CMSRN Cardiovascular and Hematological Care 2 — Questions and Answers
Question 1: A patient with heart failure has a BNP level of 900 pg/mL. What does this finding indicate?
- Adequate cardiac compensation
- Severe ventricular wall stress and volume overload (Correct answer)
- Myocardial infarction in progress
- Pulmonary embolism
Correct answer: Severe ventricular wall stress and volume overload
Elevated BNP (>100 pg/mL) reflects ventricular wall stress due to volume or pressure overload, commonly seen in decompensated heart failure.
Question 2: A patient on heparin therapy develops sudden thrombocytopenia and a new arterial clot on day 8. Which complication should the nurse suspect?
- Disseminated intravascular coagulation
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Idiopathic thrombocytopenic purpura
- Vitamin K deficiency
Correct answer: Heparin-induced thrombocytopenia (HIT)
HIT typically presents 5–10 days after heparin initiation with paradoxical thrombosis and a platelet drop, requiring immediate discontinuation of heparin.
Question 3: Which assessment finding best indicates right-sided heart failure?
- Crackles in lung bases
- S3 gallop on auscultation
- Jugular venous distension and peripheral edema (Correct answer)
- Orthopnea and paroxysmal nocturnal dyspnea
Correct answer: Jugular venous distension and peripheral edema
Right-sided heart failure causes systemic venous congestion, manifesting as JVD, hepatomegaly, and dependent edema.
Question 4: A patient with sickle cell disease is admitted in vaso-occlusive crisis. What is the priority nursing intervention?
- Administer hydroxyurea
- Apply cold packs to painful areas
- Provide IV fluids and analgesics (Correct answer)
- Restrict fluid intake to prevent hemolysis
Correct answer: Provide IV fluids and analgesics
Hydration reverses sickling by diluting the blood and analgesics address the severe pain caused by microvascular occlusion.
Question 5: A patient receiving a blood transfusion develops sudden flank pain, hemoglobinuria, and fever within 15 minutes. What should the nurse do first?
- Slow the transfusion rate and monitor
- Stop the transfusion and infuse normal saline (Correct answer)
- Administer diphenhydramine IV push
- Obtain a repeat type and crossmatch
Correct answer: Stop the transfusion and infuse normal saline
Signs of acute hemolytic reaction require immediate transfusion cessation and IV saline to maintain renal perfusion and prevent acute kidney injury.
Question 6: Which ECG change is most characteristic of hyperkalemia?
- Prolonged QT interval
- ST-segment depression
- Tall, peaked T waves (Correct answer)
- Prominent U waves
Correct answer: Tall, peaked T waves
Hyperkalemia first produces tall, peaked T waves, progressing to widened QRS and sine-wave pattern as potassium rises further.
Question 7: A patient with peripheral arterial disease reports calf pain that occurs during walking and resolves with rest. This symptom is best described as:
- Deep vein thrombosis
- Intermittent claudication (Correct answer)
- Raynaud's phenomenon
- Venous insufficiency
Correct answer: Intermittent claudication
Intermittent claudication is ischemic muscle pain triggered by exercise and relieved by rest, caused by inadequate arterial blood flow.
CMSRN Cardiovascular and Hematological Care 2
A patient with heart failure has a BNP level of 900 pg/mL.
What does this finding indicate?