MSNCB Cardiac Nursing 4 — Questions and Answers
Question 1: A patient presents with sudden-onset tearing chest pain radiating to the back. Blood pressure in the right arm is 160/90 mmHg and in the left arm is 110/70 mmHg. The nurse suspects:
- Acute anterior MI with cardiogenic shock
- Aortic dissection with involvement of subclavian artery (Correct answer)
- Hypertensive urgency with reactive pain
- Pulmonary embolism with right heart strain
Correct answer: Aortic dissection with involvement of subclavian artery
Tearing chest pain radiating to the back with a blood pressure differential greater than 20 mmHg between arms is classic for aortic dissection.
Question 2: When interpreting a 12-lead ECG, which finding is most indicative of left ventricular hypertrophy?
- Tall R waves in V1 and V2 with right axis deviation
- S wave in V1 plus R wave in V5 or V6 greater than 35 mm (Correct answer)
- Widened QRS greater than 0.12 seconds with delta waves
- Peaked T waves in precordial leads with short QT interval
Correct answer: S wave in V1 plus R wave in V5 or V6 greater than 35 mm
The Sokolow-Lyon criteria for LVH requires the S wave in V1 plus R wave in V5 or V6 to exceed 35 mm.
Question 3: A patient with heart failure and an ejection fraction of 25% is being evaluated for cardiac resynchronization therapy (CRT). The primary goal of CRT is to:
- Terminate life-threatening ventricular arrhythmias with defibrillation
- Coordinate ventricular contraction to improve cardiac output (Correct answer)
- Pace the atria to maintain normal sinus rhythm
- Monitor continuous hemodynamic parameters remotely
Correct answer: Coordinate ventricular contraction to improve cardiac output
CRT uses biventricular pacing to resynchronize left and right ventricular contractions, improving cardiac output in patients with ventricular dyssynchrony.
Question 4: A patient with chronic heart failure is started on spironolactone. The nurse monitors most closely for:
- Hypokalemia and metabolic alkalosis
- Hyperkalemia, especially if also taking an ACE inhibitor (Correct answer)
- Hypocalcemia and muscle cramping
- Hyponatremia and fluid retention
Correct answer: Hyperkalemia, especially if also taking an ACE inhibitor
Spironolactone is a potassium-sparing diuretic; when combined with ACE inhibitors (which also retain potassium), dangerous hyperkalemia can develop.
Question 5: A patient in the cardiac ICU has a pulmonary artery catheter. The nurse notes a PCWP of 22 mmHg. This finding indicates:
- Hypovolemia requiring fluid resuscitation
- Normal left heart filling pressure
- Elevated left ventricular end-diastolic pressure (Correct answer)
- Right ventricular failure with elevated preload
Correct answer: Elevated left ventricular end-diastolic pressure
A PCWP above 18 mmHg reflects elevated left ventricular end-diastolic pressure, indicating left heart congestion and volume overload.
Question 6: A patient experiences a run of ventricular tachycardia lasting 28 seconds that terminates spontaneously. This is classified as:
- Ventricular fibrillation requiring immediate defibrillation
- Sustained ventricular tachycardia requiring antiarrhythmic therapy
- Non-sustained ventricular tachycardia (Correct answer)
- Torsades de pointes from prolonged QT syndrome
Correct answer: Non-sustained ventricular tachycardia
Non-sustained VT is defined as three or more consecutive ventricular beats lasting less than 30 seconds that terminate spontaneously.
Question 7: A nurse caring for a patient receiving IV heparin for NSTEMI notes an aPTT of 200 seconds (therapeutic range 60–100 seconds). The priority intervention is:
- Administer protamine sulfate and notify the provider immediately
- Continue the infusion and recheck the aPTT in 6 hours
- Reduce the heparin infusion rate per protocol and notify the provider (Correct answer)
- Obtain a stat platelet count to rule out HIT
Correct answer: Reduce the heparin infusion rate per protocol and notify the provider
A supratherapeutic aPTT requires reducing the heparin infusion rate per protocol and notifying the provider to prevent hemorrhagic complications.
MSNCB Cardiac Nursing 4
A patient presents with sudden-onset tearing chest pain radiating to the back.
Blood pressure in the right arm is 160/90 mmHg and in the left arm is 110/70 mmHg.
The nurse suspects: