CMSRN Cardiac Vascular 3 — Questions and Answers
Question 1: A patient with an acute MI reports sudden, severe midscapular tearing back pain. What complication should the nurse suspect first?
- Pericarditis
- Pulmonary embolism
- Aortic dissection (Correct answer)
- Esophageal rupture
Correct answer: Aortic dissection
Tearing or ripping back pain radiating to the interscapular region is the hallmark presentation of aortic dissection, a life-threatening emergency.
Question 2: A nurse notes a patient's cardiac monitor shows a rhythm with no P waves, irregular RR intervals, and a rate of 110 bpm. What rhythm is this?
- Sinus tachycardia
- Atrial fibrillation (Correct answer)
- Ventricular tachycardia
- Third-degree heart block
Correct answer: Atrial fibrillation
Atrial fibrillation is characterized by an absence of distinct P waves, an irregularly irregular ventricular rate, and chaotic atrial activity.
Question 3: Which instruction is most important when teaching a patient about warfarin therapy?
- Take an extra dose if a scheduled dose is missed
- Avoid consistent consumption of vitamin K-rich foods (Correct answer)
- Limit fluid intake to 1 liter per day
- Report any yellow discoloration of the skin immediately
Correct answer: Avoid consistent consumption of vitamin K-rich foods
Consistent vitamin K intake is essential because vitamin K antagonizes warfarin; drastic changes in dietary vitamin K can cause INR fluctuations.
Question 4: A patient's arterial blood pressure waveform shows pulsus paradoxus of 18 mmHg. What condition does this suggest?
- Hypertensive crisis
- Cardiac tamponade (Correct answer)
- Left ventricular failure
- Pulmonary hypertension
Correct answer: Cardiac tamponade
Pulsus paradoxus greater than 10 mmHg (exaggerated fall in systolic BP during inspiration) is a classic sign of cardiac tamponade.
Question 5: A nurse is caring for a patient with deep vein thrombosis (DVT) of the left leg. Which intervention is contraindicated?
- Elevating the affected extremity
- Administering prescribed anticoagulants
- Applying warm compresses as ordered
- Massaging the affected calf to relieve discomfort (Correct answer)
Correct answer: Massaging the affected calf to relieve discomfort
Massaging a limb with DVT can dislodge the thrombus and cause a pulmonary embolism.
Question 6: Which hemodynamic parameter best reflects left ventricular preload?
- Systemic vascular resistance (SVR)
- Pulmonary artery wedge pressure (PAWP) (Correct answer)
- Mean arterial pressure (MAP)
- Cardiac index (CI)
Correct answer: Pulmonary artery wedge pressure (PAWP)
The pulmonary artery wedge pressure (PAWP) reflects left atrial pressure and left ventricular end-diastolic pressure, serving as the best clinical measure of LV preload.
Question 7: A patient develops cardiogenic shock after a large anterior MI. Which hemodynamic pattern is expected?
- High CO, low SVR, low PAWP
- Low CO, high SVR, high PAWP (Correct answer)
- High CO, high SVR, low PAWP
- Low CO, low SVR, low PAWP
Correct answer: Low CO, high SVR, high PAWP
Cardiogenic shock produces low cardiac output due to pump failure, compensatory high SVR from vasoconstriction, and high PAWP from backward failure.
CMSRN Cardiac Vascular 3
A patient with an acute MI reports sudden, severe midscapular tearing back pain.
What complication should the nurse suspect first?