Question 1

A nurse is taking care of a patient who has undergone pacemaker implantation. What investigations should the nurse order for this patient?

Accepted Answer

The nurse should order electrocardiogram, echocardiogram, chest X-ray for this patient. Post permanent pacemaker implantation, the clinician should perform an electrocardiogram, echocardiogram, perform a physical assessment, monitor peripheral blood flow and look for swelling and evaluate cardiac pain. Chest X-ray should also be performed pre and post pacemaker placement.

Question 2

What is the basis of pacing of atria and ventricles in rate modulated pacing?

Accepted Answer

Basis of pacing in rate modulated pacing is increased heart rate with physiological stress. Rate modulated pacing involves the pacing of the atria and ventricles based on physiological stress with increased heart rate. This type of pacing uses sensors to modulate pacing.

Question 3

Which of the following anti-dysrhythmic class of drugs is not correctly matched with its mechanism of action?

Accepted Answer

Class II - Potassium channel openers is not a correct match. Class I anti-dysrhythmic agents inhibit sodium channels. Class II drugs include beta-adrenergic receptor antagonists, which slow heart rate and increase cardiac muscle contraction. Class III drugs inhibit potassium efflux during repolarization. Class IV agents include calcium channel blocker. Unclassified agents such as digoxin decrease conduction velocity and adenosine activates adenosine receptors that play a role in potassium conductance.

Question 4

The fibrinolytic mechanism of streptokinase and urokinase are:

Accepted Answer

Both inhibit the formation of fibrin by disrupting the conversion of plasminogen to plasmin. Specifically, streptokinase, urokinase, and anistreplase inhibit the formation of fibrin by disrupting the conversion of plasminogen to plasmin. Alteplase, tenecteplase, and reteplase activate the conversion of fibrin-bound plasminogen to plasmin.

Question 5

Which leadership style involves a vision and commitment to meet a team's goals?

Accepted Answer

Transformational leadership involves a vision and commitment to meet a team's goals. Leadership styles include autocratic, participative, laissez-faire, transactional, and transformational. Autocratic leadership uses power to influence members of a team. Participative leadership uses a democratic process for decisions among team members. Laissez-faire leadership involves minimal guidance from a leader and provides little feedback to team members. Transactional leadership focuses on daily activities and is comfortable with the status quo. Transformational leadership involves a vision and commitment to meet a team's goals.

Question 6

In which leadership style is the democratic process used for decisions among team members?

Accepted Answer

In participative leadership style, the democratic process is used for decisions among team members. Leadership styles include autocratic, participative, laissez-faire, transactional, and transformational. Autocratic leadership uses power to influence members of a team. Participative leadership uses a democratic process for decisions among team members. Laissez-faire leadership involves minimal guidance from a leader and provides little feedback to team members. Transactional leadership focuses on daily activities and is comfortable with the status quo. Transformational leadership involves a vision and commitment to meet a team's goals.

Question 7

Which of the following is not a possible disciplinary action measure which can be taken if a nurse is found guilty of misconduct?

Accepted Answer

Prosecution is not a possible disciplinary action to be taken if nurse is found guilty of misconduct. Possible disciplinary action measures taken if found guilty include revocation of license, suspension of license for a specified period of time, suspension of license for a program of study or treatment, and/or prohibition of work in specified settings.

Question 8

Which of the following are non-cardiac causes of pulmonary edema?

Accepted Answer

Lung infections, high altitude and acute respiratory syndrome are non-cardiac causes of pulmonary edema. Other non-cardiac causes and risk factors for pulmonary edema include exposure to certain toxins such as chlorine, ammonia and nitrogen dioxide, kidney disease, smoke inhalation, and adverse drug reaction to drugs such as illicit drugs and chemotherapy drugs.

Question 9

The nurse records the EKG of an asymptomatic patient. Which of the following EKG findings confirms the diagnosis of Wenckebach phenomena?

Accepted Answer

The EKG finding of progressive lengthening of PR interval followed by a P wave without an associated QRS complex confirms the diagnosis of Wenckebach phenomena. Second-degree atrioventricular block type I, also known as Wenckebach or Mobitz I, is an asymptomatic dysrhythmia typically diagnosed on electrocardiogram which shows progressive lengthening of PR interval followed by a P wave without an associated QRS complex.

Question 10

Which of the following correctly represents the pathophysiologic mechanism behind development of cor pulmonale?

Accepted Answer

The pathophysiologic mechanism behind development of cor pulmonale include pulmonary vasoconstriction, compromise of vascular bed due to lung disease such as emphysema and interstitial lung disease, increased blood viscosity due to diseases like sickle cell anemia and primary pulmonary hypertension. Cor pulmonale is an enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs.

Question 11

Which of the following conditions is not an example of acute inflammation?

Accepted Answer

Tuberculosis is not an example of acute inflammation. Tuberculosis is an example of chronic inflammation. Acute appendicitis, acute tonsillitis, and acute gout are examples of acute inflammation. Acute dermatitis and acute bacterial meningitis are also examples of acute inflammation.

Question 12

A 75-year old diabetic, obese male patient presenting with complaints of intermittent palpitation and excessive sleepiness during daytime was advised 24-hour Holter monitoring. The nurse is explaining to the patient about the diagnostic significance of Holter monitoring. Which of the following cannot be determined by Holter monitoring?

Accepted Answer

Cause of excessive sleepiness during daytime cannot be determined by Holter monitoring. A sleep study would need to be completed to help determine the cause of excessive sleepiness during daytime.
Holter monitor can be used to determine:
•Detect intermittent arrhythmias
•Relate symptoms to dysrhythmias
•Detect myocardial ischemia

Question 13

Which of the following murmurs is not audible while auscultating a patient of aortic regurgitation?

Accepted Answer

Crescendo-decrescendo murmur is not heard in aortic regurgitation.
Murmurs heard in aortic regurgitation:
•Early diastolic decrescendo murmur (EDM) - high-pitched, length correlates with severity, best heard with patient sitting, leaning forward on full expiration
•Systolic ejection murmur - physiologic, high flow murmur in aortic area
•Austin Flint murmur - diastolic rumble at apex, secondary to regurgitant jet on anterior MV leaflet

Question 14

How many positions does the generic pacemaker code have?

Accepted Answer

A generic pacemaker code has 5 positions. Pacemakers are classified using a 5-position code, which describes the different types of pacemakers and their function. Position one (I) indicates the chamber(s) being paced. Position two (II) indicates the chamber(s) being sensed. Position three (III) indicates the device's response to sensing. Position four (IV) indicates the programmability and rate of modulation function. Position five (V) is only used for tachycardia functions.

Question 15

A nurse records an EKG of an asymptomatic person coming for routine check-up. After looking at the EKG, which of the following findings might the nurse say that there is nothing wrong with the EKG?

Accepted Answer

After looking at the PR interval of 210 milliseconds, the nurse can say that there is nothing wrong with the EKG. First degree AV block is characterized by prolonged PR interval (greater than 200 millisecond), which can also occur as a normal variant in some individuals.

Question 16

Which of the following is a characteristic feature of syndrome X?

Accepted Answer

Patient presenting with typical symptoms of angina but normal angiogram is a characteristic feature of syndrome X. Angiogram showing severe abnormalities is not a feature of syndrome X.
Features of syndrome X are:
•Patient has typical symptoms of angina yet has normal angiogram
•May show definite signs of ischemia during exercise testing
•Pathogenesis thought to be due to inadequate vasodilator reserve of coronary resistance vessels
•Has better prognosis than patient with overt atherosclerotic disease

Question 17

You are working as RN in cardiac emergency. Which patient would you see first?

Accepted Answer

The patient with a history of deep vein thrombosis presenting with acute onset dyspnea and pink frothy sputum is potentially suffering from pulmonary embolism and needs immediate treatment. Patient 'B' is most likely suffering from angina and needs to be attended promptly. Patient 'C' is suffering from postural hypotension and can be asked to lie down for a while before doing any intervention.

Question 18

The following patients arrived in emergency room and you are the attending cardiac nurse. Assessment of which of the following patients is a priority?

Accepted Answer

Assessment of the 70-year old male patient with left sided chest pain radiating to left arm accompanied by profuse sweating is a priority.. This patient appears to be suffering an acute myocardial infarction and is need of immediate intervention. Patient 'B' is most likely suffering from anxiety disorder and is not serious or life threatening. Patient 'C' is potentially suffering from a myocarditis or pericarditis and does not require urgent attention. Patient 'D' is suffering from angina which is also not an emergency and can be attended after the patient of myocardial infarction.

Question 19

You are working in cardiac ICU as RN and have to take care of patients with cardiac arrhythmia. Which of the following patients will you attend first?

Accepted Answer

Ventricular tachycardia is an emergency condition and may be a life-threatening cardiac event thus needs immediate attention as well as defibrillation. CPR may also be necessary. First degree heart block and AF are rarely life-threatening events. The patient with AF should be evaluated for ventricular rate and attended as needed and sorted according to their hemodynamic status. Patients with myocardial infarction showing occasional ventricular ectopics are usually stable and do not need immediate attention.

Question 20

A nurse is explaining about foot care to a patient being discharged with peripheral vascular disease . Which of the following information should be included in instructions?

Accepted Answer

The instruction to avoid keeping the legs crossed must be included in the information. Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Walking barefoot is not recommended as foot trauma may lead to serious infection. Heating pads are also liable to cause injury, which also increases the risk of infection. Skin lesions at risk for infection should not be ignored and the physician should be consulted for treatment.

Quiz 3: AACN Cardiac Vascular Nursing