive cardiomyopathy and constrictive pericarditis. A friction rub can be seen in
any condition associated with pericardial inflammation.
3. A 66-year-old man, known to have melanoma, presents to the emergency
department with dizziness and shortness of breath for that last 3 days. On
exam his blood pressure is 80/50 mmHg. He has muffled heart sounds and
pedal edema. Chest x-ray revealed an enlarged cardiac silhouette. Which of
the following is most likely true of his physical exam?
1. Clear lungs with decreased jugular venous pressure (JVP).
2. Increased JVP with inspiration.
3. A greater than 10 mmHg drop in his systolic blood pressure with inspiration.
4. Pericardial knock.
3. A greater than 10 mmHg drop in his systolic blood pressure with inspiration.
Rationale: This patient most likely has a developing cardiac tamponade from a
previously formed pericardial effusion. Melanoma is a known tumor to infiltrate the
pericardium. Cardiac tamponade is characterized by increased jugular venous
pressure, muffled heart sounds, hypotension, and pulsus paradoxus (greater than 10
mmHg drop in systolic blood pressure with inspiration). Answer 1 is not correct
because the JVP increases. A pericardial knock is more likely to be noted in
constrictive pericarditis.
, Page 3 of 140
4. A 70-year-old woman, known to have breast cancer, presents to the
emergency department with a sudden attack of syncope. On exam she is
hypotensive, blood pressure (BP) is 75/50 mmHg, bilateral vesicular breathing
with no added sounds are heard on auscultation of the chest, distant heart
sounds, and more than 10 mmHg drop of systolic BP with inspiration. Which
of the following findings is most probably seen on electrocardiogram when
requested?
1. Prolonged PR interval with dropped P-wave.
2. Widespread ST elevation.
3. Varied QRS complex from beat to beat.
4. Delta wave in almost all leads.
3. Varied QRS complex from beat to beat.
Rationale: This patient most likely has cardiac tamponade, which is characterized by
altered and varied QRS complexes from beat to beat caused by the heart swinging
in the accumulating fluid in the pericardial cavity.
5. All of the following physical findings could be found in cardiac tamponade,
except:
1. Sinus bradycardia.
2. Sinus tachycardia.
3. Increased jugular venous pressure.
4. None of the above.
4. None of the above.
Rationale: Cardiac tamponade is associated with sinus tachycardia in almost all
cases, but sinus bradycardia could be found in subacute cardiac tamponade
associated with hypothyroidism. The Beck triad (hypotension, increased jugular
venous pressure, muffled heart sounds), pulsus paradoxus, and peripheral edema
also are present in patients with cardiac tamponade.
6. All of the following sentences are true about cardiac tamponade, except:
1. Acute cardiac tamponade occurs within minutes and it can be caused by
trauma.
2. Subacute cardiac tamponade occurs within days to weeks and it can be
caused by neoplasm.
3. Beck triad (hypotension, increased jugular venous pressure, muffled heart
sounds) is present in almost all patients with cardiac tamponade.
, Page 4 of 140
4. Cardiomegaly associated with acute cardiac tamponade is not usually seen
on a chest x-ray until 200 mL fluid accumulates in the pericardial sac.
3. Beck triad (hypotension, increased jugular venous pressure, muffled heart
sounds) is present in almost all patients with cardiac tamponade.
Rationale: All the previous facts are true about cardiac tamponade except that the
Beck triad, which consists of hypotension, elevated jugular venous pressure, and
muffled heart sounds, is present in only a minority of patients.
7. Which of the following drugs is involved in cardiac tamponade formation?
1. Corticosteroids.
2. Ranitidine.
3. Amiodarone.
4. Procainamide.
4. Procainamide.
Rationale: Drug-induced cardiac tamponade is rare. Procainamide, isoniazid, and
hydralazine (drug-induced lupus) are involved in cardiac tamponade formation.
Others drugs found in drug-induced cardiac tamponade include dantrolene,
anticoagulants, thrombolytics, phenytoin, penicillin, and doxorubicin.
8. A 69-year-old man presents to the emergency department with a sudden
attack of syncope. On exam, his blood pressure is 70/45 mmHg. He has
muffled heart sounds, pulsus paradoxus, and peripheral edema. The chest x-
ray reveals an enlarged cardiac silhouette. He was diagnosed with lung cancer
3 years ago. Which of the following is most correct management step for this
patient?
1. Giving streptokinase immediately.
2. Urgent catheter pericardiocentesis.
3. Percutaneous coronary intervention within minutes.
4. Immediate open cardiac surgery.
2. Urgent catheter pericardiocentesis.
Rationale: This patient with suspected acute cardiac tamponade is hemodynamically
unstable. Both catheter pericardiocentesis and surgical drainage of a pericardial
effusion are highly effective at removal of pericardial fluid. Catheter
pericardiocentesis is the treatment of choice because it is less invasive, less
expensive, and does not need general anesthesia, which may worsen the
