Cardiac Vascular Nursing Exam Case Studies & Practical Application 3 — Questions and Answers
Question 1: A 45-year-old woman presents with severe tearing chest pain radiating to her back. BP is 185/100 mmHg in the right arm and 140/85 mmHg in the left arm. CT shows aortic dissection. Which medication class is the priority treatment?
- Calcium channel blockers
- IV beta-blockers (Correct answer)
- Loop diuretics
- Thrombolytics
Correct answer: IV beta-blockers
IV beta-blockers (e.g., esmolol or labetalol) are the first-line treatment for Type B aortic dissection to reduce heart rate and blood pressure, decreasing aortic wall stress.
Question 2: A patient with NSTEMI is receiving IV nitroglycerin when his BP drops from 118/72 to 78/50 mmHg and HR remains at 88 bpm. He had taken sildenafil 12 hours ago. What is the most likely cause?
- Nitroglycerin-induced reflex tachycardia has masked hypotension
- Synergistic vasodilation from PDE5 inhibitor and nitrate combination (Correct answer)
- Right ventricular infarction causing preload dependence
- Anaphylactic reaction to IV nitroglycerin
Correct answer: Synergistic vasodilation from PDE5 inhibitor and nitrate combination
Both sildenafil (PDE5 inhibitor) and nitroglycerin cause vasodilation; combining them produces profound, potentially fatal hypotension; nitroglycerin is contraindicated within 24–48 hours of PDE5 inhibitor use.
Question 3: A 78-year-old female with atrial fibrillation and a CHA₂DS₂-VASc score of 5 is on warfarin with an INR of 1.4. She presents with new-onset left-sided weakness. What is the priority nursing action?
- Administer vitamin K to reverse the subtherapeutic INR
- Activate the stroke protocol and obtain emergent head CT (Correct answer)
- Increase warfarin dose and recheck INR in 48 hours
- Administer IV heparin as a bridge while obtaining imaging
Correct answer: Activate the stroke protocol and obtain emergent head CT
Acute neurologic deficits in a patient with AF require immediate stroke protocol activation; CT head must be obtained before any anticoagulation decisions are made.
Question 4: A postoperative patient 6 hours after an open abdominal aortic aneurysm repair develops abdominal pain, absent bowel sounds, and bloody diarrhea. What complication should the nurse suspect?
- Anastomotic leak
- Ischemic colitis (Correct answer)
- Paralytic ileus
- Clostridium difficile colitis
Correct answer: Ischemic colitis
Ischemic colitis, particularly involving the sigmoid colon supplied by the inferior mesenteric artery, is a known post-AAA repair complication due to disrupted mesenteric circulation.
Question 5: A patient 48 hours post-MI develops a new holosystolic murmur at the apex with radiation to the axilla, dyspnea, and pulmonary edema. Echo shows flail mitral leaflet. What intervention is most likely needed?
- Aggressive diuresis and nitrates only
- Intra-aortic balloon pump as bridge to emergency mitral valve surgery (Correct answer)
- Thrombolysis to restore coronary perfusion
- Implantation of a permanent pacemaker
Correct answer: Intra-aortic balloon pump as bridge to emergency mitral valve surgery
Acute papillary muscle rupture causing severe mitral regurgitation post-MI is a surgical emergency; IABP reduces afterload and provides hemodynamic support as a bridge to surgery.
Question 6: A 65-year-old male in the cardiac step-down unit is on metoprolol and lisinopril post-MI. His HR is 48 bpm and BP is 96/60 mmHg with complaints of dizziness. His potassium is 5.8 mEq/L. What is the nurse's priority action?
- Administer calcium gluconate IV for hyperkalemia
- Hold metoprolol and notify the provider immediately (Correct answer)
- Increase IV fluid rate to improve perfusion pressure
- Administer atropine 1 mg IV push
Correct answer: Hold metoprolol and notify the provider immediately
Symptomatic bradycardia and hypotension in a patient on beta-blockers requires holding the offending medication and notifying the provider before further interventions.
Question 7: A patient with a left ventricular assist device (LVAD) presents to the ED without a palpable pulse but is conscious and talking. The nurse should:
- Begin CPR immediately for pulselessness
- Check the LVAD device display for alarms and flow rate (Correct answer)
- Administer epinephrine 1 mg IV for cardiac arrest
- Apply transcutaneous pacing pads emergently
Correct answer: Check the LVAD device display for alarms and flow rate
LVAD patients often have non-pulsatile or very low pulsatile flow; absence of palpable pulse is expected, and the LVAD controller display provides critical hemodynamic data.
Cardiac Vascular Nursing Exam Case Studies & Practical Application 3
A 45-year-old woman presents with severe tearing chest pain radiating to her back.
BP is 185/100 mmHg in the right arm and 140/85 mmHg in the left arm.
CT shows aortic dissection.
Which medication class is the priority treatment?