Cardiac Vascular Nursing Exam Risk Assessment & Management 4 — Questions and Answers
Question 1: A patient with newly diagnosed heart failure with reduced ejection fraction (HFrEF, EF 35%) has a serum potassium of 5.6 mEq/L. Which medication should be held?
- Carvedilol
- Sacubitril/valsartan
- Spironolactone (Correct answer)
- Furosemide
Correct answer: Spironolactone
Spironolactone is a potassium-sparing aldosterone antagonist that is contraindicated or should be held when potassium exceeds 5.0 mEq/L due to hyperkalemia risk.
Question 2: Which electrocardiographic finding in a patient with suspected hyperkalemia (K⁺ = 7.2 mEq/L) requires the most urgent intervention?
- Peaked T waves
- Prolonged PR interval
- Widened QRS complex with sine-wave pattern (Correct answer)
- Flattened P waves
Correct answer: Widened QRS complex with sine-wave pattern
A widened QRS with a sine-wave pattern indicates severe, life-threatening hyperkalemia with imminent risk of ventricular fibrillation, requiring immediate IV calcium gluconate.
Question 3: A nurse notes a patient's pulmonary artery wedge pressure (PAWP) is 24 mmHg. Which clinical condition does this most likely indicate?
- Hypovolemia
- Left ventricular failure with pulmonary congestion (Correct answer)
- Right heart failure
- Normal cardiac function
Correct answer: Left ventricular failure with pulmonary congestion
A PAWP greater than 18 mmHg suggests elevated left ventricular end-diastolic pressure, consistent with left ventricular failure and pulmonary congestion.
Question 4: A patient undergoing risk stratification for sudden cardiac death (SCD) is found to have a QTc interval of 510 ms. Which medication in their current regimen most likely contributed to this finding?
- Metoprolol succinate
- Amiodarone (Correct answer)
- Lisinopril
- Aspirin
Correct answer: Amiodarone
Amiodarone prolongs ventricular repolarization and is a common cause of QT prolongation, increasing the risk of torsades de pointes.
Question 5: During a carotid endarterectomy, the patient develops new onset contralateral arm weakness. What is the nurse's priority action?
- Reassess in 15 minutes to determine if symptoms resolve
- Administer IV labetalol to lower blood pressure
- Alert the surgical team immediately and prepare for emergency neurological assessment (Correct answer)
- Position the patient in reverse Trendelenburg
Correct answer: Alert the surgical team immediately and prepare for emergency neurological assessment
New neurological deficits during carotid surgery indicate possible stroke or cerebral hypoperfusion and require immediate surgical team notification and neurological evaluation.
Question 6: A patient with chronic heart failure is admitted with decompensation. Which finding on risk stratification best predicts 30-day mortality and readmission?
- Peripheral edema with weight gain of 3 lbs
- Elevated BNP >1000 pg/mL at discharge (Correct answer)
- New-onset atrial fibrillation during hospitalization
- Systolic blood pressure of 110 mmHg on admission
Correct answer: Elevated BNP >1000 pg/mL at discharge
A discharge BNP greater than 1000 pg/mL is strongly associated with increased 30-day mortality and heart failure readmission rates.
Question 7: A 68-year-old female on dual antiplatelet therapy (aspirin + clopidogrel) after drug-eluting stent placement 4 months ago now needs urgent hip replacement surgery. What is the safest approach?
- Stop both antiplatelet agents 7 days preoperatively
- Continue both antiplatelet agents through surgery
- Continue aspirin, stop clopidogrel 5 days before surgery after cardiology consultation (Correct answer)
- Switch to warfarin bridging and stop both agents
Correct answer: Continue aspirin, stop clopidogrel 5 days before surgery after cardiology consultation
Stopping dual antiplatelet therapy less than 6 months after DES placement carries a high risk of stent thrombosis; aspirin should be continued and clopidogrel stopped only after cardiology consultation confirms acceptable risk.
Cardiac Vascular Nursing Exam Risk Assessment & Management 4
A patient with newly diagnosed heart failure with reduced ejection fraction (HFrEF, EF 35%) has a serum potassium of 5.6 mEq/L.
Which medication should be held?