PCCN DETAILED EXAM STUDY QUESTIONS
WITH RATIONALED ANSWERS ALREADY
GRADED A+ | GUARANTEE PASS
1. Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR) - ANSWER A. diastolic pressure
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, a pressure gradient known as
coronary artery prefusion pressure. As diastolic pressure drops, there is a
decrease in coronary artery blood flow. Coronary artery perfusion is not
affected by systolic pressure, afterload or SVR, but they all increase the demand
of oxygen in the heart.
2. The layer of the arterial vessel wall responsible for changes in the diameter
of the artery is the:
A. media
B. intima
C. externa
D. adventitia - ANSWER A. media
The media layer of the arterial wall contains vascular smooth muscle cells and
is responsible for arterial tone. Vasoactive substances released in response to
the sympathetic nervous system and/or the renin-angiotensin system determine
arterial tone. Intima, externa and adventitia are incorrect.
3. A patient presents in acute distress with rales halfway up bilaterally; cool
and clammy extremities; elevated jugular venous distention (JVD); oxygen
, saturations at 95%, down from 99%; and complaints of shortness of breath.
Which of the following findings correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion - ANSWER D. pulmonary
congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary
edema, causing pulmonary congestion. Pneumonia can also cause fluid in the
alveolar sacs. The patient is complaining of shortness of breath, and the oxygen
saturations are lowering, also indicating that the patient has pulmonary
congestion. The patient's skin is cool and clammy, indicating that the skin is
poorly perfused. Skin does not require oxygen and shunts blood away in
decreased cardiac function; therefore, this patient has pulmonary congestion
and low perfusion state. The other answers are incorrect.
4. When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction - ANSWER A. the beginning
of ventricular systole
The heart sound of S1 indicates the opening of the aortic and pulmonic valves
and marks the beginning of ventricular systole or ejection. The beginning of
diastole is after S2, propulsion of blood into a noncompliant chamber is S4, and
blood going in the wrong direction will cause a murmur.
5. A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure - ANSWER A. increased thickness of the
alveolar capillary membrane
,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 increase, the fluid then
shifts to the alveolar space, causing pulmonary edema. This fluid acts as a
deterrent to oxygen diffusion. Retention of CO2 does not impair diffusion. An
elevated body temperature associated with pulmonary edema is not causing a
diffusion abnormality; increased temperature shifts the oxyhemoglobin curve to
the right, more quickly releasing oxygen to the tissues. Low barometric pressure
has no effect on diffusion of gases in the lung.
6. A patient with an anterior-wall STEMI is in cardiogenic shock. What would
be the hemodynamic profile assessment?
A. decreased cardiac index, increased preload, increased afterload
B. decreased cardiac index, decreased preload, increased afterload
C. decreased cardiac index, decreased preload, decreased afterload
D. increased cardiac index, decreased preload, decreased afterload -
ANSWER A. decreased cardiac index, increased preload, increased
afterload
In a patient with cardiogenic shock, both preload and afterload are increased
due to severe vasoconstriction on both the venous and arterial side. Arterial
vasoconstriction increases afterload and therefore lowers cardiac index.
Because the ventricle is failing and contractility is also low, the left ventricular
pressures increase and cause blood to increase in the pulmonary bed, resulting
in increased right ventricular pressures and preload. In heart failure, there is an
increase in preload and afterload with a decrease in cardiac index and
contractility. The other answers are incorrect.
7. Medications commonly used in the treatment of heart failure include:
A. ACE inhibitors, beta blockers
B. calcium channel blockers
C. nitrates
D. calcium channel blockers and digoxin (Lanoxicaps) - ANSWER A.
ACE inhibitors, beta blockers
, The most effective and evidence-based practice treatment of heart failure is
neurohormonal blockade. These medications include beta blockers and ACE
inhibitors. They reduce preload and afterload as well as controlling heart rate
and BP. Calcium channel blockers are not used in heart failure since they tend
to increase the absorption of sodium and water. Nitrates are used for treatment
in conjunction with other drugs. Beta blockers are ACE-I are the foundation of
treatments. Digoxin is also used but only after the beta blockers and ACE-I are
started.
8. The heart's primary compensatory response to chronic aortic stenosis
includes:
A. left arterial hypertrophy
B. left ventricular hypertrophy
C. left ventricular dilation
D. right ventricular dysfunction - ANSWER B. left ventricular
hypertrophy
With chronic aortic stenosis, the left ventricle hypertrophies over time due to
the increased workload of pumping blood through a narrowed opening. This
leads to diastolic dysfunction as well as hypertrophy. The left atrium will
enlarge over time, but the primary result is left ventricular hypertrophy, not
dilation. The right ventricle remains normal for a period of time.
9. Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizziness, recent
K+ lvl is 3.4. What action would you do first?
a. emergent defib
b. amio 300mg IVP
c. emergent cardioversion
d. hang 10 mEq KCL/50mL D5W - ANSWER C
The nurse notes the following when analyzing a patient's telemetry strip: HR,
65/min and regular; PR interval, 0.22 seconds; QRS complex, 0.10 seconds; QTc,
0.52 seconds. Which of the following dysrhythmias is the patient at risk for?
WITH RATIONALED ANSWERS ALREADY
GRADED A+ | GUARANTEE PASS
1. Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR) - ANSWER A. diastolic pressure
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, a pressure gradient known as
coronary artery prefusion pressure. As diastolic pressure drops, there is a
decrease in coronary artery blood flow. Coronary artery perfusion is not
affected by systolic pressure, afterload or SVR, but they all increase the demand
of oxygen in the heart.
2. The layer of the arterial vessel wall responsible for changes in the diameter
of the artery is the:
A. media
B. intima
C. externa
D. adventitia - ANSWER A. media
The media layer of the arterial wall contains vascular smooth muscle cells and
is responsible for arterial tone. Vasoactive substances released in response to
the sympathetic nervous system and/or the renin-angiotensin system determine
arterial tone. Intima, externa and adventitia are incorrect.
3. A patient presents in acute distress with rales halfway up bilaterally; cool
and clammy extremities; elevated jugular venous distention (JVD); oxygen
, saturations at 95%, down from 99%; and complaints of shortness of breath.
Which of the following findings correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion - ANSWER D. pulmonary
congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary
edema, causing pulmonary congestion. Pneumonia can also cause fluid in the
alveolar sacs. The patient is complaining of shortness of breath, and the oxygen
saturations are lowering, also indicating that the patient has pulmonary
congestion. The patient's skin is cool and clammy, indicating that the skin is
poorly perfused. Skin does not require oxygen and shunts blood away in
decreased cardiac function; therefore, this patient has pulmonary congestion
and low perfusion state. The other answers are incorrect.
4. When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction - ANSWER A. the beginning
of ventricular systole
The heart sound of S1 indicates the opening of the aortic and pulmonic valves
and marks the beginning of ventricular systole or ejection. The beginning of
diastole is after S2, propulsion of blood into a noncompliant chamber is S4, and
blood going in the wrong direction will cause a murmur.
5. A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure - ANSWER A. increased thickness of the
alveolar capillary membrane
,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 increase, the fluid then
shifts to the alveolar space, causing pulmonary edema. This fluid acts as a
deterrent to oxygen diffusion. Retention of CO2 does not impair diffusion. An
elevated body temperature associated with pulmonary edema is not causing a
diffusion abnormality; increased temperature shifts the oxyhemoglobin curve to
the right, more quickly releasing oxygen to the tissues. Low barometric pressure
has no effect on diffusion of gases in the lung.
6. A patient with an anterior-wall STEMI is in cardiogenic shock. What would
be the hemodynamic profile assessment?
A. decreased cardiac index, increased preload, increased afterload
B. decreased cardiac index, decreased preload, increased afterload
C. decreased cardiac index, decreased preload, decreased afterload
D. increased cardiac index, decreased preload, decreased afterload -
ANSWER A. decreased cardiac index, increased preload, increased
afterload
In a patient with cardiogenic shock, both preload and afterload are increased
due to severe vasoconstriction on both the venous and arterial side. Arterial
vasoconstriction increases afterload and therefore lowers cardiac index.
Because the ventricle is failing and contractility is also low, the left ventricular
pressures increase and cause blood to increase in the pulmonary bed, resulting
in increased right ventricular pressures and preload. In heart failure, there is an
increase in preload and afterload with a decrease in cardiac index and
contractility. The other answers are incorrect.
7. Medications commonly used in the treatment of heart failure include:
A. ACE inhibitors, beta blockers
B. calcium channel blockers
C. nitrates
D. calcium channel blockers and digoxin (Lanoxicaps) - ANSWER A.
ACE inhibitors, beta blockers
, The most effective and evidence-based practice treatment of heart failure is
neurohormonal blockade. These medications include beta blockers and ACE
inhibitors. They reduce preload and afterload as well as controlling heart rate
and BP. Calcium channel blockers are not used in heart failure since they tend
to increase the absorption of sodium and water. Nitrates are used for treatment
in conjunction with other drugs. Beta blockers are ACE-I are the foundation of
treatments. Digoxin is also used but only after the beta blockers and ACE-I are
started.
8. The heart's primary compensatory response to chronic aortic stenosis
includes:
A. left arterial hypertrophy
B. left ventricular hypertrophy
C. left ventricular dilation
D. right ventricular dysfunction - ANSWER B. left ventricular
hypertrophy
With chronic aortic stenosis, the left ventricle hypertrophies over time due to
the increased workload of pumping blood through a narrowed opening. This
leads to diastolic dysfunction as well as hypertrophy. The left atrium will
enlarge over time, but the primary result is left ventricular hypertrophy, not
dilation. The right ventricle remains normal for a period of time.
9. Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizziness, recent
K+ lvl is 3.4. What action would you do first?
a. emergent defib
b. amio 300mg IVP
c. emergent cardioversion
d. hang 10 mEq KCL/50mL D5W - ANSWER C
The nurse notes the following when analyzing a patient's telemetry strip: HR,
65/min and regular; PR interval, 0.22 seconds; QRS complex, 0.10 seconds; QTc,
0.52 seconds. Which of the following dysrhythmias is the patient at risk for?
