Cardiac Vascular Nursing Exam Communication & Stakeholder Relations 5 — Questions and Answers
Question 1: A cardiac nurse is caring for a patient whose advance directive specifies 'no resuscitation,' but the patient's adult children are demanding that everything be done. What is the nurse's primary obligation?
- Honor the patient's documented advance directive and work with the team and ethics committee to support the family through the decision (Correct answer)
- Follow the family's wishes since they are the legal next of kin
- Withhold the advance directive information from the family to avoid conflict
- Attempt resuscitation to avoid family conflict and document the contradiction afterward
Correct answer: Honor the patient's documented advance directive and work with the team and ethics committee to support the family through the decision
A valid advance directive reflects the patient's autonomous decision and legally and ethically supersedes family requests; the care team must honor it while supporting the family.
Question 2: When reporting a change in a cardiac patient's condition to a physician via telephone, the nurse should use which communication tool to organize information most effectively?
- SBAR (Situation, Background, Assessment, Recommendation) to provide a structured, concise report that prompts a clear response (Correct answer)
- A chronological narrative of everything that happened since admission
- Only the most recent vital signs without context
- A written email sent to the physician's secure inbox
Correct answer: SBAR (Situation, Background, Assessment, Recommendation) to provide a structured, concise report that prompts a clear response
SBAR organizes critical information into a predictable format that reduces cognitive load for physicians and ensures key clinical details and the nurse's recommendation are communicated.
Question 3: A hospital quality team asks the cardiac unit's nurses to participate in a sentinel event review following a medication error. A nurse involved refuses, fearing punitive consequences. How should the charge nurse respond?
- Explain that the review is conducted under a just culture framework focused on system improvement, not individual punishment, and encourage honest participation (Correct answer)
- Force the nurse to participate by threatening disciplinary action
- Excuse the nurse from the review to avoid escalating anxiety
- Tell the nurse their account will be used in a disciplinary report regardless
Correct answer: Explain that the review is conducted under a just culture framework focused on system improvement, not individual punishment, and encourage honest participation
Just culture principles distinguish system errors from individual misconduct; nurses must understand that honest participation in safety reviews is protected and essential for improvement.
Question 4: A vascular access nurse is coordinating care with interventional radiology for a patient requiring urgent PICC placement. The IR team is unavailable for four hours. What is the most effective stakeholder communication action?
- Contact the IR charge nurse and attending directly, clearly state the clinical urgency, document all communications, and activate the escalation protocol if the delay is clinically unsafe (Correct answer)
- Wait the four hours without notifying anyone further
- Insert peripheral IV access without informing the IR team
- Ask the patient to call IR themselves
Correct answer: Contact the IR charge nurse and attending directly, clearly state the clinical urgency, document all communications, and activate the escalation protocol if the delay is clinically unsafe
Direct, documented escalation to the responsible team's leadership with clear articulation of clinical urgency is the standard approach when care delays threaten patient safety.
Question 5: A post-operative cardiac surgery patient is being transferred from the ICU to a step-down unit. Which handoff strategy most effectively reduces information loss during this high-risk transition?
- Conduct a face-to-face bedside handoff using a standardized tool with both sending and receiving nurses present at the patient's side (Correct answer)
- Send a written summary via electronic health record without verbal communication
- Have the ICU nurse call the step-down unit from the nursing station before transport
- Ask the patient to summarize their own care history to the receiving nurse
Correct answer: Conduct a face-to-face bedside handoff using a standardized tool with both sending and receiving nurses present at the patient's side
Bedside face-to-face handoffs using standardized tools allow real-time clarification, direct patient involvement, and verification of equipment, reducing errors during high-risk ICU transitions.
Question 6: A cardiac nurse discovers that a colleague routinely documents assessments before actually performing them. What is the most appropriate response?
- Address the concern directly with the colleague first, and if the behavior continues, report it to the charge nurse or nurse manager as a documentation integrity issue (Correct answer)
- Ignore the behavior since patient outcomes have not been affected
- Alter the colleague's documentation to reflect accurate times
- Report the colleague anonymously to the licensing board without first addressing it internally
Correct answer: Address the concern directly with the colleague first, and if the behavior continues, report it to the charge nurse or nurse manager as a documentation integrity issue
Falsified documentation is a patient safety and professional integrity violation; the ethical approach begins with direct peer conversation followed by management escalation if needed.
Question 7: A patient with atrial fibrillation is being seen via telehealth for a follow-up. The nurse notices the patient seems confused but the video quality is poor. What is the most appropriate action?
- Flag the concern immediately to the supervising provider, recommend in-person evaluation or emergency assessment, and document the observed behavior despite the technical limitation (Correct answer)
- Assume the confusion is an artifact of poor video quality and proceed with the appointment
- End the telehealth visit and schedule a follow-up in two weeks
- Ask the patient to troubleshoot their internet connection before continuing
Correct answer: Flag the concern immediately to the supervising provider, recommend in-person evaluation or emergency assessment, and document the observed behavior despite the technical limitation
New confusion in an AF patient may indicate a thromboembolic event; nurses must escalate safety concerns identified via telehealth regardless of technical quality limitations.
Cardiac Vascular Nursing Exam Communication & Stakeholder Relations 5
A cardiac nurse is caring for a patient whose advance directive specifies 'no resuscitation,' but the patient's adult children are demanding that everything be done.
What is the nurse's primary obligation?