CCRN Cardiovascular Emergencies 3 — Questions and Answers
Question 1: A patient in cardiogenic shock has cold extremities, hypotension, and pulmonary congestion. Which hemodynamic profile is expected?
- Low CO, low PCWP, low SVR
- Low CO, high PCWP, high SVR (Correct answer)
- High CO, low PCWP, low SVR
- High CO, high PCWP, low SVR
Correct answer: Low CO, high PCWP, high SVR
Cardiogenic shock features low cardiac output, elevated filling pressures (PCWP), and compensatory high systemic vascular resistance.
Question 2: Which medication is a first-line inotrope for a patient in cardiogenic shock with adequate blood pressure?
- Norepinephrine
- Dobutamine (Correct answer)
- Phenylephrine
- Vasopressin
Correct answer: Dobutamine
Dobutamine improves contractility and cardiac output and is preferred when blood pressure is marginally adequate.
Question 3: How does an intra-aortic balloon pump improve cardiac function in cardiogenic shock?
- It directly pumps blood from the ventricle
- It increases coronary perfusion during diastole and reduces afterload during systole (Correct answer)
- It oxygenates blood externally
- It paces the heart
Correct answer: It increases coronary perfusion during diastole and reduces afterload during systole
The IABP inflates in diastole to augment coronary perfusion and deflates in systole to reduce afterload.
Question 4: A patient with acute decompensated heart failure has an SpO2 of 84% and crackles throughout. What is the priority intervention?
- Administer a fluid bolus
- Provide supplemental oxygen and consider noninvasive positive pressure ventilation (Correct answer)
- Start a beta-blocker
- Place the patient flat
Correct answer: Provide supplemental oxygen and consider noninvasive positive pressure ventilation
Oxygenation and positive pressure ventilation improve gas exchange and reduce preload in acute pulmonary edema.
Question 5: Which sign distinguishes right-sided heart failure from left-sided heart failure?
- Pulmonary crackles
- Jugular venous distention and peripheral edema (Correct answer)
- Orthopnea
- Pink frothy sputum
Correct answer: Jugular venous distention and peripheral edema
Right-sided failure causes systemic venous congestion with JVD and peripheral edema, whereas left-sided failure causes pulmonary symptoms.
Question 6: A heart failure patient's BNP is markedly elevated. What does this indicate?
- Renal failure
- Increased ventricular wall stretch and volume overload (Correct answer)
- Pulmonary embolism
- Myocardial ischemia
Correct answer: Increased ventricular wall stretch and volume overload
BNP is released in response to ventricular stretch, so elevation reflects volume overload and heart failure severity.
Question 7: Why are ACE inhibitors a cornerstone of chronic heart failure management?
- They increase heart rate
- They reduce afterload and prevent ventricular remodeling (Correct answer)
- They directly increase contractility
- They are potent diuretics
Correct answer: They reduce afterload and prevent ventricular remodeling
ACE inhibitors lower afterload and inhibit the RAAS, slowing maladaptive ventricular remodeling.
CCRN Cardiovascular Emergencies 3
A patient in cardiogenic shock has cold extremities, hypotension, and pulmonary congestion.
Which hemodynamic profile is expected?