CFRN Cardiovascular Emergencies 5

Question 1

A flight nurse is transporting a patient with a suspected right ventricular infarction (RVI). Which intervention is most harmful in this patient?

Accepted Answer

Nitrates for chest pain relief

Answer

Nitrates cause venodilation and preload reduction, which is extremely dangerous in RVI because the right ventricle depends on adequate preload to maintain cardiac output.

Question 2

During transport, a patient develops third-degree (complete) AV block with a ventricular escape rate of 28 bpm and hypotension. The transcutaneous pacemaker fails to capture. What is the pharmacologic bridge therapy?

Accepted Answer

Epinephrine infusion 2–10 mcg/min

Answer

In complete heart block with a slow ventricular escape below the His-Purkinje system, atropine is ineffective; epinephrine (or dopamine) infusion is used as a bridge when transcutaneous pacing fails.

Question 3

A CFRN calculates a patient's cardiac output (CO) using the Fick principle. If oxygen consumption (VO2) is 250 mL/min and the arteriovenous oxygen difference (avDO2) is 5 mL/dL, what is the cardiac output?

Accepted Answer

5.0 L/min

Answer

CO = VO2 ÷ avDO2 = 250 mL/min ÷ 50 mL/L (5 mL/dL × 10 dL/L) = 5.0 L/min, which is normal.

Question 4

A patient with dilated cardiomyopathy and an ejection fraction of 20% is being transported. Which finding would most indicate worsening acute decompensation requiring emergent intervention?

Accepted Answer

SpO2 of 88% with respiratory distress and frothy sputum

Answer

SpO2 88% with respiratory distress and frothy (pink) sputum indicates acute pulmonary edema from severely decompensated heart failure requiring immediate intervention.

Question 5

Which lead configuration is most sensitive for detecting ST changes associated with left anterior descending (LAD) artery occlusion during continuous cardiac monitoring in flight?

Accepted Answer

Lead V5 or MCL5

Answer

Lead V5 (or its modified equivalent MCL5) overlies the lateral precordium and is most sensitive for detecting anterior and lateral wall ischemia from LAD territory involvement.

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Cardiovascular Emergencies 5