AACN-Critical Care Fundamentals (Cardiology, Pulmonary, Neurology) questions, answers and
explanations
1. Question: What are the diagnostic criteria for acute coronary syndrome (ACS), and how do ST-
elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI)
differ in presentation and management?
o Answer: Diagnostic criteria for ACS include chest pain, elevated cardiac biomarkers (e.g.,
troponin), and ECG changes. STEMI is characterized by ST-segment elevation on the ECG
and requires urgent reperfusion therapy (e.g., PCI or thrombolysis). NSTEMI presents
with ST-segment depression or T-wave inversion and is managed with antiplatelet
therapy and possibly invasive procedures.
o Explanation: STEMI and NSTEMI both involve myocardial infarction but differ in their
ECG findings and immediate management strategies, with STEMI requiring rapid
reperfusion and NSTEMI often managed with medical therapy and risk assessment.
2. Question: How is heart failure classified according to the New York Heart Association (NYHA)
functional classification system, and what are the implications for patient management?
o Answer: The NYHA classification system categorizes heart failure into four classes based
on functional limitations: Class I (no symptoms), Class II (mild symptoms), Class III
(marked symptoms), and Class IV (severe symptoms at rest). Management strategies are
tailored to the functional class, with more advanced therapies needed for higher classes.
o Explanation: The NYHA classification helps determine the severity of heart failure and
guides treatment decisions, including medication adjustments and lifestyle
modifications.
3. Question: What are the key features of cardiogenic shock, and how does it differ from other
types of shock in terms of treatment approaches?
o Answer: Cardiogenic shock is characterized by decreased cardiac output due to severe
left ventricular dysfunction, leading to hypotension and organ hypoperfusion. Treatment
includes inotropic support, vasopressors, and addressing the underlying cause (e.g.,
revascularization). It differs from hypovolemic shock, which requires fluid resuscitation,
and septic shock, which requires antibiotics and fluid management.
o Explanation: Cardiogenic shock results from heart failure, necessitating different
management strategies compared to other shock types, which focus on fluid
resuscitation or infection control.
4. Question: What are the indications and contraindications for implantable cardioverter-
defibrillator (ICD) therapy in patients with heart failure?
o Answer: ICD therapy is indicated for patients with symptomatic heart failure and a
reduced ejection fraction (EF ≤ 35%) who are at high risk of sudden cardiac death.
Contraindications include conditions that limit life expectancy to less than one year or
severe comorbidities that may preclude benefit from ICD therapy.
, AACN-Critical Care Fundamentals (Cardiology, Pulmonary, Neurology) questions, answers and
explanations
o Explanation: ICDs are used to prevent sudden cardiac death in high-risk heart failure
patients, with contraindications related to prognosis and overall health status.
5. Question: How is atrial fibrillation (AF) managed in the acute setting, and what are the goals of
treatment?
o Answer: Acute management of AF involves rate control with beta-blockers or calcium
channel blockers, rhythm control (e.g., electrical cardioversion or antiarrhythmic drugs),
and anticoagulation to prevent thromboembolism. The goals are to restore normal sinus
rhythm, control ventricular rate, and reduce the risk of stroke.
o Explanation: The acute management of AF focuses on stabilizing the heart rhythm and
preventing complications, with treatment tailored to the patient's clinical presentation
and underlying conditions.
6. Question: What are the major side effects of commonly used anticoagulants, such as warfarin
and direct oral anticoagulants (DOACs), and how are they managed?
o Answer: Major side effects include bleeding risks. For warfarin, management involves
monitoring INR levels and reversing with vitamin K or prothrombin complex
concentrates if needed. For DOACs, management includes using specific antidotes (e.g.,
andexanet for factor Xa inhibitors) or supportive care for bleeding complications.
o Explanation: Anticoagulants can cause bleeding, requiring careful monitoring and
appropriate reversal strategies to manage adverse effects and ensure patient safety.
7. Question: How does the presence of left bundle branch block (LBBB) affect the interpretation of
ECGs in patients with suspected myocardial infarction (MI)?
o Answer: LBBB can obscure ST-segment changes and T-wave inversions on ECGs, making
the diagnosis of MI challenging. In the presence of LBBB, additional diagnostic methods,
such as echocardiography or cardiac biomarkers, may be necessary to confirm an MI.
o Explanation: LBBB can complicate MI diagnosis due to altered ECG patterns, requiring
supplementary diagnostic tools for accurate assessment.
8. Question: What are the key principles in the management of a patient with hypertensive
emergency, and how do they differ from hypertensive urgency?
o Answer: In hypertensive emergency, blood pressure must be reduced rapidly but
cautiously to prevent organ damage, using intravenous medications (e.g., nitroprusside,
labetalol). In hypertensive urgency, blood pressure reduction is less immediate, typically
achieved with oral medications (e.g., clonidine, captopril) over a period of hours to days.
o Explanation: Hypertensive emergencies require urgent blood pressure management to
prevent end-organ damage, while urgencies are managed with slower, oral medications.
9. Question: What are the indications for coronary artery bypass grafting (CABG) versus
percutaneous coronary intervention (PCI), and how are these decisions made?
