Cardiac Vascular Nursing Flashcards

A patient is in narrow complex tachycardia at 180 bpm, regular rhythm, hemodynamically stable. Which is the first-line treatment per ACLS?

Answer: Vagal maneuvers followed by adenosine 6 mg rapid IV push

Stable narrow complex regular tachycardia (likely AVNRT or AVRT) is treated first with vagal maneuvers. If unsuccessful, adenosine 6 mg rapid IV push is the first-line pharmacologic treatment.

A post-PCI patient on DAPT (clopidogrel and aspirin) needs emergency appendectomy. Which antiplatelet management is most appropriate?

Answer: Consult cardiology; if within 30 days of BMS or 12 months of DES, delay surgery if possible

Premature DAPT discontinuation within 30 days of BMS or 6-12 months of DES carries high stent thrombosis risk. Emergency surgery requires cardiology consultation to weigh bleeding versus stent thrombosis risk.

A patient with chronic heart failure develops acute pulmonary edema with SpO2 84%, severe dyspnea, and pink frothy sputum. Which initial intervention has highest priority?

Answer: Position upright (high Fowler's), apply high-flow oxygen or NIV, and prepare IV furosemide

Acute pulmonary edema is a respiratory emergency. Immediate priorities: upright positioning (reduces preload), high-flow O2 or NIV (improves oxygenation), and IV furosemide (rapid diuresis). These occur simultaneously.

A patient with inferior STEMI has ST elevation in II, III, aVF; ST depression in V1-V2; and elevated JVP without pulmonary congestion. Which structure is most likely involved?

Answer: Right ventricular infarction complicating inferior STEMI

Inferior STEMI with ST depression in V1-V2 (posterior involvement) and elevated JVP without pulmonary edema (right-sided heart failure) indicates right ventricular infarction. Confirm with right-sided leads (V4R ST elevation).

For a patient on IABP for cardiogenic shock, what is the primary mechanism by which IABP improves myocardial oxygen supply?

Answer: Inflation during diastole increases coronary artery perfusion pressure

IABP counterpulsation inflates during diastole (triggered by the dicrotic notch), augmenting diastolic pressure and improving coronary perfusion pressure — called diastolic augmentation.

A telemetry strip shows a regular atrial rate near 300 bpm with sawtooth deflections and variable ventricular response. Which rhythm does this describe?

Answer: Atrial flutter with variable block

Atrial flutter shows regular sawtooth flutter waves at 250-350 bpm (classically 300 bpm) with variable AV block (2:1, 3:1, 4:1), creating a regularly irregular ventricular response.