Progressive Care Nursing Certification (PCCN) Practice Exam

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In a patient experiencing cardiogenic shock due to anterior-wall STEMI, what hemodynamic changes are typically observed?

  1. Decreased cardiac index, increased preload, increased afterload

  2. Increased cardiac index, decreased preload, decreased afterload

  3. Decreased cardiac index, decreased preload, decreased afterload

  4. Increased cardiac index, increased preload, increased afterload

The correct answer is: Decreased cardiac index, increased preload, increased afterload

In the context of cardiogenic shock resulting from an anterior-wall ST-Elevation Myocardial Infarction (STEMI), the hemodynamic profile reflects significant disturbances in cardiac function. The correct answer indicates a decreased cardiac index, which is expected because the heart's ability to pump effectively is impaired due to the loss of myocardium from the infarction. This results in inadequate output to meet the body's demands, leading to a significantly lower cardiac index. In addition, the preload is increased because of fluid accumulation and decreased stroke volume, causing a backlog of blood. This increased preload occurs as the volume of blood in the ventricles at the end of diastole rises, reflecting compromised ventricular function. Afterload is also increased in this setting, primarily due to systemic vasoconstriction and compensatory mechanisms in response to hypotension. The body attempts to maintain perfusion pressure, which results in elevated systemic vascular resistance. Together, these changes illustrate a hemodynamic profile characteristic of cardiogenic shock, where the heart struggles with both volume and pressure, leading to vascular congestion and insufficient cardiac performance. Understanding these dynamics is crucial for effective management in progressive care nursing.