Cardiac Vascular Nursing Flashcards

A patient develops ventricular fibrillation (VF) on a cardiac monitor and the nurse is alone at the bedside. What is the correct first action?

Answer: Confirm pulselessness, call for help and crash cart, then begin CPR immediately

For witnessed VF with confirmed pulselessness: call for help and crash cart, then immediately begin high-quality CPR. Every minute without defibrillation decreases survival by 7-10%.

A patient with PAD reports cramping calf pain after walking two blocks that reliably resolves with rest. This symptom pattern is called:

Answer: Intermittent claudication

Intermittent claudication is reproducible ischemic muscle pain during exercise that reliably resolves with rest, resulting from inadequate arterial flow to meet muscle oxygen demands during exertion.

A patient is preparing for permanent pacemaker insertion. Which finding is most important to communicate to the proceduralist?

Answer: The left subclavian vein was used for a previous central line

Previous subclavian vein use may have caused stenosis or occlusion, preventing pacemaker lead placement via that route. The proceduralist needs this information to plan venous access.

Which ECG finding is consistent with left ventricular hypertrophy (LVH)?

Answer: S wave in V1 + R wave in V5 or V6 at or above 35 mm (Sokolow-Lyon criteria)

The Sokolow-Lyon criteria for LVH: S wave depth in V1 plus the tallest R wave in V5 or V6 at or above 35 mm. LVH reflects increased myocardial mass from hypertension or aortic stenosis.

A patient on IV heparin for DVT develops platelet count drop from 210,000 to 62,000/uL on day 7 and has a new arterial clot in the left arm. Which condition is suggested?

Answer: Heparin-induced thrombocytopenia Type II (HIT) with thrombosis (HITT)

HIT Type II presents with platelet count drop greater than 50% on days 5-10 of heparin therapy plus paradoxical thrombosis. When combined with thrombosis it is called HITT.

A patient on clopidogrel and aspirin for unstable angina — which factor most significantly reduces clopidogrel effectiveness?

Answer: CYP2C19 poor metabolizer genetic variant

Clopidogrel is a prodrug requiring activation by CYP2C19. Poor metabolizers with loss-of-function alleles have significantly reduced active metabolite levels and diminished platelet inhibition.