CMSRN Cardiovascular and Hematological Care 3 — Questions and Answers
Question 1: A patient with atrial fibrillation has a ventricular rate of 140 bpm and is hemodynamically unstable. What intervention is the priority?
- Administer IV amiodarone
- Perform synchronized cardioversion (Correct answer)
- Start anticoagulation therapy
- Obtain a 12-lead ECG
Correct answer: Perform synchronized cardioversion
Hemodynamically unstable tachyarrhythmias require immediate synchronized cardioversion to restore sinus rhythm.
Question 2: Which lab value is the most specific marker for myocardial cell damage following an acute MI?
- CK-MB
- Myoglobin
- Troponin I or T (Correct answer)
- LDH
Correct answer: Troponin I or T
Cardiac troponin I and T are highly specific for myocardial injury and remain elevated for 7–14 days after an acute MI.
Question 3: A nurse caring for a patient with deep vein thrombosis notes the INR is 4.8 on warfarin. Which action is most appropriate?
- Administer the next scheduled warfarin dose as ordered
- Hold warfarin and notify the provider (Correct answer)
- Give vitamin C to lower the INR
- Administer protamine sulfate immediately
Correct answer: Hold warfarin and notify the provider
An INR above the therapeutic range (2–3 for DVT) increases bleeding risk and requires dose withholding and provider notification.
Question 4: A patient with chronic anemia has a hemoglobin of 6.5 g/dL and reports dyspnea on minimal exertion. After transfusion is initiated, which assessment finding indicates a transfusion-related circulatory overload (TACO)?
- Urticaria and pruritus
- New onset crackles and hypertension (Correct answer)
- Fever and rigors
- Wheezing and hypotension
Correct answer: New onset crackles and hypertension
TACO presents with pulmonary edema signs including crackles, hypertension, and respiratory distress from fluid volume overload.
Question 5: When teaching a patient about dietary management of hypertension, which recommendation is most evidence-based?
- Eliminate all fat from the diet
- Follow the DASH diet and limit sodium to <2,300 mg/day (Correct answer)
- Increase potassium by eating bananas only
- Avoid all caffeine permanently
Correct answer: Follow the DASH diet and limit sodium to <2,300 mg/day
The DASH diet combined with sodium restriction is the most evidence-based dietary approach to reducing blood pressure.
Question 6: A patient with heart failure is prescribed furosemide. Which electrolyte imbalance should the nurse monitor most closely?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypermagnesemia
- Hypercalcemia
Correct answer: Hypokalemia
Loop diuretics like furosemide cause urinary potassium wasting, placing patients at risk for hypokalemia, which can precipitate dysrhythmias.
Question 7: A patient is ordered to receive packed red blood cells. The nurse verifies the blood product at the bedside. Which action is essential before beginning the transfusion?
- Warm the blood to body temperature in a microwave
- Prime the tubing with dextrose solution
- Confirm patient identity using two identifiers and compare with blood product label (Correct answer)
- Obtain a baseline ECG
Correct answer: Confirm patient identity using two identifiers and compare with blood product label
Two-identifier verification of both the patient and the blood product is the critical safety step to prevent a fatal hemolytic transfusion reaction.
CMSRN Cardiovascular and Hematological Care 3
A patient with atrial fibrillation has a ventricular rate of 140 bpm and is hemodynamically unstable.
What intervention is the priority?