NURS 6560 WEEK 4 BOARD VITALS – QUESTION
AND ANSWERS
1. A patient is examined in the ED for chest pain and dyspnea. His heart rate is 110 and on
exam, he has muffled heart sounds and JVD. On measurement of blood pressure by a
cuff sphygmomanometer, there is an exaggerated decrease in blood pressure with
inspiration. What is his most likely diagnosis? Cardiac tamponade.
2. A 49-year-old man with a history of chronic renal failure on intermittent HD, HTN, and
DM presents to the ED ℅ weakness, nausea, and mild SOB for the past few days. An
ECG shows wide QRS and peaked T-waves. The patient receives 325 mg ASA and SL
NTG. Which of the following answer choices is another critical treatment priority?
Calcium gluconate.
3. Which of the following statements concerning ECG findings during an acute MI is
incorrect? An accelerated idioventricular rhythm post fibrinolytic therapy warrants urgent
electric cardioversion.
4. The generation of an action potential w/in cardiac monocytes is largely governed by ion
movement. Movement of several different ions generates 4 general phases of each AP:
rapid depolarization, rapid repolarization, plateau, final rapid repolarization, and resting.
Which ion is primarily responsible for rapid depolarization? Sodium
5. Both ACE inhibitors and ARBS act on the renin-angiotensin system. ACE can cause a
cough while ARBS typically do not. Why is this? ARBs cause less bradykinin formation.
6. According to the American College of Cardiology/AHA Guidelines, which of the following
is an indication for prophylactic antibiotics to prevent bacterial endocarditis in a patient
with a prosthetic heart valve? Routine teeth cleaning.
7. Which of the following is initially characterized by high cardiac output, low right atrial
pressure, low pulmonary capillary wedge pressure and low systemic vascular
resistance? Septic shock.
8. A 64-year-old Caucasian male with a history of extensive tobacco use, HTN, HLD, and
obesity presents with acute onset chest pain. On arrival, the following EKG is obtained.
Emergency angiography reveals complete occlusion of the most common culprit vessel
implicated in inferior MI. PCI is unsuccessful, so he is prepared for medical
management. About 48 hours after the patient’s initial presentation, while in the coronary
care unit, he suddenly becomes dyspneic. Exam is notable for tachycardia, elevated
JVP, diffuse rales, and early 2/6 systolic murmur loudest at the cardiac apex. Which of
the following most likely accounts for his acute decompensation? Acute MR
9. A 50-year-old woman presents to the ED w/ a pulsating HA and dizziness. She also has
splinter hemorrhages and cotton wool spots on an ophthalmic exam. What is the best
treatment option among the choices listed? Labetalol
10. A patient presents w/ ℅ of a racing heart. Her VS include BP 110/80 and RR 16. She is
afebrile and her exam is significant for a rapid HR. Her ECG is pictured below. What is
the best course of management? Vagal maneuver.
11. A 24-year-old male patient presents to the ED after experiencing palpitations when
playing basketball. Upon arrival in the ED, an ECG is obtained. What is his probable
diagnosis? Wolff Parkinson White Syndrome
AND ANSWERS
1. A patient is examined in the ED for chest pain and dyspnea. His heart rate is 110 and on
exam, he has muffled heart sounds and JVD. On measurement of blood pressure by a
cuff sphygmomanometer, there is an exaggerated decrease in blood pressure with
inspiration. What is his most likely diagnosis? Cardiac tamponade.
2. A 49-year-old man with a history of chronic renal failure on intermittent HD, HTN, and
DM presents to the ED ℅ weakness, nausea, and mild SOB for the past few days. An
ECG shows wide QRS and peaked T-waves. The patient receives 325 mg ASA and SL
NTG. Which of the following answer choices is another critical treatment priority?
Calcium gluconate.
3. Which of the following statements concerning ECG findings during an acute MI is
incorrect? An accelerated idioventricular rhythm post fibrinolytic therapy warrants urgent
electric cardioversion.
4. The generation of an action potential w/in cardiac monocytes is largely governed by ion
movement. Movement of several different ions generates 4 general phases of each AP:
rapid depolarization, rapid repolarization, plateau, final rapid repolarization, and resting.
Which ion is primarily responsible for rapid depolarization? Sodium
5. Both ACE inhibitors and ARBS act on the renin-angiotensin system. ACE can cause a
cough while ARBS typically do not. Why is this? ARBs cause less bradykinin formation.
6. According to the American College of Cardiology/AHA Guidelines, which of the following
is an indication for prophylactic antibiotics to prevent bacterial endocarditis in a patient
with a prosthetic heart valve? Routine teeth cleaning.
7. Which of the following is initially characterized by high cardiac output, low right atrial
pressure, low pulmonary capillary wedge pressure and low systemic vascular
resistance? Septic shock.
8. A 64-year-old Caucasian male with a history of extensive tobacco use, HTN, HLD, and
obesity presents with acute onset chest pain. On arrival, the following EKG is obtained.
Emergency angiography reveals complete occlusion of the most common culprit vessel
implicated in inferior MI. PCI is unsuccessful, so he is prepared for medical
management. About 48 hours after the patient’s initial presentation, while in the coronary
care unit, he suddenly becomes dyspneic. Exam is notable for tachycardia, elevated
JVP, diffuse rales, and early 2/6 systolic murmur loudest at the cardiac apex. Which of
the following most likely accounts for his acute decompensation? Acute MR
9. A 50-year-old woman presents to the ED w/ a pulsating HA and dizziness. She also has
splinter hemorrhages and cotton wool spots on an ophthalmic exam. What is the best
treatment option among the choices listed? Labetalol
10. A patient presents w/ ℅ of a racing heart. Her VS include BP 110/80 and RR 16. She is
afebrile and her exam is significant for a rapid HR. Her ECG is pictured below. What is
the best course of management? Vagal maneuver.
11. A 24-year-old male patient presents to the ED after experiencing palpitations when
playing basketball. Upon arrival in the ED, an ECG is obtained. What is his probable
diagnosis? Wolff Parkinson White Syndrome
