MCQ Quiz: CV Emergencies

Cardiovascular emergencies represent some of the most time-critical and high-stakes scenarios in medicine. As integral members of the healthcare team, pharmacists must possess a deep and immediate knowledge of the pharmacotherapy used to manage these life-threatening events. The Patient Care VII curriculum dedicates a significant module to CV Emergencies and Advanced Cardiovascular Life Support (ACLS), preparing students to handle conditions ranging from acute decompensated heart failure (ADHF) and hypertensive crises to cardiac arrest. This quiz will test your knowledge on the rapid assessment and management of these critical conditions, focusing on the evidence-based guidelines and pharmacologic principles essential for every future pharmacist.

1. A patient with acute decompensated heart failure (ADHF) who presents with evidence of both congestion (“wet”) and hypoperfusion (“cold”) requires which combination of therapies?

• a) An oral beta-blocker and IV fluids
• b) An IV loop diuretic and an IV inotrope (e.g., dobutamine)
• c) An oral ACE inhibitor only
• d) High-dose aspirin and a statin Answer: b) An IV loop diuretic and an IV inotrope (e.g., dobutamine)

2. According to the Advanced Cardiovascular Life Support (ACLS) guidelines, what is the first-line pharmacologic agent for symptomatic bradycardia?

• a) Epinephrine
• b) Amiodarone
• c) Atropine
• d) Adenosine Answer: c) Atropine

3. A hypertensive emergency is distinguished from hypertensive urgency by the:

• a) Systolic blood pressure being greater than 200 mmHg.
• b) Presence of acute, ongoing end-organ damage.
• c) Patient reporting a severe headache.
• d) Time of day the blood pressure is measured. Answer: b) The presence of acute, ongoing end-organ damage.

4. In the ACLS algorithm for a patient in pulseless ventricular fibrillation (pVT) or ventricular fibrillation (VF), what is the immediate priority after initiating CPR?

• a) Administering epinephrine
• b) Intubation
• c) Defibrillation
• d) Establishing IV access Answer: c) Defibrillation

5. A patient with ADHF who is “wet and warm” (congested but well-perfused) will receive the most benefit from which initial therapy?

• a) An IV inotrope
• b) An IV vasopressor
• c) An IV loop diuretic
• d) IV fluid bolus Answer: c) An IV loop diuretic

6. What is the standard dose of epinephrine administered during an adult cardiac arrest scenario?

• a) 0.5 mg every 10 minutes
• b) 1 mg every 3-5 minutes
• c) 3 mg as a one-time dose
• d) 0.1 mg/kg as needed Answer: b) 1 mg every 3-5 minutes

7. A patient presents with an acute ischemic stroke and concurrent, severe hypertension. The management goal is to:

• a) Lower the blood pressure as quickly as possible to normal levels.
• b) Cautiously lower the blood pressure, as aggressive reduction can worsen cerebral ischemia.
• c) Administer a beta-blocker immediately.
• d) Not treat the blood pressure at all. Answer: b) Cautiously lower the blood pressure, as aggressive reduction can worsen cerebral ischemia.

8. Dobutamine is an inotrope used in cardiogenic shock and some cases of ADHF. It primarily stimulates which receptors to increase cardiac contractility?

• a) Alpha-1
• b) Beta-1
• c) Beta-2
• d) Dopamine Answer: b) Beta-1

9. In the management of a patient in asystole or pulseless electrical activity (PEA), which of the following is NOT an indicated intervention?

• a) High-quality CPR
• b) Epinephrine administration
• c) Searching for reversible causes (Hs and Ts)
• d) Defibrillation Answer: d) Defibrillation

10. A patient presents with supraventricular tachycardia (SVT) and is hemodynamically stable. After vagal maneuvers fail, what is the first-line drug of choice, known for its extremely short half-life?

• a) Amiodarone
• b) Diltiazem
• c) Adenosine
• d) Lidocaine Answer: c) Adenosine

11. The management of a hypertensive emergency associated with an acute aortic dissection requires rapid lowering of both blood pressure and heart rate. What is a preferred agent?

• a) Hydralazine
• b) Nicardipine
• c) Esmolol
• d) Enalaprilat Answer: c) Esmolol

12. After the third shock for a patient in refractory VF/pVT, what is the first-line antiarrhythmic agent to consider?

• a) Atropine
• b) Magnesium sulfate
• c) Amiodarone
• d) Sodium bicarbonate Answer: c) Amiodarone

13. Intravenous nitroglycerin is used in some cardiovascular emergencies, such as ADHF or ACS with hypertension. Its primary effect is:

• a) Arterial vasoconstriction
• b) Venous vasodilation, which reduces preload
• c) Increased heart rate
• d) Negative inotropy Answer: b) Venous vasodilation, which reduces preload

14. A patient with ADHF is receiving a continuous infusion of a loop diuretic. What is a critical monitoring parameter?

• a) Urine output and renal function
• b) Liver function tests
• c) White blood cell count
• d) Hemoglobin A1c Answer: a) Urine output and renal function

15. A key difference between inotropes dobutamine and milrinone is that milrinone causes more:

• a) Vasoconstriction
• b) Vasodilation and hypotension
• c) Bradycardia
• d) Renal toxicity Answer: b) Vasodilation and hypotension

16. For a patient with stable atrial fibrillation with rapid ventricular response (RVR), a common initial agent for rate control is:

• a) Digoxin
• b) An IV non-dihydropyridine calcium channel blocker (e.g., diltiazem)
• c) Amiodarone
• d) Adenosine Answer: b) An IV non-dihydropyridine calcium channel blocker (e.g., diltiazem)

17. What is the role of the pharmacist during a “code blue” or cardiac arrest?

• a) To perform chest compressions only.
• b) To prepare and dispense emergency medications accurately and timely.
• c) To make the diagnosis.
• d) To lead the code. Answer: b) To prepare and dispense emergency medications accurately and timely.

18. The “Hs and Ts” are a mnemonic used in ACLS to remember:

• a) The doses of emergency medications.
• b) The members of the code team.
• c) The potentially reversible causes of cardiac arrest.
• d) The steps for intubation. Answer: c) The potentially reversible causes of cardiac arrest.

19. A patient with an acute coronary syndrome (ACS) is given aspirin. What is its role in this setting?

• a) To relieve pain
• b) To dissolve the existing clot
• c) To inhibit platelet aggregation and prevent further thrombus formation
• d) To lower blood pressure Answer: c) To inhibit platelet aggregation and prevent further thrombus formation

20. A hypertensive emergency is defined by severe hypertension and evidence of end-organ damage, such as:

• a) A mild headache
• b) Acute kidney injury, encephalopathy, or stroke
• c) Muscle soreness
• d) An elevated blood glucose level Answer: b) Acute kidney injury, encephalopathy, or stroke

21. Sodium nitroprusside is a potent arterial and venous vasodilator, but its use is limited by the risk of:

• a) Severe bradycardia
• b) Cyanide toxicity with prolonged use
• c) Hyperglycemia
• d) A severe allergic reaction Answer: b) Cyanide toxicity with prolonged use

22. A patient with ADHF who is “warm and dry” (well-perfused and not congested) requires what intervention?

• a) IV diuretics
• b) IV inotropes
• c) Optimization of their oral home medications
• d) IV fluids Answer: c) Optimization of their oral home medications

23. If a patient in cardiac arrest has a non-shockable rhythm like asystole or PEA, what is the cornerstone of their management?

• a) Repeated defibrillation attempts
• b) High-quality CPR with minimal interruptions
• c) Administration of amiodarone
• d) Immediate transfer to the cardiac cath lab Answer: b) High-quality CPR with minimal interruptions

24. The management of pulmonary hypertension (PH), as covered in the CV Emergencies unit, often involves therapies that target what pathway?

• a) The renin-angiotensin-aldosterone system
• b) The nitric oxide, endothelin, or prostacyclin pathways
• c) The coagulation cascade
• d) The inflammatory cascade Answer: b) The nitric oxide, endothelin, or prostacyclin pathways

25. A key role for the pharmacist in managing CV emergencies is ensuring correct dosing, especially for high-risk infusions. This is a primary objective of which course?

• a) Hospital Introductory Pharmacy Practice Experience (HIPPE)
• b) Professional Practice Skills Laboratory IV
• c) Principles of Law & Ethics
• d) Population Health Answer: b) Professional Practice Skills Laboratory IV

26. Why should IV beta-blockers be used with caution in a patient with ADHF and signs of hypoperfusion?

• a) They can worsen pump function due to their negative inotropic effects.
• b) They cause severe hypertension.
• c) They have no role in heart failure.
• d) They are too expensive. Answer: a) They can worsen pump function due to their negative inotropic effects.

27. After successful return of spontaneous circulation (ROSC) following a cardiac arrest, a key management goal is:

• a) Inducing a fever to improve neurological outcomes.
• b) Targeted temperature management (hypothermia).
• c) Administering a bolus of IV fluids.
• d) Discontinuing all medications. Answer: b) Targeted temperature management (hypothermia).

28. An IV formulation of which P2Y12 inhibitor is available for use in the setting of ACS?

• a) Clopidogrel
• b) Prasugrel
• c) Ticagrelor
• d) Cangrelor Answer: d) Cangrelor

29. The management of a CV emergency in a patient with chronic kidney disease requires the pharmacist to:

• a) Use standard doses for all medications.
• b) Adjust the doses of renally cleared medications.
• c) Avoid all medications.
• d) Focus only on non-pharmacologic therapies. Answer: b) Adjust the doses of renally cleared medications.

30. Which of the following is a potential adverse effect of amiodarone administration?

• a) Tachycardia
• b) Hypertension
• c) Hypotension and bradycardia
• d) Hyperglycemia Answer: c) Hypotension and bradycardia

31. The primary goal of diuretic therapy in a “wet” ADHF patient is to:

• a) Lower blood pressure.
• b) Improve cardiac contractility.
• c) Reduce congestion and relieve symptoms like dyspnea.
• d) Increase heart rate. Answer: c) Reduce congestion and relieve symptoms like dyspnea.

32. A patient presenting with an ST-segment elevation myocardial infarction (STEMI) requires what immediate intervention?

• a) Urgent reperfusion therapy (e.g., PCI or thrombolysis)
• b) A five-day course of oral antibiotics
• c) Discharge home with an aspirin
• d) An exercise stress test Answer: a) Urgent reperfusion therapy (e.g., PCI or thrombolysis)

33. The administration of adenosine for SVT should be done as a:

• a) Slow IV infusion over 30 minutes.
• b) Rapid IV push followed by a saline flush.
• c) Subcutaneous injection.
• d) Continuous infusion. Answer: b) Rapid IV push followed by a saline flush.

34. The “Stop the Bleed” training is relevant to which CV emergency?

• a) Hypertensive crisis
• b) Acute decompensated heart failure
• c) Hemorrhagic shock
• d) Atrial fibrillation Answer: c) Hemorrhagic shock

35. A patient develops diuretic resistance while being treated for ADHF. A potential strategy is to:

• a) Discontinue the diuretic.
• b) Add a thiazide-like diuretic (e.g., metolazone) before the loop diuretic.
• c) Decrease the dose of the loop diuretic.
• d) Switch to an oral formulation. Answer: b) Add a thiazide-like diuretic (e.g., metolazone) before the loop diuretic.

36. A key part of the assessment of a patient with a suspected CV emergency is to obtain:

• a) A 12-lead electrocardiogram (EKG).
• b) A diet history.
• c) A list of their favorite hobbies.
• d) A chest X-ray only. Answer: a) A 12-lead electrocardiogram (EKG).

37. Which of the “H’s” in the “Hs and Ts” mnemonic is a common cause of PEA?

• a) Hyperoxia
• b) Hypovolemia
• c) Hypertension
• d) Hypernatremia Answer: b) Hypovolemia

38. The use of nicardipine or clevidipine is often preferred in hypertensive emergencies because they are:

• a) Oral agents with a slow onset.
• b) Titratable IV agents with a rapid onset and offset.
• c) Negative inotropes.
• d) Agents with a very long half-life. Answer: b) Titratable IV agents with a rapid onset and offset.

39. In a patient with ADHF and severe hyponatremia, what class of medication might be considered?

• a) A vasopressin receptor antagonist (e.g., tolvaptan)
• b) A beta-blocker
• c) An ACE inhibitor
• d) A potassium-sparing diuretic Answer: a) A vasopressin receptor antagonist (e.g., tolvaptan)

40. A patient in cardiac arrest is found to have hyperkalemia as the likely cause. The management includes:

• a) Intravenous potassium
• b) Intravenous calcium, insulin with dextrose, and sodium bicarbonate
• c) Amiodarone
• d) Atropine Answer: b) Intravenous calcium, insulin with dextrose, and sodium bicarbonate

41. The primary role of morphine in the management of some ACS cases is to:

• a) Inhibit platelets.
• b) Lower blood pressure.
• c) Relieve pain and anxiety, which reduces myocardial oxygen demand.
• d) Dissolve the clot. Answer: c) Relieve pain and anxiety, which reduces myocardial oxygen demand.

42. Which of the “T’s” in the “Hs and Ts” mnemonic is a cause of obstructive shock?

• a) Thrombosis (pulmonary or coronary)
• b) Toxins
• c) Trauma
• d) Tamponade (cardiac)
• e) Both A and D Answer: e) Both A and D

43. A pharmacist on rounds recommends switching from an IV to an oral formulation of a diuretic for an ADHF patient who is stabilizing. This is an example of:

• a) Promoting cost-effective care and facilitating discharge.
• b) A medication error.
• c) A therapeutic duplication.
• d) Exceeding their scope of practice. Answer: a) Promoting cost-effective care and facilitating discharge.

44. A major side effect to monitor for with sodium nitroprusside is:

• a) Profound hypotension
• b) Bradycardia
• c) Hyperglycemia
• d) Hypertension Answer: a) Profound hypotension

45. What is the appropriate action if a patient develops symptomatic bradycardia and does not respond to atropine?

• a) Administer a higher dose of atropine.
• b) Initiate transcutaneous pacing or an epinephrine/dopamine infusion.
• c) Administer amiodarone.
• d) Observe the patient. Answer: b) Initiate transcutaneous pacing or an epinephrine/dopamine infusion.

46. A patient is having an anaphylactic reaction with cardiovascular collapse. The treatment is epinephrine. What is the concentration used for the IM injection versus the IV push in cardiac arrest?

• a) IM is 1:1,000; IV is 1:10,000
• b) IM is 1:10,000; IV is 1:1,000
• c) They are the same concentration.
• d) Epinephrine is not used for anaphylaxis. Answer: a) IM is 1:1,000; IV is 1:10,000

47. A key educational point for a patient being discharged after an episode of ADHF is:

• a) To stop all heart medications once they feel better.
• b) The importance of daily weights, sodium restriction, and medication adherence.
• c) To double their diuretic dose if they gain any weight.
• d) To avoid all physical activity. Answer: b) The importance of daily weights, sodium restriction, and medication adherence.

48. What is the primary reason to avoid non-dihydropyridine calcium channel blockers in a patient with HFrEF?

• a) They cause severe hypertension.
• b) They have negative inotropic effects that can worsen heart failure.
• c) They are not effective for rate control.
• d) They have too many drug interactions. Answer: b) They have negative inotropic effects that can worsen heart failure.

49. The overall management of CV emergencies, as taught in the Patient Care curriculum, relies heavily on:

• a) Guesswork
• b) A single person’s opinion
• c) Following evidence-based algorithms and guidelines (e.g., ACLS)
• d) The cost of the drugs only Answer: c) Following evidence-based algorithms and guidelines (e.g., ACLS)

50. An understanding of the pathophysiology of the cardiovascular system is essential for managing CV emergencies. This knowledge is a primary focus of which foundational course?

• a) Principles of Medicinal Chemistry
• b) Pathophysiology and Patient Assessment I
• c) Drug Delivery Systems
• d) Principles of Law & Ethics Answer: b) Pathophysiology and Patient Assessment I