ELABORATE QUESTIONS AND
ANSWERS - AACN CCRN .
A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation
and T wave inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy
was started in ED. Indications of successful reperfusion would include all of the
following except:
(A) pain cessation
(B) decrease in CK or troponin
(C) reversal of ST segment elevation with return to baseline
(D) short runs of ventricular tachycardia -
\(B)Coronary artery reperfusion due to PCI or fibrinolysis results in an ELEVATION of
creatinine kinase (CK) or troponin, not decrease. The theory is that the return of blood
flow distal to the occlusion can result in 'reperfusion injury' of the muscle, elevating
cardiac biomarkers.
The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST
segment elevation with return to baseline, short runs of ventricular tachycardia.
Which of the following medication orders should the nurse question for the patient in
question 1-reperfusion question-patient having an MI?
(A) metoprolol (Lopressor)
(B) aspirin
(C) propranolol (Inderal)
(D) heparin -
\(C) The patient in the scenario is having an acute anterior wall MI. A beta blocker is
beneficial for an acute MI as these agents decrease the work of the heart and increase
the threshold for ventricular fibrillation. Propranolol, although a beta-andrenergic blocker
like metoprolol, is NOT a cardioselective beta blocker. It affects beta receptors in heart
muscle AND lung tissue. Therefore, it is more likely to cause bronchoconstriction than a
cardioselective beta blocker.
The other 3- cardioselective beta blocker, antiplatelet, and anticoagulation-are indicated
in an acute MI.
If heart block develops while caring for the patient in question 1 (pt with an MI who went
through reperfusion from PCI or fibrinolytic therapy), which of the following would it most
likely be?
(A) sinoatrial block
(B) second degree, Type I
(C) second degree, Type II
(D) third degree, complete -
\(C) The patient is having an acute anterior MI, which is generally due to LAD occlusion.
The LAD supplies the HIS bundle, which could result in a second-degree, type II heart
block. The other 3 types are due to SA node or AV node ischemia, which generally
occur with an RCA occlusion — interior wall MI.
, Appropriate drug therapy for dilated cardiomyopathy is aimed toward:
(A) decreasing contractility and decreasing preload and afterload
(B) decreasing contractility and increasing preload and afterload
(C) increasing contractility and increasing both preload and afterload
(D) increasing contractility and decreasing both preload and afterload -
\(D) Dilated cardiomyopathy is likely to result in systolic dysfunction, which decreases
contractility, causes compensatory arterial constriction , and results in a higher left
ventricular preload. To treat this, therapy is aimed at increasing contractility, decreasing
afterload (arterial constriction), and decreasing preload that is too high.😃
An 18 year old is admitted with a history of syncopal episode at the mall and has a
history of an eating disorder. The nurse notes a prolonged QT on the 12-lead EKG and
anticipates a reduction in an electrolyte to be the cause. Which of the following is
LEAST likely to cause this patient's problems?
(A) sodium
(B) magnesium
(C) potassium
(D) calcium -
\(A) Abnormal sodium does NOT cause QT prolongation. In contrast, a low magnesium,
potassium, or calcium, may cause QT prolongation and may result in TORSADES DE
POINTES ventricular tachycardia and, if self-limiting, transient syncopal episodes.
On the third day after admission for acute MI, a 67 year old male complains of chest
pain and develops a fever. The pain is worse with deep inspiration and is relieved when
he leans forward. There are nonspecific ST changes in the precordial leads of the EKG.
The nurse anticipates that the patient will most likely need treatment for:
(A) thoracic aneurysm
(B) Dressler's syndrome
(C) reinfarction
(D) pleuritis -
\(B) The pain described in the scenario is typical of the pain caused by pericarditis.
Dressler's syndrome is the pericarditis that may result after an acute MI.
A patient is admitted to the CCU after a PCI with stent. Femoral sheath is in place, site
is dry with no hematoma. He suddenly complains of severe back pain. Neck veins are
flat with head of bed 30 degrees, heart sounds are normal. Vital signs are BP 78/48, HR
124 and RR 26. What should the nurse suspect?
(A) cardiac tamponade
(B) retroperitoneal bleeding
(C) coronary artery dissection
(D) acute closure of the stented coronary artery -
\(B) Retroperitoneal bleeding may cause signs of hypovolemia and hypovolemic shock
as described in the scenario. It may be a complication of a PCI if the femoral artery is
the access site during the procedure. Only this problem results in severe back pain;
none of the other 3 choices results in back pain
ANSWERS - AACN CCRN .
A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation
and T wave inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy
was started in ED. Indications of successful reperfusion would include all of the
following except:
(A) pain cessation
(B) decrease in CK or troponin
(C) reversal of ST segment elevation with return to baseline
(D) short runs of ventricular tachycardia -
\(B)Coronary artery reperfusion due to PCI or fibrinolysis results in an ELEVATION of
creatinine kinase (CK) or troponin, not decrease. The theory is that the return of blood
flow distal to the occlusion can result in 'reperfusion injury' of the muscle, elevating
cardiac biomarkers.
The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST
segment elevation with return to baseline, short runs of ventricular tachycardia.
Which of the following medication orders should the nurse question for the patient in
question 1-reperfusion question-patient having an MI?
(A) metoprolol (Lopressor)
(B) aspirin
(C) propranolol (Inderal)
(D) heparin -
\(C) The patient in the scenario is having an acute anterior wall MI. A beta blocker is
beneficial for an acute MI as these agents decrease the work of the heart and increase
the threshold for ventricular fibrillation. Propranolol, although a beta-andrenergic blocker
like metoprolol, is NOT a cardioselective beta blocker. It affects beta receptors in heart
muscle AND lung tissue. Therefore, it is more likely to cause bronchoconstriction than a
cardioselective beta blocker.
The other 3- cardioselective beta blocker, antiplatelet, and anticoagulation-are indicated
in an acute MI.
If heart block develops while caring for the patient in question 1 (pt with an MI who went
through reperfusion from PCI or fibrinolytic therapy), which of the following would it most
likely be?
(A) sinoatrial block
(B) second degree, Type I
(C) second degree, Type II
(D) third degree, complete -
\(C) The patient is having an acute anterior MI, which is generally due to LAD occlusion.
The LAD supplies the HIS bundle, which could result in a second-degree, type II heart
block. The other 3 types are due to SA node or AV node ischemia, which generally
occur with an RCA occlusion — interior wall MI.
, Appropriate drug therapy for dilated cardiomyopathy is aimed toward:
(A) decreasing contractility and decreasing preload and afterload
(B) decreasing contractility and increasing preload and afterload
(C) increasing contractility and increasing both preload and afterload
(D) increasing contractility and decreasing both preload and afterload -
\(D) Dilated cardiomyopathy is likely to result in systolic dysfunction, which decreases
contractility, causes compensatory arterial constriction , and results in a higher left
ventricular preload. To treat this, therapy is aimed at increasing contractility, decreasing
afterload (arterial constriction), and decreasing preload that is too high.😃
An 18 year old is admitted with a history of syncopal episode at the mall and has a
history of an eating disorder. The nurse notes a prolonged QT on the 12-lead EKG and
anticipates a reduction in an electrolyte to be the cause. Which of the following is
LEAST likely to cause this patient's problems?
(A) sodium
(B) magnesium
(C) potassium
(D) calcium -
\(A) Abnormal sodium does NOT cause QT prolongation. In contrast, a low magnesium,
potassium, or calcium, may cause QT prolongation and may result in TORSADES DE
POINTES ventricular tachycardia and, if self-limiting, transient syncopal episodes.
On the third day after admission for acute MI, a 67 year old male complains of chest
pain and develops a fever. The pain is worse with deep inspiration and is relieved when
he leans forward. There are nonspecific ST changes in the precordial leads of the EKG.
The nurse anticipates that the patient will most likely need treatment for:
(A) thoracic aneurysm
(B) Dressler's syndrome
(C) reinfarction
(D) pleuritis -
\(B) The pain described in the scenario is typical of the pain caused by pericarditis.
Dressler's syndrome is the pericarditis that may result after an acute MI.
A patient is admitted to the CCU after a PCI with stent. Femoral sheath is in place, site
is dry with no hematoma. He suddenly complains of severe back pain. Neck veins are
flat with head of bed 30 degrees, heart sounds are normal. Vital signs are BP 78/48, HR
124 and RR 26. What should the nurse suspect?
(A) cardiac tamponade
(B) retroperitoneal bleeding
(C) coronary artery dissection
(D) acute closure of the stented coronary artery -
\(B) Retroperitoneal bleeding may cause signs of hypovolemia and hypovolemic shock
as described in the scenario. It may be a complication of a PCI if the femoral artery is
the access site during the procedure. Only this problem results in severe back pain;
none of the other 3 choices results in back pain
