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Which of the following type of drug would be prescribed after a MI to aid in prevention of remodeling?
A. Beta-blockers
B. Calcium channel blockers C. Angiotensin-converting enzyme (ACE) inhibitors
D. Anticoagulants - ✔ ✔ C. ACE inhibitors
Which of the following types of drugs can cause hypotension, hyperkalemia, angioedema, proteinuria, and cough?
A. Beta-blockers
B. Loop diuretics C. Calcium channel blockers
D. Angiotensin-converting enzyme (ACE) inhibitors - ✔ ✔ D. Angiotensin- converting enzyme (ACE) inhibitors
Which of the following would be a contraindication to the use of fibrinolytic drugs, such as recombinant tissue plasminogen activator?
A. Hypotension
B. Heart block C. Uncontrolled hypertension
D. Pain lasting more than 6 hours - ✔ ✔ C. uncontrolled hypertension
Which of the following would be contraindicated in a patient with Wolff- Parkinson-White (WPW) syndrome?
A. Amiodarone (Cordarone)
B. Lidocaine (Xylocaine) C. Adenosine (Adenocard)
D. Verapamil (Calan) - ✔ ✔ D. Verapamil (Calan)
Which of the following would not be associated with a false-positive result for an acute MI using the total creatine kinase (CK)?
A. Hypothyroidism
B. Hemorrhagic stroke C. Cardioversion
D. Ulcerative colitis - ✔ ✔ D. Ulcerative colitis
A 40-year-old patient has been admitted to the critical care unit after sustaining multiple injuries from a cave-in accident this morning. X-ray confirm multiple fractures, including the left femur. During the afternoon he was taken to surgery for internal fixation of the left femur. It is now 10 pm, and the patient is complaining of severe throbbing pain in his thigh. The patient received 5 mg of morphine sulfate IV 30 minutes ago. The anterior left thigh is firm to touch, and the pain increases when the patient flexes his left leg. The nurse should suspect which of the following?
A. Normal pain related to fractured femur
B. Abnormal pain related to compartment syndrome
tachycardia. Vital signs are temperature 98.6° F, BP 80/60, HR 120 and RR 24. Mediastinal tube drainage is approximately 50 mL/hr. He is diagnosed with decreased cardiac contractility. Which of the following would be an appropriate treatment for this patient?
A. Beta-adrenergic stimulant (e.g., dobutamine)
B. Diuretic (e.g., furosemide) C. Normal saline bolus
D. Antibiotics - ✔ ✔ A. Beta-adrenergic stimulant (e.g., dobutamine)
A 55-year-old man with a long history of alcoholism continues to drink alcohol and now has alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of the following would this patient not be expected to receive?
A. Angiotensin-converting enzyme inhibitors B. Cardiac transplant referral
C. Diuretics
D. Inotropes - ✔ ✔ B. Cardiac transplant referral
A 57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal MI. A PA catheter was inserted, and initial readings were within normal limits. BP 140/92, HR 110 and regular, RR 24. Breath sounds equal and clear. 3 hrs after admission, the pt becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR 28 and labored. Crackles are audible at the lung bases BL. The patient is given furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of the following would be the most appropriate intervention at this time?
A. Administer saline bolus.
B. Decrease dobutamine drip rate. C. Increase nitroglycerin drip rate.
D. Replace potassium. - ✔ ✔ A. Administer saline bolus.
A 61-year-old man is admitted to the critical care unit from the cath lab. He has just had a PCI and stent insertion to the RCA. His leg is immobilized, and the HOB 30 degrees. Six hours later the patient is restless and complaining of back pain. The femoral sheath is intact in the right femoral area, and there is no evidence of bleeding or hematoma. Neck veins are flat with the HOB 30 degrees, and heart sounds are normal. Vital signs are BP 80/50, HR 120, and RR 24. Which of the following is the priority issue for patient education for this patient?
A. The need for lifestyle changes to decelerate the atherosclerotic process B. To avoid magnetic resonance imaging
C. The need for taking a platelet aggregation inhibitor daily
D. How to take nitroglycerin - ✔ ✔ C. The need for taking a platelet aggregation inhibitor daily
A 65-year-old black man comes to the ER with complaints of headache. His admission BP 220/150. A nitroprusside (Nipride) drip is initiated. Which of the following would not be an important aspect of care for a patient receiving nitroprusside?
A. Closely assessing the patient for clinical indications of hypoxia
B. Monitoring the patient's blood pressure every 1-2 minutes until it stabilizes and dosage is established
C. Checking the patient's serum glucose every 6 hours
D. Monitoring the patient for signs of thiocyanate poisoning - ✔ ✔ C. Checking the patient's serum glucose every 6 hours
B. Mild heart failure C. Massive pulmonary embolus
D. Acute pulmonary edema - ✔ ✔ D.
Acute pulmonary edema
A patient arrives to the ED with a knife sticking out of his chest. He is stable at this time but complaining of pain at the knife insertion site. The physician is busy resuscitating another patient. What should be done?
A. Remove the knife so that the wound can be cleansed.
B. Remove the knife and apply a sterile, occlusive dressing. C. Leave the knife in but stabilize it with adhesive tape.
D. Leave the knife in but apply a pressure dressing over it. - ✔ ✔ C. Leave the knife in but stabilize it with adhesive tape.
A patient becomes apneic and pulseless. CPR has been initiated, and the monitor shows asystole in two leads. Which of the following drugs would be used initially?
A. Calcium gluconate B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone) - ✔ ✔ C
After CPR is initiated and an intravenous access is established, epinephrine should be given. Calcium was used in the past in asystole but is used today only for hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia. Atropine is no longer recommended for asystole. Amiodarone is not indicated in asystole because asystole is the absolute absence of irritability.
A patient has developed a 2:1 AV block. Which of the following two factors would be helpful in deciding that it is most likely type II second-degree AV block?
A. The QRS complex is 0.1 second wide, and the patient has had an anterior myocardial infarction (MI).
B. The QRS complex is 0.14 second wide, and the patient has had an anterior MI.
C. The QRS complex is 0.1 second wide, and the patient has had an inferior MI. D. The QRS complex is 0.14 second wide, and the patient has had an inferior MI.
- ✔ ✔ B. The QRS complex is 0.14 second wide, and the patient has had an anterior MI.
A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following complications most likely is occurring in this patient?
A. Acute mitral regurgitation
B. Rupture of left ventricular free wall
C. Ventricular septal rupture
D. Acute aortic stenosis - ✔ ✔ A
With an inferior MI, the risk of the papillary muscles being affected is greater. The papillary muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral regurgitation occurs and is manifested by a new holosystolic murmur at the apex, acute pulmonary edema, and decreased cardiac output/index
A patient has just arrived in the ED with severe dyspnea. His history includes an inferior MI approximately 1 week ago. Physical assessment reveals a loud, blowing holosystolic murmur that is loudest at the apex and radiates to the axilla.
B. ventricle is paced in response to a sensed intrinsic atrial impulse.
C. atrium and ventricle are paced, but only ventricular pacing can be inhibited by a sensed intrinsic ventricular impulse.
D. ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by a sensed intrinsic ventricular impulse. - ✔ ✔ D.
The ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by a sensed intrinsic ventricular impulse
A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system?
A. Sinoatrial (SA) node
B. Bachmann's bundle
C. Atrioventricular (AV) node
D. Bundle of His - ✔ ✔ LAD so D. bundle of his
A patient is admitted to the coronary care unit in third-degree AV heart block with syncopal episodes. Which of the following defines syncope?
A. Dizziness B. Ataxia
C. Vertigo
D. Transient loss of consciousness - ✔ ✔ D. Transient loss of consciousness
A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV block with a ventricular rate of 52 and no pacing spikes. This indicates which of the following?
A. Failure to capture B. Failure to pace
C. Competition between pacemaker and intrinsic rhythm
D. Failure to sense - ✔ ✔ B. Failure to pace
A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV heart block with a ventricular rate of 52 beats/min and no pacing spikes. This indicates failure to pace, and the patient is taken to surgery for insertion of a DVI permanent pacemaker. Which of the following describes the function of a DVI pacemaker?
A. Senses atrium and ventricle; paces ventricle; inhibited by QRS complex
B. Senses atrium and ventricle; paces ventricle; triggered by QRS complex C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex
D. Paces and senses atrium and ventricle; inhibited by the P wave - ✔ ✔ C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex
A patient is in cardiogenic shock and requires careful volume titration to enhance contractility. Which of the following ranges describes the most likely optimal PAOP in this patient?
C. Bradycardia
D. S3 at the apex - ✔ ✔ A. Jugular venous distention
A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type of drug is carvedilol?
A. Calcium channel blocker
B. Angiotensin-converting enzyme inhibitor
C. Alpha- and noncardioselective beta-blocker
D. Cardioselective beta-blocker - ✔ ✔ C. Alpha- and noncardioselective beta- blocker
A postoperative cardiac surgery patient's blood pressure suddenly drops to 70 mm Hg palpable, with a loss of the a wave in the PAOP waveform. What change in his cardiac rhythm would cause this change in his PAOP waveform?
A. Sinus tachycardia B. Sinus dysrhythmia
C. Atrial tachycardia
D. Atrial fibrillation - ✔ ✔ D. afib
A premature P wave buried in the T wave before a run of wide QRS complex tachycardia indicates that the wide QRS complex tachycardia is most likely which of the following?
A. Supraventricular tachycardia with aberrancy
B. Ventricular tachycardia C. Bundle branch block
D. Wolff-Parkinson-White syndrome - ✔ ✔ A.
Supraventricular tachycardia with aberrancy
Aortic stenosis would elevate which of the following?
A. Left ventricular systolic pressure
B. Pulmonary artery systolic pressure C. Arterial systolic pressure
D. Arterial diastolic pressure - ✔ ✔ A. Left ventricular systolic pressure
If the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system is 2 inches below the phlebostatic axis, what effect would it have on pressure measurements?
A. The pressures recorded would be falsely high by about 2 mm Hg. B. The pressures recorded would be falsely low by about 2 mm Hg.
C. The pressures recorded would be falsely high by about 4 mm Hg.
D. The pressures recorded would be falsely low by about 4 mm Hg. - ✔ ✔ C. The pressures recorded would be falsely high by about 4 mm Hg.
In which quadrant is the mean QRS complex axis located if the QRS complex is predominantly positive in lead I and negative in lead aVF?
A. Normal quadrant
B. Left axis deviation quadrant C. Right axis deviation quadrant
D. Indeterminant quadrant - ✔ ✔ *B
C. Ventricular filling
D. Isovolumetric relaxation - ✔ ✔ B. Isovolumetric contraction
patient is in cardiac and respiratory arrest. The selection of medications
to reestablish cardiac function would stimulate the sympathetic nervous
system beta1 receptors. This stimulation would result in increased
automaticity and which of the following?
A. Increased myocardial contractility
B. Decreased left ventricular stroke work
C. Decreased myocardial oxygen consumption
D. Increased left ventricular afterload - ✔ ✔ A. Increased
myocardial contractility
Patients with mitral stenosis may exhibit a pinkish discoloration of the
cheeks (i.e., malar blush). Mitral stenosis causes a diastolic murmur.
Widened pulse pressure is associated with aortic regurgitation.
Narrowed pulse pressure is associated with mitral regurgitation.
What is the most frequently identified primary mechanism of cardiac
arrest?
A. Asystole
B. Ventricular tachycardia
C. Third-degree atrioventricular block
D. Ventricular fibrillation - ✔ ✔ D. Ventricular fibrillation
What type of AV block is characterized by a progressive prolongation of
the PR interval followed by a nonconducted P wave?
A. First-degree AV block
B. Second-degree AV block, type I
C. Second-degree AV block, type II
D. Third-degree AV block - ✔ ✔ B.
Second-degree AV block, type I
When pulmonary arterial diastolic pressure (PAd) is more than 5 mm Hg
higher than pulmonary artery occlusive pressure (PAOP), it signals
which abnormal condition?
A.Right ventricular failure
B.Left ventricular failure
C.Pulmonary hypertension
D.Systemic hypertension - ✔ ✔ C. Pulmonary HTN
*When the PAd is more than 5 mm Hg higher than the PAOP, it is an
indication of pulmonary hypertension. Possible causes of pulmonary
hypertension are passive (e.g., mitral valve disease) or active (e.g.,
causes of hypoxemic pulmonary vasoconstriction such as acute
respiratory distress syndrome, chronic obstructive pulmonary disease, or
pulmonary embolism). Pulmonary embolism causes pulmonary
hypertension by mechanical obstruction and by hypoxemic pulmonary
vasoconstriction.
D. a catheterization of the right side of the heart. - ✔ ✔ A. return to
cardiac catheterization for an additional procedure.
Substernal chest pain, low-grade fever, and pericardial friction rub are
clinical indications of which of the following?
A. Pericarditis
B. Pericardial tamponade
C. Pneumothorax
D. Pleurisy - ✔ ✔ A. Pericarditis
The reciprocal changes of a posterior MI are evident in which leads?
A. II, III, aVF
B. V1, V
C. V5, V
D. I, aVL - ✔ ✔ B. V1, V
The skin changes associated with chronic peripheral arterial disease are:
A. thickened with brownish discoloration at the ankles.
B. pale and shiny.
C. ulcerations at the sides of the ankles.
D. rubor when in dependent position. - ✔ ✔ B. pale and shiny.
Unstable angina that presents as pain at rest is likely to be due to
progression of CAD or which of the following?
A. Dysrhythmias
B. Hypertension
C. Coronary artery spasm
D. Anxiety - ✔ ✔ C. Coronary artery spasm
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure - ✔ ✔ A
Which of the following are clinical indications of bacterial endocarditis?
A. Fever and new murmur
B. Chest pain and pericardial friction rub
C. Dyspnea and crackles
D. Chest pain and syncope - ✔ ✔ A. fever and new murmur
Which of the following are therapeutic goals for drug therapy for dilated
cardiomyopathy?
