Acute Cardiac Care

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. This phase is represented by the QRS complex on the ECG. There is a rise in pressure and the AV valves close:

a) Phase 1:Atrial systole
b) Phase 2:Isovolumetric contraction
c) Phase 3:Rapid ventricular ejection
d) Phase 4:Reduced ventricular ejection
e) Phase 5:Isovolumetric relaxation

2. The force or pressure against which the ventricular myocardium must push prior to contraction is the definition of:

a) cardiac output
b) preload
c) afterload
d) contractility

3. Peripheral chemoreceptors are located in the aortic arch and carotid arteries whereas central chemoreceptors are located in the:

a) medulla of the brain
b) subclavian artery
c) carotid sinuses
d) pituitary gland

4. This chemical is a peptid hormone, produced in the hypothalamus and stored in the posterior pituitary. It is released into the blood stream, resulting in reducing urine volume by concentration and elevating the blood pressure:

a) epinephrine
b) aldosterone
c) rennin
d) arginine vasopressin

5. This type of cell accounts for 99% of cardiac cells:

a) autorhythmic
b) myocyte
c) troponin
d) conduction

6. The SA node while at rest will generate an inherent rate between 60 and 70 impulses a minute, but may increase with pyrexia.

a) true
b) false

7. When the left circumflex artery supplies the posterior descending artery and posterior lateral artery, the person is said to:

a) be right dominant
b) be left dominant
c) have collateral circulation
d) have blood supply to the septum

8. This system drains the myocardial capillary bed and empties into the right and left atrium with a limited amount into the right ventricle:

a) the coronary sinus and its coronary veins
b) the anterior cardiac veins
c) the thespian veins

9. Which of the following are biomedical and modifiable risk factors for the development of cardiovascular disease:
  1. poor nutrition
  2. hypertension
  3. overweight
  4. family history of CVD
  5. renal disease

a) 1 and 2
b) 3 and 4
c) 2, 3, and 5
d) 2, 4, and 5
e) 1 and 3

10. The first cause of death worldwide is:

a) heart disease
b) cancer
c) obesity
d) hypertension

11. The most powerful independent risk factor for cardiovascular disease is:

a) advancing age
b) family history
c) ethnicity
d) an elevated cholesterol level

12. According to studies by Van Melle et al. 2004, a psychiatric disorder such as depression increases the rate of death from a myocardial infarction.

a) true
b) false

13. When using evidence-based practice, a health care problem is identified. The second step is:

a) assess the evidence
b) find the evidence
c) implement the evidence
d) formulate a question

14. The clinical audit is a clinically led initiative which seeks to:

a) evaluate the population at risk
b) improve the quality and outcome of patient care
c) reduce health care costs
d) form a database of health care literature
e) utilize available resources to support treatment

15. Seedhouse (1998) defines an ethical dilemma when there is no clear “right or wrong answer” to an issue.

a) true
b) false

16. Genetic research is vital to the development of medications and therapies which:
  1. is capable of saving lives
  2. will reduce morbidity
  3. limits potential risks
  4. improves the quality of life
  5. offers alternatives to standard treatment

a) 1 and 4
b) 2 and 5
c) 1, 2, and 3
d) 4 and 5
e) 2, 3, and 4

17. When measuring jugular venous pressure, the patient is placed:
  1. in a semi-recumbent position at a 45 degree angle
  2. with the head turned slightly to the right
  3. in a supine position
  4. with the head turned slightly to the left

a) 1 and 2
b) 1 and 4
c) 2 and 3
d) 3 and 4

18. A pulse that disappears during inspiration but reappears during expiration is known as:

a) pulsus paradoxus
b) pulsus alternans

19. This breath sound often occurs with pulmonary edema and the sound is simulated by rubbing strands of hair together between two fingers near the ear:

a) rhonchi
b) wheezes
c) crackles
d) egophony
e) friction rub

20. These leads examine cardiac electrical activity in the horizontal plane from sternum to vertebral column:

a) limb leads 1, 11, and 111
b) leads aVR, aVL, and aVF
c) leads 11, 111, and aVF
d) precordial leads V1-V6

21. This waveform represents ventricular depolarization. It is measured from the first upward/downward deflection from baseline until return to baseline:

a) P wave
b) QRS interval
c) ST segment
d) T wavc

22. The ideal position for a patient when obtaining an ECG is:

a) supine with the head of the bed elevated 15 degrees
b) semi-Fowlers with the head of the bed elevated 45 degrees
c) prone
d) low Fowlers with the head of the bed elevated 30 degrees

23. The goal of this type of monitoring is to track heart rate, sense R waves for synchronized cardioversion and detect ventricular fibrillation:

a) three-electrode monitoring
b) five- electrode monitoring
c) ten-electrode monitoring

24. The measurement or recording of signals at a distance is the definition of:

a) halter monitoring
b) telemetry monitoring

25. Triglyceride testing should be done on fasting samples.

a) true
b) false

26. The most sensitive used markers of myocardial necrosis is:

a) creatine kinase
b) CK-MB
c) troponine 1 and troponine T

27. The most common vascular complication following the femoral approach of coronary angiography is:

a) bradycardia
b) hypotension
c) nausea and sweating
d) bleeding at the site

28. One of the risks of this type of echocardiography is aspiration of stomach contents into the lungs:

a) transthoracic echocardiography
b) transesophageal echocardiography

29. Initially thought to be safe, gadolinium contrast can lead to:

a) anaphylactic shock
b) vascular collapse
c) hypertension and chest pain
d) severe nephrotoxicity

30. The most common electrical event associated with sudden cardiac death is:

a) ventricular fibrillation
b) bundle branch block
c) torsades de pointes
d) chamber enlargement

31. This type of cardiomyopathy is typically seen in young men and associated with syncope and presyncope:

a) dilated cardiomyopathy
b) hypertrophic cardiomyopathy
c) arrhythmogenic right ventricular cardiomyopathy

32. There are no reported incidence of HIV transmission from performing CPR.

a) true
b) false

33. The first step in the basic life-support flow chart is:

a) open the airway
b) summon help
c) check for danger
d) establish responsiveness

34. Beneficence is best defined as:

a) do no harm
b) do only good
c) fairness and equity
d) self-determination

35. Following advance directives is not a legal requirement in many countries.

a) true
b) false

36. Atherosclerosis is a progressive disease that probably begins in:

a) pre-teen years
b) adolescence
c) the third decade
d) the fifth decade

37. Patients with an elevated ST segment on the ECG when presenting with an acute MI often had:

a) an occluded circumflex artery
b) a third-degree heart block
c) an occluded epicardial coronary artery
d) subendocardial ischemia

38. When the triage nurse is identifying acute coronary syndrome patients, this group typically has no chest pain:

a) women
b) elderly
c) diabetic

39. Traditional risk factors for CAD such as hypertension and smoking are only weakly predictive of acute ischemia and are much less significant than the duration of symptoms, ECG findings and biomarker levels.

a) true
b) false

40. The main aims of exercise tolerance tests are to:
  1. determine the maximum workload
  2. assess prognosis
  3. rule out cardiomyopathy
  4. assess electrical activity

a) 1, 2, and 3
b) 2 and 4
c) 3 and 4
d) 1 and 2
e) 2, 3, and 4

41. In this concept, time is of the essence. Rapid assessment of the patient is undertaken and resuscitation is initiated if required. The presence of a defibrillator is mandatory.

a) Door
b) Data
c) Decision
d) Drug or Destination

42. The key goal of any reperfusion strategy is to:

a) prevent cardiac arrhythmia
b) improve cardiac output
c) restore normal myocardial tissue perfusion as rapidly as possible
d) prevent further occlusive complications

43. The main risk of lytic therapy relates to:

a) fluid overload
b) intracranial bleeding
c) allergic reactions
d) hypertension

44. It is standard practice to monitor either door-to-needle or door-to-balloon times with targets of _____ and _____ minutes respectively.

a) 30, 90
b) 60, 90
c) 60, 120
d) 30, 120

45. This anti-ischemic therapy comes in a variety of preparations including IV, transdermal. sublingual spray and tablets, and oral tablets:

a) beta blockers
b) calcium channel blockers
c) nitrates

46. In order to reverse the effects of low-molecular-weight heparin, which of the following should be available:

a) aqua-mephyton
b) protamine sulfate
c) a low dose of regular insulin

47. This type of heart block is commonly seen in digoxin overdose or following an inferior MI but does not usually cause hemodynamic compromise:

a) first-degree AV block
b) second-degree AV block
c) third-degree AV block

48. This is one of the most commonly occurring arrhythmias in clinical practice, complicating 15-20 percent of myocardial infarctions:

a) atrial fibrillation
b) atrial flutter

49. According to Peberdy et al. 2003, survival rates following an in-hospital cardiac arrest are:

a) good
b) fair
c) poor

50. When following the ABCDE approach in post-resuscitation care, the “D” is for assessment of disability.

a) true
b) false

51. According to the “2 minute” bedside tool for clinical assessment of a patient’s hemodynamic status in acute heart failure, a patient is volume overloaded with adequate end-organ perfusion. This patient would be:

a) warm and dry
b) warm and wet
c) cold and wet
d) cold and dry

52. An example of treatment for “refractory” acute heart failure would be an extracorporeal pump for ______-term use.

a) short
b) long

53. The Chronic Care Model focuses on patient-centered care and self-management as part of a multidimensional approach to improving the management of chronic care.

a) true
b) false

54. Identifying and managing those with established coronary heart disease and those at high risk of developing it is the definition of:

a) discharge planning
b) primary prevention
c) secondary prevention
d) risk factor management