CEN Cardiovascular Emergencies
A 25-year-old male is brought by EMS to the emergency department. He has been shot in the
chest. When he arrives, he is alert and talking. His blood pressure begins to fall and the chest
tube that has been inserted drains 1600 cc of bright red blood. The cardiac monitor shows
tachycardia with palpable pulses. Suddenly, the patient goes into witnessed cardiac arrest. What
should the nurse do?
a. Prepare the patient for a transesophageal echocardiogram.
b. Perform synchronized cardioversion.
c. Continue to monitor.
d. Prepare the patient for a thoracotomy. - ANS-D. A patient with penetrating chest trauma who
begins to drain large amounts of blood from a chest tube and then experiences cardiac arrest
should be prepared for an emergency thoracotomy. It is likely that this patient has experienced a
penetrating injury to his heart. While another staff member calls the operating room, you should
call the ED physician and prepare for a thoracotomy to temporarily plug the hole while a surgical
suite is prepared.
A 28-year old patient presents to the ED with fever, heart rate of 94, pleuritic type chest pain
and an abnormal chest x-ray. As a nurse does the physical assessment, he notices old and
fresh "tracks" on the patient's arms. What is the likely diagnosis?
a. Acute MI
b. Heart failure
c. Endocarditis
d. Pericarditis - ANS-C. There is a growing population of infectious endocarditis in IV drug
abusers. These infections are typically caused by enterococci or Staph aureus. While most
patients with endocarditis require surgical treatment, those with IV drug abuse endocarditis may
respond to antibiotics.
A 29-year old man is brought to the emergency department after an automobile crash. As the
unrestrained driver, he has bruising over his sternum, shortness of breath, pain and anxiety. The
cardiac monitor shows a sinus tachycardia. Chest x-ray reveals a non-displaced fracture of the
sternum. Treatment for this patient will include all of the following EXCEPT:
a. Immediate surgery to correct the fractured sternum.
b. Medication for pain relief.
c. An ECG to evaluate potential cardiac injury.
d. Supplemental oxygen. - ANS-A. Unless the fractured sternum is displaced and causing
problems, surgical intervention is usually not required. Frequent assessments and continuous
monitoring should be implemented.
A 41 year old patient without diabetes or renal disease is being examined. A systolic blood
pressure of 145 mm Hg would be classified as:
a. Normotensive
b. Prehypertension
c. Stage I hypertension
, d. Stage II hypertension - ANS-C. Normotensive is a systolic pressure less than 120.
Prehypertension is a systolic pressure of 120-139. Stage I hypertension is a systolic pressure of
140-159. Stage II hypertension is a systolic pressure greater than 160.
A 45-year old man comes to the emergency department with a complaint of chest pain after
being kicked in the chest by his horse the previous night. He is diagnosed with blunt cardiac
injury. The most critical intervention for this patient is to:
a. Perform an echocardiogram
b. Ensure continuous cardiac monitoring.
c. Treat the pain with nitroglycerine.
d. Collect serial cardiac enzymes. - ANS-B. Continuous cardiac monitoring is essential. An
echocardiogram may help develop the extent of the cardiac injury but may be delayed.
Nitroglycerine will not relieve the pain associated with a cardiac injury. Cardiac isoenzyme
evaluation is not predictive of injury from blunt cardiac injury.
A 55-year-old patient is diagnosed with Acute Coronary Syndrome (ACS). The ED nurse should
expect to give medications to relieve pain and prevent clots. Assuming oxygen is needed, what
is the correct sequence for these frontline drugs?
a. Oxygen, Aspirin, Nitroglycerin, Morphine
b. Aspirin, Oxygen, Nitroglycerin, Morphine
c. Nitroglycerin, Oxygen, Aspirin, Morphine
d. Aspirin, Oxygen, Morphine, Nitroglycerin - ANS-A. Oxygen should be the first drug given for
the patient with ACS. Aspirin is the front line drug for dissolving clots associated with ACS.
Nitroglycerine is typically readily available and should be administered third. Finally, for
continued pain, morphine may be necessary. During the initial assessment phase, the following
steps should be accomplished for any patient at significant risk for ACS:
•Airway, breathing, and circulation assessed
•Preliminary history and examination obtained
•12-lead ECG interpreted
•Resuscitation equipment brought to the bedside
•Cardiac monitor attached to patient
•Oxygen given
•IV access and blood work obtained
•Aspirin 162 to 325 mg given
•Nitrates and morphine given (unless contraindicated)
A 65-year-old ED patient has been diagnosed with an acute myocardial infarction. The nurse
assesses the patient for possible fibrinolytic therapy. Which of the following is an absolute
contraindication for fibrinolytic therapy?
a. Severe hypertension
b. Current use of an anticoagulant
c. Active peptic ulcer
d. Prior intracranial hemorrhage - ANS-D. A prior intracranial hemorrhage is an absolute
contraindication to use of fibrinolytics due to the high risk of recurrent bleeding. The other
options are all relative contraindications that should be documented and evaluated by the
treating physician. The physician and patient will make the risk/benefit decision. Other
contraindications for fibrinolytic therapy include: previous intracranial hemorrhage (ICH),
A 25-year-old male is brought by EMS to the emergency department. He has been shot in the
chest. When he arrives, he is alert and talking. His blood pressure begins to fall and the chest
tube that has been inserted drains 1600 cc of bright red blood. The cardiac monitor shows
tachycardia with palpable pulses. Suddenly, the patient goes into witnessed cardiac arrest. What
should the nurse do?
a. Prepare the patient for a transesophageal echocardiogram.
b. Perform synchronized cardioversion.
c. Continue to monitor.
d. Prepare the patient for a thoracotomy. - ANS-D. A patient with penetrating chest trauma who
begins to drain large amounts of blood from a chest tube and then experiences cardiac arrest
should be prepared for an emergency thoracotomy. It is likely that this patient has experienced a
penetrating injury to his heart. While another staff member calls the operating room, you should
call the ED physician and prepare for a thoracotomy to temporarily plug the hole while a surgical
suite is prepared.
A 28-year old patient presents to the ED with fever, heart rate of 94, pleuritic type chest pain
and an abnormal chest x-ray. As a nurse does the physical assessment, he notices old and
fresh "tracks" on the patient's arms. What is the likely diagnosis?
a. Acute MI
b. Heart failure
c. Endocarditis
d. Pericarditis - ANS-C. There is a growing population of infectious endocarditis in IV drug
abusers. These infections are typically caused by enterococci or Staph aureus. While most
patients with endocarditis require surgical treatment, those with IV drug abuse endocarditis may
respond to antibiotics.
A 29-year old man is brought to the emergency department after an automobile crash. As the
unrestrained driver, he has bruising over his sternum, shortness of breath, pain and anxiety. The
cardiac monitor shows a sinus tachycardia. Chest x-ray reveals a non-displaced fracture of the
sternum. Treatment for this patient will include all of the following EXCEPT:
a. Immediate surgery to correct the fractured sternum.
b. Medication for pain relief.
c. An ECG to evaluate potential cardiac injury.
d. Supplemental oxygen. - ANS-A. Unless the fractured sternum is displaced and causing
problems, surgical intervention is usually not required. Frequent assessments and continuous
monitoring should be implemented.
A 41 year old patient without diabetes or renal disease is being examined. A systolic blood
pressure of 145 mm Hg would be classified as:
a. Normotensive
b. Prehypertension
c. Stage I hypertension
, d. Stage II hypertension - ANS-C. Normotensive is a systolic pressure less than 120.
Prehypertension is a systolic pressure of 120-139. Stage I hypertension is a systolic pressure of
140-159. Stage II hypertension is a systolic pressure greater than 160.
A 45-year old man comes to the emergency department with a complaint of chest pain after
being kicked in the chest by his horse the previous night. He is diagnosed with blunt cardiac
injury. The most critical intervention for this patient is to:
a. Perform an echocardiogram
b. Ensure continuous cardiac monitoring.
c. Treat the pain with nitroglycerine.
d. Collect serial cardiac enzymes. - ANS-B. Continuous cardiac monitoring is essential. An
echocardiogram may help develop the extent of the cardiac injury but may be delayed.
Nitroglycerine will not relieve the pain associated with a cardiac injury. Cardiac isoenzyme
evaluation is not predictive of injury from blunt cardiac injury.
A 55-year-old patient is diagnosed with Acute Coronary Syndrome (ACS). The ED nurse should
expect to give medications to relieve pain and prevent clots. Assuming oxygen is needed, what
is the correct sequence for these frontline drugs?
a. Oxygen, Aspirin, Nitroglycerin, Morphine
b. Aspirin, Oxygen, Nitroglycerin, Morphine
c. Nitroglycerin, Oxygen, Aspirin, Morphine
d. Aspirin, Oxygen, Morphine, Nitroglycerin - ANS-A. Oxygen should be the first drug given for
the patient with ACS. Aspirin is the front line drug for dissolving clots associated with ACS.
Nitroglycerine is typically readily available and should be administered third. Finally, for
continued pain, morphine may be necessary. During the initial assessment phase, the following
steps should be accomplished for any patient at significant risk for ACS:
•Airway, breathing, and circulation assessed
•Preliminary history and examination obtained
•12-lead ECG interpreted
•Resuscitation equipment brought to the bedside
•Cardiac monitor attached to patient
•Oxygen given
•IV access and blood work obtained
•Aspirin 162 to 325 mg given
•Nitrates and morphine given (unless contraindicated)
A 65-year-old ED patient has been diagnosed with an acute myocardial infarction. The nurse
assesses the patient for possible fibrinolytic therapy. Which of the following is an absolute
contraindication for fibrinolytic therapy?
a. Severe hypertension
b. Current use of an anticoagulant
c. Active peptic ulcer
d. Prior intracranial hemorrhage - ANS-D. A prior intracranial hemorrhage is an absolute
contraindication to use of fibrinolytics due to the high risk of recurrent bleeding. The other
options are all relative contraindications that should be documented and evaluated by the
treating physician. The physician and patient will make the risk/benefit decision. Other
contraindications for fibrinolytic therapy include: previous intracranial hemorrhage (ICH),
