Barron's CCRN Cardiac questions
A 59 12 months antique male is admitted with ST elevation in V2, V3, V4. IV thrombolytics
remedy became started within the ED. Indications of successful reperfusion would include all
of the following besides:
a) Pain cessation
b) Absence of troponin elevation
c) Reversal of ST segment elevation with go back to baseline
d) Short runs of ventricular tachycardia - ANS-Answer B
The patient is having an anterior wall MI. Even with reperfusion done in a timely manner, the
cardiac biomarkers (troponin) can be multiplied. When the artery opens alternatives A, C,
and D will occur
A patient is admitted with chest ache and ST elevation in II, III, aVF. Fe is receiving
dobutamine at 10 mcg/kg/min and nitroglycerin at 20 mcg/min. His BP is 90/60, sinus
tachycardia at one hundred ten minute. A pulmonary artery catheter is inserted and the
following are acquired:
RAP= 16
PAOP= five
PAP= 26/10
Cardiac Index: 1.9 L/min
The affected person has JVD in a semi-fowlers position; Tall, peaked P-waves are visible in
lead II. Which of the following healing procedures is indicated for this patient?
A) Increase the Dobutamine infusion to 20 mcg/kg/minute, and infuse 50 mL
b) Begin milrinone infusion at zero.5 mcg/kg/minute after a loading dose of 50 mcg/kg
c) Discontinue the nitroglycerin and infuse 500 mL NS
d) Discontinue dobutamine, and begin a dopamine infusion at 10 mcg/kg/minute -
ANS-Answer C
The affected person is having an acute inferior MI. The accelerated RAP, JVD, and tall
peaked P-waves are medical indications of RV failure, most probably secondary to RV
infarct. Preload discount (nitroglycerin) will further lower LV filling and CO. Therefore, it must
be discontinued, and fluid boluses will assist to increase the LV preload. Dobutamine has a
moderate dilating effect and can in addition lower the BP. Therefore, an boom in dose would
not be really helpful. Starting milrinone would offer no blessings at this time. Dopamine 20
mcg/kg/min, now not at 10 mcg/kg/min
A affected person changed into 48-hours submit aortic valve replacement. Which of following
could be a primary intention for this affected person?
A) Diuretic remedy
b) Stabilize blood pressure
c) Prophylactic antibiotics
d) Prevent thrombus - ANS-Answer: D
Clot formation on the valve is a first-rate difficulty of valvular substitute, mainly a mechanical
valve. Therefore, anticoagulation could be wished. Fluid overload, labile BP, and
, contamination are all viable headaches. However, they may be not as possibly as thrombus
formation and resultant stroke (if related to aortic valve)
A affected person with a records of heart failure and MI provides following an episode of
syncope. The evaluation 2 hours later demonstrates:
BP 134/64 (supine); a hundred and ten/70 (sitting)
HR 115 with susceptible and thready pulse (supine)
one hundred thirty (sitting)
RR 32 and shallow
Urine output 30 mL over the past 2 hours
Breath sounds are clear
The affected person most in all likelihood requires
a) Vasodilators
b) loop diuretics
c) IV fluids
d) Vasopressors - ANS-Answer C
The lower in bp and increase in heart rate with function change (orthastatic hypotension),
clear lungs, and occasional urine output is a sign of hypovolemia. Vasodilators or diuretics
will exacerbate this trouble. Vasopressors will only further increase the SVR, increasing the
work of the coronary heart
All of the subsequent support the prognosis of cardiac tamponade EXCEPT:
a) Widening pulse strain
b) equalization of proper and left heart pressures
c) Pulsus paradoxus
d) enlarged heart on chest x-ray (CXR) - ANS-Answer A
The pulse stress narrows with cardiac tamponade. The different 3 selections are seen with
cardiac tamponade
Cardiogenic surprise secondary to left ventricular failure will commonly bring about:
a) Decreased afterload
b) narrow pulse stress
c) decreased preload
d) Widening pulse stress - ANS-Answer: B
The systolic pressure decreases because of a drop in cardiac output; however, the diastolic
stress both remains the identical or will increase because of a compensatory boom of the
systemic vascular resistance. The final picks aren't discovered in cardiogenic surprise.
Desirable BP degrees vary depending on the neurological trouble and need to be clarified
with the physician. Which of the following BP levels is correct?
A) Treat BP for an acute ischemic stroke affected person, now not a candidate for
thrombolytic remedy, if more than two hundred-220 mmHg systolic or a hundred mmHg
diastolic
b) Keep systolic BP extra than 180 mmHg for an acute ischemic stroke paient who's a
candidate for thrombolytic remedy
c) Keep systolic BP for a patient wit acute subarachnoid hemorrhage, preop a hundred and
sixty-one hundred eighty mmHg
d) Keep systolic BP less than a hundred and twenty mmHg to save you vasospasms after a
subarachnoid hemorrhage - ANS-Answer A
Abrupt decreasing of the BO to everyday inside the presence of an acute schemic stroke
may additionally decrease perfusion to the region of damage and result in more mind harm.
A 59 12 months antique male is admitted with ST elevation in V2, V3, V4. IV thrombolytics
remedy became started within the ED. Indications of successful reperfusion would include all
of the following besides:
a) Pain cessation
b) Absence of troponin elevation
c) Reversal of ST segment elevation with go back to baseline
d) Short runs of ventricular tachycardia - ANS-Answer B
The patient is having an anterior wall MI. Even with reperfusion done in a timely manner, the
cardiac biomarkers (troponin) can be multiplied. When the artery opens alternatives A, C,
and D will occur
A patient is admitted with chest ache and ST elevation in II, III, aVF. Fe is receiving
dobutamine at 10 mcg/kg/min and nitroglycerin at 20 mcg/min. His BP is 90/60, sinus
tachycardia at one hundred ten minute. A pulmonary artery catheter is inserted and the
following are acquired:
RAP= 16
PAOP= five
PAP= 26/10
Cardiac Index: 1.9 L/min
The affected person has JVD in a semi-fowlers position; Tall, peaked P-waves are visible in
lead II. Which of the following healing procedures is indicated for this patient?
A) Increase the Dobutamine infusion to 20 mcg/kg/minute, and infuse 50 mL
b) Begin milrinone infusion at zero.5 mcg/kg/minute after a loading dose of 50 mcg/kg
c) Discontinue the nitroglycerin and infuse 500 mL NS
d) Discontinue dobutamine, and begin a dopamine infusion at 10 mcg/kg/minute -
ANS-Answer C
The affected person is having an acute inferior MI. The accelerated RAP, JVD, and tall
peaked P-waves are medical indications of RV failure, most probably secondary to RV
infarct. Preload discount (nitroglycerin) will further lower LV filling and CO. Therefore, it must
be discontinued, and fluid boluses will assist to increase the LV preload. Dobutamine has a
moderate dilating effect and can in addition lower the BP. Therefore, an boom in dose would
not be really helpful. Starting milrinone would offer no blessings at this time. Dopamine 20
mcg/kg/min, now not at 10 mcg/kg/min
A affected person changed into 48-hours submit aortic valve replacement. Which of following
could be a primary intention for this affected person?
A) Diuretic remedy
b) Stabilize blood pressure
c) Prophylactic antibiotics
d) Prevent thrombus - ANS-Answer: D
Clot formation on the valve is a first-rate difficulty of valvular substitute, mainly a mechanical
valve. Therefore, anticoagulation could be wished. Fluid overload, labile BP, and
, contamination are all viable headaches. However, they may be not as possibly as thrombus
formation and resultant stroke (if related to aortic valve)
A affected person with a records of heart failure and MI provides following an episode of
syncope. The evaluation 2 hours later demonstrates:
BP 134/64 (supine); a hundred and ten/70 (sitting)
HR 115 with susceptible and thready pulse (supine)
one hundred thirty (sitting)
RR 32 and shallow
Urine output 30 mL over the past 2 hours
Breath sounds are clear
The affected person most in all likelihood requires
a) Vasodilators
b) loop diuretics
c) IV fluids
d) Vasopressors - ANS-Answer C
The lower in bp and increase in heart rate with function change (orthastatic hypotension),
clear lungs, and occasional urine output is a sign of hypovolemia. Vasodilators or diuretics
will exacerbate this trouble. Vasopressors will only further increase the SVR, increasing the
work of the coronary heart
All of the subsequent support the prognosis of cardiac tamponade EXCEPT:
a) Widening pulse strain
b) equalization of proper and left heart pressures
c) Pulsus paradoxus
d) enlarged heart on chest x-ray (CXR) - ANS-Answer A
The pulse stress narrows with cardiac tamponade. The different 3 selections are seen with
cardiac tamponade
Cardiogenic surprise secondary to left ventricular failure will commonly bring about:
a) Decreased afterload
b) narrow pulse stress
c) decreased preload
d) Widening pulse stress - ANS-Answer: B
The systolic pressure decreases because of a drop in cardiac output; however, the diastolic
stress both remains the identical or will increase because of a compensatory boom of the
systemic vascular resistance. The final picks aren't discovered in cardiogenic surprise.
Desirable BP degrees vary depending on the neurological trouble and need to be clarified
with the physician. Which of the following BP levels is correct?
A) Treat BP for an acute ischemic stroke affected person, now not a candidate for
thrombolytic remedy, if more than two hundred-220 mmHg systolic or a hundred mmHg
diastolic
b) Keep systolic BP extra than 180 mmHg for an acute ischemic stroke paient who's a
candidate for thrombolytic remedy
c) Keep systolic BP for a patient wit acute subarachnoid hemorrhage, preop a hundred and
sixty-one hundred eighty mmHg
d) Keep systolic BP less than a hundred and twenty mmHg to save you vasospasms after a
subarachnoid hemorrhage - ANS-Answer A
Abrupt decreasing of the BO to everyday inside the presence of an acute schemic stroke
may additionally decrease perfusion to the region of damage and result in more mind harm.
