Cardiac Vascular Nursing Exam Case Studies & Practical Application 5 — Questions and Answers
Question 1: A 50-year-old male is admitted with hypertensive emergency (BP 220/130 mmHg) and new onset confusion. Fundoscopy reveals papilledema. Which medication and target BP reduction are most appropriate in the first hour?
- Oral amlodipine, reduce BP to normal within 1 hour
- IV labetalol or nicardipine, reduce MAP by no more than 25% in the first hour (Correct answer)
- IV nitroprusside, normalize BP within 30 minutes
- Oral clonidine, reduce BP by 50% within 2 hours
Correct answer: IV labetalol or nicardipine, reduce MAP by no more than 25% in the first hour
Hypertensive emergency with end-organ damage requires IV antihypertensives with controlled reduction (≤25% MAP in first hour) to avoid precipitating ischemia from abrupt pressure normalization.
Question 2: A patient 3 days post-MI develops fever (38.8°C), pleuritic chest pain, and a friction rub. ECG shows diffuse saddle-shaped ST elevation. What is the most likely diagnosis?
- Reinfarction
- Dressler syndrome (post-MI pericarditis) (Correct answer)
- Pulmonary embolism
- Aortic dissection
Correct answer: Dressler syndrome (post-MI pericarditis)
Dressler syndrome is an autoimmune pericarditis occurring days to weeks post-MI, characterized by fever, pleuritic chest pain, friction rub, and diffuse saddle-shaped ST elevation.
Question 3: A nurse is caring for a patient receiving a continuous heparin infusion. The aPTT result is 210 seconds (therapeutic range 60–100 seconds). The patient shows no signs of bleeding. What is the appropriate response?
- Continue current infusion rate and repeat aPTT in 6 hours
- Hold heparin infusion, notify provider, and recheck aPTT per protocol (Correct answer)
- Administer protamine sulfate immediately to reverse anticoagulation
- Reduce heparin rate by 10% and continue monitoring
Correct answer: Hold heparin infusion, notify provider, and recheck aPTT per protocol
A supratherapeutic aPTT (>3× upper limit) requires holding the infusion and notifying the provider per heparin protocol to prevent bleeding complications.
Question 4: A patient with end-stage heart failure on maximal medical therapy is evaluated for heart transplant. Which condition would be an absolute contraindication to cardiac transplantation?
- Age 65 years
- Insulin-dependent diabetes with no end-organ damage
- Fixed pulmonary hypertension with PVR > 6 Wood units (Correct answer)
- History of atrial fibrillation
Correct answer: Fixed pulmonary hypertension with PVR > 6 Wood units
Fixed (irreversible) pulmonary hypertension with PVR >6 Wood units is an absolute contraindication to cardiac transplantation because the donor right ventricle cannot overcome the elevated pulmonary resistance.
Question 5: A 66-year-old woman with a history of breast cancer treated with doxorubicin presents with progressive dyspnea and an EF of 30% on echo, down from 60% two years ago. What is the most likely etiology of her cardiomyopathy?
- Ischemic cardiomyopathy from undetected CAD
- Anthracycline-induced cardiomyopathy (Correct answer)
- Hypertensive heart disease
- Cardiac amyloidosis from age-related protein deposition
Correct answer: Anthracycline-induced cardiomyopathy
Anthracyclines (doxorubicin) cause dose-dependent cardiotoxicity leading to dilated cardiomyopathy, which can manifest months to years after treatment.
Question 6: A patient on telemetry develops a wide-complex tachycardia at 180 bpm. He is conscious with a BP of 104/68 mmHg. His history includes Wolff-Parkinson-White syndrome. Which drug should be avoided?
- Procainamide
- Amiodarone
- Adenosine (Correct answer)
- IV magnesium
Correct answer: Adenosine
In WPW with pre-excitation, adenosine (and AV nodal blockers like verapamil/diltiazem) can precipitate rapid accessory pathway conduction leading to ventricular fibrillation.
Question 7: A 58-year-old male with critical limb ischemia undergoes femoral-popliteal bypass. Six hours post-op, his calf is tense, with pain on passive dorsiflexion, paresthesias, and a weakened pedal pulse. What is the priority nursing action?
- Elevate the extremity to reduce edema
- Apply a cold pack to reduce inflammation
- Notify the surgeon immediately for suspected compartment syndrome (Correct answer)
- Administer IV morphine and reassess in 1 hour
Correct answer: Notify the surgeon immediately for suspected compartment syndrome
Compartment syndrome after vascular surgery presents with the 6 P's (pain, pressure, paresthesias, paresis, pallor, pulselessness); emergency fasciotomy within hours prevents permanent ischemic damage.
Cardiac Vascular Nursing Exam Case Studies & Practical Application 5
A 50-year-old male is admitted with hypertensive emergency (BP 220/130 mmHg) and new onset confusion.
Fundoscopy reveals papilledema.
Which medication and target BP reduction are most appropriate in the first hour?