AACN CCRN-Adult Exam With Confidence Using Practice Dumps

For a patient with unstable angina, the major goal of treatment is to decrease myocardial oxygen consumption. This can be achieved by reducing heart rate, blood pressure, and myocardial contractility to lessen the workload on the heart and reduce the demand for oxygen. This helps in preventing further ischemia and potential myocardial infarction. Treatment strategies may include the use of medications such as beta-blockers, nitrates, and calcium channel blockers, which all help in decreasing the oxygen demand of the heart.References: = CCRN Exam Handbook, page 10

The patient’s present clinical status is most likely a result of a ventricular septal defect (VSD), which is a hole in the wall between the left and right ventricles. A VSD can occur as a mechanical complication of MI, usually within the first week, due to necrosis and rupture of the ventricular septum. A VSD causes a left-to-right shunt of blood, which leads to increased pulmonary pressure, pulmonary edema, and reduced cardiac output. The patient’s symptoms and signs are consistent with a VSD, such as severe chest pain, hypotension, tachycardia, respiratory distress, high PAOP with large V waves, low CI, cool and clammy skin, inspiratory crackles, and a loud blowing holosystolic murmur at the apex. A papillary muscle rupture, a cardiac tamponade, and an acute aortic insufficiency are other possible mechanical complications of MI, but they have different clinical manifestations. A papillary muscle rupture causes acute mitral regurgitation, which presents with a soft systolic murmur at the apex and pulmonary congestion1. A cardiac tamponade causes compression of the heart by pericardial fluid, which presents with hypotension, muffled heart sounds, and jugular venous distension2. An acute aortic insufficiency causes backflow of blood from the aorta to the left ventricle, which presents with a diastolic decrescendo murmur at the left sternal border and a wide pulse pressure3.

References:

• 1: Mechanical complications of acute myocardial infarction - UpToDate4, p. 2-3.
• 2: Cardiac tamponade - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.
• 3: Acute aortic regurgitation - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome," is characterized by transient left ventricular dysfunction often precipitated by significant emotional or physical stress. The key findings of chest pain and ST elevation without significant coronary artery disease, along with left ventricular dysfunction and apical ballooning observed on imaging, are classic for takotsubo cardiomyopathy. This condition is often reversible and is associated with a temporary reduction in the heart's pumping ability, indicated by the reduced ejection fraction (EF) of 35%. References: =

• American Association of Critical-Care Nurses (AACN). (2024). CCRN Exam Handbook. Retrieved from AACN CCRN Exam Handbook
• Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online. AACN