Prophecy/Relias Cardiac Cath Lab RN A
Exam Study Guide (2025 Update)
Section 1: Cardiac Catheterization Lab Clinical Practice
Question 1
Which of the following is the most important pre-procedure assessment for a patient
scheduled for a cardiac catheterization? A) Allergy to shellfish B) Baseline creatinine and
BUN C) History of motion sickness D) Last tetanus vaccination
Correct Answer: B Rationale: Baseline creatinine and BUN are essential to assess renal
function before administering contrast media, which can cause contrast-induced
nephropathy (CIN). Shellfish allergy (A) is not relevant to iodine contrast allergy. Motion
sickness (C) and tetanus (D) are not priorities for cath lab safety.
Question 2 (Select All That Apply)
Which of the following are absolute contraindications to cardiac catheterization? A)
Active gastrointestinal bleed B) Uncontrolled hypertension (BP 220/120 mmHg) C) Severe
coagulopathy (INR > 3.0) D) History of contrast allergy managed with premedication E) Stable
angina on medical therapy
Correct Answers: A, B, C Rationale:
● Active GI bleed (A) → High risk of hemorrhage with anticoagulation.
● Uncontrolled HTN (B) → Risk of stroke or aortic dissection during catheter
manipulation.
● Severe coagulopathy (C) → Bleeding risk at access site.
● Contrast allergy with premedication (D) is not an absolute contraindication if
pretreated.
● Stable angina (E) is not a contraindication (elective cath may proceed).
, Question 3
A patient’s activated clotting time (ACT) during PCI is 220 seconds. The physician
requests an additional heparin bolus. What is the most appropriate nursing action? A)
Administer protamine sulfate. B) Give an additional heparin bolus as ordered. C) Check aPTT
before administering more heparin. D) Hold heparin and reassess ACT in 30 minutes.
Correct Answer: B Rationale: An ACT of 220 seconds is subtherapeutic for PCI (target
250–350 seconds for heparin). Additional heparin is indicated. Protamine (A) reverses
heparin and is contraindicated here. aPTT (C) is not used for ACT monitoring. Holding
heparin (D) would increase thrombus risk.
Question 4 (Priority/Delegation)
A patient develops bradycardia (HR 40 bpm) during right coronary artery (RCA)
engagement. What is the first priority nursing intervention? A) Administer atropine 0.5 mg
IV. B) Notify the physician immediately. C) Assess blood pressure and oxygen saturation. D)
Prepare for transcutaneous pacing.
Correct Answer: C Rationale: Assess BP and O₂ saturation first to determine
hemodynamic stability. Bradycardia during RCA engagement may indicate vasovagal
response or ischemia. Atropine (A) or pacing (D) may be needed after assessment. Notifying
the physician (B) is secondary to immediate patient assessment.
Question 5 (Interpretation of Data)
A patient’s hemodynamic pressures are:
● RA: 8 mmHg
● RV: 40/8 mmHg
● PA: 60/25 mmHg (mean 40)
● PCWP: 20 mmHg
● CO: 3.5 L/min
● CI: 1.8 L/min/m²
What is the most likely diagnosis? A) Hypovolemic shock B) Cardiogenic shock C) Septic
shock D) Pulmonary hypertension
Correct Answer: B Rationale:
● Elevated PCWP (20 mmHg) = left ventricular failure .
● Low CI (1.8 L/min/m²) = cardiogenic shock.
Exam Study Guide (2025 Update)
Section 1: Cardiac Catheterization Lab Clinical Practice
Question 1
Which of the following is the most important pre-procedure assessment for a patient
scheduled for a cardiac catheterization? A) Allergy to shellfish B) Baseline creatinine and
BUN C) History of motion sickness D) Last tetanus vaccination
Correct Answer: B Rationale: Baseline creatinine and BUN are essential to assess renal
function before administering contrast media, which can cause contrast-induced
nephropathy (CIN). Shellfish allergy (A) is not relevant to iodine contrast allergy. Motion
sickness (C) and tetanus (D) are not priorities for cath lab safety.
Question 2 (Select All That Apply)
Which of the following are absolute contraindications to cardiac catheterization? A)
Active gastrointestinal bleed B) Uncontrolled hypertension (BP 220/120 mmHg) C) Severe
coagulopathy (INR > 3.0) D) History of contrast allergy managed with premedication E) Stable
angina on medical therapy
Correct Answers: A, B, C Rationale:
● Active GI bleed (A) → High risk of hemorrhage with anticoagulation.
● Uncontrolled HTN (B) → Risk of stroke or aortic dissection during catheter
manipulation.
● Severe coagulopathy (C) → Bleeding risk at access site.
● Contrast allergy with premedication (D) is not an absolute contraindication if
pretreated.
● Stable angina (E) is not a contraindication (elective cath may proceed).
, Question 3
A patient’s activated clotting time (ACT) during PCI is 220 seconds. The physician
requests an additional heparin bolus. What is the most appropriate nursing action? A)
Administer protamine sulfate. B) Give an additional heparin bolus as ordered. C) Check aPTT
before administering more heparin. D) Hold heparin and reassess ACT in 30 minutes.
Correct Answer: B Rationale: An ACT of 220 seconds is subtherapeutic for PCI (target
250–350 seconds for heparin). Additional heparin is indicated. Protamine (A) reverses
heparin and is contraindicated here. aPTT (C) is not used for ACT monitoring. Holding
heparin (D) would increase thrombus risk.
Question 4 (Priority/Delegation)
A patient develops bradycardia (HR 40 bpm) during right coronary artery (RCA)
engagement. What is the first priority nursing intervention? A) Administer atropine 0.5 mg
IV. B) Notify the physician immediately. C) Assess blood pressure and oxygen saturation. D)
Prepare for transcutaneous pacing.
Correct Answer: C Rationale: Assess BP and O₂ saturation first to determine
hemodynamic stability. Bradycardia during RCA engagement may indicate vasovagal
response or ischemia. Atropine (A) or pacing (D) may be needed after assessment. Notifying
the physician (B) is secondary to immediate patient assessment.
Question 5 (Interpretation of Data)
A patient’s hemodynamic pressures are:
● RA: 8 mmHg
● RV: 40/8 mmHg
● PA: 60/25 mmHg (mean 40)
● PCWP: 20 mmHg
● CO: 3.5 L/min
● CI: 1.8 L/min/m²
What is the most likely diagnosis? A) Hypovolemic shock B) Cardiogenic shock C) Septic
shock D) Pulmonary hypertension
Correct Answer: B Rationale:
● Elevated PCWP (20 mmHg) = left ventricular failure .
● Low CI (1.8 L/min/m²) = cardiogenic shock.
