Cardiac Vascular Nursing Exam Case Studies & Practical Application 2 — Questions and Answers
Question 1: A 68-year-old male post-CABG on day 2 develops sudden onset chest pain, dyspnea, and JVD with muffled heart sounds and hypotension. BP is 80/60 mmHg. What is the most likely diagnosis?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Pulmonary embolism
- Acute MI
Correct answer: Cardiac tamponade
Beck's triad (hypotension, JVD, muffled heart sounds) is classic for cardiac tamponade, a known post-cardiac surgery complication.
Question 2: A patient with chronic heart failure presents with 3+ pitting edema, orthopnea, and a BNP of 1,200 pg/mL. Creatinine is 2.1 mg/dL. Which diuretic strategy is most appropriate?
- Hold all diuretics due to elevated creatinine
- IV furosemide bolus titrated to urine output (Correct answer)
- Oral hydrochlorothiazide alone
- Restrict fluids only without diuresis
Correct answer: IV furosemide bolus titrated to urine output
IV furosemide is preferred in decompensated heart failure to achieve rapid decongestion, even with mild renal impairment when volume overload is present.
Question 3: A 55-year-old woman with a mechanical mitral valve prosthesis presents with fever, new murmur, and hematuria. Blood cultures grow Streptococcus viridans. What complication should the nurse monitor for most urgently?
- Acute renal failure
- Embolic stroke
- Prosthetic valve endocarditis with valve dehiscence (Correct answer)
- Hemolytic anemia
Correct answer: Prosthetic valve endocarditis with valve dehiscence
Prosthetic valve endocarditis can lead to valve dehiscence and acute hemodynamic collapse, the most life-threatening complication requiring urgent surgical evaluation.
Question 4: A patient on IV heparin for STEMI develops a platelet count drop from 240,000 to 48,000 on day 7. The nurse suspects HIT. Which action is most appropriate?
- Increase the heparin dose to maintain therapeutic aPTT
- Administer a platelet transfusion
- Discontinue heparin and start a direct thrombin inhibitor (Correct answer)
- Switch to low-molecular-weight heparin
Correct answer: Discontinue heparin and start a direct thrombin inhibitor
HIT requires immediate cessation of all heparin products and substitution with a non-heparin anticoagulant such as argatroban or bivalirudin.
Question 5: A 72-year-old patient post-PCI is being discharged on dual antiplatelet therapy (aspirin + clopidogrel). She mentions she takes omeprazole for GERD. What should the nurse educate her about?
- Omeprazole has no interaction with clopidogrel
- Omeprazole may reduce clopidogrel's antiplatelet effectiveness via CYP2C19 inhibition (Correct answer)
- She should stop aspirin and continue clopidogrel only
- Omeprazole increases bleeding risk when combined with clopidogrel
Correct answer: Omeprazole may reduce clopidogrel's antiplatelet effectiveness via CYP2C19 inhibition
Omeprazole inhibits CYP2C19, the enzyme that activates clopidogrel, potentially reducing its antiplatelet effect; pantoprazole is a preferred alternative.
Question 6: A patient in the cardiac ICU post-TAVR develops complete heart block on telemetry with a ventricular rate of 32 bpm and is hemodynamically unstable. What is the priority intervention?
- Administer atropine 0.5 mg IV and reassess
- Prepare for transcutaneous pacing immediately (Correct answer)
- Obtain a 12-lead ECG and call the cardiologist
- Increase IV fluids to support cardiac output
Correct answer: Prepare for transcutaneous pacing immediately
Complete heart block with hemodynamic instability after TAVR requires immediate transcutaneous pacing as a bridge to transvenous pacing or permanent pacemaker implantation.
Question 7: A 60-year-old male with peripheral artery disease reports calf pain that begins after walking two blocks and resolves with rest. ABI is 0.62. What does this clinical picture represent?
- Critical limb ischemia
- Venous claudication
- Intermittent claudication (Correct answer)
- Acute arterial occlusion
Correct answer: Intermittent claudication
Intermittent claudication is defined by reproducible exertional limb pain relieved by rest, with an ABI between 0.4–0.9 indicating moderate PAD.
Cardiac Vascular Nursing Exam Case Studies & Practical Application 2
A 68-year-old male post-CABG on day 2 develops sudden onset chest pain, dyspnea, and JVD with muffled heart sounds and hypotension.
BP is 80/60 mmHg.
What is the most likely diagnosis?