CMSRN Cardiac Vascular 4 — Questions and Answers
Question 1: A patient is ordered to receive adenosine 6 mg IV push for SVT. What is the correct administration technique?
- Dilute in 100 mL NS and infuse over 30 minutes
- Administer rapidly over 1-2 seconds followed immediately by a 20 mL NS flush (Correct answer)
- Give slowly over 5 minutes to avoid hypotension
- Mix with D5W and administer via infusion pump
Correct answer: Administer rapidly over 1-2 seconds followed immediately by a 20 mL NS flush
Adenosine must be pushed rapidly over 1-2 seconds and followed immediately by a rapid saline flush to reach the heart before it is metabolized in peripheral circulation.
Question 2: Which sign would differentiate a venous leg ulcer from an arterial leg ulcer?
- Located on the lateral malleolus with well-defined, punched-out edges
- Located near the medial malleolus with irregular borders and surrounding hyperpigmentation (Correct answer)
- Painful with elevation of the limb
- Associated with absent pedal pulses
Correct answer: Located near the medial malleolus with irregular borders and surrounding hyperpigmentation
Venous ulcers typically appear near the medial malleolus with irregular edges and surrounding lipodermatosclerosis or hyperpigmentation from hemosiderin deposits.
Question 3: A patient post-CABG has a chest tube output of 250 mL in the last hour. What is the priority nursing action?
- Document as a normal finding and continue monitoring
- Clamp the chest tube to prevent further blood loss
- Notify the surgeon and prepare for possible return to the OR (Correct answer)
- Increase IV fluid rate to compensate for losses
Correct answer: Notify the surgeon and prepare for possible return to the OR
Chest tube drainage exceeding 200 mL/hr after cardiac surgery indicates excessive bleeding and requires immediate surgical notification for possible re-exploration.
Question 4: A patient with dilated cardiomyopathy is prescribed carvedilol. What is the primary reason beta-blockers are used in heart failure with reduced ejection fraction (HFrEF)?
- To increase heart rate and improve cardiac output acutely
- To block harmful neurohormonal activation and remodel the ventricle over time (Correct answer)
- To promote diuresis and reduce preload
- To prevent atrial fibrillation in all HF patients
Correct answer: To block harmful neurohormonal activation and remodel the ventricle over time
Beta-blockers counteract chronic sympathetic activation in HFrEF, reducing harmful neurohormonal effects and promoting reverse ventricular remodeling, improving long-term outcomes.
Question 5: Which laboratory value requires the nurse to hold a scheduled dose of digoxin and contact the provider?
- Serum potassium of 4.2 mEq/L
- Serum digoxin level of 2.8 ng/mL (Correct answer)
- BUN of 18 mg/dL
- Serum sodium of 138 mEq/L
Correct answer: Serum digoxin level of 2.8 ng/mL
The therapeutic range for digoxin is 0.5-2.0 ng/mL; a level of 2.8 ng/mL is toxic and requires holding the dose and notifying the provider.
Question 6: A patient with an acute inferior wall MI is most likely to exhibit which ECG finding?
- ST elevation in leads V1-V4
- ST elevation in leads II, III, and aVF (Correct answer)
- ST depression in leads I and aVL
- New left bundle branch block
Correct answer: ST elevation in leads II, III, and aVF
The inferior wall is supplied by the right coronary artery; occlusion causes ST elevation in the inferior leads II, III, and aVF.
Question 7: A nurse is preparing to remove a patient's temporary transvenous pacemaker. Which action is essential before removal?
- Administer a bolus of IV heparin
- Confirm the patient has an underlying rhythm that maintains adequate perfusion (Correct answer)
- Place the patient in Trendelenburg position
- Obtain a 12-lead ECG immediately after removal
Correct answer: Confirm the patient has an underlying rhythm that maintains adequate perfusion
Before removing a temporary pacemaker, the nurse must confirm the patient has a stable underlying rhythm capable of maintaining adequate cardiac output without pacing support.
CMSRN Cardiac Vascular 4
A patient is ordered to receive adenosine 6 mg IV push for SVT.
What is the correct administration technique?