Philadelphia University
Nursing Faculty
Critical Care Nursing
Academic Year 2013-2014
Second Semester- Final Exam
Exam Duration: Two Hours
Date: 12/6/2014
Student ID
Student’s Name:..........................................................................................
Student’s University Number:....................................................................
Session Number: (1)
Examiner
Dr. Mayada Daibes
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PART I: CASE-RELATED MULTIPLE CHOICE QUESTIONS
A 71-years old male is admitted to your unit with shortness of breath, orthopnea,
and progressive reduction in exercise tolerance. His lungs sounds demonstrate
crackles in most of his posterior lobes. A pulse oximeter indicates a value of 89%.
The following data are available:
Blood pressure: 118/70; Pulse: 110; Respiratory rate: 28; Temperature: 37.1
Answer Questions 1-2
1. Based on the above information, what conditions is likely developing?
a. Primary pulmonary hypertension
b. Sepsis
c. Anterior Myocardial infarction
d. Left ventricular failure
2. What therapy would most likely improve his symptoms?
a. Oxygyn therapy
b. Furosemide
c. Nitrates
d. Norepeniphrene
A 65-year-old male is admitted to your unit with a chest pain. The chest pain
developed 2 hours ago at his home. The pain went away while he rested but then
returned. Currently, he has substernal chest pain radiating to the left arm and
chin. The pain is the same regardless of position. No change in the pain occurs
during inspiration. Vital signs are as follow: BP: 132/86 mm Hg; PR: 96 bpm; RR:
25 breath/min. The patient's 12-lead ECG shows depressed ST segments in the
inferior leads. Small Q waves, less than one-third the height of the R wave, are
present in the inferior leads.
Answer Questions 3-4
3. Based on the preceding information, which condition is likely to be
developing?
a. Angina
b. Acute anterior-lateral MI
c. Pericarditis
d. Pericardial tamponade
4. What would be the most likely treatment for the condition?
a. Nitrates and beta blockers
b. Thrombolytic therapy
c. Pericardiocentesis
d. Aspirin and analgesics
A 51-years old male is admitted to your unit with the symptoms of crushing chest
pain that is unrelieved by nitrates or rest. He has ST segments elevated 3 mm in
V1 through V4, with ST-Segment depression in II, III, & aVF. His blood pressure in
94/64 mmHg, Pulse 110, and respiratory rate 32.
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Answer Question 5.
5. Based on the preceding information, which type of MI would most likely be
represented by the ECG changes?
a. Anterior
b. Inferior
c. Lateral
d. Posterior
A 59 years old male is admitted to your unit with the diagnosis "rule out MI". He
states that at work, 1 hour ago, he felt severe chest pain, became cool and clammy,
and felt nauseated. He came immediately to the hospital. The ECG indicates STsegment elevation in leads II, III, and aVF. ST-segment depression exists in V1
through V6. He has not responded to nitrates in the emergency debarment or the
ICU. His vital signs are as follows: BP: 98/68 mmHg; PR: 107; RR: 32.
Answer Questions 6-7
6. Which type of MI is represented by the ECG?
a. Anterior
b. Inferior
c. Lateral
d. Posterior
7. Based on the preceding description, which initial treatment is indicated?
a. Dobutamine
b. Thrombolytic therapy
c. Coronary artery bypass graft
d. Cardiac catheterization for stent placement
PART II: CASE-UNRELATED MULTIPLE CHOICE QUESTIONS:
8. Which of the following is the outermost lining of the heart?
a. Endocardium
b. Myocardium
c. Mediastinum
d. Pericardium
9. Of the following four factors, three determine the stroke volume. Identify
factors that do NOT affect the stroke volume?
a. Preload
b. Afterload
c. Contractility
d. cardiac output (C.O)
10. Which of the following are atrioventricular valves?
a. Mitral and tricuspid
b. Pulmonic and aortic
c. Mitral and aortic
d. Tricuspid and pulmonic
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11. Which of the following corresponds most closely to the normal ejection
fraction?
a. 10 to 20%
b. 25 to 35%
c. 40 to 50%
d. 60%
12. Reduction of the myocardial oxygen consumption is best achieved through
which of the following changes?
a. Reducing afterload
b. Reducing preload
c. Increasing contractility
d. Increasing preload
13. Which of the following is NOT an example of AV dissociation?
a. Ventricular tachycardia
b. Third-degree heart block
c. First degree heart block
d. All of the above are examples of the AV dissociation.
14. What is the initial treatment of the sinus tachycardia?
a. Calcium channel blockers
b. Initially carotid massage then digoxin
c. Beta-blockers
d. There is no primary treatment. The source of the tachycardia must first be
identified.
15. Unstable angina is characterized by all of the following features but one.
Which feature does NOT characterize unstable angina?
a. Increasing frequency of chest pain
b. Chest pain at rest
c. Increasing severity of symptoms
d. Q-wave formation
16. Which of the following is a treatment for Prinzmetal's variant angina?
a. Nitrates, ACE inhibitors
b. Nitrates, Aspirin
c. Nitrates, calcium channel blockers
d. Nitrates, Atropin
17. Dopamine is used with caution in patients with MI for which reason?
a. Its potential for increasing myocardial oxygen consumption
b. Because it has no inotropic agent
c. Because it might provoke bradyarrythmias
d. None of the above is correct
18. What is the stroke volume for a patient who has a cardiac output of 5.2
L/min, and a heart rate of 80 b/min?
a. 11 ml
b. 52 ml
c. 65 ml
d. 101 ml
19. Pulsus paradoxus is utilized to identify which of the following conditions?
a. Constrictive pericarditis
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b. MI
c. Respiratory failure
d. Ruptured papillary muscle
20. Physical signs associated with CHF include all of the following but one.
Identify the one sign that is NOT associated with CHF?
a. Dependent crackles in the lungs
b. S3 heart sound
c. Dependent edema
d. Systolic murmur
21. Vasodilation may help reduce myocardial oxygen consumption in the
failing left ventricle. Which of the following medications produce(s)
vasodilation that could be useful in the treatment of congestive heart
failure?
a. Beta blockers
b. Inotropes
c. Diuritics
d. Calcium channel blockers
22. Which of the following is a common sign in cardiac tamponade?
a. Increased CVP with inspiration
b. Increased diastolic blood pressure
c. Ejection fraction > 75 %
d. Decreased CVP with inspiration
23. Dissection of an artery occurs because of which type of injury to the blood
vessel?
a. Intimal tear
b. Weakness of the entire vessel wall
c. Thickening of the arterial wall
d. Bleeding into an already formed aneurysm
24. Which mode of ventilation delivers a preset volume with or without a
preset pressure and also allows the patient to take breaths of their own at
the same preset volume?
a. SIMV
b. Assist Control
c. CPAP
d. Pressure Control
25. Minute ventilation is equal to
a.
b.
c.
d.
FiO2 X PEEP
FiO2 / PEEP
Tidal Volume X Respiratory Rate
Tidal Volume / Respiratory Rate
26. The pathogenesis of acute myocardial infarction includes which of the
following?
a. Endothelial injury associated with one or more coronary risk factors
b. Endothelial dysfunction preceding atherosclerosis
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c. Coronary endothelial fatty streak preceding atherosclerotic plaque
formation
d. Thrombus formation following atherosclerotic plaque rupture
e. All of the above
27. Myocardial ischemia differs from or is related to myocardial infarction in
which of the following ways?
a. Ischemia follows infarction
b. Ischemia is not reversible, whereas infarction is
c. Infarction is not reversible, whereas ischemia is
d. Ische
e. mia is characterized by an increase in myocardial oxygen supply but not
demand
f. Ischemia is associated with myocardial cell necrosis, whereas infarction is
not.
28. Which of the following correctly characterizes the clinical presentation of
MI?
a. Chest pain is an infrequent finding in patients with an MI
b. All patients with MI have chest pain
c. Chest pain is the sole diagnostic determinant of MI
d. Chest pain may occur together with diaphoresis, nausea or vomiting, and
shortness of breath
e. Chest pain associated with MI varies with movement, deep breathing, and/or
body movement
29. Which of the following correctly characterizes the objective signs of MI?
a. Increase in circulating concentration of either troponin I or T is a more
sensitive indicator of MI than CK-MB.
b. Increase in circulation concentration of CK-MB continues to be a more
sensitive indicator of MI than troponin I or T
c. ECG is unaffected by MI
d. Increase in LDH concentration is still considered the most reliable change
associated with MI.
e. Change in total CK is a more sensitive indicator of MI than either CK-MB or
troponin I or T.
30. In DIC, platelets is less than:
a. 100,000
b. 200,000
c. 300,000
d. 400,000
31. Which is correct regarding DIC:
a. blockages in the small vessels
b. depletes the body's supply of clotting factors and platelets
c. destroys fibrin and leads to hemorrhage
d. all of the above
32. Alkalemia would be indicated by:
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a.
b.
c.
d.
HCO3- less than 22
pH less than 7.35
PaCO2 less than 35
pH more than 7.45
33. The acid-base disorder associated with elevated respirations is:
a. Lactic acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Hyperventilation acidosis
34. An abnormally large accumulation of ketones in the blood would give rise
to a(n):
a. Metabolic acidosis
b. pH greater than 7.45
c. Metabolic depression
d. Respiratory acidosis
35. Respiratory failure is often associated with a(n):
a. Anxiety
b. Elevated PaO2
c. Depressed PaCO2
d. PaC02 above 45
36. pH 7.51, PaCO2 40, HCO3- 31:
a. Normal
b. Uncompensated metabolic alkalosis
c. Partially compensated respiratory acidosis
d. Uncompensated respiratory alkalosis
37. pH 7.40, PaCO2 40, HCO3- 24:
a. Normal
b. Uncompensated metabolic acidosis
c. Partially compensated respiratory acidosis
d. Partially compensated metabolic acidosis
38. pH 7.48, PaCO2 30, HCO3- 23:
a. Uncompensated metabolic alkalosis
b. Uncompensated respiratory alkalosis
c. Partially compensated respiratory alkalosis
d. Partially compensated metabolic alkalosis
39. pH 7.62, PaCO2 47, HCO3- 30:
a. Uncompensated metabolic alkalosis
b. Uncompensated respiratory alkalosis
c. Partially compensated respiratory alkalosis
d. Partially compensated metabolic alkalosis
40. pH 7.30, PaCO2 59, HCO3- 28:
a. Uncompensated metabolic acidosis
b. Uncompensated respiratory acidosis
c. Partially compensated respiratory acidosis
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d. Partially compensated metabolic acidosis
Best wishes
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