MSNCB Cardiac Nursing 5 — Questions and Answers
Question 1: A patient develops heparin-induced thrombocytopenia (HIT) confirmed by laboratory testing. The nurse anticipates which medication will be ordered?
- Warfarin initiated immediately as a bridge therapy
- Argatroban or bivalirudin as a direct thrombin inhibitor (Correct answer)
- Low-molecular-weight heparin such as enoxaparin
- Aspirin and clopidogrel dual antiplatelet therapy
Correct answer: Argatroban or bivalirudin as a direct thrombin inhibitor
In confirmed HIT, all heparin products are contraindicated and a direct thrombin inhibitor such as argatroban or bivalirudin must be substituted.
Question 2: A patient with aortic stenosis develops syncope, angina, and dyspnea. The nurse recognizes these symptoms indicate:
- Early disease that can be managed with medication alone
- Progression to critical stenosis requiring urgent valve intervention (Correct answer)
- Fluid overload requiring aggressive diuresis
- Concurrent mitral valve disease complicating treatment
Correct answer: Progression to critical stenosis requiring urgent valve intervention
The classic triad of syncope, angina, and dyspnea in aortic stenosis signals critical disease with significantly reduced survival if valve replacement is not performed.
Question 3: A patient is admitted with Wolff-Parkinson-White syndrome and develops atrial fibrillation. Which medication is contraindicated in this situation?
- Procainamide
- Adenosine
- Amiodarone
- IV diltiazem (Correct answer)
Correct answer: IV diltiazem
In WPW with atrial fibrillation, AV nodal blocking agents like diltiazem, verapamil, and digoxin are contraindicated because they can accelerate conduction through the accessory pathway, causing ventricular fibrillation.
Question 4: A patient post-PCI with stent placement is being discharged. The nurse understands the most critical teaching point regarding dual antiplatelet therapy is:
- Aspirin can be stopped after 30 days once the stent is fully endothelialized
- Both aspirin and the P2Y12 inhibitor must be taken consistently to prevent in-stent thrombosis (Correct answer)
- The P2Y12 inhibitor should be held if the patient undergoes minor dental procedures
- Dual antiplatelet therapy can be stopped if significant GI bleeding develops without provider consultation
Correct answer: Both aspirin and the P2Y12 inhibitor must be taken consistently to prevent in-stent thrombosis
Premature discontinuation of dual antiplatelet therapy after coronary stenting dramatically increases the risk of acute in-stent thrombosis, which carries very high mortality.
Question 5: When assessing a patient with right-sided heart failure, the nurse expects to find which clinical manifestations?
- Pulmonary edema, orthopnea, and pink frothy sputum
- Peripheral edema, hepatomegaly, and jugular venous distension (Correct answer)
- Bilateral crackles, S3 gallop, and elevated BNP only
- Hypotension, tachycardia, and cool clammy extremities
Correct answer: Peripheral edema, hepatomegaly, and jugular venous distension
Right-sided heart failure causes systemic venous congestion manifesting as peripheral edema, hepatomegaly, ascites, and jugular venous distension.
Question 6: A patient's ECG shows a regularly irregular rhythm with progressive lengthening of the PR interval until a P wave is not conducted, followed by resumption of the pattern. This describes:
- Second-degree AV block, Mobitz type II
- Third-degree (complete) AV block
- Second-degree AV block, Mobitz type I (Wenckebach) (Correct answer)
- First-degree AV block with occasional PACs
Correct answer: Second-degree AV block, Mobitz type I (Wenckebach)
Progressive PR prolongation until a dropped QRS, followed by the same repeating cycle, is the hallmark of Mobitz type I (Wenckebach) second-degree AV block.
Question 7: A nurse is educating a patient about activity restrictions following acute MI. Which statement by the patient indicates correct understanding?
- I can return to heavy lifting and strenuous exercise within two weeks.
- I will gradually increase my activity level and follow the cardiac rehabilitation program. (Correct answer)
- I should remain on bed rest for at least four weeks to allow complete healing.
- I can resume all normal activities once my chest pain is gone.
Correct answer: I will gradually increase my activity level and follow the cardiac rehabilitation program.
Graduated activity progression through a structured cardiac rehabilitation program is the evidence-based approach to safely restoring function after acute MI.
MSNCB Cardiac Nursing 5
A patient develops heparin-induced thrombocytopenia (HIT) confirmed by laboratory testing.
The nurse anticipates which medication will be ordered?