PCCN - Cardiovascular Patient Management Questions and Answers — Questions and Answers
Question 1: A patient is admitted with acute decompensated heart failure (ADHF) and presents with dyspnea, orthopnea, and 3+ pitting edema in the lower extremities. The patient's blood pressure is 98/60 mmHg. Which of the following interventions is the priority for this patient?
- Administering a bolus of intravenous normal saline.
- Applying multi-layer compression wraps to the lower extremities.
- Administering intravenous furosemide. (Correct answer)
- Initiating an intravenous dobutamine infusion.
Correct answer: Administering intravenous furosemide.
The primary goal in treating acute decompensated heart failure with fluid overload is to reduce volume and relieve congestion. Intravenous loop diuretics, such as furosemide, are the first-line therapy to achieve this by promoting diuresis. Administering a fluid bolus would worsen the fluid overload. Compression wraps are contraindicated in hemodynamically unstable patients as they can shift fluid centrally and increase pulmonary congestion. While dobutamine (an inotrope) may be used if there is evidence of hypoperfusion, the initial priority is to address the severe fluid overload causing the patient's symptoms.
Question 2: A patient returns to the progressive care unit after a percutaneous coronary intervention (PCI) via the right radial artery. Which of the following assessment findings requires immediate nursing intervention?
- The patient reports a pain level of 2/10 at the access site.
- Capillary refill in the right hand is less than 3 seconds.
- The patient complains of numbness and tingling in the right fingers. (Correct answer)
- A small amount of bruising is noted around the insertion site.
Correct answer: The patient complains of numbness and tingling in the right fingers.
Numbness and tingling in the affected extremity after a radial artery PCI can indicate nerve compromise or impaired circulation, possibly due to hematoma formation or nerve compression. This is a serious complication that requires immediate assessment and intervention to prevent permanent damage. Mild pain, brisk capillary refill, and minor bruising are expected findings after this procedure.
Question 3: Which of the following medication classes is considered first-line for rate control in a stable patient newly diagnosed with atrial fibrillation and a rapid ventricular response?
- Amiodarone
- Beta-blockers (Correct answer)
- Digoxin
- Sodium channel blockers
Correct answer: Beta-blockers
For stable patients with atrial fibrillation and a rapid ventricular response, beta-blockers (e.g., metoprolol) or non-dihydropyridine calcium channel blockers (e.g., diltiazem) are recommended as first-line agents for rate control. Amiodarone is typically used for rhythm control or in specific situations like heart failure. Digoxin is generally considered a second-line agent as it is less effective at controlling heart rate during exercise. Sodium channel blockers are used for rhythm control, not rate control.
Question 4: A progressive care nurse is caring for a patient who is 48 hours post-coronary artery bypass graft (CABG) surgery. The patient is hemodynamically stable and has been extubated. Which nursing intervention is crucial to prevent postoperative pulmonary complications?
- Maintaining strict bed rest for 72 hours.
- Administering cough suppressants to minimize incisional pain.
- Encouraging the use of an incentive spirometer and splinting the incision when coughing. (Correct answer)
- Limiting oral fluid intake to prevent fluid overload.
Correct answer: Encouraging the use of an incentive spirometer and splinting the incision when coughing.
Postoperative pulmonary complications, such as atelectasis and pneumonia, are significant risks after CABG surgery. Encouraging deep breathing and coughing is essential to keep the lungs clear. Using an incentive spirometer helps with deep breathing, and splinting the chest incision with a pillow provides support and reduces pain during coughing, making it more effective. Strict bed rest, cough suppression, and fluid restriction would increase the risk of pulmonary complications.
Question 5: A patient with a history of heart failure is being discharged from the progressive care unit. The nurse is providing education on lifestyle modifications. Which statement by the patient indicates a need for further teaching?
- "I will weigh myself every morning and call my doctor if I gain more than 3 pounds in a day."
- "I should limit my sodium intake to no more than 2,000 milligrams per day."
- "I will try to drink at least 3 liters of water every day to stay hydrated." (Correct answer)
- "I need to make sure I take my medications every day, even if I am feeling better."
Correct answer: "I will try to drink at least 3 liters of water every day to stay hydrated."
Patients with heart failure are often on a fluid restriction to prevent volume overload. Encouraging a high fluid intake, such as 3 liters per day, would be contraindicated and indicates a need for further education. Daily weights, sodium restriction, and medication adherence are all key components of successful heart failure self-management.
Question 6: A patient is admitted with an acute inferior wall myocardial infarction. The nurse should be most vigilant for the development of which of the following dysrhythmias?
- Atrial fibrillation
- Ventricular tachycardia
- Sinus tachycardia
- Atrioventricular (AV) block (Correct answer)
Correct answer: Atrioventricular (AV) block
An inferior wall myocardial infarction often involves the right coronary artery (RCA), which supplies blood to the atrioventricular (AV) node in the majority of the population. Ischemia or damage to the AV node can lead to conduction disturbances, such as first-degree, second-degree, or third-degree AV block. Therefore, the nurse must closely monitor the patient's ECG for signs of heart block.
PCCN - Cardiovascular Patient Management Questions and Answers
A patient is admitted with acute decompensated heart failure (ADHF) and presents with dyspnea, orthopnea, and 3+ pitting edema in the lower extremities.
The patient's blood pressure is 98/60 mmHg.
Which of the following interventions is the priority for this patient?