CMSRN Cardiovascular and Hematological Care 5 — Questions and Answers
Question 1: A patient with a pacemaker has a paced rhythm on the monitor, but the nurse notes the patient's heart rate is 38 bpm and symptoms of dizziness. What does this indicate?
- Normal pacemaker function
- Pacemaker failure to capture (Correct answer)
- Pacemaker oversensing
- Appropriate rate-response pacing
Correct answer: Pacemaker failure to capture
Failure to capture occurs when the pacemaker delivers a stimulus but the myocardium does not depolarize, resulting in bradycardia despite paced spikes.
Question 2: Which intervention is most important when caring for a patient receiving thrombolytic therapy for acute MI?
- Monitor blood glucose every hour
- Avoid all arterial and venous punctures at non-compressible sites (Correct answer)
- Administer aspirin concurrently to enhance clot dissolution
- Elevate the head of bed to 45 degrees
Correct answer: Avoid all arterial and venous punctures at non-compressible sites
Thrombolytics cause systemic fibrinolysis; avoiding punctures at non-compressible sites reduces the risk of uncontrolled hemorrhage.
Question 3: A patient with polycythemia vera is at highest risk for which complication?
- Hemorrhagic stroke
- Thromboembolism (Correct answer)
- Aplastic anemia
- Disseminated intravascular coagulation
Correct answer: Thromboembolism
The elevated red blood cell mass in polycythemia vera increases blood viscosity, dramatically raising the risk of arterial and venous thrombosis.
Question 4: A nurse administers digoxin to a patient with heart failure. Before administration, the apical pulse is 52 bpm. What should the nurse do?
- Administer the dose since it is within the bradycardic threshold
- Hold the dose and notify the provider (Correct answer)
- Give half the dose and reassess in 30 minutes
- Administer atropine and then the digoxin
Correct answer: Hold the dose and notify the provider
Digoxin is typically held and the provider notified if the apical pulse is below 60 bpm due to its negative chronotropic effect, which can worsen bradycardia.
Question 5: A patient receiving IV vancomycin develops sudden flushing, erythema, and hypotension during the infusion. This reaction is most consistent with:
- Anaphylaxis
- Red man syndrome (Correct answer)
- Septic reaction
- Vasovagal response
Correct answer: Red man syndrome
Red man syndrome is a non-immune infusion reaction to vancomycin characterized by flushing and hypotension, prevented by slowing the infusion rate.
Question 6: A patient with chronic heart failure has a serum sodium of 128 mEq/L. The nurse anticipates which prescribed intervention?
- Administer hypertonic saline rapidly
- Fluid restriction and review of diuretic regimen (Correct answer)
- Increase oral sodium intake aggressively
- Administer sodium bicarbonate IV
Correct answer: Fluid restriction and review of diuretic regimen
Dilutional hyponatremia in heart failure is treated with fluid restriction and optimization of diuretic therapy, not sodium replacement.
Question 7: A patient with hemophilia A requires emergency surgery. Which product should the nurse anticipate administering?
- Platelet concentrate
- Fresh frozen plasma only
- Factor VIII concentrate (Correct answer)
- Protamine sulfate
Correct answer: Factor VIII concentrate
Hemophilia A is caused by factor VIII deficiency; surgical patients require factor VIII concentrate to prevent life-threatening hemorrhage.
CMSRN Cardiovascular and Hematological Care 5
A patient with a pacemaker has a paced rhythm on the monitor, but the nurse notes the patient's heart rate is 38 bpm and symptoms of dizziness.
What does this indicate?