Cardiac Vascular Nursing Exam Case Studies & Practical Application 5

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?

Accepted Answer

IV labetalol or nicardipine, reduce MAP by no more than 25% in the first hour

Answer

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?

Accepted Answer

Dressler syndrome (post-MI pericarditis)

Answer

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?

Accepted Answer

Hold heparin infusion, notify provider, and recheck aPTT per protocol

Answer

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?

Accepted Answer

Fixed pulmonary hypertension with PVR > 6 Wood units

Answer

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?

Accepted Answer

Anthracycline-induced cardiomyopathy

Answer

Anthracyclines (doxorubicin) cause dose-dependent cardiotoxicity leading to dilated cardiomyopathy, which can manifest months to years after treatment.

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Practice Test

Cardiac Vascular Nursing Exam Case Studies & Practical Application 5