1. While caring for a patient with an IABP at 3:1, the nurse notes blood in the IABP tubing. What
is the most appropriate action?
A) Increase the timing to 2:1
B) Apply pressure at the insertion site
C) Disconnect the balloon catheter from the IABP
D) Anticipate an emergency fasciotomy
Rationale: Disconnect the balloon catheter from the IABP – Blood in the tubing indicates
balloon rupture; continuing inflation will enlarge the tear and worsen bleeding.
2. An IABP is currently at 3:1 when the patient suddenly goes into ventricular fibrillation. In
addition to resuscitative measures, what should the nurse do?
A) Increase timing back to 1:1
B) Put the pump on standby until ROSC
C) Change the trigger to internal or pressure support
D) Assess IABP timing to chest compressions at 1:2
Rationale: Change the trigger to internal or pressure support – The IABP will not time correctly
in V-fib; internal trigger allows synchronization with chest compressions.
3. A patient is admitted with chest pain. Serial ECGs and blood tests are negative, so an exercise
stress test is scheduled. Which medication may result in a false-positive finding?
A) Potassium chloride (K-Dur)
B) Sotalol (Betapace)
C) Diltiazem (Cardizem)
D) Digitalis (Digoxin)
Rationale: Digitalis (Digoxin) – Digitalis can cause false-positive ST-segment depression during
stress testing; it should be withheld on the day of the test.
,4. A patient is admitted with elevated troponin and ST-segment elevation in leads II, III, and aVF.
Which medication should the nurse anticipate administering initially?
A) Enoxaparin (Lovenox)
B) Streptokinase (Strepase)
C) Alteplase (Activase)
D) Reteplase (Retavase)
Rationale: Reteplase (Retavase) – Reteplase is indicated for acute myocardial infarction when
fibrinolytics are indicated, such as inferior wall STEMI.
5. Which characteristic is typical of diastolic heart failure?
A) Dilation of the ventricular chambers
B) Increased filling of the left ventricle
C) Decreased ability of the ventricle to contract
D) Inability of the heart muscle to relax
Rationale: Inability of the heart muscle to relax – Diastolic heart failure involves impaired
relaxation and filling with preserved ejection fraction.
6. Following a STEMI, the nurse auscultates a late systolic murmur at the apex. This finding is
most likely related to new onset of:
A) Right bundle branch block
B) Left bundle branch block
C) Papillary muscle rupture
D) Calcific plaque rupture
Rationale: Papillary muscle rupture – Papillary muscle rupture causes mitral regurgitation,
producing a late systolic murmur at the apex.
7. A patient with systolic heart failure has enalapril, furosemide, metoprolol, and carvedilol
ordered. Which intervention provides the most accurate assessment of regimen effectiveness?
A) Strict intake and output
B) BMP every morning
C) Serial chest X-rays
D) Daily weights
,Rationale: Daily weights – Daily weights are noninvasive, easy, and effective for assessing fluid
status and medication compliance in heart failure.
8. Which patient situation is best treated with the maze procedure?
A) Recurrent VT refractory to cardioversion
B) Recurrent atrial fibrillation refractory to drug therapy
C) Cardiomyopathy with EF <20%
D) Coronary artery restenosis following PCI
Rationale: Recurrent atrial fibrillation refractory to drug therapy – The maze procedure creates
scar tissue in the atria to disrupt abnormal electrical pathways in AF.
9. A patient develops chest pain, nausea, vomiting, and diaphoresis. The 12-lead ECG is normal.
Further cardiac assessment is warranted because ST-segment elevation is commonly absent in:
A) Anterior wall MI
B) Posterior wall MI
C) Lateral wall MI
D) Inferior wall MI
*Rationale: Posterior wall MI – The standard 12-lead ECG does not directly view the posterior
wall, so ST elevation may be absent; reciprocal changes may be seen.*
10. The nurse reviews a 12-lead ECG showing new ST-segment elevation in leads I, aVL, and
V2-V6 with reciprocal changes in III, aVF, and aVR. The area of infarct involves the:
A) Posterior and inferior walls
B) Lateral and septal walls
C) Septal and posterior walls
D) Anterior and lateral walls
*Rationale: Anterior and lateral walls – ST elevation in I, aVL, V2-V6 indicates occlusion of the
LAD and circumflex arteries affecting the anterior and lateral walls.*
11. A patient is being discharged on aspirin therapy following recovery from an AMI. Which
comorbidity puts the patient at greatest risk for bleeding complications?
A) Asthma
B) Transient ischemic attack
, C) Chronic kidney failure
D) Cor pulmonale
Rationale: Chronic kidney failure – Kidney failure impairs platelet aggregation and alters
clotting factor response, increasing bleeding risk with antiplatelet therapy.
12. A patient is to undergo PCI. In a previous admission, the patient received heparin. The
platelet count was 250,000 initially and dropped to 115,000 a few days later. Which medication
should the nurse anticipate for the current procedure?
A) Dalteparin (Fragmin)
B) Bivalirudin (Angiomax)
C) Enoxaparin (Lovenox)
D) Alteplase (Activase)
Rationale: Bivalirudin (Angiomax) – The patient likely has HIT; bivalirudin is a direct thrombin
inhibitor safe for use in HIT patients.
13. While timing the balloon pump, the nurse understands that during the deflation phase the
patient will benefit from:
A) Increased perfusion of the coronary arteries
B) Decreased resistance to closing the aortic valve
C) Decreased ventricular preload
D) Improved cardiac output
Rationale: Improved cardiac output – IABP deflation reduces systemic vascular resistance,
which improves cardiac output.
14. Which monitoring parameter is the best choice for evaluating tissue oxygenation?
A) PAOP
B) SvO₂
C) SVR
D) EF
Rationale: SvO₂ – Mixed venous oxygen saturation reflects the balance between oxygen delivery
and consumption, indicating tissue oxygenation adequacy.
is the most appropriate action?
A) Increase the timing to 2:1
B) Apply pressure at the insertion site
C) Disconnect the balloon catheter from the IABP
D) Anticipate an emergency fasciotomy
Rationale: Disconnect the balloon catheter from the IABP – Blood in the tubing indicates
balloon rupture; continuing inflation will enlarge the tear and worsen bleeding.
2. An IABP is currently at 3:1 when the patient suddenly goes into ventricular fibrillation. In
addition to resuscitative measures, what should the nurse do?
A) Increase timing back to 1:1
B) Put the pump on standby until ROSC
C) Change the trigger to internal or pressure support
D) Assess IABP timing to chest compressions at 1:2
Rationale: Change the trigger to internal or pressure support – The IABP will not time correctly
in V-fib; internal trigger allows synchronization with chest compressions.
3. A patient is admitted with chest pain. Serial ECGs and blood tests are negative, so an exercise
stress test is scheduled. Which medication may result in a false-positive finding?
A) Potassium chloride (K-Dur)
B) Sotalol (Betapace)
C) Diltiazem (Cardizem)
D) Digitalis (Digoxin)
Rationale: Digitalis (Digoxin) – Digitalis can cause false-positive ST-segment depression during
stress testing; it should be withheld on the day of the test.
,4. A patient is admitted with elevated troponin and ST-segment elevation in leads II, III, and aVF.
Which medication should the nurse anticipate administering initially?
A) Enoxaparin (Lovenox)
B) Streptokinase (Strepase)
C) Alteplase (Activase)
D) Reteplase (Retavase)
Rationale: Reteplase (Retavase) – Reteplase is indicated for acute myocardial infarction when
fibrinolytics are indicated, such as inferior wall STEMI.
5. Which characteristic is typical of diastolic heart failure?
A) Dilation of the ventricular chambers
B) Increased filling of the left ventricle
C) Decreased ability of the ventricle to contract
D) Inability of the heart muscle to relax
Rationale: Inability of the heart muscle to relax – Diastolic heart failure involves impaired
relaxation and filling with preserved ejection fraction.
6. Following a STEMI, the nurse auscultates a late systolic murmur at the apex. This finding is
most likely related to new onset of:
A) Right bundle branch block
B) Left bundle branch block
C) Papillary muscle rupture
D) Calcific plaque rupture
Rationale: Papillary muscle rupture – Papillary muscle rupture causes mitral regurgitation,
producing a late systolic murmur at the apex.
7. A patient with systolic heart failure has enalapril, furosemide, metoprolol, and carvedilol
ordered. Which intervention provides the most accurate assessment of regimen effectiveness?
A) Strict intake and output
B) BMP every morning
C) Serial chest X-rays
D) Daily weights
,Rationale: Daily weights – Daily weights are noninvasive, easy, and effective for assessing fluid
status and medication compliance in heart failure.
8. Which patient situation is best treated with the maze procedure?
A) Recurrent VT refractory to cardioversion
B) Recurrent atrial fibrillation refractory to drug therapy
C) Cardiomyopathy with EF <20%
D) Coronary artery restenosis following PCI
Rationale: Recurrent atrial fibrillation refractory to drug therapy – The maze procedure creates
scar tissue in the atria to disrupt abnormal electrical pathways in AF.
9. A patient develops chest pain, nausea, vomiting, and diaphoresis. The 12-lead ECG is normal.
Further cardiac assessment is warranted because ST-segment elevation is commonly absent in:
A) Anterior wall MI
B) Posterior wall MI
C) Lateral wall MI
D) Inferior wall MI
*Rationale: Posterior wall MI – The standard 12-lead ECG does not directly view the posterior
wall, so ST elevation may be absent; reciprocal changes may be seen.*
10. The nurse reviews a 12-lead ECG showing new ST-segment elevation in leads I, aVL, and
V2-V6 with reciprocal changes in III, aVF, and aVR. The area of infarct involves the:
A) Posterior and inferior walls
B) Lateral and septal walls
C) Septal and posterior walls
D) Anterior and lateral walls
*Rationale: Anterior and lateral walls – ST elevation in I, aVL, V2-V6 indicates occlusion of the
LAD and circumflex arteries affecting the anterior and lateral walls.*
11. A patient is being discharged on aspirin therapy following recovery from an AMI. Which
comorbidity puts the patient at greatest risk for bleeding complications?
A) Asthma
B) Transient ischemic attack
, C) Chronic kidney failure
D) Cor pulmonale
Rationale: Chronic kidney failure – Kidney failure impairs platelet aggregation and alters
clotting factor response, increasing bleeding risk with antiplatelet therapy.
12. A patient is to undergo PCI. In a previous admission, the patient received heparin. The
platelet count was 250,000 initially and dropped to 115,000 a few days later. Which medication
should the nurse anticipate for the current procedure?
A) Dalteparin (Fragmin)
B) Bivalirudin (Angiomax)
C) Enoxaparin (Lovenox)
D) Alteplase (Activase)
Rationale: Bivalirudin (Angiomax) – The patient likely has HIT; bivalirudin is a direct thrombin
inhibitor safe for use in HIT patients.
13. While timing the balloon pump, the nurse understands that during the deflation phase the
patient will benefit from:
A) Increased perfusion of the coronary arteries
B) Decreased resistance to closing the aortic valve
C) Decreased ventricular preload
D) Improved cardiac output
Rationale: Improved cardiac output – IABP deflation reduces systemic vascular resistance,
which improves cardiac output.
14. Which monitoring parameter is the best choice for evaluating tissue oxygenation?
A) PAOP
B) SvO₂
C) SVR
D) EF
Rationale: SvO₂ – Mixed venous oxygen saturation reflects the balance between oxygen delivery
and consumption, indicating tissue oxygenation adequacy.
