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PCCN questions with correct answers updated 2024

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PCCN questions with correct answers updated 2024 Coronary artery perfusion is dependent upon: A. diastolic pressure B. systolic pressure C. afterload D. systemic vascular resistance (SVR) - ANSWER-A. diastolic pressure Diastolic pressure in the aortic root is higher than left ventricular end...

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Copyright © KAYLIN 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH NOVEMBER, 2024

PCCN questions with correct answers

updated 2024

Coronary artery perfusion is dependent upon:

A. diastolic pressure

B. systolic pressure

C. afterload

D. systemic vascular resistance (SVR) - ANSWER✔✔-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

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C. swelling of the tongue and face

D. rhinorrhea - ANSWER✔✔-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 - ANSWER✔✔-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

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B. ST-segment depression and T-wave elevation

C. Q-wave formation

D. ST-segment depression and T-wave inversion - ANSWER✔✔-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 - ANSWER✔✔-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

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B. recent abdominal surgery

C. recent gastrointestinal bleed

D. recent intracranial bleed - ANSWER✔✔-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) - ANSWER✔✔-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

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