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A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system? A. Sinoatrial (SA) node B. Bachmann's bundle C. Atrioventricular (AV) node D. Bundle of His ANSWERV V LAD so D. bundle of his Which of the following is the preferred lead for ST segment monitoring for a patient with a suspected RCA occlusion? Al B.aVR c. II D. V1 ANSWERVV ce. III Which of the following is not a manifestation of hypertrophic cardiomyopathy? A. Syncope B. Murmur that increases with squatting C. Chest pain D. Sudden cardiac death ANSWERV J *B Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an aortic stenosis type of murmur that decreases when the patient is in a squatting position. The first manifestation of this condition is occasionally sudden cardiac death during exercise. In which quadrant is the mean QRS complex axis located if the QRS complex is predominantly positive in lead I and negative in lead aVF? A. Normal quadrant B. Left axis deviation quadrant C. Right axis deviation quadrant D. Indeterminant quadrant ANSWERV V *B Because the positive of lead | is the left arm, if the QRS complex is upright in lead I, the mean QRS axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the foot, if the QRS complex is negative in lead aVF, the mean QRS axis is upward away from the foot. This axis would be in the upper left quadrant, described as left axis deviation. A patient becomes apneic and pulseless. CPR has been initiated, and the monitor shows asystole in two leads. Which of the following drugs would be used initially? A. Calcium gluconate B. Atropine C. Epinephrine D. Amiodarone (Cordarone) ANSWERYV ¥ C After CPR is initiated and an intravenous access is established, epinephrine should be given. Calcium was used in the past in asystole but is used today only for hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia. Atropine is no longer recommended for asystole. Amiodarone is not indicated in asystole because asystole is the absolute absence of irritability. B. Administer nitroglycerin sublingual spray. C. Stop the heparin. D. Notify the physician ANSWERV V D New-onset severe chest pain after percutaneous coronary intervention suggests acute closure of the dilated coronary artery. The patient needs to be returned to the cardiac catheterization laboratory for repeat dilation and probable ins: in of stent. A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What other data would indicate the development of cardiac tamponade? A. Increased yenous oxygen saturation (SvO2) B. Decreased UO C. Muffled heart sounds D. New holosystolic murmur at the sternum ANSWERV ¥ C Muffled heart sounds are a classic finding in cardiac tamponade. Remember the classic indications of cardiac tamponade referred to as Beck's triad: muffled heart sounds, jugular venous distention, and hypotension. Even though urine output is a sensitive indicator of cardiac output and in cardiac tamponade a decreased stroke volume results in a decreased cardiac output, by the time a nurse would notice the decreased urine output, the patient may have already had a cardiopulmonary arrest. The SvO2 actually would decrease because of the decrease in cardiac output. New holosystolic murmur at the lower left sternal border is a sign of ventricular septal rupture. A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acule severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following complications most likely is occurring in this patient? A. Acute mitral regurgitation B. Rupture of left ventricular free wall C. Ventricular septal rupture D. Acute aortic stenosis ANSWERVV A With an inferior MI, the risk of the papillary muscles being affected is greater. The papillary muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral regurgitation occurs and is manifested by a new holosystolic murmur at the apex, acute pulmonary edema, and decreased cardiac output/index A patient with IF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type of drug is carvedilol? A. Calcium channel blocker B. Angiotensin-converting enzyme inhibitor C. Alpha- and noncardiosclective beta-blocker D. Cardioselective beta-blocker ANS WERV ¥ C. Alpha- and noncardioselective beta- blocker A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute MI. EKG shows ST elevation and T wave inversion in leads V2, V3, and V4. His history includes HTN, 80 pack-years of smoking, COPD, and HLD. An IV and fibrinolytic therapy were initiated in the ED. Which of the following would not be an indication of successful reperfusion? A. Pain cessation B. Absence of creatine kinase (CK) enzyme elevation C. Reversal of ST segment elevation with return of ST segment to baseline D. Failure to sense ANSWERV ¥ RB. Failure to pace Which one of the following structures is at greatest risk for trauma in myocardial contusion? A. Right atrium B. Right ventricle C. Aorta D. Left ventricle ANSWERV ¥ B. RV Leads V8 and V9 are used to evaluate which of the following? A. Left ventricular failure B. Posterior myocardial infarction (MI) C. Lateral MI D. Left bundle branch block ANSWERV V B. posterior MI Which of the following is the major advantage of minimally invasive direct coronary artery bypass grafting (MIDCABG)? A. Decreased cost B. Decreased length of stay C. Avoidance of cardiopulmonary bypass D. Less patient pain ANSWERV V C. avoidance of cardiopulmonary bypass A patient arrives to the ED with a knife sticking out of his chest. Ie is stable at this time but complaining of pain at the knife insertion site. The physician is busy resuscitating another patient. What should be done? A. Remove the knife so that the wound can be cleansed. B. Remove the knife and apply a sterile, occlusive dressing. C. Leave the knife in but stabilize it with adhesive tape. D. Leave the knife in but apply a pressure dressing over it. ANSWERV ¥ C. Leave the knife in but stabilize it with adhesive tape. A.57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal MI. A PA catheter was inserted, and initial readings were within normal limits. BP 140/92, HR 110 and regular, RR 24. Breath sounds cqual and clear. 3 hrs afier admission, the pt becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR 28 and labored. Crackles are audible at the lung bases BL. The patient is given furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of the following would be the most appropriate intervention at this time? A. Administer saline bolus. B. Decrease dobutamine drip rate. C. Increase nitroglycerin drip rate. D. Replace potassium. ANS WERV V A. Administer saline bolus. What type of AV block is characterized by a progressive prolongation of the PR interval followed by a nonconducted P wave? A. First-degree AV block B. Sccond-degree AV block, type I with the HOB 30 degrees, and heart sounds are normal. Vital signs are BP 80/50, HR 120, and RR 24. Which of the following is the priority issue for patient education for this patient’? A. The need for lifestyle changes to decelerate the atherosclerotic process B. To avoid magnetic resonance imaging C. The need for taking a platelet aggregation inhibitor daily D. How to take nitroglycerin ANS WERV V C. The need for taking a platelet aggregation inhibitor daily Unstable angina that presents as pain at rest is likely to be due to progression of CAD or which of the following? A. Dysrhythmias B. Hypertension C. Coronary artery spasm D. Anxiety ANSWERV ¥ C. Coronary artery spasm Which of the following is the major disadvantage of the use of seram myoglobin for the diagnosis of an acute MI? A. Low specificity and false-positive results B. High specificity and false-negative results C. High sensitivity and false-positive results D. Low sensitivity and false-negative results ANSWERV V C. High sensitivity and false- positive results Which of the following is the most likely mechanism for atrial tachycardias? A. Reentry B. Triggered activity C. Accessory pathways D. Enhanced automaticity ANSWERV V A. re-entry Which of the following would be a contraindication to the use of fibrinolytic drugs, such as recombinant tissue plasminogen activator? A. Hypotension B. Heart block C. Uncontrolled hypertension D. Pain lasting more than 6 hours ANSWERV ¥ C. uncontrolled hypertension A patient returns to the critical care unit after insertion of a transvenous pacemaker. There are pacing spikes not followed by a QRS. Which of the following is a method to facilitate capture during pacing? A. Increase the pacing rate. B. Increase the milliamperage. C. Suppress the competitive rhythm. D. Increase the sensitivity ANSWERV ¥ B. Increase the milliamperage. eduction in peripheral circulation and shifting of the oxyhemoglobin dissociation curve can affect the accuracy of which of the following? D. Arterial diastolic pressure ANSWERY V A. Left ventricular systolic pressure Which of the following does not predispose the patient to digitalis toxicity? A. Hypokalemia B. Hypercalcemia C. Hypomagnesemia D. Hyponatremia ANS WERV ¥ D. Hyponatremia Which of the following types of drugs can cause hypotension, hyperkalemia, angioedema, proteinuria, and cough? A. Beta-blockers B. Loop diuretics C. Calcium channel blockers D. Angiotensin-converting enzyme (ACE) inhibitors ANSWERV ¥ D. Angiotensin- converting enzyme (ACE) inhibitors Ashman's phenomenon is most likely to be evident in which of the following electrocardiogram changes? A. Second-degree atrioventricular block, type I (Wenckcbach) B. Atrial fibrillation C. Sinus dysrhythmia D. Premature ventricular contraction ANSWERV V B. A-fib Ashman's phenomenon is more likely to be evident in rhythms that are irregular; therefore having more short cycles after long cycles. The most likely rhythm to demonstrate Ashman's phenomenon is atrial fibrillation because it is irregularly irregular. Ashman's phenomenon is also evident in carly premature atrial complexes. Again, Ashman's phenomenon occurs when a short cycle follows a long cycle. Which of the following is a clinical indication of diastolic dysfunction? A.S3 B. S4 C. Murmur D. Midsystolic click ANSWERVV B. S4 Which of the following type of drug would be prescribed aficr a MI to aid in prevention of remodeling? A. Beta-blockers B. Calcium channel blockers C. Angiotensin-converting enzyme (ACE) inhibitors D. Anticoagulants ANS WERV ¥ C. ACE inhibitors Which of the following are clinical indications of bacterial endocarditis? A. Fever and new murmur B. Chest pain and pericardial friction rub C. Dyspnea and crackles D. Chest pain and syncope ANSWERV V A. fever and new murmur A 55-year-old man with a long history of alcoholism continues to drink alcohol and now has alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of the following would this patient not be expected to receive? A. Angiotensin-conyerling enzyme inhibitors B. Cardiac transplant referral C. Diuretics D. Inotropes ANSWERV ¥ B. Cardiac transplant referral The reciprocal changes of a posterior MI are evident in which leads? A. LL LW, aVi’ B. V1, V2 C.V5, V6 D. I, aVL ANSWERV ¥ B. VI, V2 A 52-year-old woman arrives in the ED. started having fluttering in her chest about 1 hour ago and now is having chest pain. She has a history of HTN. The EKG monitor shows paroxysmal atrial tachycardia with IIR 150, BP 130/88. Verapamil 5 mg is given via slow IV push. What would be a desirable therapeutic outcome? A, Decrease in blood pressure B. Decrease in heart rate C. Change in rhythm to atrial fibrillation D. A decrease in the fluttering feeling in her chest ANS WERV ¥ B. Decrease in heart rate Which of the following is the most common cause of death associated with an acute MI? A. Heart failure B. Ventricular dysrhythmias C. Pulmonary edema D. Thromboembolism ANS WERV ¥ B. Ventricular dysrhythmias Ifa murmur is audible at the same time that the carotid pulse is felt, the murmur is: A. systolic. B. diastolic. C. always normal. D. always pathologic. ANSWERV V A. systolic Which drug has Class II and Class III properties? A. Verapamil (Calan) B. Propranolol (Inderal) C. Sotalol (Betapace) D. Tocainide (Tonocard) ANSWERV ¥ C. Sotalol (Betapace) The skin changes associated with chronic peripheral arterial disease are: A. thickened with brownish discoloration at the ankles. C. Tracheal shift toward the left with diminished or absent breath sounds on the left D. Tracheal shift toward the right with diminished or absent breath sounds on the right ANSWERV ¥ B. Tracheal shift toward the left with diminished or absent breath sounds on the right A 70-year-old woman, weighing 50 kg, comes to the ED complaining of chest pain and shortness of breath. EKG shows ventricular tachycardia HR 150. Which treatment is appropriate in this situation? A. Amiodarone (Cordarone) IV B. Verapamil HCI (Calan) 1V C. Defibrillation beginning at 200 J D. Synchronized cardioversion beginning at 100 J ANSWERV¥V D. Synchronized cardioversion beginning at 100 J A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV heart block with a ventricular rate of 52 beats/min and no pacing spikes. This indicates failure to pace, and the patient is taken to surgery for insertion of a DVI permanent pacemaker. Which of the following describes the function of a DVI pacemaker? A. Senses atrium and ventricle; paces ventricle; inhibited by QRS complex B. Senses atrium and ventricle; paces ventricle; triggered by QRS complex C. Paces atrium and ventricle: senses ventricle: inhibited by the QRS complex D. Paces and senses atrium and ventricle; inhibited by the P wave ANS WERV ¥ C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex Shortly after returning from PCI, a patient begins to complain of chest pain similar in intensity and character to the pre-PCI pain. The pain is unresponsive to nitroglycerin infusion titration. The patient should be prepared for: A. return to cardiac catheterization for an additional procedure. B. cmergency coronary artery bypass grafling. C. intraaortic balloon pump therapy. D. a catheterization of the right side of the heart. ANSWERV Vv A. return to cardiac catheterization for an additional procedure. Which of the following would not be associated with a false-positive result for an acute MI using the total creatine kinase (CK)? A. Hypothyroidism B. Hemorrhagic stroke C. Cardioversion D. Ulcerative colitis ANSWERV ¥ D. Ulcerative colitis While auscultating the patient's heart, an S3 is noted. What does this heart sound indicate? A. Atrial contraction and propulsion of blood into a noncompliant ventricle B. Inflammation of the pericardium C. Opening of a defective semilunar valve D. Rapid ventricular filling into an already distended ventricle ANSWERV ¥ D. Rapid ventricular filling into an already distended ventricle 
