Cardiac Vascular Nursing Exam Case Studies & Practical Application 4

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?

Accepted Answer

Hyponatremia

Answer

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?

Accepted Answer

Proarrhythmic effect of dobutamine causing ventricular tachycardia

Answer

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?

Accepted Answer

Cancel surgery and pursue full cardiac evaluation before proceeding

Answer

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?

Accepted Answer

Systemic thrombolysis with alteplase

Answer

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?

Accepted Answer

Femoral pseudoaneurysm

Answer

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.

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Case Studies & Practical Application 4