NR571 Midterm Exam | Complex Diagnosis
& Management in Acute Care Exam |
Questions and Answers with Rationale|
Graded A+ | Latest 2024/2025
What diagnostic is considered the test of choice when differentiating
between the cardiomyopathies?
A.Cardiac catheterization
B.Echocardiogram
C.EKG
D.Cardiac CT
Answer: B. Echocardiogram
Rationale: Echocardiogram provides a window to the structure of the
heart and is diagnostic for the type of cardiomyopathy present. Cardiac
catheterization can give detailed information about coronary perfusion,
and intracardiac hemodynamics but is not considered the diagnostic of
choice for cardiomyopathy. EKG gives information about the conductive
system of the heart but does not allow for differentiation between the
types of cardiomyopathies. Cardiac CT is not indicated for differentiating
between types of cardiomyopathies.
Which class of medications must be used with extreme caution in
patients with hypertrophic cardiomyopathy (HCM)?
A.Beta-blockers
Rationale: Diuretics must be used with extreme caution in people with
HCM as they may result in hypovolemia and reduced stroke volume that
will further exacerbate a left ventricular outflow obstruction and may
result in hypotension. Beta-blockers are not contraindicated in HCM and
may be part of the treatment plan. Antibiotics are not indicated in the
treatment of HCM. Calcium channel blockers may be used to treat HCM
and do not carry any special precautions with their use for this illness.
What characteristic findings on EKG are expected for the patient
diagnosed with cardiac ischemia?
A.ST depressions
B.Global concave-shaped ST elevations
C.T-wave elevations
D.An S1Q3T3 pattern
Answer: A. ST depressions
Rationale: ST depressions are indicative of myocardial ischemia. T-wave
inversions may indicate ischemia but not elevations. Global concave-
shaped ST elevations and PR depressions may be seen in patients with
pericarditis. An S1Q3T3 pattern may be seen in the presence of
pulmonary embolism (PE).
,A 16-year-old female patient presents after having passed out after
jumping up quickly to answer a knock at the door. This event was
preceded by a feeling of warmth throughout. A bystander reports that the
patient became "pale and sweaty." What differential diagnosis is most
consistent with this presentation?
Vasovagal syncope
Orthostatic hypotension
Arrhythmia
Seizure
Answer: B. Orthostatic hypotension
Rationale: Orthostatic hypotension uncommonly results in syncope and
is preceded by a sudden change in position from sitting or lying to
standing. Arrhythmogenic syncope may be preceded by palpitations,
chest discomfort, diaphoresis, and a feeling of light-headedness.
Syncope that is preceded by an aura and that has fecal or urinary
incontinence is highly suspicious for a seizure.
What is considered the intervention of choice to treat a ST-segment
elevation myocardial infarction (STEMI)?
A.Percutaneous coronary intervention (PCI)
B.Echocardiogram
C.EKG
D.Coronary artery bypass grafting (CABG)
Answer: B. Echocardiogram
Rationale: Echocardiogram provides a window to the structure of the
heart and is diagnostic for the type of cardiomyopathy present. CABG is
a suitable intervention, but not initially, unless other circumstances
, dictate need for immediate CABG. PCI gives detailed information about
coronary perfusion and intracardiac hemodynamics and is the choice of
intervention to reperfuse coronary vessels in patients without diabetes.
EKG provides information about the ischemia of the heart but does not
allow for intervention.
A 62-year-old male patient with a history of hypertension, hyperlipidemia,
and diabetes presents with 3 hours of substernal chest pain. He is
anxious, diaphoretic, and nauseous. His blood pressure (BP) is 90/70
mmHg, pulse 50 beats per minute, respirations 24 per minute. His lungs
are clear, no murmurs, and there is ~10 cm of jugular venous distension
(JVD). His EKG is shown below.
Answer: A. Inferior myocardial infarction with evidence of right
ventricular involvement
Rationale: This patient has ST-segment elevation in the inferior leads, II,
III, and aVF indicating inferior wall involvement. He also has elevated
jugular venous distension in the setting of clear lung fields, a sign for
right ventricular involvement. Confirming right ventricular involvement
would be noted by changes in the placement of right ventricular V3–V4
leads with noted ST-segment changes.
A 33-year-old patient with a recent history of viral infection is now
presenting with acute onset of substernal chest pain that radiates to the
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