Mixed Deck — All CMC Topics Flashcards

What are the five process groups in CMC project management?

Answer: Initiating, Planning, Executing, Monitoring & Controlling, and Closing

The five process groups provide a framework for managing any project: Initiating (defining the project), Planning (establishing scope and approach), Executing (doing the work), Monitoring & Controlling (tracking progress), and Closing (formal completion).

What is the specific antidote used to reverse unfractionated heparin-induced bleeding?

Answer: Protamine sulfate

Protamine sulfate is a positively charged protein that binds and neutralizes negatively charged heparin, reversing its anticoagulant effect.

A patient who has ST-segment elevation in leads II, III, and aVF with high troponin is hospitalized. Which medicine administration should the nurse initially prepare for?

Answer: Reteplase (Retavase)

ST-segment elevation in leads II, III, and aVF, along with elevated troponin, indicates an acute inferior wall myocardial infarction (STEMI). For STEMI, immediate reperfusion therapy is critical to restore blood flow. Reteplase (Retavase) is a thrombolytic agent used to dissolve the clot causing the MI, making it an appropriate initial medication to prepare for in this emergency scenario.

In a patient with aortic stenosis being evaluated for transcatheter aortic valve replacement (TAVR), the STS-PROM score is 8%. How is this risk categorized?

Answer: High surgical risk (> 8% STS-PROM)

An STS-PROM of > 8% is classified as high surgical risk, supporting TAVR over SAVR in eligible patients with severe symptomatic aortic stenosis.

A cardiac manager is asked to prepare a zero-based budget. This approach requires that:

Answer: Every budget line must be justified from scratch each cycle regardless of history

Zero-based budgeting requires full justification of all expenditures each period rather than incremental adjustments from prior budgets.

In a cardiac quality dashboard, which approach best supports a 'balanced scorecard' reporting framework?

Answer: Including metrics across safety, effectiveness, patient experience, and efficiency domains simultaneously

A balanced scorecard integrates multiple performance domains to provide a comprehensive view of quality, preventing overemphasis on any single dimension.

In a patient with STEMI, which feature on admission identifies highest 30-day mortality risk according to the Killip classification?

Answer: Killip Class IV (cardiogenic shock)

Killip Class IV (cardiogenic shock) carries 30-day mortality approaching 50–80% and is the highest-risk category in the Killip classification of acute MI.

A patient asks whether they should share their cardiac diagnosis with their employer. What is the nurse's best response?

Answer: Explain that disclosure is their personal decision and offer to discuss potential implications

Respecting patient autonomy means supporting informed decision-making rather than directing the patient's personal choices.

The project management concept of 'triple constraint' in a cardiac quality improvement project refers to:

Answer: Scope, time, and cost (resources)

The triple constraint (iron triangle) is scope, time, and cost—changes to one typically require adjustments to the others to maintain balance.

The symptoms of a 72-year-old man with persistent systolic congestive heart failure have gotten worse, so he is admitted to the hospital. He initially appears to be in good health, but on the second day of his hospital stay, he suddenly starts to have chest pain, a cough that gets worse, and rapidly deteriorating shortness of breath. An abrupt ST-segment elevation myocardial infarction on the left side is seen on an ECG. What is the most likely reason for his breathing difficulties?

Answer: Pulmonary edema

The patient's sudden onset of chest pain, worsening cough, and rapidly deteriorating shortness of breath, coupled with a new ST-segment elevation myocardial infarction (STEMI), strongly suggest acute left ventricular dysfunction. A STEMI, especially on the left side, can severely impair the heart's pumping ability, leading to a rapid increase in pressure within the left atrium and pulmonary veins. This acute pressure overload forces fluid into the lung's interstitial spaces and alveoli, resulting in acute pulmonary edema, which directly causes severe breathing difficulties and cough.

Which hemodynamic parameter is measured by a thermodilution pulmonary artery catheter (Swan-Ganz) that cannot be obtained by echocardiography alone?

Answer: Cardiac output measured by thermodilution with cold saline injection

Thermodilution cardiac output requires a PA catheter for cold injectate delivery and thermistor measurement, which cannot be replicated non-invasively by echo.

A pharmaceutical company offers a cardiac nurse a gift card for attending a product promotion dinner. According to professional ethics, the nurse should:

Answer: Decline the gift to avoid a conflict of interest and maintain professional integrity

Professional standards and most institutional policies prohibit accepting gifts from industry to prevent conflicts of interest.

A nurse manager assigns a culturally incompetent colleague to care for a patient whose religious customs require same-gender care providers. The nurse's advocacy role requires:

Answer: Raising the concern with the manager and facilitating a culturally congruent care assignment

Patient advocacy requires nurses to proactively address cultural care needs and work with management to honor patient preferences.

A 65-year-old woman with HFrEF (EF 30%) and LBBB has a QRS duration of 158 ms despite optimal medical therapy. What device therapy is indicated for risk reduction?

Answer: Cardiac resynchronization therapy with defibrillator (CRT-D)

CRT-D is indicated for HFrEF with LBBB and QRS ≥ 150 ms on optimal medical therapy to reduce mortality, hospitalization, and reverse remodel the LV.

Instantaneous wave-free ratio (iFR) differs from FFR in that it:

Answer: Measures pressure ratio during the diastolic wave-free period without pharmacologic hyperemia

iFR measures the pressure ratio across a stenosis during a naturally occurring low-resistance period in diastole, eliminating the need for adenosine.

A cardiac quality improvement team wants to identify which of 15 possible factors most contributes to prolonged ICU length of stay. Which tool is most appropriate first?

Answer: Pareto chart

A Pareto chart ranks contributing factors by frequency or impact, identifying the vital few causes responsible for the majority of the problem.

What is a near-miss report in CMC safety management?

Answer: Documentation of an event that could have resulted in harm but did not

A near-miss report documents events where an injury, damage, or loss almost occurred. These reports provide valuable data for preventing future incidents by identifying systemic weaknesses before actual harm occurs.

A cardiologist disagrees with a hospitalist's management of a shared patient. The most professional approach is to:

Answer: Contact the hospitalist directly to discuss clinical rationale and reach a shared plan

Direct collegial communication is the first step in resolving clinical disagreements and preserving patient safety.

A 72-year-old man who was admitted to the hospital to rule out acute coronary syndrome is being cared for by the nurse. He immediately clutches his chest and slumps back into his bed motionless as the nurse is in the room speaking to him. The nurse starts cardiopulmonary resuscitation and makes a call for assistance. A monitor/defibrillator is fastened to the patient's chest by a crew that has arrived with the crash cart. Monitor readings show asystole. What should be done as soon as possible?

Answer: Resume chest compressions

Asystole represents a complete absence of electrical activity in the heart, making it a non-shockable rhythm. In this critical situation, the immediate and most crucial action is to resume high-quality chest compressions without delay. Chest compressions are vital to maintain some blood flow to the brain and other vital organs, buying time until other advanced cardiac life support (ACLS) interventions, such as epinephrine administration and identification of reversible causes, can be implemented.

A QI team finds that only 60% of STEMI patients receive aspirin within 10 minutes of arrival. Using a cause-and-effect analysis, which category would 'no aspirin stocked in triage' fall under?

Answer: Materials/Equipment

In a fishbone (Ishikawa) diagram, absence of a required supply like aspirin in triage falls under the 'Materials' (or Equipment) category.