MSNCB Cardiac Nursing 2 — Questions and Answers
Question 1: A patient with heart failure has a BNP level of 850 pg/mL. What does this value indicate?
- Mild cardiac stress with compensated function
- Severe ventricular wall stress and volume overload (Correct answer)
- Normal cardiac function in an elderly patient
- Renal failure causing elevated peptide levels
Correct answer: Severe ventricular wall stress and volume overload
BNP above 400 pg/mL indicates significant ventricular wall stress and volume overload consistent with decompensated heart failure.
Question 2: A patient presents with ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in II, III, and aVF indicates an inferior wall MI, which is most commonly caused by occlusion of the right coronary artery.
Question 3: A nurse is administering IV furosemide to a patient with acute decompensated heart failure. Which assessment finding requires immediate intervention?
- Urine output of 80 mL/hr
- Serum potassium of 2.8 mEq/L (Correct answer)
- Blood pressure of 138/88 mmHg
- Heart rate of 88 beats/min
Correct answer: Serum potassium of 2.8 mEq/L
A serum potassium of 2.8 mEq/L indicates hypokalemia, which increases the risk of life-threatening dysrhythmias in cardiac patients receiving diuretics.
Question 4: Which rhythm is characterized by an irregular R-R interval, absence of distinct P waves, and an irregularly irregular ventricular rate?
- Atrial flutter with variable block
- Multifocal atrial tachycardia
- Atrial fibrillation (Correct answer)
- Wandering atrial pacemaker
Correct answer: Atrial fibrillation
Atrial fibrillation is characterized by absent distinct P waves, a chaotic atrial baseline, and an irregularly irregular ventricular response.
Question 5: A patient with stable angina asks about the difference between their condition and unstable angina. The nurse correctly explains that unstable angina:
- Occurs only with exertion and resolves with rest
- Occurs at rest or with minimal exertion and is unpredictable (Correct answer)
- Always indicates an acute MI is in progress
- Is characterized by ST elevation on the 12-lead ECG
Correct answer: Occurs at rest or with minimal exertion and is unpredictable
Unstable angina occurs at rest or with minimal exertion, is unpredictable, and represents worsening coronary perfusion without myocardial necrosis.
Question 6: A patient is prescribed carvedilol for heart failure with reduced ejection fraction. The nurse knows this medication works primarily by:
- Increasing myocardial contractility and heart rate
- Blocking both alpha-1 and beta-adrenergic receptors (Correct answer)
- Blocking calcium channels to reduce cardiac workload
- Inhibiting angiotensin-converting enzyme activity
Correct answer: Blocking both alpha-1 and beta-adrenergic receptors
Carvedilol is a non-selective beta-blocker with alpha-1 blocking activity, reducing afterload and heart rate while blocking catecholamine effects on the heart.
Question 7: During post-cardiac catheterization care, a patient develops sudden severe chest pain, hypotension, and distended neck veins. The nurse should suspect:
- Pulmonary embolism
- Cardiac tamponade (Correct answer)
- Hematoma at the access site
- Contrast dye allergic reaction
Correct answer: Cardiac tamponade
The triad of chest pain, hypotension, and distended neck veins (Beck's triad) following a cardiac procedure is classic for cardiac tamponade.
MSNCB Cardiac Nursing 2
A patient with heart failure has a BNP level of 850 pg/mL.
What does this value indicate?