Cardiac Vascular Nursing Flashcards

A patient presents with sudden tearing chest pain radiating to the back and unequal blood pressures between arms (160/90 right vs 120/70 left). Which diagnosis is most likely?

Answer: Aortic dissection

Tearing chest/back pain with unequal blood pressures between arms is the classic presentation of aortic dissection — a surgical emergency.

A patient with HFrEF (EF 30%) is being discharged. Which medication combination has the strongest evidence for reducing mortality?

Answer: ACE inhibitor or ARNI, beta-blocker, aldosterone antagonist, and SGLT2 inhibitor

The four pillars of HFrEF therapy with mortality benefit are: ACE inhibitor or ARNI (sacubitril/valsartan), beta-blocker, aldosterone antagonist, and SGLT2 inhibitor.

A patient with complete heart block shows ventricular rate 32 bpm and hemodynamic instability. What is the immediate treatment?

Answer: Transcutaneous pacing followed by transvenous pacing

Symptomatic third-degree AV block requires immediate transcutaneous pacing as a bridge to transvenous pacing. Amiodarone and beta-blockers are contraindicated as they worsen bradycardia.

A patient underwent PCI via the right radial artery. Which complication should the nurse assess for first post-procedure?

Answer: Radial artery occlusion and hand ischemia

Radial artery occlusion is the most common complication of transradial PCI, occurring in 1-10% of cases. Assessment of radial pulse, capillary refill, and hand perfusion is the priority.

A stable patient with new-onset atrial flutter (rate 150 bpm) has estimated onset greater than 48 hours ago. What is the priority before electrical cardioversion?

Answer: Rate control followed by anticoagulation for at least 3 weeks before cardioversion

For AF/flutter with onset greater than 48 hours or unknown duration in a stable patient, at least 3 weeks of therapeutic anticoagulation is required before cardioversion, or a TEE must rule out left atrial thrombus.

A patient has a mechanical mitral valve replacement and is prescribed warfarin. What is the correct target INR range?

Answer: 2.5-3.5

Mechanical mitral valves carry higher thromboembolic risk and require a target INR of 2.5-3.5. Mechanical aortic valves in normal sinus rhythm with low thrombogenic features may have a target of 2.0-3.0.