Cardiac Vascular Nursing Exam Case Studies & Practical Application 2

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?

Accepted Answer

Cardiac tamponade

Answer

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?

Accepted Answer

IV furosemide bolus titrated to urine output

Answer

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?

Accepted Answer

Prosthetic valve endocarditis with valve dehiscence

Answer

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?

Accepted Answer

Discontinue heparin and start a direct thrombin inhibitor

Answer

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?

Accepted Answer

Omeprazole may reduce clopidogrel's antiplatelet effectiveness via CYP2C19 inhibition

Answer

Omeprazole inhibits CYP2C19, the enzyme that activates clopidogrel, potentially reducing its antiplatelet effect; pantoprazole is a preferred alternative.

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Case Studies & Practical Application 2