CARDIAC PCCN TEST EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 CARDIAC PCCN TEST EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ Coronary artery perfusion is dependent upon: A. Diastolic pressure B. Systolic pressure C. Afterload D. SVR Correct Answer: A. Diastolic pressure Rationale: 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. This pressure gradient is known as coronary artery perfusion pressure. As diastolic pressure drops, there is a decrease in coronary artery blood flow. The Intra-aortic Balloon Pump (IABP) has the following hemodynamic effects: A. Increases left ventricular pressure B. Increases wedge pressure C. Increases coronary artery perfusion D. Increases afterload Correct Answer: C. Increases coronary artery perfusion 2 Rationale: The major hemodynamic effects of the IABP are increased coronary artery perfusion and decreased afterload. It improves perfusion and decreases the workload of the myocardium. The IABP improves coronary artery perfusion by increasing diastolic pressure, thereby improving coronary perfusion pressure. When listening to heart sounds, the fourth heart sound (S4) occurs: A. After ventricular contraction B. Is best heard with the diaphragm of the stethoscope C. Is a normal finding in children D. During late diastole when the atria contracts Correct Answer: D. During late diastole when the atria contracts Rationale: The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left ventricle. An S4 is also called an atria 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. When the left ventricle is stiff (decreased compliance—with long term hypertension, aortic stenosis, or with acute STEMI) the atrial has to pump harder to move blood from the atria to the ventricle causing a turbulent blood flow and causing the extra heart sound. This heart sound is always pathologic. The pathologic changes found on the 12 Lead ECG that indicates myocardial ischemia are: A. ST elevation B. ST segment depression and T wave elevation C. Q wave formation 3 D. ST segment depression and T wave inversion Correct Answer: D. ST segment depression and T wave inversion Rationale: Myocardial ischemia changes the repolarization of the ventricular muscle and that change is seen on the 12 Lead ECG as ST segment depression and T wave inversion. ST segment depression and T wave inversion demonstrates subendocardial ischemia— the inter most layer of muscle in the myocardium. A patient presents in acute distress with rales ½ the way up bilaterally, extremities are cool and wet, elevated JVD, oxygen saturations are 95% down from 99% and complains of shortness of breath. Which assessment corresponds to the patient's cardiac status? A. No pulmonary congestion, normal perfusion B. Pulmonary congestion, normal perfusion C. Pulmonary congestion, low perfusion D. No pulmonary congestion, low perfusion Correct Answer: C. Pulmonary congestion, low perfusion Rationale: Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary edema (pneumonia can also cause fluid in the alveolar sacs) causing pulmonary congestion. The patient is complaining of shortness of breath and their oxygen saturations are lowering, also indications that the patient has pulmonary congestion. The patient's skin is cool and wet indicating that the skin is poorly perfused. Skin is a non-oxygen requiring organ and shunts blood away early in decreased cardiac function. 4 A major nursing concern in caring for the pre-operative aortic dissection patient is: A. Maintaining fluid and electrolyte balance B. Monitoring blood sugar levels C. Maintaining adequate fluid resuscitation D. Monitoring and controlling arterial blood pressure Correct Answer: D. Monitoring and controlling arterial blood pressure Rationale: Preoperative care of any type of aortic dissection is blood pressure control. All patients require maintenance of fluid and electrolytes, not essential to the care of the acute preoperative aortic dissection patient. Blood sugar is controlled in all patients, although not specific to aortic dissection. Fluid resuscitation may be harmful in this patient since that technique may increase blood pressure and worsen the dissection. The goal of preoperative therapy is to control pressure and force of contraction to lessen the progression of the dissection. Positive inotropic agents are used to: A. Improve cardiac output and tissue perfusion B. Decrease water loss through the kidney C. Increase heart rate D. Vasodilate vessels Correct Answer: A. Improve cardiac output and tissue perfusion Rationale: The term inotropic means affecting the force of myocardial contraction. Improvement of cardiac muscle contraction leads to an improved cardiac output and tissue perfusion 5 A patient with pulmonary edema has impaired diffusion due to: A. Increased thickness of the alveolar capillary membrane B. Retained PCO2 C. An elevated body temperature D. Low barometric pressure Correct Answer: A. Increased thickness of the alveolar capillary membrane Rationale: With increasing left ventricular pressures, blood moves back into the left atrium then to the pulmonary veins. When the pressure in the pulmonary veins increases, capillary function decreases and fluid then shifts to the interstitial space causing interstitial edema, thereby increasing the thickness of the space oxygen must travel. When left ventricular pressures increases more, the fluid then shifts to the alveolar space causing pulmonary edema. This fluid acts as a deterrent to oxygen diffusion. A patient with an anterior wall STEMI is in cardiogenic shock. What would the hemodynamic profile assessment be? A. Decreased cardiac index, increased preload, increased afterload B. Decreased cardiac index, decreased preload, increased afterload C. Increased cardiac index, decreased preload, decreased afterload D. Decreased cardiac index, decreased preload, decreased afterload Correct Answer: A. Decreased cardiac index, increased preload, increased afterload Rationale: In the patient with cardiogenic shock preload and afterload are increased. This is caused by severe vasoconstriction both on the venous and arterial side. Arterial 6 vasoconstriction caused increased SVR and therefore lowers cardiac index. Because the ventricle is failing and contractility is also low, the left ventricular pressures increase, causes blood to increase in the pulmonary bed causing increased right ventricular pressures and CVP. In heart failure, there is an increase in preload, afterload and a decrease in cardiac index and contractility. A medication that dilates both the venous and arterial beds will cause: A. Increased preload, decrease afterload B. Increased preload, increase afterload C. Decreased preload, decreased afterload D. Decreased preload, increased afterload Correct Answer: C. Decreased preload, decreased afterload Rationale: When both the venous and arterial bed are dilated there will be less venous return causing a decreased preload (example: nitroglycerin). With arterial vasodilation, the SVR will decrease and therefor cause afterload (afterload is determined by SVR) to decrease (example: nitroprusside).