PCCN questions and answers 100% GRADE A+ GUARANTEED
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PCCN
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PCCN
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic pressure (LVEDP), the pressure exerted on the ve...
diastolic pressure in the aortic root is higher th
although all of the answers may occur swelling og
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PCCN questions and answers 100%
GRADE A+ GUARANTEED
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular
end-diastolic pressure (LVEDP), the pressure exerted on the
ventricular muscle at the end of diastole when the ventricle is full.
This enables blood to flow from a higher pressure through open
arteries to a lower pressure, a pressure gradient known as coronary
artery prefusion pressure. As diastolic pressure drops, there is a
decrease in coronary artery blood flow. Coronary artery perfusion is
not affected by systolic pressure, afterload or SVR, but they all
increase the demand of oxygen in the heart.
A post-STEMI (ST elevation myocardial infarction) patient is started
on an angiotensin-converting enzyme (ACE) inhibitor during his
hospital stay. Which of the following is the most common serious side
effect that may occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
D. rhinorrhea
C. swelling of the tongue and face
Although all of the answers may occur, swelling og the tongue and
face is the most serious and may require intervention. Patients
should be instructed to seek medical attention immediately for any
signs of swelling in the tongue or throat.
Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts
D. It occurs during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant
(stiff) left ventricle. An S4 is also called an atrial heart sound
since it occurs at the end of diastolic filling when the atria
,contracts and fully fills the left ventricle. Known as "atrial kick",
this filling is important to cardiac output. The increased end-
diastolic volume in the ventricle improves cardiac output. When the
left ventricle is stiff (decreased compliance with long term
hypertension, aortic stenosis or with acute STEMI), the atrium has to
pump harder to move blood from the atrium to the ventricle, causing a
turbulent blood flow and extra heart sound. This heart sound is
always pathologic. It occurs before ventricular contraction, is best
heard with the bell of the stethoscope and is never a normal heart
sound, even in children.
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
C. Q-wave formation
D. ST-segment depression and T-wave inversion
D. ST segment depression and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular
muscle. That change is seen on the 12 lead ECG as ST-segment
depression and T wave inversion, which demonstrate subendocardial
ischemia -- the innermost layer of muscle in the myocardium. ST-
segment elevation indicates acute injury or infarction, ST segment
depression and T wave elevation may indicate an electrolyte
abnormality, while Q wave formation indicates total infarction.
Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
D. vasodilate vessels
A. improve cardiac output and tissue perfusion
The term "inotropic" refers to affecting the force of myocardial
contraction. Improvement of cardiac muscle contraction leads to
improved cardiac output and tissue perfusion.
A patient in the ED is now being admitted to telemetry bwith
complaint of chest pain and has been judged to be a possible
candidate for therapy with alteplase (Activase). Which of the
following is not considered a contraindication for the use of this
medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed
A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase.
,All the other answers -- recent abdominal surgery, recent
gastrointestinal bleeding and a recent intracranial bleed -- are
contraindications for the use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload)
A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac
output. If the SVR (afterload) is high and the cardiac output low,
the patient may still have a normal BP. the pulse pressure will be
lower, but this is a compensatory response by the heart to maintain
BP. If the SVR (afterload) is low (as in early septic shock), the
cardiac output is very high, thereby trying to support BP.
The layer of the arterial vessel wall responsible for changes in the
diameter of the artery is the:
A. media
B. intima
C. externa
D. adventitia
A. media
The media layer of the arterial wall contains vascular smooth muscle
cells and is responsible for arterial tone. Vasoactive substances
released in response to the sympathetic nervous system and/or the
renin-angiotensin system determine arterial tone. Intima, externa and
adventitia are incorrect.
A patient presents in acute distress with rales halfway up
bilaterally; cool and clammy extremities; elevated jugular venous
distention (JVD); oxygen saturations at 95%, down from 99%; and
complaints of shortness of breath. Which of the following findings
correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion
D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to
pulmonary edema, causing pulmonary congestion. Pneumonia can also
cause fluid in the alveolar sacs. The patient is complaining of
shortness of breath, and the oxygen saturations are lowering, also
indicating that the patient has pulmonary congestion. The patient's
skin is cool and clammy, indicating that the skin is poorly perfused.
, Skin does not require oxygen and shunts blood away in decreased
cardiac function; therefore, this patient has pulmonary congestion
and low perfusion state. The other answers are incorrect.
When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction
A. the beginning of ventricular systole
The heart sound of S1 indicates the opening of the aortic and
pulmonic valves and marks the beginning of ventricular systole or
ejection. The beginning of diastole is after S2, propulsion of blood
into a noncompliant chamber is S4, and blood going in the wrong
direction will cause a murmur.
A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure
A. increased thickness of the alveolar capillary membrane
With increasing left ventricular pressures, blood moves back into the
left atrium, then to the pulmonary veins. When the pressure in the
pulmonary veins increases, capillary function decreases, and fluid
then shifts to the interstitial space, causing interstitial edema,
thereby, increasing the thickness of the space oxygen must travel.
When left ventricular pressures increase, the fluid then shifts to
the alveolar space, causing pulmonary edema. This fluid acts as a
deterrent to oxygen diffusion. Retention of CO2 does not impair
diffusion. An elevated body temperature associated with pulmonary
edema is not causing a diffusion abnormality; increased temperature
shifts the oxyhemoglobin curve to the right, more quickly releasing
oxygen to the tissues. Low barometric pressure has no effect on
diffusion of gases in the lung.
A patient with an anterior-wall STEMI is in cardiogenic shock. What
would be the hemodynamic profile assessment?
A. decreased cardiac index, increased preload, increased afterload
B. decreased cardiac index, decreased preload, increased afterload
C. decreased cardiac index, decreased preload, decreased afterload
D. increased cardiac index, decreased preload, decreased afterload
A. decreased cardiac index, increased preload, increased afterload
In a patient with cardiogenic shock, both preload and afterload are
increased due to severe vasoconstriction on both the venous and
arterial side. Arterial vasoconstriction increases afterload and
therefore lowers cardiac index. Because the ventricle is failing and
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