CCS PRACTICE EXAM 1 & 2 LATEST EXAM ACTUAL EXAM
200 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES| (ALREADY GRADED A+) |BRAND
NEW!!
Which mechanism is responsible for the augmentation of coronary arterial blood
flow and increased myocardial oxygen supply seen with the intra-aortic balloon
pump?
a. The vacuum created in the aorta as a result of balloon deflation
b. Diastolic inflation with retrograde perfusion
c. Forward flow to the peripheral circulation
d. Inflation during systole to augment blood pressure - ANSWER: B.
The blood volume in the aorta below the level of the balloon is propelled forward
toward the
peripheral vascular system, which may enhance renal perfusion. Subsequently, the
deflation
of the balloon just before the opening of the aortic valve creates a potential space or
vacuum
in the aorta, toward which blood flows unimpeded during ventricular ejection. This
decreased
resistance to left ventricular ejection, or decreased afterload, facilitates ventricular
emptying
and reduces myocardial oxygen demands.
What is the most common complication of fibrinolytic therapy?
a. Reperfusion chest pain
b. Lethargy
c. Bleeding
d. Heart blocks - ANSWER: ANS: C
The most common complication related to thrombolysis is bleeding.
What is the preferred initial treatment of an acute myocardial infarction?
a. Fibrinolytic therapy
b. Percutaneous coronary intervention (PCI)
c. Coronary artery bypass surgery (CABG)
d. Implanted cardioverter defibrillator (ICD) - ANSWER: ANS: B
PCI is now preferred as the initial method of treatment for acute MI (primary PCI).
PCI
includes balloon angioplasty, atherectomy, and stent implantation, as well as a
number of
adjunctive devices used to facilitate successful revascularization in coronary vessels.
5. What is the rationale for administrating a fibrinolytic agent to a patient
experiencing acute
,ST-elevation myocardial infarction (STEMI)?
a. Dilation of the blocked coronary artery
b. Anticoagulation to prevent formation of new emboli
c. Dissolution of atherosclerotic plaque at the site of blockage
d. Restoration of blood flow via lysis of the thrombus - ANSWER: ANS: D
The administration of a fibrinolytic agent results in the lysis of the acute thrombus,
thus
recanalizing, or opening, the obstructed coronary artery and restoring blood flow to
the
affected tissue. After perfusion is restored, adjunctive measures are taken to prevent
further
clot formation and reocclusion.
6. A nurse is providing care to a patient on fibrinolytic therapy. Which statement
from the
patient warrants further assessment and intervention by the nurse?
a. "My back is killing me!"
b. "There is blood on my toothbrush!"
c. "Look at the bruises on my arms!"
d. "My arm is bleeding where my IV is!" - ANSWER: ANS: A
The nurse must continually monitor for clinical manifestations of bleeding. Mild
gingival
bleeding and oozing around venipuncture sites are common and not causes for
concern.
However, severe lower back pain and ecchymoses are suggestive of retroperitoneal
bleeding.
If serious bleeding occurs, all fibrinolytic heparin therapies are discontinued, and
volume
expanders, coagulation factors, or both are administered.
Which finding is a reliable indicator of reperfusion after fibrinolytic therapy?
a. Dysrhythmias
b. Q waves
c. Elevated ST segments
d. Immediate rapid decrease in cardiac biomarkers - ANSWER: ANS: A
Initially, when there is reperfusion, ischemic chest pain ceases abruptly as blood flow
is
restored. Another reliable indicator of reperfusion is the appearance of various
"reperfusion"
dysrhythmias. Premature ventricular contractions, bradycardias, heart block,
ventricular
tachycardia, and (rarely) ventricular fibrillation may occur.
Which patients would be a candidate for fibrinolytic therapy? (Select all that apply.)
a. The patient's chest pain started 8 hours ago. She has a diagnosis of NSTEMI.
b. The patient's chest pain started 3 hours ago, and her ECG shows a new left bundle
branch block.
, c. The patient presents to the emergency department with chest pain of 30 minutes'
duration. She has a history of cerebrovascular accident 1 month ago.
d. The patient has a history of unstable angina. He has been experiencing chest pain
with sudden onset.
e. The patient's chest pain started 1 hour ago, and his ECG shows ST elevation -
ANSWER: ANS: B, E
Eligibility criteria for administering fibrinolytics include chest pain of less than 12
hours'
duration and persistent ST elevation. Exclusion criteria include recent surgery,
cerebrovascular accident, and trauma.
Which signs and symptoms would indicate successful reperfusion after
administration of a
fibrinolytic agent? (Select all that apply.)
a. Gradual decrease in chest pain
b. Intermittent, multifocal premature ventricular contractions
c. Rapid resolution of ST elevation
d. Rapid rise in creatine kinase MB fraction - ANSWER: ANS: B, C, D
A reliable indicator of reperfusion is the appearance of various "reperfusion"
dysrhythmias
such as premature ventricular contractions, bradycardia, heart block, and ventricular
tachycardia. Rapid resolution of the previously elevated ST segment should occur.
The serum
concentration of creatine kinase rises rapidly and markedly, a phenomenon termed
washout.
What are the clinical manifestations of right-sided heart failure?
a. Elevated central venous pressure and sacral edema
b. Pulmonary congestion and jugular venous distention
c. Hypertension and chest pain
d. Liver tenderness and pulmonary edema - ANSWER: ANS: A
The common manifestations of right ventricular failure are the following: jugular
venous
distention, elevated central venous pressure, weakness, peripheral or sacral edema,
hepatomegaly (enlarged liver), jaundice, and liver tenderness. Gastrointestinal
symptoms
include poor appetite, anorexia, nausea, and an uncomfortable feeling of fullness.
Which mechanism is responsible for the augmentation of coronary arterial blood
flow and
increased myocardial oxygen supply seen with the intra-aortic balloon pump?
a. The vacuum created in the aorta as a result of balloon deflation
b. Diastolic inflation with retrograde perfusion
c. Forward flow to the peripheral circulation
d. Inflation during systole to augment blood pressure - ANSWER: ANS: B
The blood volume in the aorta below the level of the balloon is propelled forward
toward the
200 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES| (ALREADY GRADED A+) |BRAND
NEW!!
Which mechanism is responsible for the augmentation of coronary arterial blood
flow and increased myocardial oxygen supply seen with the intra-aortic balloon
pump?
a. The vacuum created in the aorta as a result of balloon deflation
b. Diastolic inflation with retrograde perfusion
c. Forward flow to the peripheral circulation
d. Inflation during systole to augment blood pressure - ANSWER: B.
The blood volume in the aorta below the level of the balloon is propelled forward
toward the
peripheral vascular system, which may enhance renal perfusion. Subsequently, the
deflation
of the balloon just before the opening of the aortic valve creates a potential space or
vacuum
in the aorta, toward which blood flows unimpeded during ventricular ejection. This
decreased
resistance to left ventricular ejection, or decreased afterload, facilitates ventricular
emptying
and reduces myocardial oxygen demands.
What is the most common complication of fibrinolytic therapy?
a. Reperfusion chest pain
b. Lethargy
c. Bleeding
d. Heart blocks - ANSWER: ANS: C
The most common complication related to thrombolysis is bleeding.
What is the preferred initial treatment of an acute myocardial infarction?
a. Fibrinolytic therapy
b. Percutaneous coronary intervention (PCI)
c. Coronary artery bypass surgery (CABG)
d. Implanted cardioverter defibrillator (ICD) - ANSWER: ANS: B
PCI is now preferred as the initial method of treatment for acute MI (primary PCI).
PCI
includes balloon angioplasty, atherectomy, and stent implantation, as well as a
number of
adjunctive devices used to facilitate successful revascularization in coronary vessels.
5. What is the rationale for administrating a fibrinolytic agent to a patient
experiencing acute
,ST-elevation myocardial infarction (STEMI)?
a. Dilation of the blocked coronary artery
b. Anticoagulation to prevent formation of new emboli
c. Dissolution of atherosclerotic plaque at the site of blockage
d. Restoration of blood flow via lysis of the thrombus - ANSWER: ANS: D
The administration of a fibrinolytic agent results in the lysis of the acute thrombus,
thus
recanalizing, or opening, the obstructed coronary artery and restoring blood flow to
the
affected tissue. After perfusion is restored, adjunctive measures are taken to prevent
further
clot formation and reocclusion.
6. A nurse is providing care to a patient on fibrinolytic therapy. Which statement
from the
patient warrants further assessment and intervention by the nurse?
a. "My back is killing me!"
b. "There is blood on my toothbrush!"
c. "Look at the bruises on my arms!"
d. "My arm is bleeding where my IV is!" - ANSWER: ANS: A
The nurse must continually monitor for clinical manifestations of bleeding. Mild
gingival
bleeding and oozing around venipuncture sites are common and not causes for
concern.
However, severe lower back pain and ecchymoses are suggestive of retroperitoneal
bleeding.
If serious bleeding occurs, all fibrinolytic heparin therapies are discontinued, and
volume
expanders, coagulation factors, or both are administered.
Which finding is a reliable indicator of reperfusion after fibrinolytic therapy?
a. Dysrhythmias
b. Q waves
c. Elevated ST segments
d. Immediate rapid decrease in cardiac biomarkers - ANSWER: ANS: A
Initially, when there is reperfusion, ischemic chest pain ceases abruptly as blood flow
is
restored. Another reliable indicator of reperfusion is the appearance of various
"reperfusion"
dysrhythmias. Premature ventricular contractions, bradycardias, heart block,
ventricular
tachycardia, and (rarely) ventricular fibrillation may occur.
Which patients would be a candidate for fibrinolytic therapy? (Select all that apply.)
a. The patient's chest pain started 8 hours ago. She has a diagnosis of NSTEMI.
b. The patient's chest pain started 3 hours ago, and her ECG shows a new left bundle
branch block.
, c. The patient presents to the emergency department with chest pain of 30 minutes'
duration. She has a history of cerebrovascular accident 1 month ago.
d. The patient has a history of unstable angina. He has been experiencing chest pain
with sudden onset.
e. The patient's chest pain started 1 hour ago, and his ECG shows ST elevation -
ANSWER: ANS: B, E
Eligibility criteria for administering fibrinolytics include chest pain of less than 12
hours'
duration and persistent ST elevation. Exclusion criteria include recent surgery,
cerebrovascular accident, and trauma.
Which signs and symptoms would indicate successful reperfusion after
administration of a
fibrinolytic agent? (Select all that apply.)
a. Gradual decrease in chest pain
b. Intermittent, multifocal premature ventricular contractions
c. Rapid resolution of ST elevation
d. Rapid rise in creatine kinase MB fraction - ANSWER: ANS: B, C, D
A reliable indicator of reperfusion is the appearance of various "reperfusion"
dysrhythmias
such as premature ventricular contractions, bradycardia, heart block, and ventricular
tachycardia. Rapid resolution of the previously elevated ST segment should occur.
The serum
concentration of creatine kinase rises rapidly and markedly, a phenomenon termed
washout.
What are the clinical manifestations of right-sided heart failure?
a. Elevated central venous pressure and sacral edema
b. Pulmonary congestion and jugular venous distention
c. Hypertension and chest pain
d. Liver tenderness and pulmonary edema - ANSWER: ANS: A
The common manifestations of right ventricular failure are the following: jugular
venous
distention, elevated central venous pressure, weakness, peripheral or sacral edema,
hepatomegaly (enlarged liver), jaundice, and liver tenderness. Gastrointestinal
symptoms
include poor appetite, anorexia, nausea, and an uncomfortable feeling of fullness.
Which mechanism is responsible for the augmentation of coronary arterial blood
flow and
increased myocardial oxygen supply seen with the intra-aortic balloon pump?
a. The vacuum created in the aorta as a result of balloon deflation
b. Diastolic inflation with retrograde perfusion
c. Forward flow to the peripheral circulation
d. Inflation during systole to augment blood pressure - ANSWER: ANS: B
The blood volume in the aorta below the level of the balloon is propelled forward
toward the
