PCCN( PROGRESSIVE CARE CERTIFIED NURSE)
PRACTICE TEST (2022/2023 LATEST UPDATE)
What layer of the arterial vessel wall is responsible for changes in the diameter of the artery (correct
answers)Media: contains vascular smooth muscle and is responsible for arterial tone
S1 signifies (correct answers)the beginning of ventricular systole
What determines stroke volume? (correct answers)preload afterload and contractility
Preload is determined by what 3 things? *The amount of volume returned to the ventricle at the end of
diastole (correct answers)Venous return, intrathoracic pressure , drugs (If high, give diuretics or
vasodilators, if low give volume)
A patient with anterior wall STEMI in cardiogenic shock will have what hemodynamic profile? (correct
answers)Decreased cardiac index, increased preload and increased afterload... (severe vasoconstriction
on venous and arterial side --> ^SVR and lowers cardiac index *** Pulmonary pressures increase -->
^CVP)
How is systemic vascular resistance measured without hemodynamic monitoring? (correct
answers)Diastolic BP: an increase in SVR an increase in DPB will follow. DBP is a reflection of arterial
tone. Pulse pressure will also narrow.
What is the most common dysrhythmia following an inferior wall STEMI? (correct answers)Bradycardia
and Heart block
What is the most common dysrhythmia following an anterior wall STEMI? (correct
answers)tachydysrhythmias: V-tach and V-fib
What is the most common cause of heart failure? (correct answers)Ischemic heart disease following
STEMI and NSTEMI (it damages the myocardium, ventricular failure results secondary to decreased EF
When plasma glucose falls to 250 in DKA, IV fluids should be changed to D5 1/2 NS. Why? (correct
answers)To prevent cerebral edema. The patient is fluid depleted secondary to hyperosmolar diuresis.
So lowering the BS too fast will cause cerebral edema without proper fluid replacement.
Dehydration in HHNK coma is primarily due to which event? (correct answers)Osmotic diuresis from
elevated blood glucose levels
What abnormal lab value is common in HHNK? (correct answers)Azotemia as a result of severe
dehydration leading to renal injury --> Azotemia
Where is ADH produced? (correct answers)hypothalamic supraoptic nuclei of the posterior pituitary
gland
, The distal convoluted tubules in the kidney are influenced by ADH in order to ... (correct
answers)concentrate the urine... It decreases urine output and conserves water for the body. Its effect is
to reabsorb sodium and water and reduce UO to maintain intravascular volume
Why are patients with DKA hyperkalemic? (correct answers)Elevated keytones lead to metabolic acidosis
(ketoacidosis). This acidosis pulls potassium and fluid from the cell making the patient hyperkalemic
SIADH is clinically manifested by what signs? (correct answers)Water intoxication from hypervolemia
and hyponatremia. urine output is also low
Aldosterone antagonists are contraindicated in what heart patient? (correct answers)Serum creatinine
greater than 4.0 (these are potassium sparing drugs and would increase creatinine and potassium)
What nursing interventions are important in pericarditis? (correct answers)Pain relief, auscultate heart
sounds for signs of tamponade ***no anticoagulation
What are signs of cardiac tamponade? What is a precursor to tamponade? (correct answers)tachycardia,
narrowed pulse pressure, hypotension and increased JVD. Pericardial effusion
normal CVP measures? (correct answers)3-5mmHg
Normal RV pressure measures? (correct answers)25/3-5mmHg
Normal PAP measures? (correct answers)25/8-12 mmHg
PCWP? (correct answers)8-12 mmHg
LA pressure? (correct answers)4-12 mmHg
LV pressure? (correct answers)120/ 4-12 mmHg
normal amount of CO? (correct answers)4-8 liters per minute
What is normal cardiac index? (correct answers)2.4 -4.2 liters/min/m2
Normal PVR ? (correct answers)37-250 dynes/sec/cm2
Normal SVR? (correct answers)800-1200 dynes/sec/cm2
A post CABG patient in cariogenic shock will require what interventions? (correct answers)Patient needs
lowered preload, afterload, and drugs that improve contractility therefore... IABP + ionotropes and
vasodilators, diuretics
How is a NSTEMI differentiated from unstable angina? (correct answers)Cardiac Biomarkers: in unstable
angina patient will have ECG changes but no cardiac enzyme changes.. NSTEMI will have elevated trops
What is the cause of unstable angina? (correct answers)Abnormal plaque formation, rupture and
platelet aggregation cause varying degrees of blood supply and discomfort.
PRACTICE TEST (2022/2023 LATEST UPDATE)
What layer of the arterial vessel wall is responsible for changes in the diameter of the artery (correct
answers)Media: contains vascular smooth muscle and is responsible for arterial tone
S1 signifies (correct answers)the beginning of ventricular systole
What determines stroke volume? (correct answers)preload afterload and contractility
Preload is determined by what 3 things? *The amount of volume returned to the ventricle at the end of
diastole (correct answers)Venous return, intrathoracic pressure , drugs (If high, give diuretics or
vasodilators, if low give volume)
A patient with anterior wall STEMI in cardiogenic shock will have what hemodynamic profile? (correct
answers)Decreased cardiac index, increased preload and increased afterload... (severe vasoconstriction
on venous and arterial side --> ^SVR and lowers cardiac index *** Pulmonary pressures increase -->
^CVP)
How is systemic vascular resistance measured without hemodynamic monitoring? (correct
answers)Diastolic BP: an increase in SVR an increase in DPB will follow. DBP is a reflection of arterial
tone. Pulse pressure will also narrow.
What is the most common dysrhythmia following an inferior wall STEMI? (correct answers)Bradycardia
and Heart block
What is the most common dysrhythmia following an anterior wall STEMI? (correct
answers)tachydysrhythmias: V-tach and V-fib
What is the most common cause of heart failure? (correct answers)Ischemic heart disease following
STEMI and NSTEMI (it damages the myocardium, ventricular failure results secondary to decreased EF
When plasma glucose falls to 250 in DKA, IV fluids should be changed to D5 1/2 NS. Why? (correct
answers)To prevent cerebral edema. The patient is fluid depleted secondary to hyperosmolar diuresis.
So lowering the BS too fast will cause cerebral edema without proper fluid replacement.
Dehydration in HHNK coma is primarily due to which event? (correct answers)Osmotic diuresis from
elevated blood glucose levels
What abnormal lab value is common in HHNK? (correct answers)Azotemia as a result of severe
dehydration leading to renal injury --> Azotemia
Where is ADH produced? (correct answers)hypothalamic supraoptic nuclei of the posterior pituitary
gland
, The distal convoluted tubules in the kidney are influenced by ADH in order to ... (correct
answers)concentrate the urine... It decreases urine output and conserves water for the body. Its effect is
to reabsorb sodium and water and reduce UO to maintain intravascular volume
Why are patients with DKA hyperkalemic? (correct answers)Elevated keytones lead to metabolic acidosis
(ketoacidosis). This acidosis pulls potassium and fluid from the cell making the patient hyperkalemic
SIADH is clinically manifested by what signs? (correct answers)Water intoxication from hypervolemia
and hyponatremia. urine output is also low
Aldosterone antagonists are contraindicated in what heart patient? (correct answers)Serum creatinine
greater than 4.0 (these are potassium sparing drugs and would increase creatinine and potassium)
What nursing interventions are important in pericarditis? (correct answers)Pain relief, auscultate heart
sounds for signs of tamponade ***no anticoagulation
What are signs of cardiac tamponade? What is a precursor to tamponade? (correct answers)tachycardia,
narrowed pulse pressure, hypotension and increased JVD. Pericardial effusion
normal CVP measures? (correct answers)3-5mmHg
Normal RV pressure measures? (correct answers)25/3-5mmHg
Normal PAP measures? (correct answers)25/8-12 mmHg
PCWP? (correct answers)8-12 mmHg
LA pressure? (correct answers)4-12 mmHg
LV pressure? (correct answers)120/ 4-12 mmHg
normal amount of CO? (correct answers)4-8 liters per minute
What is normal cardiac index? (correct answers)2.4 -4.2 liters/min/m2
Normal PVR ? (correct answers)37-250 dynes/sec/cm2
Normal SVR? (correct answers)800-1200 dynes/sec/cm2
A post CABG patient in cariogenic shock will require what interventions? (correct answers)Patient needs
lowered preload, afterload, and drugs that improve contractility therefore... IABP + ionotropes and
vasodilators, diuretics
How is a NSTEMI differentiated from unstable angina? (correct answers)Cardiac Biomarkers: in unstable
angina patient will have ECG changes but no cardiac enzyme changes.. NSTEMI will have elevated trops
What is the cause of unstable angina? (correct answers)Abnormal plaque formation, rupture and
platelet aggregation cause varying degrees of blood supply and discomfort.
