Cardiac Vascular Nursing Exam Risk Assessment & Management 3 — Questions and Answers
Question 1: A patient is admitted with a non-ST-elevation myocardial infarction (NSTEMI). Which TIMI risk score finding carries the most weight in predicting 14-day adverse outcomes?
- Age 55–64 years
- ST deviation ≥0.5 mm on presenting ECG (Correct answer)
- Single coronary artery risk factor
- Aspirin use in prior 7 days
Correct answer: ST deviation ≥0.5 mm on presenting ECG
ST deviation ≥0.5 mm is heavily weighted in the TIMI risk score as it reflects significant myocardial ischemia and predicts adverse outcomes.
Question 2: Which patient characteristic most significantly increases the risk of heparin-induced thrombocytopenia (HIT) in a cardiac unit?
- Female gender over age 70
- Post-cardiac surgery patient receiving unfractionated heparin for >4 days (Correct answer)
- Patient on low-molecular-weight heparin for DVT prophylaxis for 2 days
- Patient with chronic kidney disease receiving heparin flushes only
Correct answer: Post-cardiac surgery patient receiving unfractionated heparin for >4 days
Post-cardiac surgery patients exposed to unfractionated heparin for more than 4 days have the highest incidence of HIT due to platelet factor 4 antibody formation.
Question 3: When using the 4T scoring system to assess HIT risk, a score of 6–8 indicates:
- Low probability of HIT — continue heparin
- Intermediate probability — send HIT antibody panel only
- High probability — stop heparin and start alternative anticoagulation immediately (Correct answer)
- Confirmed HIT — initiate platelet transfusion
Correct answer: High probability — stop heparin and start alternative anticoagulation immediately
A 4T score of 6–8 represents high clinical probability for HIT, requiring immediate cessation of heparin and initiation of a non-heparin anticoagulant such as argatroban.
Question 4: A 72-year-old woman with heart failure (EF 30%) is being evaluated for ICD implantation. Which condition must be optimized for at least how many months before reassessing EF eligibility?
- 1 month of optimal medical therapy
- 3 months of guideline-directed medical therapy (Correct answer)
- 6 months of diuretic therapy alone
- No waiting period — implant immediately
Correct answer: 3 months of guideline-directed medical therapy
Current guidelines recommend at least 3 months of guideline-directed medical therapy (GDMT) before reassessing EF, as EF may improve with optimization.
Question 5: Which laboratory value is the most sensitive early marker for acute kidney injury following cardiovascular surgery?
- Serum creatinine
- Blood urea nitrogen (BUN)
- Serum cystatin C (Correct answer)
- Urine specific gravity
Correct answer: Serum cystatin C
Cystatin C rises within 24 hours of AKI, making it more sensitive than creatinine, which may not rise for 48–72 hours after renal injury.
Question 6: A patient on warfarin for mechanical heart valve presents with an INR of 1.6 prior to an elective colonoscopy. What is the most appropriate bridging strategy?
- Hold warfarin and proceed without bridging
- Hold warfarin and bridge with therapeutic low-molecular-weight heparin (Correct answer)
- Continue warfarin at the current dose
- Switch permanently to a direct oral anticoagulant
Correct answer: Hold warfarin and bridge with therapeutic low-molecular-weight heparin
Patients with mechanical heart valves have high thromboembolic risk and require therapeutic LMWH bridging when warfarin is interrupted for procedures.
Question 7: A 65-year-old male smoker with hypertension is found to have a 4.8 cm abdominal aortic aneurysm on routine ultrasound. What is the recommended management?
- Emergent surgical repair
- Elective endovascular repair (EVAR) within 2 weeks
- Surveillance ultrasound every 6–12 months and risk factor modification (Correct answer)
- No further follow-up needed as it is below surgical threshold
Correct answer: Surveillance ultrasound every 6–12 months and risk factor modification
Aneurysms between 4.0–5.4 cm are monitored with serial ultrasound every 6–12 months while aggressively managing cardiovascular risk factors.
Cardiac Vascular Nursing Exam Risk Assessment & Management 3
A patient is admitted with a non-ST-elevation myocardial infarction (NSTEMI).
Which TIMI risk score finding carries the most weight in predicting 14-day adverse outcomes?