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AACN Cardiac Medicine (Adult)
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A patient presents with acute onset dyspnea, tachycardia, and hypotension. Physical examination reveals distended neck veins and muffled heart sounds. These findings are consistent with:
Cardiac tamponade.
cute coronary syndrome. ypertensive urgency.
wer: A
anation: The patient's presentation with acute onset dyspnea, tachycar tension, distended neck veins, and muffled heart sounds is indicative ac tamponade. Cardiac tamponade occurs when fluid or blood accum pericardial sac, exerting pressure on the heart and impeding its abilit nd pump effectively. This leads to hemodynamic compromise, reflect atient's symptoms and physical examination findings. Acute pulmona ma (option A) typically presents with severe respiratory distress, pink f
um, and crackles on auscultation. Acute coronary syndrome (option C) ent with chest pain, ECG changes, and cardiac enzyme elevation. ertensive urgency (option D) is characterized by severely elevated blo ure without evidence of acute end-organ damage.
Acute pulmonary edema.
A
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A patient presents with muffled heart sounds, hypotension, and jugular venous distension. The patient's blood pressure is 80/50 mm Hg. What is the diagnosis?
Myocarditis
Acute pericarditis
Cardiac tamponade
Aortic dissection
Answer: C
ar venous distension, and low blood pressure is highly suggestive of ac tamponade. Cardiac tamponade occurs when fluid accumulates in t ardial space, compressing the heart and impeding its ability to fill erly. This leads to decreased cardiac output and systemic hypotension.
mpt recognition and intervention, such as pericardiocentesis, are necess lieve the tamponade and restore cardiac function.
tient presents with fatigue, dyspnea on exertion, and peripheral edema ical examination reveals an S3 gallop and bilateral crackles on lung ultation. The diagnosis is:
ilated cardiomyopathy
eart failure with preserved ejection fraction (HFpEF) eart failure with reduced ejection fraction (HFrEF) ypertrophic cardiomyopathy
Explanation: The clinical presentation of muffled heart sounds, hypotension, jugul
cardi he
peric prop
Pro ary
to re
A pa .
Phys ausc
D
H
H
H
Answer: C
Explanation: The clinical presentation of fatigue, dyspnea on exertion, peripheral edema, S3 gallop, and crackles on lung auscultation is consistent with heart failure with reduced ejection fraction (HFrEF). HFrEF is characterized by impaired systolic function, leading to decreased cardiac output
and the accumulation of fluid in the lungs and peripheral tissues. It is often associated with dilated cardiomyopathy, a condition characterized by ventricular dilation and impaired contractility.
ope is:
asovagal syncope ardiac dysrhythmia rthostatic hypotension eizure disorder
wer: B
anation: The sudden loss of consciousness without prodrome or associ ptoms suggests cardiac dysrhythmia as the most likely cause of synco iac dysrhythmias, such as ventricular tachycardia or complete heart bl ead to a transient loss of blood flow to the brain, resulting in syncope. her evaluation with an electrocardiogram (ECG) and cardiac monitorin anted to identify the specific dysrhythmia and guide appropriate agement.
A patient presents with sudden loss of consciousness and spontaneous recovery. There is no prodrome or associated symptoms. The MOST LIKELY cause of sync
V
C
O
S
Ans
Expl ated
sym pe.
Card ock,
can l
Furt g is
warr man
A patient is diagnosed with dilated cardiomyopathy. Which of the following interventions is a key component of the management plan for this patient?
Implantable cardioverter-defibrillator (ICD) placement.
Initiation of beta-blocker therapy.
Administration of anticoagulant therapy.
Coronary artery bypass graft (CABG) surgery.
Answer: B
ove cardiac function, reduce symptoms, and decrease the risk of disea ression in patients with dilated cardiomyopathy. Implantable cardiove rillator (ICD) placement (option A) may be considered in patients at h f sudden cardiac death. Anticoagulant therapy (option B) is typically ated in patients with specific risk factors for thromboembolism, such a fibrillation. Coronary artery bypass graft (CABG) surgery (option D) primary treatment modality for dilated cardiomyopathy unless there i ficant coexisting coronary artery disease.
tient presents with sudden-onset dyspnea, frothy pink sputum, and cra ng auscultation. The diagnosis is:
ulmonary edema neumonia
cute respiratory distress syndrome (ARDS) ulmonary embolism
Explanation: In the management of dilated cardiomyopathy, the initiation of beta-blocker therapy is a key intervention. Beta-blockers have been shown to impr se
prog rter-
defib igh
risk o
indic s
atrial is
not a s
signi
A pa ckles
on lu
P
P
A
P
Answer: A
Explanation: The clinical presentation of sudden-onset dyspnea, frothy pink sputum, and crackles on lung auscultation is highly suggestive of pulmonary edema. Pulmonary edema occurs when there is an abnormal accumulation of
fluid in the lungs, leading to impaired gas exchange and respiratory distress. It is commonly caused by heart failure or fluid overload, and prompt management is necessary to improve oxygenation and relieve symptoms.
ch of the following is the MOST LIKELY diagnosis?
nstable angina STEMI
TEMI
table angina
wer: C
anation: The presentation of severe chest pain, diaphoresis, dyspnea, a findings of ST-segment elevation in the anterior leads, along with
ated troponin levels, is highly suggestive of ST-elevation myocardial ction (STEMI). STEMI is characterized by complete occlusion of a nary artery, leading to myocardial ischemia and necrosis. Prompt vention, such as percutaneous coronary intervention (PCI) or thrombo py, is crucial to restore blood flow and salvage the myocardium.
A patient presents with severe chest pain, diaphoresis, and dyspnea. The ECG shows ST-segment elevation in the anterior leads. Troponin levels are elevated. Whi
U
N
S
S
Ans
Expl nd
ECG
elev infar coro
inter lytic
thera
A patient presents with fever, malaise, pleuritic chest pain, and a friction rub on auscultation. The diagnosis is:
Pericardial effusion
Myocarditis
Infective endocarditis
Acute pericarditis Answer: D
heart. It often presents with chest pain that is worsened by deep brea ing flat, along with other systemic symptoms. The presence of a fricti n auscultation is a classic finding in acute pericarditis.
tient presents with episodes of rapid heart rate, palpitations, and headedness. An electrocardiogram (ECG) reveals a regular aventricular tachycardia (SVT) with narrow QRS complexes. Which o wing interventions is the initial treatment of choice for this patient?
nitiation of beta-blocker therapy. dministration of adenosine. lectrical cardioversion.
agal maneuvers. wer: D
Explanation: The clinical presentation of fever, malaise, pleuritic chest pain, and a friction rub on auscultation is consistent with acute pericarditis. Acute pericarditis is characterized by inflammation of thepericardium, the outer lining of the thing
or ly on
rub o
A pa light
supr f the
follo
I
A
E
V
Ans
Explanation: In the initial treatment of supraventricular tachycardia (SVT) with narrow QRS complexes, vagal maneuvers are considered the first-line intervention. Vagal maneuvers, such as carotid sinus massage or Valsalva maneuver, aim to stimulate the vagus nerve and slow down the heart rate. They are non-invasive and can often terminate or reduce the frequency of SVT episodes. Administration of adenosine (option B) is the second-line intervention if vagal maneuvers are ineffective. Electrical cardioversion (option C) is
reserved for unstable patients or those with hemodynamic compromise. Initiation of beta-blocker therapy (option D) may be considered for long-term management and prevention of SVT recurrence but is not the initial treatment of choice for acute episodes.
ly history of premature cardiovascular disease.
yperlipidemia etabolic syndrome therosclerosis
amilial hypercholesterolemia wer: D
anation: The combination of elevated cholesterol levels (LDL > 190 L), a family history of premature cardiovascular disease, and the pres enetic predisposition suggests the diagnosis of familial rcholesterolemia. Familial hypercholesterolemia is an inherited disord acterized by impaired clearance of low-density lipoprotein (LDL) esterol from the bloodstream, resulting in elevated LDL levels and an ased risk of atherosclerosis and cardiovascular disease. Early identific ggressive management of hyperlipidemia are essential in individuals lial hypercholesterolemia to reduce the risk of cardiovascular events.
A patient presents with elevated cholesterol levels (LDL > 190 mg/dL) and a fami
H
M
A
F
Ans Expl
mg/d ence
of a g
hype er
char chol
incre ation
and a with
fami
A patient presents with sudden-onset severe chest pain, dyspnea, and hypotension. Diagnosis is:
Acute arterial occlusion
Acute venous thrombosis
Aortic aneurysm
Aortic dissection Answer: D
nea, and hypotension is highly suggestive of aortic dissection. Aortic ction occurs when there is a tear in the inner lining of the aorta, leadi ormation of a false lumen and the potential for life-threatening plications. It is a medical emergency that requires immediate intervent event further dissection, rupture, or organ ischemia.
tient presents with severe headache, blurred vision, and epistaxis. Blo ure measurement reveals a reading of 200/120 mm Hg. The diagnosis
ypertensive urgency ypertensive emergency ssential hypertension ypertensive crisis
wer: B
Explanation: The clinical presentation of sudden-onset severe chest pain, dysp
disse ng to
the f
com ion
to pr
A pa od
press is:
H
H
E
H
Ans
Explanation: The clinical presentation of severe headache, blurred vision, epistaxis, and severely elevated blood pressure (200/120 mm Hg) is indicative of a hypertensive emergency. A hypertensive emergency is defined as severely elevated blood pressure associated with end-organ damage. It requires immediate blood pressure reduction with intravenous antihypertensive medications to prevent further complications, such as stroke, myocardial
infarction, or renal failure.
A patient with heart failure presents with worsening dyspnea, orthopnea, and bilateral lower extremity edema. The nurse auscultates crackles in the lung bases and an S3 gallop rhythm. These findings are consistent with:
cute pulmonary embolism.
cute exacerbation of chronic obstructive pulmonary disease (COPD). ight-sided heart failure.
eft-sided heart failure. wer: D
anation: The patient's presentation with worsening dyspnea, orthopnea eral lower extremity edema, crackles in the lung bases, and an S3 gall hm is consistent with left-sided heart failure. Left-sided heart failure o
the left ventricle fails to effectively pump blood forward, leading to f mulation in the lungs (pulmonary congestion). This results in sympto as dyspnea, orthopnea, and crackles on auscultation. Right-sided hear re (option D) typically presents with peripheral edema, hepatomegaly, ar venous distention.
A
A
R
L
Ans
Expl ,
bilat op
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when luid
accu ms
such t
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jugul
A patient presents with sudden-onset severe chest pain that radiates to the back. Blood pressure measurements in both arms reveal a significant difference. These findings are highly suggestive of:
Acute myocardial infarction (MI).
Aortic dissection.
Pulmonary embolism.
Pericarditis.
Answer: B
urements between both arms is highly suggestive of aortic dissection. ic dissection is a life-threatening condition characterized by a tear in t layer of the aorta, leading to the formation of a false lumen and pote ure of the aortic wall. The chest pain associated with aortic dissection described as tearing or ripping and may radiate to the back. Acute cardial infarction (option A) typically presents with chest pain and EC ges indicative of myocardial ischemia. Pulmonary embolism (option C
ents with sudden-onset dyspnea, pleuritic chest pain, and signs of odynamic instability. Pericarditis (option D) is characterized by sharp, itic chest pain that is typically relieved by sitting forward and may be ciated with a pericardial friction rub on auscultation.
tient presents with chest pain and electrocardiogram (ECG) findings istent with ST-segment elevation myocardial infarction (STEMI). Whi ollowing interventions should be prioritized?
Explanation: The patient's presentation with sudden-onset severe chest pain that radiates to the back and a significant difference in blood pressure
meas
Aort he
inner ntial
rupt is
often
myo G
chan )
pres hem pleur asso
A pa
cons ch of
the f
Administration of fibrinolytic therapy.
Initiation of antiplatelet therapy with aspirin and clopidogrel.
Immediate coronary angiography and percutaneous coronary intervention (PCI).
Administration of oxygen therapy.
Answer: C
latelet therapy (option C) and oxygen therapy (option D) are importan ponents of the overall management of STEMI, they are not the prioriti ventions. Prompt revascularization through PCI is crucial in minimizi cardial damage and improving patient outcomes.
Explanation: In patients with ST-segment elevation myocardial infarction (STEMI), the priority intervention is immediate coronary angiography and percutaneous coronary intervention (PCI). PCI involves the use of a catheter to open the blocked coronary artery and restore blood flow to the heart. This intervention is considered the gold standard treatment for STEMI and has shown superior outcomes compared to fibrinolytic therapy (option A). While antip t
com zed
inter ng
myo