Pance Cardiology - Final Test Review(Qns & Ans) - 2025, Exams of Nursing

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Pance Cardiology Exam

Final Test Review

(Questions & Solutions)

Coronary Artery Disease & Ischemia

1. Multiple Choice A 58-year-old male with a history of hypertension and smoking presents with substernal chest pain lasting 30 minutes, radiating to his left arm, nausea, and diaphoresis. His EKG shows ST-elevation in leads II, III, and aVF. What is the most appropriate initial management? A) Administer nitroglycerin and aspirin and observe B) Immediate coronary angiography with possible PCI C) Start intravenous heparin and beta-blockers, discharge home D) Start thrombolytic therapy if PCI unavailable after 12 hours ANS: B) Immediate coronary angiography with possible PCI Rationale: ST-elevation in leads II, III, and aVF indicates an inferior STEMI. Immediate revascularization with PCI is recommended within 90 minutes to limit myocardial damage.
2. Fill-in-the-Blank The biochemical marker most specific for myocardial injury and preferred for diagnosing acute myocardial infarction is ________________. ANS: Troponin I or Troponin T Rationale: Troponins are cardiac-specific proteins released during myocardial injury and remain elevated for days, allowing for accurate diagnosis.
3. True/False Stable angina is characterized by predictable chest pain brought on by exertion and relieved by rest or nitroglycerin. ANS: True Rationale: Stable angina results from fixed atherosclerotic plaques causing demand ischemia; symptoms are reproducible with exertion.

independently due to complete conduction block.

7. True/False In atrial fibrillation, the irregularly irregular rhythm results from multiple chaotic atrial impulses conducting irregularly to the ventricles. ANS: True Rationale: This results in irregular ventricular response and absence of discrete P waves.
8. Multiple Response Which medications are used to control ventricular rate during atrial fibrillation? (Select all that apply) A) Digoxin B) Amiodarone C) Beta-blockers D) Calcium channel blockers (non-dihydropyridine) ANS: A) Digoxin, C) Beta-blockers, D) Calcium channel blockers (non- dihydropyridine) Rationale: These slow AV nodal conduction to control ventricular rate. Amiodarone is usually for rhythm control. Heart Failure
9. Multiple Choice A 65-year-old man with hypertension develops dyspnea on exertion and lower extremity edema. Echocardiogram shows an ejection fraction of 35%. Which of the following medications has been shown to improve mortality in this patient? A) Lisinopril B) Furosemide C) Digoxin D) Hydralazine ANS: A) Lisinopril

Rationale: ACE inhibitors improve mortality in heart failure with reduced EF by inhibiting RAAS, reducing remodeling.

10. Fill-in-the-Blank In heart failure with preserved ejection fraction (HFpEF), the ejection fraction is typically ________________%. ANS: ≥ Rationale: HFpEF is characterized by normal or near-normal EF but impaired diastolic function causing symptoms.
11. True/False B-type natriuretic peptide (BNP) levels are typically elevated in heart failure due to increased ventricular wall stress. ANS: True Rationale: BNP is released by ventricles in response to pressure overload, serving as a diagnostic and prognostic biomarker.
12. Multiple Response Which of the following are common causes of right heart failure? (Select all that apply) A) Left heart failure B) Pulmonary hypertension C) Chronic lung disease D) Aortic stenosis ANS: A) Left heart failure, B) Pulmonary hypertension, C) Chronic lung disease Rationale: Right heart failure often occurs secondary to left heart failure, elevated pulmonary pressures, or lung diseases (cor pulmonale). Aortic stenosis primarily affects the left heart. Valvular Disease
13. Multiple Choice

D) Tricuspid stenosis ANS: A) Mitral stenosis, C) Mitral regurgitation Rationale: Lesions affecting the mitral valve increase left atrial pressure/volume causing enlargement. Cardiomyopathies

17. Multiple Choice A 25-year-old athlete collapses during training. Echocardiogram reveals asymmetric septal hypertrophy with preserved ejection fraction and systolic anterior motion of the mitral valve. The most likely diagnosis is: A) Dilated cardiomyopathy B) Hypertrophic cardiomyopathy C) Restrictive cardiomyopathy D) Arrhythmogenic right ventricular cardiomyopathy ANS: B) Hypertrophic cardiomyopathy Rationale: Asymmetric septal hypertrophy and mitral valve involvement are diagnostic features.
18. Fill-in-the-Blank The most common cause of restrictive cardiomyopathy in developed countries is ________________. ANS: amyloidosis Rationale: Amyloid protein deposition restricts ventricular filling and is a leading cause of restrictive cardiomyopathy.
19. True/False Dilated cardiomyopathy is characterized by systolic dysfunction with an enlarged ventricular chamber and reduced ejection fraction. ANS: True Rationale: Dilated cardiomyopathy involves ventricular dilation and impaired contraction.

20. Multiple Response Which of the following are recognized causes of dilated cardiomyopathy? (Select all that apply) A) Alcohol abuse B) Viral myocarditis C) Hypertension D) Hemochromatosis ANS: A) Alcohol abuse, B) Viral myocarditis, D) Hemochromatosis Rationale: These cause direct myocardial damage leading to dilation; hypertension usually leads to hypertrophy. Vascular Medicine
21. Multiple Choice A 60-year-old smoker presents with intermittent claudication in his left calf. Ankle-brachial index (ABI) is 0.6 on the left. What is the most appropriate first-line therapy? A) Surgical revascularization B) Smoking cessation and supervised exercise program C) Immediate initiation of anticoagulation D) Amputation ANS: B) Smoking cessation and supervised exercise program Rationale: Conservative management includes risk modification and exercise; surgery is reserved for severe cases.
22. Fill-in-the-Blank In giant cell arteritis, elevated ____________ is a key laboratory finding supporting the diagnosis. ANS: erythrocyte sedimentation rate (ESR) Rationale: ESR reflects systemic inflammation common in giant cell arteritis.

Electrical alternans on EKG is classically seen in patients with ________________ pericardial effusion. ANS: large or tamponade Rationale: Alternating QRS amplitudes result from the heart swinging in a large effusion.

27. True/False Constrictive pericarditis is characterized by thickened pericardium leading to impaired diastolic filling. ANS: True Rationale: The rigid pericardium restricts ventricular expansion causing diastolic dysfunction.
28. Multiple Response Common causes of pericarditis include: (Select all that apply) A) Viral infections B) Uremia C) Acute myocardial infarction D) Aortic stenosis ANS: A) Viral infections, B) Uremia, C) Acute myocardial infarction Rationale: These causes contribute to inflammation of the pericardium; aortic stenosis does not. Congenital & Pediatric Cardiology
29. Multiple Choice A 2-week-old infant presents with tachypnea and failure to thrive. Echocardiogram shows a holosystolic murmur at the left lower sternal border and left atrial enlargement. The most likely diagnosis is: A) Ventricular septal defect (VSD) B) Patent ductus arteriosus (PDA) C) Tetralogy of Fallot D) Coarctation of the aorta

ANS: A) Ventricular septal defect (VSD) Rationale: Holosystolic murmur at the LLSB with signs of volume overload suggests VSD.

30. Fill-in-the-Blank The classic cyanotic congenital heart defect featuring right ventricular outflow tract obstruction, ventricular septal defect, aortic override, and right ventricular hypertrophy is called ________________. ANS: Tetralogy of Fallot Rationale: These 4 anatomic abnormalities define TOF producing cyanosis.
31. True/False Coarctation of the aorta typically presents with hypertension in the upper extremities and diminished pulses in the lower extremities. ANS: True Rationale: The narrowing causes upper body hypertension and lower body hypoperfusion.
32. Multiple Response Which of the following congenital heart diseases are commonly associated with Down syndrome? (Select all that apply) A) Atrioventricular septal defect B) Tetralogy of Fallot C) Ventricular septal defect D) Transposition of the great arteries ANS: A) Atrioventricular septal defect, C) Ventricular septal defect Rationale: AV septal defects are classic; VSDs are also common in Down syndrome. Mixed Concepts

ANS: A) Diuretics, B) Inotropic agents only if hypotension or poor perfusion exists, D) Oxygen supplementation if hypoxic Rationale: Beta-blockers are usually held in acute decompensation. Advanced Physiology & Pathophysiology

37. Multiple Choice Which ion channel abnormality is primarily implicated in the pathogenesis of Long QT syndrome? A) Increased inward sodium current B) Increased outward potassium current C) Reduced inward calcium current D) Reduced outward potassium current ANS: D) Reduced outward potassium current Rationale: Delayed repolarization due to reduced K+ efflux prolongs QT interval.
38. Fill-in-the-Blank Elevated jugular venous pressure with a prominent y-descent is typically seen in ________________, differentiating constrictive pericarditis from restrictive cardiomyopathy. ANS: constrictive pericarditis Rationale: Rapid early diastolic filling causes characteristic JVP waveform.
39. True/False The presence of electrical alternans on EKG in a patient with pericardial effusion necessitates urgent pericardiocentesis. ANS: True Rationale: Electrical alternans signifies swinging heart from large effusion and tamponade risk.
40. Multiple Response

Clinical features that suggest right-sided heart failure rather than left- sided include: (Select all that apply) A) Pulmonary edema B) Jugular venous distension C) Hepatomegaly D) Orthopnea ANS: B) Jugular venous distension, C) Hepatomegaly Rationale: Pulmonary edema and orthopnea are features of left-sided failure; JVD and hepatomegaly suggest right-sided failure. A 68-year-old male presents with crushing chest pain, diaphoresis, and shortness of breath. An ECG reveals ST-segment elevation in leads II, III, and aVF. Which of the following is the MOST likely culprit artery? a) Left main coronary artery b) Left anterior descending artery c) Right coronary artery d) Left circumflex artery ANS: c) Right coronary artery Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is most commonly caused by occlusion of the right coronary artery. Fill-in-the-Blank: The primary abnormality in hypertrophic cardiomyopathy is __. ANS: left ventricular hypertrophy Rationale: Hypertrophic cardiomyopathy is characterized by unexplained hypertrophy of the left ventricle, often asymmetric, and can

A 70-year-old patient with a history of hypertension and hyperlipidemia presents with intermittent claudication in the left calf. Which of the following is the MOST likely diagnosis? a) Deep vein thrombosis b) Peripheral artery disease c) Aortic dissection d) Pulmonary embolism ANS: b) Peripheral artery disease Rationale: Intermittent claudication is a classic symptom of peripheral artery disease, caused by reduced blood flow to the extremities due to atherosclerosis. Fill-in-the-Blank: The classic auscultatory finding in aortic stenosis is a __. ANS: systolic ejection murmur Rationale: Aortic stenosis typically produces a harsh, crescendo- decrescendo systolic murmur best heard at the right upper sternal border. True/False: Cardiac tamponade can cause pulsus paradoxus. ANS: True Rationale: Cardiac tamponade can lead to pulsus paradoxus, a decrease in systolic blood pressure during inspiration, due to impaired ventricular filling.

Multiple Response: A 40-year-old female presents with chest pain and a pericardial friction rub. An ECG reveals diffuse ST-segment elevation. Which of the following are consistent with the diagnosis of acute pericarditis? (Select all that apply) a) ST-segment elevation in multiple leads b) ST-segment depression in multiple leads c) Pericardial effusion d) T wave inversion ANS: a) ST-segment elevation in multiple leads, c) Pericardial effusion, d) T wave inversion Rationale: Acute pericarditis often presents with diffuse ST-segment elevation, which can progress to T wave inversion. Pericardial effusion may also be present. ST-segment depression is not a typical finding. Multiple Choice: A newborn infant presents with cyanosis at birth. An echocardiogram reveals a large ventricular septal defect (VSD) and overriding aorta. Which of the following is the MOST likely diagnosis? a) Tetralogy of Fallot b) Atrial septal defect c) Transposition of the great arteries d) Coarctation of the aorta ANS: a) Tetralogy of Fallot Rationale: Tetralogy of Fallot is characterized by a VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.

Rationale: Stable angina is characterized by chest pain that occurs with exertion and is relieved by rest. Exercise stress tests may reveal ST- segment depression. Multiple Choice: A 75-year-old patient presents with exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. An echocardiogram reveals an ejection fraction of 30%. Which of the following is the MOST likely diagnosis? a) Aortic stenosis b) Heart failure with reduced ejection fraction c) Heart failure with preserved ejection fraction d) Mitral regurgitation ANS: b) Heart failure with reduced ejection fraction Rationale: An ejection fraction of 30% indicates heart failure with reduced ejection fraction (HFrEF), also known as systolic heart failure. Fill-in-the-Blank: The QRS complex represents __. ANS: ventricular depolarization Rationale: The QRS complex on an ECG represents the depolarization of the ventricles. True/False: Aortic regurgitation can cause a widened pulse pressure. ANS: True

Rationale: Aortic regurgitation causes a widened pulse pressure due to the backflow of blood from the aorta into the left ventricle during diastole. Multiple Response: A 30-year-old female presents with palpitations. An ECG reveals a narrow QRS complex tachycardia with a rate of 180 bpm. Which of the following are possible diagnoses? (Select all that apply) a) Ventricular tachycardia b) Atrial fibrillation with rapid ventricular response c) Supraventricular tachycardia d) Sinus tachycardia ANS: c) Supraventricular tachycardia, d) Sinus tachycardia Rationale: A narrow QRS complex tachycardia suggests the origin is above the ventricles. Sinus tachycardia and supraventricular tachycardia are both possible. Ventricular tachycardia would have a wide QRS. Atrial fibrillation with rapid ventricular response can have a narrow QRS complex, but the rhythm would be irregular. Multiple Choice: A patient presents with a history of hypertension and a new diagnosis of atrial fibrillation. Which of the following is the MOST appropriate initial treatment strategy? a) Immediate cardioversion b) Rate control with beta-blockers or calcium channel blockers c) Rhythm control with amiodarone d) Anticoagulation only