Cardiac Vascular Nursing Exam Risk Assessment & Management 2 — Questions and Answers
Question 1: A patient with a history of hypertension, diabetes, and smoking presents for a preoperative cardiovascular risk assessment. Which scoring tool is most appropriate for estimating perioperative cardiac risk?
- CHADS2-VASc Score
- Revised Cardiac Risk Index (RCRI) (Correct answer)
- HEART Score
- Wells Score
Correct answer: Revised Cardiac Risk Index (RCRI)
The Revised Cardiac Risk Index (RCRI) is the validated tool for estimating perioperative major adverse cardiac events in noncardiac surgery.
Question 2: Which ankle-brachle index (ABI) value indicates severe peripheral arterial disease requiring urgent vascular evaluation?
- 0.91–1.00
- 0.71–0.90
- 0.41–0.70
- Less than 0.40 (Correct answer)
Correct answer: Less than 0.40
An ABI less than 0.40 indicates severe PAD with critical limb ischemia, requiring urgent vascular surgery consultation.
Question 3: A 58-year-old male with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the recommended management?
- No anticoagulation needed
- Aspirin 81 mg daily only
- Oral anticoagulation therapy (Correct answer)
- Rate control only with beta-blocker
Correct answer: Oral anticoagulation therapy
A CHA₂DS₂-VASc score of 4 confers high stroke risk, and oral anticoagulation is strongly recommended per ACC/AHA guidelines.
Question 4: When assessing a patient's risk for contrast-induced nephropathy (CIN) before a cardiac catheterization, which factor carries the greatest independent risk?
- Age over 65 years
- Pre-existing chronic kidney disease (Correct answer)
- Hypertension
- Use of ACE inhibitors
Correct answer: Pre-existing chronic kidney disease
Pre-existing chronic kidney disease (eGFR <60 mL/min/1.73m²) is the single greatest risk factor for contrast-induced nephropathy.
Question 5: A nurse is caring for a post-CABG patient on postoperative day 2. Which finding is most indicative of early cardiac tamponade?
- Bradycardia and hypertension
- Fever and leukocytosis
- Elevated CVP with hypotension and muffled heart sounds (Correct answer)
- Widened pulse pressure with bounding pulses
Correct answer: Elevated CVP with hypotension and muffled heart sounds
Beck's triad — elevated CVP (JVD), hypotension, and muffled heart sounds — is the classic presentation of cardiac tamponade.
Question 6: Which intervention is the priority for a patient presenting with acute limb ischemia characterized by the 6 P's (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia)?
- Apply a warm compress to the affected extremity
- Administer IV heparin and prepare for emergent revascularization (Correct answer)
- Elevate the extremity above heart level
- Schedule a non-urgent Doppler ultrasound
Correct answer: Administer IV heparin and prepare for emergent revascularization
Acute limb ischemia is a surgical emergency; IV heparin is initiated immediately while preparing for emergent revascularization to prevent limb loss.
Question 7: A patient with known aortic stenosis is being assessed for surgical risk. Which finding on echocardiography most significantly increases operative mortality risk?
- Mild aortic stenosis with valve area 1.8 cm²
- Aortic valve area less than 1.0 cm² with mean gradient >40 mmHg (Correct answer)
- Mild mitral regurgitation
- Left ventricular ejection fraction of 55%
Correct answer: Aortic valve area less than 1.0 cm² with mean gradient >40 mmHg
Severe aortic stenosis (AVA <1.0 cm², mean gradient >40 mmHg) significantly increases perioperative mortality and may warrant valve replacement before elective surgery.
Cardiac Vascular Nursing Exam Risk Assessment & Management 2
A patient with a history of hypertension, diabetes, and smoking presents for a preoperative cardiovascular risk assessment.
Which scoring tool is most appropriate for estimating perioperative cardiac risk?