Cardiac Vascular Nursing Exam Case Studies & Practical Application 3

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?

Accepted Answer

IV beta-blockers

Answer

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?

Accepted Answer

Synergistic vasodilation from PDE5 inhibitor and nitrate combination

Answer

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?

Accepted Answer

Activate the stroke protocol and obtain emergent head CT

Answer

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?

Accepted Answer

Ischemic colitis

Answer

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?

Accepted Answer

Intra-aortic balloon pump as bridge to emergency mitral valve surgery

Answer

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.

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Case Studies & Practical Application 3