FREE CMC Certification Questions and Answers


What is the acute complication of coronary artery stenting that is the most serious?

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In patients with carotid stenosis, stroke is the most severe acute complication linked to coronary artery stenting. Stroke may develop from thrombosis, hypoperfusion, intracerebral hemorrhage, or cerebral hyperperfusion. Stent fractures, myocardial infarctions, and renal impairment are other consequences of coronary artery stenting, although stroke is regarded as the most significant.

The patient was discharged with newly diagnosed atrial fibrillation. The anticoagulant warfarin was started.

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For the majority of patients with atrial fibrillation, an international normalized ratio of 2 to 3 is advised to prevent the embolization of atrial thrombi. His goal range might need to be changed if the patient has additional risk factors.

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?

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Asystole cannot be shocked (defibrillated) into a normal rhythm. Keeping chest compressions going as long as possible is one of the most crucial aspects of advanced cardiac life support. In this situation, it is important to start chest compressions again right away as the rest of the squad gets ready for the next move. Chest compressions should continue while 1 mg of epinephrine can be administered every 3 to 5 minutes with the help of a team member who will make sure the patient has a good intravenous access. Although the patient could require the placement of an advanced airway, chest compressions should be kept up throughout the process.

The nurse hears a patient's heartbeats and notices that after the initial heartbeat comes a high-pitched, holosystolic murmur, which is most audible at the apex. The axilla of the patient appears to be the source of the murmur. What most probable this murmur means?

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The murmur of mitral regurgitation may vary, but in its typical presentation, it is holosystolic, begins immediately after S1, is heard best over the apex, and may radiate to the axilla or back. The ideal place to listen for the rumbling, mid-diastolic murmur of mitral valve stenosis is over the left ventricular impulse with the stethoscope's bell. Aortic regurgitation is typically best detected near the left sternal border and is audible as a loud, early diastolic murmur that extends toward the cardiac apex. Aortic valve stenosis causes a mid-systolic murmur that is typically loudest in the right second intercostal space and may radiate to the carotids.

The following are ALL major mechanical consequences of acute myocardial infarction, EXCEPT:

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The three principal medical consequences of acute myocardial infarction include rupture of the left ventricular free wall, rupture of the interventricular septum, and the development of mitral regurgitation (frequently due to papillary muscle rupture). Suspicion of a mechanical complication is warranted if a new murmur appears, if there is evidence of hypoperfusion, or if severe decompensated heart failure takes place. The diagnosis is generally made with echocardiography. If none of these consequences are handled very away, they can all result in cardiogenic shock and death.

A 28-year-old lady with possible endocarditis is admitted to the nursing unit. The decision is made to begin antibiotic medication as soon as feasible because the patient seems to be in severe pain. What procedure should be followed in this situation to get blood cultures?

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Before starting antibiotic medication, blood samples must be taken in order to maximize the chance of identifying the infection-causing bacteria. Three different blood cultures should be acquired over the course of an hour in acutely unwell patients before beginning empiric antibiotic therapy. Once the organism is identified, the patient can be switched over to more specific antimicrobial agents. If the illness is subacute and the patient is not critically ill, three blood cultures should still be obtained before antibiotic therapy, but they can be collected over a longer period of time. In these subacute cases, delaying therapy for 1-3 days until the blood culture results are available might be preferable.

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?

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The patient's medical history, which is supplied in the question, will be used to determine the most likely cause of his shortness of breath. His previous congestive heart failure had most likely progressed to acute decompensated heart failure (ADHF) as a result of his ST-segment elevation myocardial infarction. The ADHF is a reasonably prevalent cause of acute respiratory distress due to the fast buildup of fluid in the lungs (pulmonary edema). Pneumonia, reactive airway disorders, and pulmonary embolisms can all cause dyspnea, a cough, and chest pain, but they are less likely to do so in this case given the patient's medical history.

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