PCCN Practice Q's (with Rationales) With All Correct & 100%
Verified Answers| Latest Update| Already Graded A+
1. A patient with hyperten- B. signs of HF.
sive crisis has become in-
creasingly confused and Patients with hypertensive crisis should be monitored for signs of
pulls out the IV. In or- HF, widening pulse pressure, and seizures which are all signs of
der to avoid the compli- hypertensive encephalopathy. Restraints should be avoided as they
cation of hypertensive en- increase intracranial pressure and BP contributing to worsening
cephalopathy, the nurse hypertensive crisis.
should expect to include
monitoring for
A. decreasing pulse pres-
sure MAP.
B. signs of HF.
C. bruising from re-
straints.
D. hyperglycemia.
2. A patient with mi- B. afib
tral stenosis is admit-
ted. Which dysrhythmias Mitral stenosis is characterized by a narrowing of the valve orifice and
should be of GREATEST enlargement of the left atrium due to obstruction of flow into the left
concern to the nurse? ventricle. The left atrial hypertrophy causes changes in depolariza-
tion and repolarization and increases the risk for atrial fibrillation.
A. Wolff-Parkinson-White The most common cause of monomorphic vtach (VT) is AMI, not
syndrome mitral stenosis. Other causes of monomorphic VT are hypomag-
B. afib nesemia, hypokalemia, and dilated cardiomyopathy. Woltt-Parkin-
C. torsades de pointes son-White (WPW) syndrome is characterized by a short PR interval,
D. monomorphic vtach delta wave and tachycardia greater than 200 beats per minute. WPW
syndrome is causes by early activation of the ventricles via an acces-
sory pathway and is not associated with mitral stenosis. Torsades de
pointes is a polymorphic ventricular tachycardia associated with a
, PCCN Practice Q's (with Rationales) With All Correct & 100%
Verified Answers| Latest Update| Already Graded A+
long QT interval. It is pause-dependent and commonly associated
with drug-induced QT prolongation, not mitral stenosis.
3. A patient with HF is on a C. dobutamine (Dobutrex) to augment CO
diuretic and fluid restric-
tion. The assessment in- In patients w/ decompensated HF, the use of IV inotropic agents
dicates atrial tachycardia such as dobutamine may be indicated to support cardiac function
with a rate of 130, pres- and cardiac output. Dobutamine has beta-2 ettects (in addition to
ence of crackles in all lung beta-1) which results in mild vasodilation. It is especially useful for
fields, an S3 at the left afterload reduction in HF patients that cannot tolerate vasodilator
apex and BP of 90/40 (pre- therapy. The administration of a fluid bolus will make the patient's
viously 130/60). The pa- condition worse. Dopamine does not provide afterload reduction
tient reports feeling SOB. and may worsen the patient's tachycardia. Adenosine is not indicated
The nurse should antic- as the HR is less than 150 and the goal is to treat the underlying
ipate the administration cause of the tachycardia.
of
A. a fluid bolus to enhance
preload
B. dopamine (Inotropic) to
support BP
C. dobutamine (Dobutrex)
to augment CO
D. adenosine (Adenocard)
to reverse the tachcardia
4. A patient with a hx of HF A. IV fluids
and ACS is admitted fol-
lowing an episode of syn- Although this pt has a hx of HF, data suggest orthostatic hypotension
cope. Two hours later, the and hypovolemia which should initially be treated with fluids. While
assessment reveals, shal- HF may be of concern, the patient's breath sounds are clear at pre-
low breaths and bilater- sent. Careful monitoring of patient tolerance is needed during the
, PCCN Practice Q's (with Rationales) With All Correct & 100%
Verified Answers| Latest Update| Already Graded A+
al clear lung sounds. Data administration of a fluid challenge. Nesiritide is used for short-term
are: BP 134/64 (supine); tx of decompensated CHF. It vasodilates both veins and arteries and
90/60 standing; RR 32; UO increases diuresis and natriuresis which would worsen orthostasis.
30 mL over past 2 hours. The use of an osmotic diuretic is not indicated and may cause further
The nurse should antici- hypovolemia. Dopamine augments CO by improving contractility and
pate: tissue perfusion. It will increase BP but the patient's underlying
hypovolemia needs to be corrected first.
A. IV fluids
B. nesiritide (Natrecor)
C. dopamine
D. mannitol
5. A patient who was ad- B. multidrug regimens and consequences if not followed
mitted with uncontrolled
HTN is scheduled for dis- Multidrug regimens with two or three medications of ditterent drug
charge. Which education classes are almost always required to achieve recommended BP
is a PRIORITY for the goals. Insuflcient time for patient engagement as well as multidrug
nurse during discharge in- burden, prescription drug costs, and medication side ettects are
structions? primary contributors to medication noncompliance. The primary
prevention of hypertension requires large-scale societal changes,
A. relaxation and stress including further ettorts to influence the food industry to reduce salt
management techniques in processed foods, ettorts to increase exercise, and availability of
B. multidrug regimens fresh fruits and vegetables. After a person's BP rises to hyperten-
and consequences if not sive or even pre-hypertensive levels, lifestyle modification alone is
followed almost never enough to return it to normal, and recidivism is typical.
C. BP monitoring along Lifestyle modifications are diflcult to sustain long-term and thus, are
with alcohol and caffeine a secondary focus in patient education.
changes
D. lifestyle modifications
for cessation of vaping, di-
etary and exercise adjust-
ments
, PCCN Practice Q's (with Rationales) With All Correct & 100%
Verified Answers| Latest Update| Already Graded A+
6. A patient presents with CP, D. hypertrophic cardiomyopathy
dyspnea, orthopnea, and
a systolic murmur (S3 and This patient is manifesting symptoms of hypertrophic cardiomyopa-
S4). Echocardiograph in- thy. Mitral stenosis is associated with a diastolic murmur. Cardiac
dicates a decreased left tamponade is not associated with a murmur. A systolic murmur may
ventricular chamber size develop after an AMI but there may be dilation of the left atrium and
and increased ventricular ventricle following AMI versus decreased left ventricular chamber
wall thickness. The nurse size.
should suspect the most
likely cause of the pa-
tient's symptoms is
A. acute myocardial in-
farction
B. mitral stenosis
C. cardiac tamponade
D. hypertrophic cardiomy-
opathy
7. A patient is admitted D. frequent monitoring of BP
with chest pain and start-
ed on nitroglycerin IV. Pain and ischemia management for NSTEMI patients includes ad-
The patient currently de- ministering nitroglycerin IV infusions to decrease preload and re-
nies chest pain. The ECG duce myocardial oxygen demand and consumption. Hypotension
shows no ST elevation. is one of the side ettects of nitroglycerin due to the mechanism
Cardiac biomarkers reveal of action dilating arteries and veins. While the other actions are
troponin of 0.45 (elevat- clude
ed). Lung sounds clear bi-
laterally. The SpO2 is cur-
rently 94%. The PRIORITY
nursing action should in-
Verified Answers| Latest Update| Already Graded A+
1. A patient with hyperten- B. signs of HF.
sive crisis has become in-
creasingly confused and Patients with hypertensive crisis should be monitored for signs of
pulls out the IV. In or- HF, widening pulse pressure, and seizures which are all signs of
der to avoid the compli- hypertensive encephalopathy. Restraints should be avoided as they
cation of hypertensive en- increase intracranial pressure and BP contributing to worsening
cephalopathy, the nurse hypertensive crisis.
should expect to include
monitoring for
A. decreasing pulse pres-
sure MAP.
B. signs of HF.
C. bruising from re-
straints.
D. hyperglycemia.
2. A patient with mi- B. afib
tral stenosis is admit-
ted. Which dysrhythmias Mitral stenosis is characterized by a narrowing of the valve orifice and
should be of GREATEST enlargement of the left atrium due to obstruction of flow into the left
concern to the nurse? ventricle. The left atrial hypertrophy causes changes in depolariza-
tion and repolarization and increases the risk for atrial fibrillation.
A. Wolff-Parkinson-White The most common cause of monomorphic vtach (VT) is AMI, not
syndrome mitral stenosis. Other causes of monomorphic VT are hypomag-
B. afib nesemia, hypokalemia, and dilated cardiomyopathy. Woltt-Parkin-
C. torsades de pointes son-White (WPW) syndrome is characterized by a short PR interval,
D. monomorphic vtach delta wave and tachycardia greater than 200 beats per minute. WPW
syndrome is causes by early activation of the ventricles via an acces-
sory pathway and is not associated with mitral stenosis. Torsades de
pointes is a polymorphic ventricular tachycardia associated with a
, PCCN Practice Q's (with Rationales) With All Correct & 100%
Verified Answers| Latest Update| Already Graded A+
long QT interval. It is pause-dependent and commonly associated
with drug-induced QT prolongation, not mitral stenosis.
3. A patient with HF is on a C. dobutamine (Dobutrex) to augment CO
diuretic and fluid restric-
tion. The assessment in- In patients w/ decompensated HF, the use of IV inotropic agents
dicates atrial tachycardia such as dobutamine may be indicated to support cardiac function
with a rate of 130, pres- and cardiac output. Dobutamine has beta-2 ettects (in addition to
ence of crackles in all lung beta-1) which results in mild vasodilation. It is especially useful for
fields, an S3 at the left afterload reduction in HF patients that cannot tolerate vasodilator
apex and BP of 90/40 (pre- therapy. The administration of a fluid bolus will make the patient's
viously 130/60). The pa- condition worse. Dopamine does not provide afterload reduction
tient reports feeling SOB. and may worsen the patient's tachycardia. Adenosine is not indicated
The nurse should antic- as the HR is less than 150 and the goal is to treat the underlying
ipate the administration cause of the tachycardia.
of
A. a fluid bolus to enhance
preload
B. dopamine (Inotropic) to
support BP
C. dobutamine (Dobutrex)
to augment CO
D. adenosine (Adenocard)
to reverse the tachcardia
4. A patient with a hx of HF A. IV fluids
and ACS is admitted fol-
lowing an episode of syn- Although this pt has a hx of HF, data suggest orthostatic hypotension
cope. Two hours later, the and hypovolemia which should initially be treated with fluids. While
assessment reveals, shal- HF may be of concern, the patient's breath sounds are clear at pre-
low breaths and bilater- sent. Careful monitoring of patient tolerance is needed during the
, PCCN Practice Q's (with Rationales) With All Correct & 100%
Verified Answers| Latest Update| Already Graded A+
al clear lung sounds. Data administration of a fluid challenge. Nesiritide is used for short-term
are: BP 134/64 (supine); tx of decompensated CHF. It vasodilates both veins and arteries and
90/60 standing; RR 32; UO increases diuresis and natriuresis which would worsen orthostasis.
30 mL over past 2 hours. The use of an osmotic diuretic is not indicated and may cause further
The nurse should antici- hypovolemia. Dopamine augments CO by improving contractility and
pate: tissue perfusion. It will increase BP but the patient's underlying
hypovolemia needs to be corrected first.
A. IV fluids
B. nesiritide (Natrecor)
C. dopamine
D. mannitol
5. A patient who was ad- B. multidrug regimens and consequences if not followed
mitted with uncontrolled
HTN is scheduled for dis- Multidrug regimens with two or three medications of ditterent drug
charge. Which education classes are almost always required to achieve recommended BP
is a PRIORITY for the goals. Insuflcient time for patient engagement as well as multidrug
nurse during discharge in- burden, prescription drug costs, and medication side ettects are
structions? primary contributors to medication noncompliance. The primary
prevention of hypertension requires large-scale societal changes,
A. relaxation and stress including further ettorts to influence the food industry to reduce salt
management techniques in processed foods, ettorts to increase exercise, and availability of
B. multidrug regimens fresh fruits and vegetables. After a person's BP rises to hyperten-
and consequences if not sive or even pre-hypertensive levels, lifestyle modification alone is
followed almost never enough to return it to normal, and recidivism is typical.
C. BP monitoring along Lifestyle modifications are diflcult to sustain long-term and thus, are
with alcohol and caffeine a secondary focus in patient education.
changes
D. lifestyle modifications
for cessation of vaping, di-
etary and exercise adjust-
ments
, PCCN Practice Q's (with Rationales) With All Correct & 100%
Verified Answers| Latest Update| Already Graded A+
6. A patient presents with CP, D. hypertrophic cardiomyopathy
dyspnea, orthopnea, and
a systolic murmur (S3 and This patient is manifesting symptoms of hypertrophic cardiomyopa-
S4). Echocardiograph in- thy. Mitral stenosis is associated with a diastolic murmur. Cardiac
dicates a decreased left tamponade is not associated with a murmur. A systolic murmur may
ventricular chamber size develop after an AMI but there may be dilation of the left atrium and
and increased ventricular ventricle following AMI versus decreased left ventricular chamber
wall thickness. The nurse size.
should suspect the most
likely cause of the pa-
tient's symptoms is
A. acute myocardial in-
farction
B. mitral stenosis
C. cardiac tamponade
D. hypertrophic cardiomy-
opathy
7. A patient is admitted D. frequent monitoring of BP
with chest pain and start-
ed on nitroglycerin IV. Pain and ischemia management for NSTEMI patients includes ad-
The patient currently de- ministering nitroglycerin IV infusions to decrease preload and re-
nies chest pain. The ECG duce myocardial oxygen demand and consumption. Hypotension
shows no ST elevation. is one of the side ettects of nitroglycerin due to the mechanism
Cardiac biomarkers reveal of action dilating arteries and veins. While the other actions are
troponin of 0.45 (elevat- clude
ed). Lung sounds clear bi-
laterally. The SpO2 is cur-
rently 94%. The PRIORITY
nursing action should in-
