CCRN - Review Cardiovascular Emergencies Questions and Answers 1 — Questions and Answers
Question 1: A 58-year-old male is admitted with a hypertensive emergency. His blood pressure is 220/140 mmHg, and he is complaining of a severe headache and confusion. Which of the following is the most appropriate initial nursing action?
- Administer a rapid IV bolus of 0.9% normal saline.
- Prepare for immediate endotracheal intubation.
- Initiate an IV infusion of sodium nitroprusside and titrate to a goal mean arterial pressure (MAP). (Correct answer)
- Administer a potent oral antihypertensive agent for rapid effect.
Correct answer: Initiate an IV infusion of sodium nitroprusside and titrate to a goal mean arterial pressure (MAP).
In a hypertensive emergency with signs of end-organ damage (e.g., encephalopathy), the priority is to lower the blood pressure in a controlled manner using a titratable intravenous agent. Sodium nitroprusside is a potent vasodilator that allows for precise, rapid control of blood pressure. The goal is not to normalize the blood pressure immediately but to reduce it by no more than 25% in the first hour to prevent cerebral hypoperfusion. Administering a fluid bolus would worsen hypertension. Intubation is not indicated unless there is respiratory failure. Oral agents are not used for emergencies because their absorption and effect are less predictable and controllable.
Question 2: A patient is brought to the ICU after a motor vehicle collision, presenting with hypotension, jugular venous distention (JVD), and muffled heart sounds. These findings are most indicative of which cardiovascular emergency?
- Massive pulmonary embolism
- Aortic dissection
- Cardiogenic shock
- Cardiac tamponade (Correct answer)
Correct answer: Cardiac tamponade
The classic triad of hypotension, jugular venous distention, and muffled heart sounds is known as Beck's triad, which is a hallmark sign of cardiac tamponade. This condition occurs when fluid accumulates in the pericardial sac, compressing the heart and preventing it from filling and pumping effectively. While the other conditions are serious, this specific combination of signs points directly to cardiac tamponade.
Question 3: A 65-year-old male presents with sudden, severe, tearing chest pain that radiates to his back. On assessment, the nurse notes a blood pressure of 180/100 mmHg in the right arm and 130/80 mmHg in the left arm. Which of the following is the priority intervention?
- Administer morphine for pain control.
- Obtain a 12-lead ECG to rule out myocardial infarction.
- Administer an IV beta-blocker to lower heart rate and blood pressure. (Correct answer)
- Prepare the patient for an emergent chest x-ray.
Correct answer: Administer an IV beta-blocker to lower heart rate and blood pressure.
The patient's presentation of tearing chest pain radiating to the back and a significant blood pressure discrepancy between arms is highly suggestive of an acute aortic dissection. The immediate priority is to reduce aortic wall shear stress to prevent propagation of the dissection or rupture. This is achieved by rapidly lowering the heart rate and blood pressure with intravenous beta-blockers (e.g., esmolol, labetalol). While pain control and diagnostics are important, hemodynamic control is the most critical life-saving intervention.
Question 4: Which of the following hemodynamic profiles is most consistent with cardiogenic shock?
- High cardiac index, low systemic vascular resistance (SVR)
- Low central venous pressure (CVP), low pulmonary artery occlusion pressure (PAOP)
- Low cardiac index, high systemic vascular resistance (SVR) (Correct answer)
- High cardiac index, high central venous pressure (CVP)
Correct answer: Low cardiac index, high systemic vascular resistance (SVR)
Cardiogenic shock is characterized by pump failure, leading to a decreased cardiac output and cardiac index (CI ≤ 2.2 L/min/m²). In response to this low output, the body compensates by vasoconstricting to maintain blood pressure, resulting in an elevated systemic vascular resistance (SVR). The pulmonary artery occlusion pressure (PAOP > 15-18 mmHg) is also typically elevated due to blood backing up from the failing left ventricle.
Question 5: A patient is admitted with an ST-segment elevation myocardial infarction (STEMI). According to current guidelines, what is the primary goal for reperfusion therapy?
- Administration of IV nitroglycerin within 30 minutes of arrival.
- Door-to-balloon time for percutaneous coronary intervention (PCI) within 90 minutes. (Correct answer)
- Administration of a beta-blocker within the first 24 hours.
- Door-to-needle time for fibrinolytic therapy within 60 minutes.
Correct answer: Door-to-balloon time for percutaneous coronary intervention (PCI) within 90 minutes.
For patients with STEMI, the standard of care is rapid reperfusion of the occluded coronary artery. The primary goal is to perform percutaneous coronary intervention (PCI) as quickly as possible, with a recommended door-to-balloon time of 90 minutes or less in a PCI-capable facility. If PCI is not available within 120 minutes of first medical contact, fibrinolytic therapy should be considered with a door-to-needle time of 30 minutes.
Question 6: A patient in the ICU develops cardiogenic shock following a large anterior wall myocardial infarction. The provider orders a dobutamine infusion. The nurse understands the primary therapeutic effect of this medication is to:
- Increase systemic vascular resistance to raise blood pressure.
- Decrease heart rate to reduce myocardial oxygen demand.
- Increase myocardial contractility and cardiac output. (Correct answer)
- Cause potent vasodilation to reduce preload.
Correct answer: Increase myocardial contractility and cardiac output.
Dobutamine is a positive inotropic agent that primarily stimulates beta-1 adrenergic receptors. Its main therapeutic effect in cardiogenic shock is to increase myocardial contractility (in-o-tropy), which improves stroke volume and, consequently, cardiac output. While it has some mild vasodilatory effects, its main purpose is to improve the heart's pumping function.
CCRN - Review Cardiovascular Emergencies Questions and Answers 1
A 58-year-old male is admitted with a hypertensive emergency.
His blood pressure is 220/140 mmHg, and he is complaining of a severe headache and confusion.
Which of the following is the most appropriate initial nursing action?