Cardiac Vascular Nursing Exam Communication & Stakeholder Relations 4 — Questions and Answers
Question 1: A cardiac nurse is escalating a concern about a deteriorating post-CABG patient using the chain of command. After notifying the resident, no action is taken within 30 minutes. What is the next step?
- Escalate to the attending cardiologist or cardiac surgeon, and if still unresolved, notify the nursing supervisor or use a rapid response system (Correct answer)
- Wait another hour to see if the patient stabilizes
- Document the concern and take no further escalation steps
- Contact the hospital's legal department
Correct answer: Escalate to the attending cardiologist or cardiac surgeon, and if still unresolved, notify the nursing supervisor or use a rapid response system
The chain of command exists to protect patients; nurses must continue escalating through each level until appropriate action is taken for a deteriorating patient.
Question 2: During a family meeting for a patient awaiting heart transplant listing, the patient's sibling asks the nurse directly if the patient will die without a transplant. The physician is not present. How should the nurse respond?
- Acknowledge the question, validate its importance, and offer to arrange a meeting with the physician and transplant team to address prognosis directly (Correct answer)
- Tell the sibling that death is inevitable without a transplant
- Refuse to engage with the question and leave the room
- Give a reassuring but vague answer to avoid distressing the family
Correct answer: Acknowledge the question, validate its importance, and offer to arrange a meeting with the physician and transplant team to address prognosis directly
Nurses should acknowledge prognosis questions honestly while ensuring complex discussions about survival occur with the appropriate physician-led team present.
Question 3: A nurse is providing discharge education to a patient after an acute MI. The patient says, 'I feel fine now — I don't think I need all these medications.' What is the best communication strategy?
- Use motivational interviewing to explore the patient's beliefs, address misconceptions, and collaboratively reinforce the importance of secondary prevention therapy (Correct answer)
- Tell the patient they must take the medications or risk another heart attack
- Document refusal and end the conversation
- Agree with the patient and suggest they discuss medication changes at follow-up
Correct answer: Use motivational interviewing to explore the patient's beliefs, address misconceptions, and collaboratively reinforce the importance of secondary prevention therapy
Motivational interviewing respects patient autonomy while using open-ended questions and reflective listening to address ambivalence about medication adherence after MI.
Question 4: A nurse overhears a physician speaking loudly and dismissively to a patient with peripheral vascular disease who asked about alternative treatments. What is the nurse's most appropriate response?
- Intervene calmly in the moment to support the patient, then speak privately with the physician about communication standards and report the behavior if it recurs (Correct answer)
- Do nothing to avoid conflict with the physician
- Immediately file a formal complaint without speaking to the physician first
- Tell the patient to ignore the physician's tone and focus on the treatment plan
Correct answer: Intervene calmly in the moment to support the patient, then speak privately with the physician about communication standards and report the behavior if it recurs
Nurses are patient advocates and must address disrespectful provider-patient communication by supporting the patient and addressing the behavior through appropriate channels.
Question 5: A cardiac nurse is documenting care for a patient who declined a recommended procedure. What must the documentation include to reflect proper informed refusal?
- The patient's stated reason for refusal, the risks explained to the patient, confirmation that the patient demonstrated decision-making capacity, and the provider notified (Correct answer)
- Only that the patient refused and signed the AMA form
- The nurse's opinion about why the patient made the wrong decision
- A plan to convince the patient to reconsider at the next assessment
Correct answer: The patient's stated reason for refusal, the risks explained to the patient, confirmation that the patient demonstrated decision-making capacity, and the provider notified
Informed refusal documentation must capture the patient's reasoning, risks communicated, capacity assessment, and provider notification to create a legally and ethically complete record.
Question 6: A cardiac rehabilitation nurse is leading a group session when one patient begins sharing personal health details that make other participants uncomfortable. What is the best response?
- Acknowledge the patient's willingness to share, redirect the group to the session topic, and offer the patient a private conversation after the group session (Correct answer)
- Allow the patient to continue sharing to encourage group openness
- Ask the patient to leave the group session
- Ignore the situation and proceed with the scheduled content
Correct answer: Acknowledge the patient's willingness to share, redirect the group to the session topic, and offer the patient a private conversation after the group session
Balancing group dynamics with individual needs requires the nurse to redirect respectfully while preserving the sharing patient's dignity and offering a private alternative.
Question 7: A nurse is completing a hand-off report using I-PASS. What does the 'S' in I-PASS stand for and why is it critical for cardiac patients?
- Synthesis by receiver — the receiving nurse summarizes the patient's situation, confirming they understood the key concerns and action items (Correct answer)
- Situation awareness — the sending nurse describes the ward environment
- Stability score — a numeric rating of hemodynamic stability
- Summary sheet — a printed document attached to the chart
Correct answer: Synthesis by receiver — the receiving nurse summarizes the patient's situation, confirming they understood the key concerns and action items
The 'S' in I-PASS (Synthesis by receiver) requires the receiving nurse to verbally confirm their understanding, closing the communication loop and preventing handoff errors critical in cardiac patients.
