PCCN UPDATED LATEST ANSWERS AND QUESTIONS
SET A+
✔✔Beck's triad, which includes hypotension, muffled heart sounds and jugular venous
distention (JVD), is indicative of which condition?
A. myocardial infarction
B. aortic valve stenosis
C. cardiac tamponade
D. pulmonary embolism - ✔✔C. cardiac tamponade
The classic presentation of Beck's triad, or cardiac tamponade, is hypotension, JVD and
muffled heart sounds. Also typically occurring are tachycardia (due to low cardiac
output) and narrow pulse pressure (again, due to low cardiac output and high SVR).
This classic presentation requires immediate action by the nurse caring for the patient: a
stat echocardiogram, chest X-ray and continued vital signs as well as starting large-bore
IV access for fluid resuscitation.
✔✔On the 12 lead ECG, cardiac ischemia is characterized by:
A. elevation of the ST segment and elevated peaked T waves
B. inverted T wave
C. development of Q waves
D. abnormal Q wave or decreased R wave progression in the V leads - ✔✔B. inverted T
wave
The first clinical ECG sign of myocardial ischemia is the tenting of the T wave; large
tented T waves in 2 contiguous leads. This is often missed since it occurs so early in the
ischemic period. The second sign is the inverted T wave. If ischemia persists and
infarction occurs, the ST segment elevates, and later a Q wave forms. Not all STEMIs
develop Q waves, however, so the best answer is the T wave.
✔✔An atrial septal defect is characterized by:
A. shunting of blood returning from the lungs through the left atrium back to the right
atrium and then returns to the pulmonary circulation
B. left to right shunt, increased pulmonary hypertension and right-sided heart failure
C. right ventricular hypertrophy from increased pressure in the right ventricle and
decreased pulmonary flow
,D. Left ventricular wall hypertrophy - ✔✔A. shunting of blood returning from the lungs
through the left atrium back to the right atrium and then returns to the pulmonary
circulation
An arterial septal defect (ASD) allows blood from the left atrium (due to higher pressure
gradient in the left atrium) to return to the right atrium and then the right ventricle before
returning to the lungs. This causes a shunting of oxygenated blood to go through the
pulmonary circulation again. This may cause pulmonary congestion. A ventricular septal
defect (VSD) causes blood to cross from the left ventricle to the right ventricle, causing
pulmonary hypertension and right ventricular failure. The other answers are incorrect.
✔✔The jugular venous pulse is particularly valuable for assessing:
A. right atrial function
B. left atrial function
C. right ventricular function
D. left ventricular function - ✔✔A. right atrial function
The jugular venous pulse is an excellent tool to assess the right ventricle. The right
atrium is filled by the superior vena cava; the jugular comes off the SVC. The jugular
vein will have increased pulsations when the right atrium is overloaded or overfilled.
With acute right ventricular failure, the patient will have jugular venous distention. With
prolonged right ventricular failure, the patient may exhibit JVD, but only when the right
artria is involved.
✔✔Which of the following vasodilators primarily dilates coronary arteries and is used to
treat angina and supraventricular tachycardia?
A. diltiazem (Cardizem)
B. captopril (Capoten)
C. nitroglycerin
D. sodium nitroprusside (Nipride) - ✔✔A. diltiazem
Diltiazem is an excellent vasodilator (classified as a non-dihydropyridine calcium
channel blocker) with the property to dilate the coronary arteries and to treat
supraventricular tachycardia. It is also a selective coronary vasodilator. It dilates
coronary vessels better than it does systemic vascular beds. It is also used to decrease
heart rate and treat supraventricular arrhythmias, inculding SVT. Captopril, an ACE-I, is
also a vasodilator but has no affect on coronary circulation. Nitroglycerin, a well known
coronary artery dilator, and nitroprusside, an excellent arterial and venous vasodilator,
have no affect on SVT.
✔✔A 70 year old female presents in cardiogenic shock secondary to myocardial
infarction. Which of the following symptoms are consistent with cardiogenic shock?
A. hypertension with systolic blood pressure greater than 90 mm Hg, bradycardia, chest
pain and tachypnea
B. hypotension with systolic blood pressure less than 90 mm Hg, tachycardia,
dysrhythmias and tachypnea
C. hypotension with systolic blood pressure less than 90 mm Hg, dysrhythmias and
slow, labored breathing
,D. hypotension with systolic blood pressure less than 90 mm Hg, bradycardia and slow,
labored breathing - ✔✔B. hypotension with systolic blood pressure less than 90 mm Hg,
tachycardia, dysrhythmias and tachypnea
Cardiogenic shock presents with low cardiac output syndrome: tachycardia, low systolic
pressure, elevated diastolic pressure (decreased pulse pressure), tachypnea due to
tissue hypoxia, and dysrhythmias due to myocardial ischemia. Hypertension does not fit
with low cardiac output syndrome, nor does slow labored breathing.
✔✔A patient is admitted 4 days postoperatively from an ascending aortic aneurysm
repair. He acutely develops shortness of breath after his first time ambulating in the hall.
The nurse should consider what possible problem?
A. acute heart failure
B. acute postoperative pneumonia
C. pulmonary embolus
D. routine postoperative pain - ✔✔C. pulmonary embolus
At 4 days postoperative with acute shortness of breath after first time ambulation, the
nurse should suspect pulmonary embolus. Acute heart failure is not a usual
postoperative problem with this type of patient unless he or she had heart failure before
surgery. Acute postoperative pneumonia may present with shortness of breath with
activity, but the patient may have other signs and symptoms such as tachycardia,
increased respiratory rate, fever, and cough. Routine postoperative pain does not occur
acutely; this is a change in patient condition.
✔✔The most common new-onset dysrhythmia seen in a patient with acute
decompensated heart failure is:
A. right bundle branch block
B. ventricular tachycardia
C. atrial fibrillation
D. complete heart block - ✔✔C. atrial fibrillation
Atrial fibrillation is the most common dysrhythmia in the heart failure patient.
✔✔When interpreting an arterial blood gas, which of the following is one of the most
important aspects for developing a treatment plan?
A. pH
B. arterial oxygenation
C. venous oxygenation
D. arterial bicarbonate - ✔✔A. pH
The pH is most important since it establishes whether the patient is compensating. It
also directs the action of the caregiver. If the pH is acidotic, that may be an indication for
intubation. If the pH is alkalotic, the patient may require intubation or other means of
support to improve oxygen delivery. Arterial oxygenation may be assessed using the
pulse oximetry. Venous oxygenation is a good tool for the assessment of oxygen
consumption, but not delivery. Arterial bicarbonate is a way to measure metabolic
characteristics.
, ✔✔A patient who is postoperative day 2 after a pancreatic resection for hemorrhagic
pancreatitis is now complaining of acute shortness of breath with rales bilaterally and
increasing oxygen requirements. This could be the beginning of:
A. acute respiratory distress syndrome
B. asthma
C. postoperative pain syndrome
D. gastric bleed - ✔✔A. acute respiratory distress syndrome
Any patient with an inflammatory disorder (such as postoperative abdominal surgery)
can develop acute respiratory distress syndrome approximately 24-36 hrs post event.
The signs and symptoms include acute shortness of breath, rales bilaterally, diffuse
bilateral ground-glass appearance, or white-out, on chest x-ray and increased
requirements for oxygen. Asthma would include wheezing. Postoperative pain would not
likely cause rales. A gastric bleed would not cause rales.
✔✔A patient presents with acute decompensated heart failure and pulmonary edema.
The patient has rales, dyspnea, tachycardia and cyanosis. Oxygen therapy is instituted.
What other therapies will be started?
A. oxygen therapy only
B. diuretic therapy
C. oxygen therapy and inotropic therapy
D. fluid resuscitation will be required - ✔✔B. diuretic therapy
The initial therapy for acute decompensated heart failure (pulmonary edema) is diuretic
therapy and oxygen supplementation. The patient is fluid oveerloaded and requires
diuresis with oxygen therapy for increased oxygen needs. Administering fluid will
worsen the heart failure and increase the patient's work of breathing.
✔✔A patient is admitted to your floor with the following arterial blood gas.
pH 7.55 CO2 28 PaO2 88 HCO3 26
What is the interpretation?
A. respiratory acidosis
B. compensated metabolic alkalosis
C. non-compensated respiratory alkalosis
D. metabolic alkalosis - ✔✔C. non-compensated respiratory alkalosis
The patient has a rapid respiratory rate with low CO2. The pH is alkalotic (a pH grater
than 7.45), the PaO2 is within the normal range, and the bicarbonate is normal. Since
the pH is abnormal, this ABG shows non-compensated changes.
✔✔A patient with chronic obstructive lung disease now has respiratory failure with a
PaCO2 of 65 and a pH of 7.30. The patient has dyspnea and is experiencing cardiac
dysrhythmias, confusion and hypotension. These findings are consistent with:
A. respiratory alkalosis
B. respiratory acidosis
C. metabolic alkalosis
D. metabolic acidosis - ✔✔B. respiratory acidosis
SET A+
✔✔Beck's triad, which includes hypotension, muffled heart sounds and jugular venous
distention (JVD), is indicative of which condition?
A. myocardial infarction
B. aortic valve stenosis
C. cardiac tamponade
D. pulmonary embolism - ✔✔C. cardiac tamponade
The classic presentation of Beck's triad, or cardiac tamponade, is hypotension, JVD and
muffled heart sounds. Also typically occurring are tachycardia (due to low cardiac
output) and narrow pulse pressure (again, due to low cardiac output and high SVR).
This classic presentation requires immediate action by the nurse caring for the patient: a
stat echocardiogram, chest X-ray and continued vital signs as well as starting large-bore
IV access for fluid resuscitation.
✔✔On the 12 lead ECG, cardiac ischemia is characterized by:
A. elevation of the ST segment and elevated peaked T waves
B. inverted T wave
C. development of Q waves
D. abnormal Q wave or decreased R wave progression in the V leads - ✔✔B. inverted T
wave
The first clinical ECG sign of myocardial ischemia is the tenting of the T wave; large
tented T waves in 2 contiguous leads. This is often missed since it occurs so early in the
ischemic period. The second sign is the inverted T wave. If ischemia persists and
infarction occurs, the ST segment elevates, and later a Q wave forms. Not all STEMIs
develop Q waves, however, so the best answer is the T wave.
✔✔An atrial septal defect is characterized by:
A. shunting of blood returning from the lungs through the left atrium back to the right
atrium and then returns to the pulmonary circulation
B. left to right shunt, increased pulmonary hypertension and right-sided heart failure
C. right ventricular hypertrophy from increased pressure in the right ventricle and
decreased pulmonary flow
,D. Left ventricular wall hypertrophy - ✔✔A. shunting of blood returning from the lungs
through the left atrium back to the right atrium and then returns to the pulmonary
circulation
An arterial septal defect (ASD) allows blood from the left atrium (due to higher pressure
gradient in the left atrium) to return to the right atrium and then the right ventricle before
returning to the lungs. This causes a shunting of oxygenated blood to go through the
pulmonary circulation again. This may cause pulmonary congestion. A ventricular septal
defect (VSD) causes blood to cross from the left ventricle to the right ventricle, causing
pulmonary hypertension and right ventricular failure. The other answers are incorrect.
✔✔The jugular venous pulse is particularly valuable for assessing:
A. right atrial function
B. left atrial function
C. right ventricular function
D. left ventricular function - ✔✔A. right atrial function
The jugular venous pulse is an excellent tool to assess the right ventricle. The right
atrium is filled by the superior vena cava; the jugular comes off the SVC. The jugular
vein will have increased pulsations when the right atrium is overloaded or overfilled.
With acute right ventricular failure, the patient will have jugular venous distention. With
prolonged right ventricular failure, the patient may exhibit JVD, but only when the right
artria is involved.
✔✔Which of the following vasodilators primarily dilates coronary arteries and is used to
treat angina and supraventricular tachycardia?
A. diltiazem (Cardizem)
B. captopril (Capoten)
C. nitroglycerin
D. sodium nitroprusside (Nipride) - ✔✔A. diltiazem
Diltiazem is an excellent vasodilator (classified as a non-dihydropyridine calcium
channel blocker) with the property to dilate the coronary arteries and to treat
supraventricular tachycardia. It is also a selective coronary vasodilator. It dilates
coronary vessels better than it does systemic vascular beds. It is also used to decrease
heart rate and treat supraventricular arrhythmias, inculding SVT. Captopril, an ACE-I, is
also a vasodilator but has no affect on coronary circulation. Nitroglycerin, a well known
coronary artery dilator, and nitroprusside, an excellent arterial and venous vasodilator,
have no affect on SVT.
✔✔A 70 year old female presents in cardiogenic shock secondary to myocardial
infarction. Which of the following symptoms are consistent with cardiogenic shock?
A. hypertension with systolic blood pressure greater than 90 mm Hg, bradycardia, chest
pain and tachypnea
B. hypotension with systolic blood pressure less than 90 mm Hg, tachycardia,
dysrhythmias and tachypnea
C. hypotension with systolic blood pressure less than 90 mm Hg, dysrhythmias and
slow, labored breathing
,D. hypotension with systolic blood pressure less than 90 mm Hg, bradycardia and slow,
labored breathing - ✔✔B. hypotension with systolic blood pressure less than 90 mm Hg,
tachycardia, dysrhythmias and tachypnea
Cardiogenic shock presents with low cardiac output syndrome: tachycardia, low systolic
pressure, elevated diastolic pressure (decreased pulse pressure), tachypnea due to
tissue hypoxia, and dysrhythmias due to myocardial ischemia. Hypertension does not fit
with low cardiac output syndrome, nor does slow labored breathing.
✔✔A patient is admitted 4 days postoperatively from an ascending aortic aneurysm
repair. He acutely develops shortness of breath after his first time ambulating in the hall.
The nurse should consider what possible problem?
A. acute heart failure
B. acute postoperative pneumonia
C. pulmonary embolus
D. routine postoperative pain - ✔✔C. pulmonary embolus
At 4 days postoperative with acute shortness of breath after first time ambulation, the
nurse should suspect pulmonary embolus. Acute heart failure is not a usual
postoperative problem with this type of patient unless he or she had heart failure before
surgery. Acute postoperative pneumonia may present with shortness of breath with
activity, but the patient may have other signs and symptoms such as tachycardia,
increased respiratory rate, fever, and cough. Routine postoperative pain does not occur
acutely; this is a change in patient condition.
✔✔The most common new-onset dysrhythmia seen in a patient with acute
decompensated heart failure is:
A. right bundle branch block
B. ventricular tachycardia
C. atrial fibrillation
D. complete heart block - ✔✔C. atrial fibrillation
Atrial fibrillation is the most common dysrhythmia in the heart failure patient.
✔✔When interpreting an arterial blood gas, which of the following is one of the most
important aspects for developing a treatment plan?
A. pH
B. arterial oxygenation
C. venous oxygenation
D. arterial bicarbonate - ✔✔A. pH
The pH is most important since it establishes whether the patient is compensating. It
also directs the action of the caregiver. If the pH is acidotic, that may be an indication for
intubation. If the pH is alkalotic, the patient may require intubation or other means of
support to improve oxygen delivery. Arterial oxygenation may be assessed using the
pulse oximetry. Venous oxygenation is a good tool for the assessment of oxygen
consumption, but not delivery. Arterial bicarbonate is a way to measure metabolic
characteristics.
, ✔✔A patient who is postoperative day 2 after a pancreatic resection for hemorrhagic
pancreatitis is now complaining of acute shortness of breath with rales bilaterally and
increasing oxygen requirements. This could be the beginning of:
A. acute respiratory distress syndrome
B. asthma
C. postoperative pain syndrome
D. gastric bleed - ✔✔A. acute respiratory distress syndrome
Any patient with an inflammatory disorder (such as postoperative abdominal surgery)
can develop acute respiratory distress syndrome approximately 24-36 hrs post event.
The signs and symptoms include acute shortness of breath, rales bilaterally, diffuse
bilateral ground-glass appearance, or white-out, on chest x-ray and increased
requirements for oxygen. Asthma would include wheezing. Postoperative pain would not
likely cause rales. A gastric bleed would not cause rales.
✔✔A patient presents with acute decompensated heart failure and pulmonary edema.
The patient has rales, dyspnea, tachycardia and cyanosis. Oxygen therapy is instituted.
What other therapies will be started?
A. oxygen therapy only
B. diuretic therapy
C. oxygen therapy and inotropic therapy
D. fluid resuscitation will be required - ✔✔B. diuretic therapy
The initial therapy for acute decompensated heart failure (pulmonary edema) is diuretic
therapy and oxygen supplementation. The patient is fluid oveerloaded and requires
diuresis with oxygen therapy for increased oxygen needs. Administering fluid will
worsen the heart failure and increase the patient's work of breathing.
✔✔A patient is admitted to your floor with the following arterial blood gas.
pH 7.55 CO2 28 PaO2 88 HCO3 26
What is the interpretation?
A. respiratory acidosis
B. compensated metabolic alkalosis
C. non-compensated respiratory alkalosis
D. metabolic alkalosis - ✔✔C. non-compensated respiratory alkalosis
The patient has a rapid respiratory rate with low CO2. The pH is alkalotic (a pH grater
than 7.45), the PaO2 is within the normal range, and the bicarbonate is normal. Since
the pH is abnormal, this ABG shows non-compensated changes.
✔✔A patient with chronic obstructive lung disease now has respiratory failure with a
PaCO2 of 65 and a pH of 7.30. The patient has dyspnea and is experiencing cardiac
dysrhythmias, confusion and hypotension. These findings are consistent with:
A. respiratory alkalosis
B. respiratory acidosis
C. metabolic alkalosis
D. metabolic acidosis - ✔✔B. respiratory acidosis
