CPAN Cardiovascular and Hemodynamic Management

Question 1

A PACU patient has sinus bradycardia at 38 beats/min, BP 78/40 mmHg and new confusion. Which drug is first-line?

Accepted Answer

Atropine 1 mg IV

Answer

Under ACLS guidelines, atropine 1 mg IV (repeated every 3-5 minutes up to 3 mg) is first-line for symptomatic bradycardia. Adenosine and amiodarone treat tachyarrhythmias, and metoprolol would slow the heart rate further.

Question 2

A PACU patient becomes hypertensive at 178/96 mmHg. Before giving an antihypertensive, which correctable cause should the nurse assess first?

Accepted Answer

Untreated pain or a distended bladder

Answer

Pain and bladder distention are common, easily reversed causes of postoperative hypertension. Hypovolemia, sympathectomy and opioid excess usually lower blood pressure.

Question 3

After cardiac surgery, a patient has hypotension, distended neck veins and muffled heart sounds. What does the nurse suspect?

Accepted Answer

Cardiac tamponade

Answer

Hypotension, jugular venous distention and muffled heart sounds are Beck's triad, the classic sign of cardiac tamponade. Hypovolemic shock causes flat neck veins.

Question 4

Which lab test is most specific for confirming postoperative myocardial infarction, which is often silent in older adults receiving analgesics?

Accepted Answer

Cardiac troponin

Answer

Cardiac troponin I or T is the most sensitive and specific marker of myocardial injury. CK, myoglobin and LDH also rise after surgical muscle trauma.

Question 5

A hemodynamically stable PACU patient develops new atrial fibrillation with a ventricular rate of 148. What is the usual initial treatment?

Accepted Answer

Rate control with an IV beta-blocker or diltiazem

Answer

For stable AF with rapid ventricular response, the first priority is rate control with a beta-blocker or calcium channel blocker. Cardioversion is reserved for unstable patients. Defibrillation is for pulseless rhythms, and atropine would raise the rate further.

(CPAN) Certified Post Anesthesia Nurse Practice Test

(CPAN) Certified Post Anesthesia Nurse Practice Test

CPAN Cardiovascular and Hemodynamic Management