Cardiac Vascular Nursing Exam Case Studies & Practical Application 4 — Questions and Answers
Question 1: A 70-year-old woman with CHF is admitted with worsening dyspnea. Her BNP is 1,800 pg/mL, creatinine 1.9 mg/dL, and sodium 128 mEq/L. Which finding indicates the most severe prognosis?
- Elevated BNP
- Elevated creatinine
- Hyponatremia (Correct answer)
- Bilateral rales on auscultation
Correct answer: Hyponatremia
Hyponatremia in heart failure reflects neurohormonal activation and volume overload; it is an independent predictor of poor outcomes and increased mortality.
Question 2: A patient is admitted with acute decompensated heart failure and is started on dobutamine. After 2 hours, HR increases from 88 to 122 bpm and the patient develops palpitations. What is the nurse's concern?
- Dobutamine-induced hypertension requiring antihypertensives
- Proarrhythmic effect of dobutamine causing ventricular tachycardia (Correct answer)
- Reflex bradycardia masking underlying arrhythmia
- Anaphylaxis to dobutamine infusion
Correct answer: Proarrhythmic effect of dobutamine causing ventricular tachycardia
Dobutamine has chronotropic and pro-arrhythmic properties; tachycardia and palpitations may herald ventricular arrhythmias and require dose reduction or discontinuation.
Question 3: A 58-year-old male with known CAD is undergoing elective knee replacement. Pre-operative troponin is mildly elevated at 0.08 ng/mL (normal <0.04). He is asymptomatic. What is the most appropriate action?
- Proceed with surgery as planned since the patient is asymptomatic
- Cancel surgery and pursue full cardiac evaluation before proceeding (Correct answer)
- Administer thrombolytics and reschedule for next week
- Place a prophylactic IABP before surgery
Correct answer: Cancel surgery and pursue full cardiac evaluation before proceeding
An unexplained elevated troponin in a high-risk cardiac patient requires evaluation to rule out NSTEMI or other myocardial injury before elective surgery.
Question 4: A patient with an acute lower extremity DVT reports sudden onset pleuritic chest pain and dyspnea. O2 saturation drops to 89% on room air. CT pulmonary angiography confirms massive PE with RV strain. What intervention is indicated?
- Anticoagulation with heparin alone and supplemental O2
- Systemic thrombolysis with alteplase (Correct answer)
- Surgical embolectomy as first-line therapy
- Inferior vena cava filter placement only
Correct answer: Systemic thrombolysis with alteplase
Massive PE with hemodynamic compromise or RV strain is an indication for systemic thrombolysis when there are no contraindications, to rapidly reduce RV afterload.
Question 5: A patient post-cardiac catheterization via the right femoral approach complains of right groin pain. The nurse palpates a pulsatile mass with an audible bruit. What complication has most likely occurred?
- Retroperitoneal hematoma
- Femoral pseudoaneurysm (Correct answer)
- Arteriovenous fistula
- Deep vein thrombosis
Correct answer: Femoral pseudoaneurysm
A pulsatile groin mass with bruit after femoral arterial access is classic for a pseudoaneurysm, caused by persistent blood flow into perivascular tissue through the arterial puncture site.
Question 6: A 63-year-old female with heart failure and an EF of 25% is referred for ICD implantation. She asks why she needs a defibrillator if she feels fine. What is the best nursing response?
- The ICD will improve your heart's pumping function over time
- ICDs are placed preventively because severely reduced EF significantly increases risk of sudden cardiac death from ventricular arrhythmias (Correct answer)
- The ICD replaces the need for heart failure medications
- ICDs are required by insurance guidelines for all heart failure patients
Correct answer: ICDs are placed preventively because severely reduced EF significantly increases risk of sudden cardiac death from ventricular arrhythmias
Primary prevention ICD implantation is indicated for EF ≤35% to protect against sudden cardiac death from life-threatening ventricular arrhythmias, regardless of symptoms.
Question 7: A 74-year-old patient with severe aortic stenosis (AVA 0.7 cm², mean gradient 55 mmHg) develops syncope. He is deemed high surgical risk. Which intervention is most appropriate?
- Medical management with ACE inhibitors and beta-blockers
- Balloon aortic valvuloplasty as definitive therapy
- Transcatheter aortic valve replacement (TAVR) (Correct answer)
- Watchful waiting with serial echocardiograms
Correct answer: Transcatheter aortic valve replacement (TAVR)
TAVR is the preferred intervention for severe symptomatic AS in high or prohibitive surgical risk patients, providing outcomes comparable to surgical AVR.
Cardiac Vascular Nursing Exam Case Studies & Practical Application 4
A 70-year-old woman with CHF is admitted with worsening dyspnea.
Her BNP is 1,800 pg/mL, creatinine 1.9 mg/dL, and sodium 128 mEq/L.
Which finding indicates the most severe prognosis?