CMSRN Cardiac Vascular 5 — Questions and Answers
Question 1: A patient on telemetry develops ventricular fibrillation. What is the immediate priority intervention?
- Administer amiodarone 300 mg IV push
- Initiate CPR and prepare for defibrillation (Correct answer)
- Synchronize cardioversion at 100 joules
- Increase the patient's IV fluid rate
Correct answer: Initiate CPR and prepare for defibrillation
Ventricular fibrillation is a pulseless rhythm requiring immediate CPR and unsynchronized defibrillation as the definitive treatment per ACLS guidelines.
Question 2: Which patient teaching point is most important for a patient discharged with a new mechanical heart valve?
- Restrict all physical activity for one year
- Take antibiotic prophylaxis before dental procedures for life and maintain lifelong anticoagulation (Correct answer)
- Avoid all green vegetables permanently
- Blood pressure monitoring is no longer necessary
Correct answer: Take antibiotic prophylaxis before dental procedures for life and maintain lifelong anticoagulation
Patients with mechanical heart valves require lifelong anticoagulation due to thromboembolic risk and prophylactic antibiotics before procedures that may cause bacteremia.
Question 3: A patient is receiving a dobutamine infusion for acute decompensated heart failure. The nurse notes the heart rate has increased from 88 to 122 bpm. What action is appropriate?
- Increase the infusion rate to improve contractility further
- Document the finding and continue monitoring per protocol
- Notify the provider because dobutamine-induced tachycardia increases myocardial oxygen demand (Correct answer)
- Discontinue all IV access immediately
Correct answer: Notify the provider because dobutamine-induced tachycardia increases myocardial oxygen demand
Dobutamine can cause dose-related tachycardia, which increases myocardial oxygen demand and may worsen ischemia; the provider should be notified to consider dose adjustment.
Question 4: A patient with aortic stenosis asks why they feel dizzy when exercising. What is the best explanation?
- Exercise causes the aortic valve leaflets to fuse shut completely
- The narrowed valve limits cardiac output during exertion, reducing cerebral perfusion (Correct answer)
- Increased heart rate during exercise causes fluid to shift to the lungs
- The left ventricle dilates during exercise, reducing ejection fraction
Correct answer: The narrowed valve limits cardiac output during exertion, reducing cerebral perfusion
The stenotic aortic valve creates a fixed obstruction to outflow; during exercise, the heart cannot increase cardiac output sufficiently to meet demand, resulting in decreased cerebral perfusion and syncope or dizziness.
Question 5: Which intervention is most effective for preventing contrast-induced nephropathy in a patient with CKD undergoing cardiac catheterization?
- Administering prophylactic furosemide before the procedure
- Providing IV hydration with isotonic saline before and after the procedure (Correct answer)
- Restricting all fluids for 12 hours post-procedure
- Preloading with oral potassium supplements
Correct answer: Providing IV hydration with isotonic saline before and after the procedure
Adequate IV hydration with isotonic saline before and after contrast administration is the most evidence-based intervention for reducing contrast-induced nephropathy risk.
Question 6: A patient presents with an INR of 8.2 and active gum bleeding while on warfarin. Which treatment is most appropriate?
- Administer protamine sulfate IV
- Hold warfarin and administer oral or IV vitamin K (Correct answer)
- Increase the warfarin dose to restore balance
- Administer fresh frozen plasma only, without holding warfarin
Correct answer: Hold warfarin and administer oral or IV vitamin K
For supratherapeutic INR with bleeding, holding warfarin and administering vitamin K (with FFP for significant bleeding) reverses anticoagulation by restoring clotting factor synthesis.
Question 7: A patient with hypertension has a blood pressure of 198/114 mmHg with complaints of headache and blurred vision but no end-organ damage. This is classified as which condition?
- Hypertensive emergency
- Hypertensive urgency (Correct answer)
- Malignant hypertension
- Orthostatic hypotension
Correct answer: Hypertensive urgency
Hypertensive urgency is severely elevated BP (>180/120 mmHg) without acute end-organ damage; it is managed with oral antihypertensives and gradual BP reduction over 24-48 hours.
CMSRN Cardiac Vascular 5
A patient on telemetry develops ventricular fibrillation.
What is the immediate priority intervention?