CMSRN Cardiac Vascular 2 — Questions and Answers
Question 1: A patient with heart failure has a BNP level of 850 pg/mL. What does this elevated level indicate?
- Increased cardiac output
- Ventricular wall stress from fluid overload (Correct answer)
- Improved myocardial contractility
- Adequate diuresis
Correct answer: Ventricular wall stress from fluid overload
BNP (B-type natriuretic peptide) is released by ventricular myocytes in response to wall stress caused by volume and pressure overload.
Question 2: A patient is receiving IV heparin for a pulmonary embolism. The aPTT result is 200 seconds. The therapeutic range is 60-100 seconds. What is the priority nursing action?
- Increase the heparin infusion rate
- Continue monitoring without changes
- Hold the infusion and notify the provider (Correct answer)
- Administer vitamin K immediately
Correct answer: Hold the infusion and notify the provider
An aPTT of 200 seconds is supratherapeutic and places the patient at high risk for bleeding; the infusion should be held and the provider notified.
Question 3: Which assessment finding in a patient with peripheral arterial disease (PAD) requires immediate reporting?
- Absent hair on lower legs
- Dependent rubor of the feet
- Sudden onset of rest pain and pallor of the affected limb (Correct answer)
- Thickened toenails
Correct answer: Sudden onset of rest pain and pallor of the affected limb
Sudden rest pain with pallor suggests acute arterial occlusion, a vascular emergency requiring immediate intervention to prevent limb loss.
Question 4: A nurse is caring for a patient after a cardiac catheterization via the right femoral artery. Which finding requires immediate intervention?
- Mild bruising at the puncture site
- Urge to void after contrast administration
- Expanding hematoma at the access site (Correct answer)
- Blood pressure of 128/78 mmHg
Correct answer: Expanding hematoma at the access site
An expanding hematoma indicates active arterial bleeding at the puncture site and requires immediate manual pressure and provider notification.
Question 5: A patient with chronic venous insufficiency asks the nurse what causes their leg ulcers. What is the best explanation?
- Arterial spasm reduces oxygen delivery to tissues
- Incompetent venous valves cause venous hypertension and tissue breakdown (Correct answer)
- High platelet counts cause clot formation in capillaries
- Lymphatic obstruction prevents protein removal from tissues
Correct answer: Incompetent venous valves cause venous hypertension and tissue breakdown
Incompetent venous valves lead to venous hypertension, edema, and poor tissue oxygenation, resulting in ulcer formation typically near the medial malleolus.
Question 6: Which ECG change is most consistent with hyperkalemia?
- Prolonged QT interval
- ST elevation in leads V1-V4
- Tall, peaked T waves (Correct answer)
- Shortened PR interval
Correct answer: Tall, peaked T waves
Hyperkalemia classically produces tall, peaked (tented) T waves as the earliest ECG change, progressing to widened QRS and sine wave pattern.
Question 7: A patient in atrial fibrillation with a rapid ventricular rate of 148 bpm is hemodynamically stable. Which medication class is typically used for rate control?
- Thrombolytics
- Beta-blockers or calcium channel blockers (Correct answer)
- Sodium bicarbonate
- Loop diuretics
Correct answer: Beta-blockers or calcium channel blockers
Beta-blockers (e.g., metoprolol) and non-dihydropyridine calcium channel blockers (e.g., diltiazem) are first-line agents for rate control in hemodynamically stable atrial fibrillation.
CMSRN Cardiac Vascular 2
A patient with heart failure has a BNP level of 850 pg/mL.
What does this elevated level indicate?