CMSRN Cardiovascular and Hematological Care 4 — Questions and Answers
Question 1: A patient reports tearing chest pain that radiates to the back and has unequal blood pressures in both arms. Which condition does the nurse suspect?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Cardiac tamponade
Correct answer: Aortic dissection
Aortic dissection classically presents with sudden tearing or ripping chest pain radiating to the back and a blood pressure differential between extremities.
Question 2: Which finding is a hallmark of cardiac tamponade?
- Wide pulse pressure and bounding pulses
- Beck's triad: hypotension, muffled heart sounds, JVD (Correct answer)
- S3 gallop and bilateral crackles
- Pulsus alternans and hypertension
Correct answer: Beck's triad: hypotension, muffled heart sounds, JVD
Beck's triad (hypotension, muffled heart sounds, and JVD) results from pericardial fluid compressing the heart and impeding ventricular filling.
Question 3: A post-operative patient develops a sudden onset of dyspnea, pleuritic chest pain, and tachycardia 3 days after hip replacement surgery. Which condition is most likely?
- Acute heart failure
- Pulmonary embolism (Correct answer)
- Spontaneous pneumothorax
- Pericarditis
Correct answer: Pulmonary embolism
Pulmonary embolism is a common post-operative complication, especially after orthopedic surgery, presenting with sudden dyspnea, pleuritic pain, and tachycardia.
Question 4: A patient with iron-deficiency anemia is started on oral ferrous sulfate. Which teaching point is most important?
- Take the medication with milk to reduce GI upset
- Expect black, tarry stools as a side effect (Correct answer)
- Avoid vitamin C-containing foods with the medication
- Take the medication at bedtime only
Correct answer: Expect black, tarry stools as a side effect
Iron supplementation commonly causes dark or black stools, which is expected and not a sign of GI bleeding, and patients must be educated about this.
Question 5: A patient with neutropenia following chemotherapy develops a fever of 38.5°C (101.3°F). What is the nurse's priority action?
- Administer acetaminophen and reassess in 4 hours
- Obtain blood cultures and initiate prescribed antibiotics immediately (Correct answer)
- Place the patient in reverse isolation and monitor
- Administer a cooling blanket
Correct answer: Obtain blood cultures and initiate prescribed antibiotics immediately
Febrile neutropenia is a medical emergency; cultures must be drawn and broad-spectrum antibiotics started within one hour to prevent septic shock.
Question 6: The nurse notes a patient's rhythm strip shows no P waves, a sawtooth baseline at 300 bpm with a ventricular rate of 75 bpm. Which rhythm is this?
- Atrial fibrillation
- Atrial flutter with 4:1 block (Correct answer)
- Ventricular tachycardia
- Junctional rhythm
Correct answer: Atrial flutter with 4:1 block
Atrial flutter characteristically shows a sawtooth flutter wave pattern at ~300 bpm; a 4:1 conduction ratio results in a ventricular rate of ~75 bpm.
Question 7: A patient with chronic kidney disease has a hemoglobin of 8.2 g/dL. The provider orders erythropoietin-stimulating agents (ESAs). The nurse understands this medication works by:
- Increasing iron absorption from the gut
- Stimulating bone marrow to produce red blood cells (Correct answer)
- Preventing platelet aggregation
- Binding free hemoglobin in the plasma
Correct answer: Stimulating bone marrow to produce red blood cells
ESAs mimic endogenous erythropoietin to stimulate the bone marrow to produce red blood cells, correcting anemia of chronic kidney disease.
CMSRN Cardiovascular and Hematological Care 4
A patient reports tearing chest pain that radiates to the back and has unequal blood pressures in both arms.
Which condition does the nurse suspect?