Cardiac Cath Lab RN A – New 2026 Relias Release
Comprehensive Practice Exam
Pre-Procedural Patient Assessment & Safety
Question 1
A patient is scheduled for a left heart catheterization. Which lab value is most critical to review
prior to the procedure to prevent a common complication?
A. White Blood Cell count
B. Hemoglobin A1c
C. Serum potassium level
D. Blood Urea Nitrogen (BUN) and Creatinine
-Correct Answer-: D
Rationale: Contrast-induced nephropathy (CIN) is a significant risk of cardiac catheterization
due to the nephrotoxic effects of contrast media. Reviewing BUN and creatinine to assess
baseline renal function is critical for determining safe contrast volume limits and implementing
preventive hydration protocols.
Question 2
During the pre-procedural time-out, which of the following elements must be verified according
to The Joint Commission's Universal Protocol?
A. The patient's insurance authorization and preferred language
B. The correct patient, correct procedure, and correct site
C. The patient's discharge plan and follow-up appointment
D. The surgeon's availability and anesthesia type
-Correct Answer-: B
Rationale: The universal protocol requires verification of the correct patient, correct procedure,
,and correct site/side to prevent wrong-site surgery. This safety goal must be completed
immediately before any invasive procedure with all team members participating.
Question 3
A patient reports a history of "shellfish allergy." What is the most appropriate nursing action?
A. Cancel the procedure immediately
B. Administer diphenhydramine and corticosteroids pre-procedurally
C. Notify the physician and assess for previous contrast reaction history
D. Use only carbon dioxide as contrast medium
-Correct Answer-: C
Rationale: The link between shellfish allergy and contrast media allergy is largely mythical.
Iodine is not an allergen, and shellfish allergy does not increase contrast reaction risk more than
other allergies. However, any allergy history warrants physician notification and assessment of
prior contrast exposure and reactions. Pre-medication is based on previous contrast reactions,
not shellfish allergy.
Question 4
What is the most important assessment finding to document prior to preparing a patient for
femoral artery access?
A. Presence of bilateral pedal pulses
B. Patient's favorite sleeping position
C. Time of last bowel movement
D. History of seasonal allergies
-Correct Answer-: A
Rationale: Documenting baseline distal pulses (dorsalis pedis and posterior tibial) is essential
for post-procedure comparison to detect vascular complications such as thrombosis, embolism,
or hematoma causing compromised circulation.
,Question 5
Which of the following is an absolute contraindication for femoral artery access?
A. Peripheral arterial disease
B. Previous cardiac catheterization
C. Active groin infection
D. Hypertension controlled with medication
-Correct Answer-: C
Rationale: Active infection at the puncture site is an absolute contraindication for femoral
access due to the risk of introducing bacteria into the bloodstream, which could lead to sepsis
or an infected pseudoaneurysm.
Question 6
The "ALARA" principle in the cardiac cath lab refers to:
A. Always Lower Activated Clotting Time
B. As Low As Reasonably Achievable for radiation exposure
C. A specific type of low-osmolar contrast media
D. A Left Anterior Oblique angiographic view
-Correct Answer-: B
Rationale: ALARA is the fundamental principle of radiation safety. It means using techniques to
minimize radiation exposure to patients and staff, such as using the lowest possible frame rate,
minimizing fluoroscopy time, using proper shielding, and positioning image intensifiers close to
the patient.
Question 7
What information is required prior to prepping the patient for a cardiac catheterization
procedure?
, A. Patient's preferred music and room temperature
B. Patient identifiers, allergies, NPO status, and advanced directives
C. Patient's shoe size and height for table positioning
D. Patient's occupation and educational level
-Correct Answer-: B
Rationale: Essential pre-procedure information includes verifying patient identity with two
identifiers, documenting allergies (especially to contrast, latex, or medications), confirming NPO
status to prevent aspiration during sedation, and reviewing advanced directives to guide code
status decisions.
Question 8
Which medications are used to pre-treat a patient with a history of contrast allergy?
A. Metoprolol and Lisinopril
B. Diphenhydramine, Famotidine, and Solumedrol
C. Aspirin and Clopidogrel
D. Fentanyl and Midazolam
-Correct Answer-: B
Rationale: The standard pre-medication regimen for patients with prior contrast reactions
includes an antihistamine (diphenhydramine), an H2 blocker (famotidine), and a corticosteroid
(solumedrol or prednisone). This combination blocks histamine release and reduces
inflammatory response to contrast media.
Question 9
A patient's activated clotting time (ACT) is 220 seconds during PCI. The physician requests
additional heparin. What is the most appropriate nursing action?
A. Administer protamine sulfate to reverse existing heparin
B. Give additional heparin bolus as ordered
Comprehensive Practice Exam
Pre-Procedural Patient Assessment & Safety
Question 1
A patient is scheduled for a left heart catheterization. Which lab value is most critical to review
prior to the procedure to prevent a common complication?
A. White Blood Cell count
B. Hemoglobin A1c
C. Serum potassium level
D. Blood Urea Nitrogen (BUN) and Creatinine
-Correct Answer-: D
Rationale: Contrast-induced nephropathy (CIN) is a significant risk of cardiac catheterization
due to the nephrotoxic effects of contrast media. Reviewing BUN and creatinine to assess
baseline renal function is critical for determining safe contrast volume limits and implementing
preventive hydration protocols.
Question 2
During the pre-procedural time-out, which of the following elements must be verified according
to The Joint Commission's Universal Protocol?
A. The patient's insurance authorization and preferred language
B. The correct patient, correct procedure, and correct site
C. The patient's discharge plan and follow-up appointment
D. The surgeon's availability and anesthesia type
-Correct Answer-: B
Rationale: The universal protocol requires verification of the correct patient, correct procedure,
,and correct site/side to prevent wrong-site surgery. This safety goal must be completed
immediately before any invasive procedure with all team members participating.
Question 3
A patient reports a history of "shellfish allergy." What is the most appropriate nursing action?
A. Cancel the procedure immediately
B. Administer diphenhydramine and corticosteroids pre-procedurally
C. Notify the physician and assess for previous contrast reaction history
D. Use only carbon dioxide as contrast medium
-Correct Answer-: C
Rationale: The link between shellfish allergy and contrast media allergy is largely mythical.
Iodine is not an allergen, and shellfish allergy does not increase contrast reaction risk more than
other allergies. However, any allergy history warrants physician notification and assessment of
prior contrast exposure and reactions. Pre-medication is based on previous contrast reactions,
not shellfish allergy.
Question 4
What is the most important assessment finding to document prior to preparing a patient for
femoral artery access?
A. Presence of bilateral pedal pulses
B. Patient's favorite sleeping position
C. Time of last bowel movement
D. History of seasonal allergies
-Correct Answer-: A
Rationale: Documenting baseline distal pulses (dorsalis pedis and posterior tibial) is essential
for post-procedure comparison to detect vascular complications such as thrombosis, embolism,
or hematoma causing compromised circulation.
,Question 5
Which of the following is an absolute contraindication for femoral artery access?
A. Peripheral arterial disease
B. Previous cardiac catheterization
C. Active groin infection
D. Hypertension controlled with medication
-Correct Answer-: C
Rationale: Active infection at the puncture site is an absolute contraindication for femoral
access due to the risk of introducing bacteria into the bloodstream, which could lead to sepsis
or an infected pseudoaneurysm.
Question 6
The "ALARA" principle in the cardiac cath lab refers to:
A. Always Lower Activated Clotting Time
B. As Low As Reasonably Achievable for radiation exposure
C. A specific type of low-osmolar contrast media
D. A Left Anterior Oblique angiographic view
-Correct Answer-: B
Rationale: ALARA is the fundamental principle of radiation safety. It means using techniques to
minimize radiation exposure to patients and staff, such as using the lowest possible frame rate,
minimizing fluoroscopy time, using proper shielding, and positioning image intensifiers close to
the patient.
Question 7
What information is required prior to prepping the patient for a cardiac catheterization
procedure?
, A. Patient's preferred music and room temperature
B. Patient identifiers, allergies, NPO status, and advanced directives
C. Patient's shoe size and height for table positioning
D. Patient's occupation and educational level
-Correct Answer-: B
Rationale: Essential pre-procedure information includes verifying patient identity with two
identifiers, documenting allergies (especially to contrast, latex, or medications), confirming NPO
status to prevent aspiration during sedation, and reviewing advanced directives to guide code
status decisions.
Question 8
Which medications are used to pre-treat a patient with a history of contrast allergy?
A. Metoprolol and Lisinopril
B. Diphenhydramine, Famotidine, and Solumedrol
C. Aspirin and Clopidogrel
D. Fentanyl and Midazolam
-Correct Answer-: B
Rationale: The standard pre-medication regimen for patients with prior contrast reactions
includes an antihistamine (diphenhydramine), an H2 blocker (famotidine), and a corticosteroid
(solumedrol or prednisone). This combination blocks histamine release and reduces
inflammatory response to contrast media.
Question 9
A patient's activated clotting time (ACT) is 220 seconds during PCI. The physician requests
additional heparin. What is the most appropriate nursing action?
A. Administer protamine sulfate to reverse existing heparin
B. Give additional heparin bolus as ordered
