CCRN final exam question with best answers verified by an expert 2024 latest updated., Exams of Nursing

Download CCRN final exam question with best answers verified by an expert 2024 latest updated. and more Exams Nursing in PDF only on Docsity! CCRN final exam question with best answers verified by an expert 2024 latest updated. 1. S3 occurs where and when? - Correct answer heard best at the apex of the heart right after S2 2. what is S3 associated with? - Correct answer Heart failure, Pulmonary hypertension, cor pulmonale, and mitral/aortic/tricuspid insufficiency 3. what is S3? - Correct answer rapid rush of blood into a dilated ventricle 4. what is S4? - Correct answer atrial constriction of blood into a non-compliant ventricle 5. Where and when does S4 occur? - Correct answer Best heard over the apex with the bell right before S1 6. what is s4 associated with? - Correct answer myocardial ischemia, infarction, hypertension, ventricular hypertrophy, aortic stenosis 7. Pericardial friction rub is associated with what? - Correct answer Pain during deep inspiration and positional pain 8. Pulse pressure equation - Correct answer systolic - diastolic = pulse pressure 9. normal pulse pressure values - Correct answer 40-60 10.systolic BP represents what? - Correct answer Cardiac output and stroke volume 11.what does a decrease in systolic pressure mean if diastolic doesn't change? - Correct answer This = narrowing pulse pressure. Seen often with severe hypovolemia or a severe drop in Cardiac output. 12.diastolic BP represents what? - Correct answer Systemic vascular resistance (SVR) 13.what does a decrease in diastolic BP mean? - Correct answer this = widening pulse pressure. May indicate vasodilation, severe sepsis, septic shock. 14. time ratio for systolic vs. diastolic - Correct answer 1.0/1.33 15.what is perfused during diastole? - Correct answer Coronary arteries 16.causes of valvular heart disease - Correct answer - coronary heart disease - dilated cardiomyopathy - Degeneration - Bicuspid aortic valve - Rheumatic fever - Infection - Connective tissue diseases 17.murmurs of insufficiency are? - Correct answer regurgitation when the valve is close 18.murmurs of stenosis are? - Correct answer regurgitation when the valve is open 19.are these murmurs acute or chronic? - Correct answer Stenosis = chronic 20. Insufficiency = acute or chronic 21.systolic murmurs sound like what? - Correct answer lub...shhhhh...dub 22.what are the valves doing during a systolic murmur? - Correct answer aortic and pulmonic valve stenosis (they are open) 23.Mitral and tricuspid insufficiency (they are closed) 24.how does a mitral valve insufficiency show up on a pulmonary artery catheter? - Correct answer giant v waves 25.what other defect can cause systolic murmurs? - Correct answer ventricular septal defect (heard on the left sternal border) 26.what do diastolic murmurs sound like? - Correct answer lub...dub...shhhhh 27.what are the valves doing during diastolic murmurs? - Correct answer aortic/pulmonic insufficiency (closed) 28.Mitral/Tricuspid stenosis (open) 29.mitral valve stenosis is particularly associated with what? - Correct answer atrial fibrillation due to atrial enlargement 30.grades of acute MI - Correct answer grade 1/2 -- papillary muscle dysfunction 31.grade 5/6 -- papillary muscle rupture (emergency) 32.unstable angina = - Correct answer chest pain at rest, unpredictable 33. relievers for Unstable angina? what do labs look like? ECG? - Correct answer Nitroglycerin. Troponin negative. ST depression or T wave inversion. 61.Signs of a vasovagal response? Treatment? - Correct answer s/s - Hypotension (<90 systolic) w/ or w/o bradycardia, Pallor, Nausea, Yawning, Diaphoresis 62.Tx - Give fluids and atropine 63.Treatment for sheath site bleeding? - Correct answer Tx - apply manual pressure 2 inches above the site for minimum of 20 minutes (30 if still on GP IIb/IIIa inhibitors) for hemostasis 64.Signs of retroperitoneal bleeding? Treatment? - Correct answer s/s - sudden hypotension and severe lower back pain 65. tx - fluids and blood products 66.Contradindications for fibrinolytic therapy? - Correct answer - any prior intracranial hemorrhage - known structural cerebral vascular lesion - malignant intracranial neoplasm - Ischemic stroke within 3 months except acute ischemic stroke within 3 hours - possible aortic dissection - active bleeding/diathesis (except menses) - closed head fracture or facial trauma in 3 months. 67.Signs of reperfusion? - Correct answer - chest pain relief - resolution of ST segment deviation - marked elevation of troponin/CK-MB (due to stunning when vessel opens - Reperfusion arrhythmias 68.What are some reperfusion arrythmias? - Correct answer Ventricular tachycardia, Ventricular fibrillation, accelerated idioventricular rhythm (AIVR) 69.how do you treat a STEMI? - Correct answer same as a STEMI, but no need for immediate reperfusion. 70.what is an inferior MI associated with? what leads are ST elevation noted in? - Correct answer - Right coronary artery occlusion (RCA occlusion) - ST elevation in II, III, aVF 71.what AV conduction disturbances can happen? - Correct answer 2nd degree type I, 3rd degree block, Sick sinus syndrome (SSS), bradycardia 72.what sign w/ an inferior MI will increase mortality? - Correct answer tachycardia 73.which 2 infarcts should be associated together? - Correct answer Right ventricular and posterior infarct 74.What should be used with caution in an inferior MI? - Correct answer beta blockers 75.what does the RCA supply? - Correct answer inferior wall of the left ventricle and the right ventricle --> why about 30% of inferior MI pts also have RV infracts 76.how do you see ECG changes in a RV infract? - Correct answer With a right sided ECG (ST changes occur in V4R) 77.s/s of RV infract? Tx? - Correct answer s/s - Jugular venous distention @ 45 degrees, high CVP, hypotension, clear lungs, bradyrhythmis. 78.Tx - fluids, positive inotropes 79.What to avoid with a RV infarct? - Correct answer - Preload reducers --> nitrates, diuretics - beta blockers 80.what is an anterior MI associated with? - Correct answer Left anterior Descending (LAD) occlusion 81.what will the ECG look like? - Correct answer ST elevation in V1-V4 (precordial leads, V leads) and ST depression in inferior wall (II, III, aVF) 82.what ominous signs do you look for in an anterior MI? - Correct answer second degree type II block or RBBB (due to lack of blood flow to the bundle of HIS) 83.what can one develop from an anterior MI? does anterior or inferior have higher mortality? - Correct answer - systolic murmur (possible ventricular septal defect) - High mortality in anterior. 84.what ECG changes occur with Low lateral MIs? - Correct answer ST elevation in V5, V6 85.what ECG changes occur in high lateral MIs? - Correct answer ST elevation in I, aVL 86.what does a lateral MI involve artery wise? - Correct answer Left circumflex artery 87.what are some cardiac catheterization lab procedures? - Correct answer - percutaneous coronary interventions (PCI) -- intracoronary stenting and balloon angioplasty w/o stent - Percutaneous balloon valvotomy - Pacemaker implentation - electrophysiology studies -- ICD, cardiac ablation 88.complications of PCI? - Correct answer - death rate 0.71%; in hospital MI 0.4% - coronary artery perforation - distal coronary embolization - Stent thrombosis -- usually acute (less than 24 hours) or subacute (less than 30 days) - stroke or TIA - arrhythmias - Renal Failure - retroperitoneal bleed 89.what to watch for with sheath removal - Correct answer - baseline vitals and pulses - pain - BP q 5-10 mins during removal - vasovagal response 90.what happens with a vasovagal response? - Correct answer hypotension < 90 systolic w/ or w/o bradycardia, absence of compensatory tachycardia, pallor, nausea, yawning, diaphoresis 91.management of vasovagal response - Correct answer - hold nitrates - atropine 0.5mg IV - IV bolus 250cc normal saline if atropine doesn't work immediately 92.what is hypertensive emergency/crisis - Correct answer elevated BP with evidence or end-organ damage from acute HTN 93.what is hypertensive urgency? - Correct answer elevated BP without evidence of acute end-organ damage 94.how to treat HTN emergency? - Correct answer Nitroprusside and Labetalol 95.how does nitroprusside work? what do you watch for? - Correct answer - reduces preload and afterload - watch for cyanide toxicity --> mental status change, tachycardia, seizure, need for increase in dose, unexplained metabolic acidosis (esp. renal pts) 96.Best method for giving labetalol? What is the max dose? Durations effect? - Correct answer - Preferred to give intermittent doses rather than continuous. - max dose = 300 mg - Duration = 4-6 hrs after IV discontinue 97.what is the biggest risk for HTN emergency and urgency? - Correct answer STROKE 98.s/s of peripheral arterial disease (6 Ps) - Correct answer - pain - BNP elevated 129. Tx for systolic HF - Correct answer - Beta blockers - Arbs/ACEI - Diuretics - Dilators - Aldosterone antagonists - Positive inotropes 130. Tx for diastolic HF - Correct answer - Beta blockers - ACEI/Arbs - Calcium channel blockers - Diuretics (low dose) - Aldosterone antagonists 131. Contraindications of systolic/Diastolic HF - Correct answer systolic - Negative inotropes (calcium channel blockers beta blockers) 132. Diastolic - Positive inotropes, Dehydration, Tachyarrhythmias. 133. Cardiomyopathy in systolic HF - Correct answer dilated may cause systolic HF, mitral valve insufficiency 134. Cardiomyopathy in diastolic HF - Correct answer idiopathic hypertrophic subaortic stenosis (IHSS), hypertrophic cardiomyopathy (HCM), Hypertrophic obstructive cardiomyopathy (HOCM) 135. what will you find on the chest X-ray w/ systolic HF - Correct answer large, dilated heart (will often see a shift of the point of maximal impulse from midclavicular to left) or normal heart size 136. what will you find on the chest X-ray w/ diastolic HF - Correct answer Normal heart size 137. Class 1 CHF - Correct answer extraordinary activity results in heart failure symptoms. Normal activity does not cause symptoms. 138. Class 2 CHF - Correct answer Ordinary physical activity causes symptoms. Resting will be comfortable. 139. Class 3 CHF - Correct answer Minimal activity results in symptoms. Resting will be comfortable. 140. Class 4 CHF - Correct answer Symptoms will occur at rest. 141. a pt qualifies for what with a Class 2-4 CHF? - Correct answer an ICD 142. Dilated Cardiomyopathy physical aspects - Correct answer - Systolic dysfunction (problem ejecting) - thinning dilation and enlargement of LV chamber - Mitral valve regurgitation common 143. Dilated cardiomyopathy shares symptoms with what problem? - Correct answer Systolic Heart failure 144. Diastolic Cardiomyopathy physical aspects - Correct answer - Diastolic dysfunction (problem filling) - Increased thickening of the heart muscle and septum inwardly affecting the LV chamber 145. symptoms of dilated cardiomyopathy - Correct answer - fatigue - dyspnea - chest pain - palpitations - S3, S4 - presyncope or syncope 146. an extreme drop in stroke volume secondary to systolic dysfunction results in... - Correct answer - elevated LV preload with associated pulmonary symptoms - elevated LV afterload due to vasoconstrictive compensatory mechanisms - drop in cardiac output which creates inadequate perfusion to organs. 147. etiologies of cardiogenic shock - Correct answer Acute MI 148. chronic heart failure 149. cardiomyopathy 150. Dysrhythmias 151. cardiac tamponade 152. papillary muscle rupture 153. Compensatory stage of Cardiogenic shock - Correct answer tachycardia 154. tachypnea 155. crackles w/ mild hypoxia 156. ABG w/ resp. alkalosis or early metabolic acidosis 157. Anxiety/irritability 158. Neck vein distention 159. S3 160. cool skin 161. urine output down 162. narrow pulse pressure 163. BP maintained but lower than baseline 164. Progressive stage of cardiogenic shock - Correct answer hypotension 165. worsening tachycardia, tachypnea, oliguria 166. met. Acidosis 167. worsening crackles and hypoxemia 168. skin clammy, mottled 169. Anxiety/lethargy 170. treatment of cardiogenic shock - Correct answer Identify cause 171. manage arrhythmias 172. reperfusion if STEMI 173. emergent surgery if mechanical issue 174. Ways to enhance pump effectiveness in cardiogenic shock - Correct answer positive inotropics: - norepinephrine (levophed) - Dopamine 4-10 mcg/kg/min - Dobutamine, milirinone (primacor) 175. what do we avoid with cardiogenic shock? - Correct answer negative inotropes 176. ways to decrease demand on pump in cardiogenic shock - Correct answer preload/afterload reduction 177. optimize oxygenation 178. mechanical ventilation 179. treat pain 180. VAD 181. balloon therapy for cardiogenic shock (VAD) - Correct answer inflation increases coronary artery perfusion 182. Deflation decreases afterload 183. who qualifies for a CABG? - Correct answer people with: - Chronic disabling angina unresponsive to medical therapy and not a candidate for PCI - Left main lesion - 3 vessel disease 184. what to watch for after a CABG? - Correct answer tamponade 185. pericarditis 186. bleeding 187. arrhythmias 188. hemodynamic abnormalities 189. infection 190. maintaining patency for chest tube - Correct answer - don't allow dependent loops