Progressive Care Nursing Certification (PCCN) Practice Exam

What condition should a nurse suspect in a patient who develops sudden-onset diffuse crackles and a new loud murmur after a recent STEMI?

1. Mitral regurgitation

2. Left-sided heart failure

3. Stent occlusion

4. Cardiogenic shock

The correct answer is: Mitral regurgitation

In the context of a patient who experiences sudden-onset diffuse crackles in the lungs and a new loud murmur following a recent ST-Elevation Myocardial Infarction (STEMI), mitral regurgitation is a condition that should be strongly suspected. This type of murmur is often indicative of acute changes in the heart's structure or function, particularly concerning the mitral valve, which can occur due to ischemic damage to the heart muscle. After a STEMI, particularly in the case of a significant left ventricular wall injury, the integrity of the mitral valve apparatus may be compromised. This can lead to acute mitral regurgitation, where blood flows backward from the left ventricle into the left atrium during systole. The sudden increase in volume in the atrium can lead to pulmonary congestion, which manifests as diffuse crackles upon examination of the lungs. While options like left-sided heart failure and cardiogenic shock may also present with crackles and murmurs, they do not specifically indicate the acute change related to the mitral valve. Furthermore, conditions like stent occlusion, while a serious complication after a STEMI, would typically present with symptoms more related to myocardial ischemia rather than the specific combination of