Free CMSRN Cardiac Vascular Questions and Answers — Questions and Answers
Question 1: When a patient is examined while supine, enlarged jugular veins can be seen running from the base of the neck to the angle of the jaw. This result suggests:
- left-sided heart failure.
- decreased venous return.
- increased central venous pressure. (Correct answer)
- increased pulmonary artery capillary pressure.
Correct answer: increased central venous pressure.
Enlarged jugular veins, especially when visible while supine, are a classic sign of increased central venous pressure (CVP). CVP reflects the pressure in the right atrium and vena cava, indicating the heart's ability to pump blood effectively and the overall fluid status. Conditions like right-sided heart failure, fluid overload, or tricuspid valve stenosis can lead to elevated CVP and distended jugular veins.
Question 2: One of the main ways to lower a female patient's chance of getting coronary heart disease is to:
- enroll in a cardiac rehabilitation program.
- take nitroglycerin at the onset of chest pain.
- avoid excessive weight gain during pregnancy. (Correct answer)
- take 81 mg of aspirin daily.
Correct answer: avoid excessive weight gain during pregnancy.
Avoiding excessive weight gain during pregnancy is a crucial modifiable risk factor for long-term cardiovascular health in women. Gestational weight gain beyond recommended guidelines is associated with an increased risk of developing gestational diabetes, preeclampsia, and postpartum weight retention, all of which are independent risk factors for future coronary heart disease. Managing weight during pregnancy helps mitigate these risks and promotes better cardiovascular outcomes.
Question 3: When receiving warfarin (Coumadin) medication, excessive alcohol consumption causes:
- decreased international normalized ratio.
- increased anticoagulation effect. (Correct answer)
- increased vitamin K absorption.
- decreased anticoagulation effect.
Correct answer: increased anticoagulation effect.
Excessive alcohol consumption can inhibit the metabolism of warfarin in the liver, leading to higher concentrations of the drug in the bloodstream. This increased level of warfarin enhances its anticoagulant effect, resulting in a higher International Normalized Ratio (INR) and an elevated risk of bleeding. Patients on warfarin are advised to consume alcohol in moderation or avoid it entirely to maintain stable anticoagulation.
Question 4: A nurse diagnosing cardiogenic shock gives the patient's reduced cardiac output. The patient is expected to attain the following goals with the right interventions:
- reduced anxiety.
- decreased afterload.
- baseline cardiac function. (Correct answer)
- baseline activity level.
Correct answer: baseline cardiac function.
Cardiogenic shock is a life-threatening condition where the heart's pumping ability is severely impaired, leading to critically reduced cardiac output. The primary goal of all interventions in cardiogenic shock is to restore the heart's function to effectively pump blood and maintain adequate tissue perfusion. Achieving baseline cardiac function signifies the successful reversal of the shock state and restoration of the heart's ability to meet the body's demands.
Question 5: During a cardiac-vascular nurse's evaluation for intermittent claudication, she looks for leg pain and cramps when exerted. She then questions the patient:
- "Is the leg pain relieved by rest?" (Correct answer)
- "Is the leg pain relieved with elevation?"
- "Does this same type of pain occur without activity?"
- "Does shortness of breath accompany the leg pain?"
Correct answer: "Is the leg pain relieved by rest?"
Intermittent claudication is a hallmark symptom of peripheral artery disease (PAD), characterized by muscle pain or cramping in the legs that is consistently brought on by exertion and relieved by rest. This occurs because the narrowed arteries cannot supply enough blood flow to the muscles during activity. Therefore, asking if the leg pain is relieved by rest is a crucial diagnostic question to identify this classic pattern.
Question 6: A coronary artery bypass surgery patient displays a thorough comprehension of discharge instruction by:
- describing plans to relax in a hot tub during recovery.
- planning to resume driving his or her spouse to work next week.
- asking whether smoking one cigarette per day is acceptable.
- clarifying when cardiac rehabilitation will begin. (Correct answer)
Correct answer: clarifying when cardiac rehabilitation will begin.
Cardiac rehabilitation is an essential, structured program that helps patients recover and improve their cardiovascular health after events like coronary artery bypass surgery (CABG). It involves supervised exercise, education on heart-healthy living, and counseling. A patient clarifying when cardiac rehabilitation will begin demonstrates a proactive approach to their recovery and an understanding of the importance of long-term lifestyle changes, indicating thorough comprehension of discharge instructions.
Question 7: Meditation may be helpful for a patient recovering from a myocardial infarction since this method:
- decreases vasodilation.
- decreases sympathetic nervous system activity. (Correct answer)
- increases the release of catecholamines.
- increases sympathetic nervous system activity.
Correct answer: decreases sympathetic nervous system activity.
Meditation promotes relaxation and activates the parasympathetic nervous system, which counteracts the 'fight or flight' response mediated by the sympathetic nervous system. This leads to beneficial physiological changes such as decreased heart rate, reduced blood pressure, and lower levels of stress hormones like catecholamines. For a patient recovering from a myocardial infarction, decreasing sympathetic nervous system activity helps reduce cardiac workload, promote healing, and lower the risk of further cardiac events.
Question 8: When getting ready to give thrombolytic therapy to a patient who is having an acute myocardial infarction (MI), what is the most important thing to keep in mind?
- Sensitivity to aspirin.
- Time since onset of symptoms. (Correct answer)
- Size and location of the MI.
- History of heart disease.
Correct answer: Time since onset of symptoms.
Thrombolytic therapy aims to dissolve the blood clot causing an acute myocardial infarction (MI) and restore blood flow to the heart muscle. Its effectiveness is highly time-dependent; the earlier it is administered after symptom onset, the greater the chance of reperfusion and myocardial salvage. Guidelines typically recommend administration within 6-12 hours, making the time since onset of symptoms the most critical factor for eligibility and potential benefit.
Question 9: A cardiac-vascular nurse treating a patient with intermittent claudication suggests the following to the patient:
- walk as tolerated. (Correct answer)
- refrain from exercise.
- elevate the legs when sitting.
- apply graduated compression stockings before getting out of bed.
Correct answer: walk as tolerated.
For patients with intermittent claudication due to peripheral artery disease, a supervised exercise program, particularly walking, is a cornerstone of treatment. Walking to the point of pain, resting, and then resuming helps to promote the development of collateral circulation and improve walking distance and functional capacity. Refraining from exercise would worsen the condition, and other options are not primary treatments for claudication.
Question 10: When discussing prescribed activities with a patient who experienced a myocardial infarction, the cardiac-vascular nurse steps in. "It doesn't really matter what I do or don't do. I will either get better or die," the patient says. The statement illustrates:
- projection.
- feelings of loss of control. (Correct answer)
- an internal locus of control.
- acceptance of changed health status.
Correct answer: feelings of loss of control.
The patient's statement, 'It doesn't really matter what I do or don't do. I will either get better or die,' expresses a sense of powerlessness and fatalism regarding their health outcome. This indicates a feeling of loss of control over their situation and the effectiveness of their actions. Such feelings are common psychological responses to serious health events like a myocardial infarction.
Question 11: When a patient says, "I came in because my calcium score was positive on my computed tomography scan last week," during a clinic visit, where does the cardiac-vascular nurse record this finding in the patient assessment?
- Presenting problem. (Correct answer)
- Review of symptoms.
- Personal/social history.
- Past medical history.
Correct answer: Presenting problem.
The 'presenting problem' or chief complaint is the primary reason the patient is seeking medical attention at that specific visit. In this scenario, the patient explicitly states, 'I came in because my calcium score was positive on my computed tomography scan last week.' This directly identifies the calcium score finding as the immediate impetus for their clinic visit, making it the presenting problem.
Free CMSRN Cardiac Vascular Questions and Answers
When a patient is examined while supine, enlarged jugular veins can be seen running from the base of the neck to the angle of the jaw.
This result suggests: