Q: Which heart sound indicates ventricular compliance issues often seen in left ventricular hypertrophy?

S4. S4 (atrial gallop) occurs when the atrium contracts against a stiff, non-compliant ventricle during late diastole. It is commonly heard in conditions causing ventricular hypertrophy such as hypertension, aortic stenosis, and hypertrophic cardiomyopathy. S3 indicates volume overload/heart failure. S1 and S2 are normal heart sounds.

Q: A patient presents with sudden-onset tearing chest pain radiating to the back with BP difference of 25 mmHg between arms. What is the priority intervention?

Start IV beta blocker. This presentation is classic for aortic dissection. The priority is BP control, starting with beta blockers to reduce heart rate and contractility (shear stress) before vasodilators. Aspirin and PCI would be harmful if dissection is confirmed. The target is SBP <120 and HR <60. Pain control is important but beta blockade takes priority.

Q: Normal Pulmonary Artery Occlusion Pressure (PAOP/PCWP) is:

8-12 mmHg. Normal PAOP (also called PCWP or wedge pressure) is 8-12 mmHg. This reflects left heart filling pressure (preload). RAP/CVP of 2-6 mmHg reflects right heart preload. Elevated PAOP >18 mmHg suggests left heart failure or volume overload. PA systolic pressure is normally 20-30 mmHg.

Question 1

A patient with an acute MI develops new hypotension with a BP of 78/50 mmHg, HR 110, and cool extremities. The PA catheter shows: CO 3.2 L/min, CI 1.8 L/min/m², PAOP 22 mmHg, SVR 1800 dynes. What is the most likely diagnosis?

Accepted Answer

Cardiogenic shock. The hemodynamic profile shows low CO/CI, elevated PAOP (indicating fluid overload/LV failure), and elevated SVR (compensatory vasoconstriction). This is classic for cardiogenic shock. Hypovolemic shock would show low PAOP. Septic shock typically shows low SVR with warm extremities. The patient has signs of poor perfusion (cool extremities) following MI.

Question 2

Which ECG finding is MOST indicative of hyperkalemia?

Accepted Answer

Peaked T waves. Peaked T waves are the earliest and most characteristic ECG finding of hyperkalemia. As potassium rises, the progression includes: peaked T waves → PR prolongation → loss of P wave → widened QRS → sine wave pattern → cardiac arrest. Prolonged QT and U waves are associated with hypokalemia. ST depression can indicate ischemia.

Question 3

A patient in hypertrophic obstructive cardiomyopathy (HOCM) becomes hypotensive. Which intervention should be AVOIDED?

Accepted Answer

Dobutamine. Dobutamine (an inotrope) should be AVOIDED in HOCM. Increasing contractility worsens the left ventricular outflow tract (LVOT) obstruction. Treatment focuses on decreasing contractility (beta blockers) and maintaining preload (IV fluids). Phenylephrine (pure vasoconstrictor) increases afterload and can actually help by reducing the pressure gradient.

Question 4

The nurse is caring for a patient post-PCI. Which finding requires IMMEDIATE intervention?

Accepted Answer

Back pain with decreasing hemoglobin. Back pain with decreasing hemoglobin suggests retroperitoneal bleeding, a serious complication of femoral artery access. This requires immediate intervention including holding anticoagulation and possible emergent CT/surgery. Groin ecchymosis is common and expected. The HR and BP values are acceptable.

Question 5

What is the door-to-balloon time goal for STEMI patients undergoing primary PCI?

Accepted Answer

Within 90 minutes. The goal for door-to-balloon time in STEMI is within 90 minutes. This is based on evidence that shorter times to reperfusion are associated with better outcomes. The saying "time is muscle" emphasizes the importance of rapid reperfusion to limit myocardial damage. Door-to-needle for fibrinolytics is 30 minutes when PCI is not available.

Question 6

A patient with heart failure has a BNP of 850 pg/mL. This indicates:

Accepted Answer

Significant ventricular wall stress. BNP (Brain Natriuretic Peptide) is released by ventricular myocytes in response to wall stress/stretch. A BNP >100 pg/mL suggests heart failure, and 850 pg/mL indicates significant ventricular wall stress. BNP helps differentiate cardiac from pulmonary causes of dyspnea. Normal BNP is typically <100 pg/mL.

Question 7

Which heart sound indicates ventricular compliance issues often seen in left ventricular hypertrophy?

Accepted Answer

S4. S4 (atrial gallop) occurs when the atrium contracts against a stiff, non-compliant ventricle during late diastole. It is commonly heard in conditions causing ventricular hypertrophy such as hypertension, aortic stenosis, and hypertrophic cardiomyopathy. S3 indicates volume overload/heart failure. S1 and S2 are normal heart sounds.

Question 8

A patient presents with sudden-onset tearing chest pain radiating to the back with BP difference of 25 mmHg between arms. What is the priority intervention?

Accepted Answer

Start IV beta blocker. This presentation is classic for aortic dissection. The priority is BP control, starting with beta blockers to reduce heart rate and contractility (shear stress) before vasodilators. Aspirin and PCI would be harmful if dissection is confirmed. The target is SBP <120 and HR <60. Pain control is important but beta blockade takes priority.

Question 9

Normal Pulmonary Artery Occlusion Pressure (PAOP/PCWP) is:

Accepted Answer

8-12 mmHg. Normal PAOP (also called PCWP or wedge pressure) is 8-12 mmHg. This reflects left heart filling pressure (preload). RAP/CVP of 2-6 mmHg reflects right heart preload. Elevated PAOP >18 mmHg suggests left heart failure or volume overload. PA systolic pressure is normally 20-30 mmHg.

Question 10

What is the primary action of nitroprusside in hypertensive emergency?

Accepted Answer

Both arterial and venous vasodilation. Nitroprusside is a potent vasodilator affecting both arterial and venous systems. It reduces both preload (venodilation) and afterload (arteriodilation), making it effective for rapid BP reduction. Important: Watch for cyanide/thiocyanate toxicity with prolonged use. It requires continuous monitoring due to its potent effect.

Cardiovascular CCRN Practice Questions

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