Cardiac Vascular Nursing Exam Risk Assessment & Management 5 — Questions and Answers
Question 1: Which Framingham Heart Study risk factor has the greatest attributable risk for coronary artery disease in women over 55 years of age?
- Cigarette smoking
- Hypertension
- LDL cholesterol elevation
- Diabetes mellitus (Correct answer)
Correct answer: Diabetes mellitus
Diabetes mellitus disproportionately increases cardiovascular risk in women, effectively eliminating the pre-menopausal gender-protective advantage.
Question 2: A patient in the cardiac ICU has a mean arterial pressure (MAP) of 58 mmHg after cardiac surgery. Which intervention should the nurse anticipate first?
- Administer oral metoprolol
- Infuse IV fluid bolus and reassess, then consider vasopressors if no response (Correct answer)
- Begin immediate chest compressions
- Apply a nitroglycerin patch
Correct answer: Infuse IV fluid bolus and reassess, then consider vasopressors if no response
A MAP below 65 mmHg requires prompt intervention; initial fluid resuscitation followed by vasopressors if unresponsive maintains organ perfusion in post-surgical hypotension.
Question 3: A patient with a history of inferior MI presents with new bradycardia (HR 38 bpm) and hypotension. ECG shows complete heart block. Which intervention has the highest priority?
- Administer IV atropine 0.5 mg and prepare for temporary transvenous pacing (Correct answer)
- Administer IV digoxin
- Increase IV fluid rate to 200 mL/hr
- Prepare for emergent CABG
Correct answer: Administer IV atropine 0.5 mg and prepare for temporary transvenous pacing
Symptomatic complete heart block with hemodynamic compromise requires immediate atropine as a temporizing measure while preparing for transvenous pacemaker placement.
Question 4: Which finding on a 12-lead ECG in a patient with suspected right ventricular infarction requires the nurse to withhold nitroglycerin?
- ST elevation in leads II, III, and aVF with ST elevation in V4R (Correct answer)
- ST depression in leads V1–V4
- T-wave inversions in leads V1–V3
- Left bundle branch block
Correct answer: ST elevation in leads II, III, and aVF with ST elevation in V4R
Right ventricular infarction (evidenced by inferior ST elevation plus V4R elevation) causes preload-dependent hemodynamics; nitroglycerin causes vasodilation that can precipitate severe hypotension.
Question 5: A patient with peripheral arterial disease (PAD) reports calf pain that begins after walking two blocks and is relieved by rest. This symptom pattern is best described as:
- Rest pain indicating critical limb ischemia
- Intermittent claudication (Correct answer)
- Deep vein thrombosis
- Venous insufficiency
Correct answer: Intermittent claudication
Intermittent claudication is reproducible muscle pain triggered by exertion and relieved by rest, caused by inadequate arterial blood flow to meet metabolic demand.
Question 6: A nurse is monitoring a patient post-carotid artery stenting. Which vital sign trend in the first 24 hours most warrants immediate notification of the physician?
- Heart rate of 68 bpm
- Blood pressure rising from 130/80 to 165/95 mmHg (Correct answer)
- Temperature of 37.4°C
- Respiratory rate of 16 breaths/min
Correct answer: Blood pressure rising from 130/80 to 165/95 mmHg
Hypertension after carotid stenting increases the risk of hyperperfusion syndrome, intracranial hemorrhage, and restenosis and must be promptly managed.
Question 7: Which patient scenario most accurately represents Virchow's Triad for venous thromboembolism (VTE) risk after cardiac surgery?
- Ambulatory patient with normal INR and no prior clot history
- Immobilized post-operative patient with atrial fibrillation and low cardiac output causing venous stasis (Correct answer)
- Patient with elevated HDL and low triglycerides
- Hypertensive patient with preserved ejection fraction and no surgical history
Correct answer: Immobilized post-operative patient with atrial fibrillation and low cardiac output causing venous stasis
Post-cardiac surgery patients have all three components of Virchow's Triad: stasis from immobility and low output, endothelial injury from surgery, and hypercoagulability from surgical stress response.
Cardiac Vascular Nursing Exam Risk Assessment & Management 5
Which Framingham Heart Study risk factor has the greatest attributable risk for coronary artery disease in women over 55 years of age?