Cardiovascular Med-Surg Case Study 2025/2026
1. A 68-year-old patient presents with crushing chest pain radiating
to the left arm. ECG shows ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates
an inferior myocardial infarction, typically due to occlusion of
the right coronary artery.
2. A patient with a history of hypertension is admitted with sudden
left-sided weakness and slurred speech. The nurse suspects a
stroke. Which type of stroke is most likely?
Ischemic stroke
Rationale: Hypertension is the most significant risk factor for
ischemic stroke due to arterial thrombosis or embolism. Sudden
neurologic deficits are characteristic.
3. A patient is diagnosed with heart failure with reduced ejection
fraction (HFrEF). Which medication is indicated to reduce
mortality?
ACE inhibitor
Rationale: ACE inhibitors reduce mortality and morbidity in
HFrEF by decreasing afterload and improving cardiac output.
4. A 72-year-old patient develops sudden shortness of breath, chest
pain, and hemoptysis. Vital signs show hypotension and
tachycardia. What is the most likely diagnosis?
Pulmonary embolism
Rationale: Acute onset dyspnea, chest pain, hemoptysis,
, hypotension, and tachycardia are classic signs of a massive
pulmonary embolism.
5. A patient with atrial fibrillation is prescribed warfarin. What is the
most important lab value to monitor?
INR (International Normalized Ratio)
Rationale: INR monitoring ensures therapeutic anticoagulation
while minimizing bleeding risk in patients taking warfarin.
6. A patient presents with sudden chest pain and a tearing sensation
radiating to the back. Blood pressure is 180/110 mmHg. What is
the priority intervention?
Administer IV antihypertensive therapy
Rationale: This presentation is consistent with an aortic
dissection. Rapid blood pressure control reduces risk of rupture.
7. A patient has been diagnosed with stable angina. Which lifestyle
modification has the greatest impact on symptom control?
Smoking cessation
Rationale: Smoking is a major modifiable risk factor that
contributes to atherosclerosis and angina. Quitting significantly
improves outcomes.
8. A patient develops a new systolic murmur at the apex radiating to
the axilla. This murmur is most consistent with which condition?
Mitral regurgitation
Rationale: A holosystolic murmur at the apex radiating to the
axilla indicates mitral valve regurgitation.
9. A patient is scheduled for cardiac catheterization. Which pre-
procedure instruction is essential?
Check for iodine allergy
Rationale: Iodine-containing contrast media can cause allergic
, reactions; identifying allergies is critical to prevent
complications.
10. A 60-year-old patient has peripheral edema, ascites, and
jugular vein distention. Which type of heart failure is indicated?
Right-sided heart failure
Rationale: Right-sided heart failure leads to systemic venous
congestion, resulting in peripheral edema, ascites, and JVD.
11. A patient with chronic heart failure reports weight gain of 3
pounds in 2 days. What is the most appropriate action?
Notify the healthcare provider
Rationale: Rapid weight gain in heart failure may indicate fluid
retention and decompensation; early intervention prevents
exacerbation.
12. A patient presents with syncope and a pulse of 42 bpm.
Which is the priority nursing intervention?
Prepare for transcutaneous pacing
Rationale: Symptomatic bradycardia with hypotension or
syncope may require emergent pacing to maintain cardiac
output.
13. A patient post-MI is prescribed beta-blockers. What is the
primary purpose of this medication?
Decrease myocardial oxygen demand
Rationale: Beta-blockers reduce heart rate, blood pressure, and
contractility, lowering oxygen demand and preventing further
ischemia.
14. A patient with hyperlipidemia is prescribed atorvastatin.
Which lab should be monitored?
Liver function tests
1. A 68-year-old patient presents with crushing chest pain radiating
to the left arm. ECG shows ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates
an inferior myocardial infarction, typically due to occlusion of
the right coronary artery.
2. A patient with a history of hypertension is admitted with sudden
left-sided weakness and slurred speech. The nurse suspects a
stroke. Which type of stroke is most likely?
Ischemic stroke
Rationale: Hypertension is the most significant risk factor for
ischemic stroke due to arterial thrombosis or embolism. Sudden
neurologic deficits are characteristic.
3. A patient is diagnosed with heart failure with reduced ejection
fraction (HFrEF). Which medication is indicated to reduce
mortality?
ACE inhibitor
Rationale: ACE inhibitors reduce mortality and morbidity in
HFrEF by decreasing afterload and improving cardiac output.
4. A 72-year-old patient develops sudden shortness of breath, chest
pain, and hemoptysis. Vital signs show hypotension and
tachycardia. What is the most likely diagnosis?
Pulmonary embolism
Rationale: Acute onset dyspnea, chest pain, hemoptysis,
, hypotension, and tachycardia are classic signs of a massive
pulmonary embolism.
5. A patient with atrial fibrillation is prescribed warfarin. What is the
most important lab value to monitor?
INR (International Normalized Ratio)
Rationale: INR monitoring ensures therapeutic anticoagulation
while minimizing bleeding risk in patients taking warfarin.
6. A patient presents with sudden chest pain and a tearing sensation
radiating to the back. Blood pressure is 180/110 mmHg. What is
the priority intervention?
Administer IV antihypertensive therapy
Rationale: This presentation is consistent with an aortic
dissection. Rapid blood pressure control reduces risk of rupture.
7. A patient has been diagnosed with stable angina. Which lifestyle
modification has the greatest impact on symptom control?
Smoking cessation
Rationale: Smoking is a major modifiable risk factor that
contributes to atherosclerosis and angina. Quitting significantly
improves outcomes.
8. A patient develops a new systolic murmur at the apex radiating to
the axilla. This murmur is most consistent with which condition?
Mitral regurgitation
Rationale: A holosystolic murmur at the apex radiating to the
axilla indicates mitral valve regurgitation.
9. A patient is scheduled for cardiac catheterization. Which pre-
procedure instruction is essential?
Check for iodine allergy
Rationale: Iodine-containing contrast media can cause allergic
, reactions; identifying allergies is critical to prevent
complications.
10. A 60-year-old patient has peripheral edema, ascites, and
jugular vein distention. Which type of heart failure is indicated?
Right-sided heart failure
Rationale: Right-sided heart failure leads to systemic venous
congestion, resulting in peripheral edema, ascites, and JVD.
11. A patient with chronic heart failure reports weight gain of 3
pounds in 2 days. What is the most appropriate action?
Notify the healthcare provider
Rationale: Rapid weight gain in heart failure may indicate fluid
retention and decompensation; early intervention prevents
exacerbation.
12. A patient presents with syncope and a pulse of 42 bpm.
Which is the priority nursing intervention?
Prepare for transcutaneous pacing
Rationale: Symptomatic bradycardia with hypotension or
syncope may require emergent pacing to maintain cardiac
output.
13. A patient post-MI is prescribed beta-blockers. What is the
primary purpose of this medication?
Decrease myocardial oxygen demand
Rationale: Beta-blockers reduce heart rate, blood pressure, and
contractility, lowering oxygen demand and preventing further
ischemia.
14. A patient with hyperlipidemia is prescribed atorvastatin.
Which lab should be monitored?
Liver function tests
