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PCCN questions with correct answers

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  • 2024/2025
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PCCN questions with correct answers 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 pre...

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  • October 15, 2024
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EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024.




PCCN questions with correct answers

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


C. swelling of the tongue and face
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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?

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A. ST-segment elevation


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.




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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 - 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



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