ABPANC Cardiovascular Assessment & Monitoring 2 — Questions and Answers
Question 1: A post-operative patient develops atrial fibrillation with a ventricular rate of 148 bpm and BP 80/50 mmHg. The MOST appropriate initial intervention is:
- Administer oral metoprolol to slow ventricular rate
- Prepare for immediate synchronized cardioversion (Correct answer)
- Initiate IV amiodarone infusion at 1 mg/min
- Place the patient in Trendelenburg position only
Correct answer: Prepare for immediate synchronized cardioversion
Hemodynamically unstable atrial fibrillation with hypotension requires immediate synchronized cardioversion to restore sinus rhythm and re-establish hemodynamic stability.
Question 2: Which assessment finding is MOST consistent with right-sided heart failure in a perianesthesia patient?
- Pulmonary crackles and pink frothy sputum
- Jugular venous distension and dependent peripheral edema (Correct answer)
- Narrowed pulse pressure with cool extremities
- Inspiratory stridor with accessory muscle use
Correct answer: Jugular venous distension and dependent peripheral edema
Right-sided heart failure causes blood to back up into the systemic venous circulation, producing jugular venous distension and dependent peripheral edema.
Question 3: The perianesthesia nurse notes PVCs occurring every other beat on the cardiac monitor. This rhythm pattern is called:
- Ventricular bigeminy (Correct answer)
- Ventricular trigeminy
- Ventricular tachycardia
- Accelerated idioventricular rhythm
Correct answer: Ventricular bigeminy
Ventricular bigeminy is the pattern of alternating normal sinus beats and PVCs, where every other beat is a premature ventricular contraction.
Question 4: Which electrolyte imbalance MOST commonly predisposes post-operative patients to ventricular dysrhythmias?
- Hypernatremia
- Hypermagnesemia
- Hypokalemia (Correct answer)
- Hypercalcemia
Correct answer: Hypokalemia
Hypokalemia reduces the cardiac cell resting membrane potential, increasing myocardial irritability and significantly predisposing the heart to ventricular dysrhythmias.
Question 5: A patient's arterial line waveform shows a markedly diminished dicrotic notch. This finding MOST likely indicates:
- Increased systemic vascular resistance
- Decreased cardiac output or reduced arterial compliance (Correct answer)
- Hypervolemia with elevated preload
- Normal hemodynamic status in a post-operative patient
Correct answer: Decreased cardiac output or reduced arterial compliance
A diminished dicrotic notch suggests decreased forward cardiac output or reduced arterial compliance, as the notch reflects the pressure change at aortic valve closure.
Question 6: A patient post-cardiac surgery develops Beck's Triad (hypotension, jugular venous distension, muffled heart sounds). The nurse should FIRST suspect:
- Pulmonary embolism
- Acute myocardial infarction
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
Correct answer: Cardiac tamponade
Beck's Triad is the classic presentation of cardiac tamponade, where pericardial fluid compresses the heart, impairing filling and reducing cardiac output.
Question 7: On a post-operative patient's 12-lead ECG, ST depression in leads V4–V6 MOST likely indicates:
- Acute anterior ST-elevation MI (STEMI)
- Subendocardial ischemia or non-ST elevation myocardial ischemia (NSTEMI) (Correct answer)
- Right bundle branch block
- Normal post-operative variant
Correct answer: Subendocardial ischemia or non-ST elevation myocardial ischemia (NSTEMI)
ST depression reflects subendocardial ischemia or NSTEMI, indicating reduced oxygen supply to the inner myocardial layers without complete transmural infarction.
ABPANC Cardiovascular Assessment & Monitoring 2
A post-operative patient develops atrial fibrillation with a ventricular rate of 148 bpm and BP 80/50 mmHg.
The MOST appropriate initial intervention is: