Cardio Assessment & Hemodynamics
A heart sound that corresponds with the closure of the mitral and tricuspid valves
What is S1 “lub”?
Rationale: S1 occurs at the onset of systole when the AV valves close. Best heard at the apex with the diaphragm.
Which rhythm is shown below?
Sinus Tachycardia
Which valve disorder causes a diastolic murmur best heard at the left sternal border?
Aortic regurgitation
Rationale: Murmur radiates along left sternal border during diastole.
What class of drug is lisinopril and what major side effect should be monitored?
ACE inhibitor — monitor for cough & hyperkalemia.
What is the priority in acute pulmonary edema?
Position upright and administer oxygen.
Rationale: Improves gas exchange rapidly.
This indicates a widened pulse pressure
What is Aortic regurgitation?
Rationale: Widened pulse pressure often reflects increased stroke volume, as in aortic regurgitation.
Priority nursing intervention for a patient with new-onset atrial fibrillation and unstable BP?
Prepare for synchronized cardioversion
Rationale: Unstable AF requires immediate rhythm control.
What is the most common cause of mitral stenosis worldwide?
Rheumatic fever
Rationale: Rheumatic heart disease is still a leading cause globally.
Which beta blocker is cardioselective and safer in patients with COPD?
Metoprolol
Rationale: Cardioselective beta-1 blockers have less bronchoconstriction effect.
Which finding after cardiac catheterization requires immediate notification?
Cool, pale extremity distal to puncture site.
Rationale: Indicates compromised circulation.
When assessing a patient with left-sided heart failure, which lung sound is most expected
What is Fine crackles at lung bases?
Rationale: Fluid backs up into the pulmonary circulation, causing pulmonary edema and crackles.
What medications slows AV conduction and is commonly used to control ventricular rate in AF (afib)?
β-Blockers, Calcium Channel Blockers, Digoxin
Rationale: Calcium channel blockers slow AV node conduction, controlling ventricular response.
Digoxin increases vagal (parasympathetic) tone → slows AV nodal conduction and decreases ventricular response
Beta Blockers block sympathetic stimulation of the AV node → slows conduction reducing ventricular rate and myocardial oxygen demand
Nursing priority after valve replacement surgery?
Monitor for bleeding and embolic events
Rationale: Anticoagulation and close monitoring are crucial due to prosthetic valve risk.
Nitrate administration teaching?
Sit down before taking; may cause headache and hypotension.
Rationale: Vasodilation lowers BP.
BNP of 600 pg/mL most likely indicates…
Heart failure exacerbation.
Rationale: BNP >100 suggests HF.
Identify the waveform below and explain its significance
CVP waveform — used to assess right atrial pressure and fluid volume status.
Rationale: Helps guide fluid management and detect right heart failure or hypovolemia.
Identify the strip and appropriate first action.
Ventricular fibrillation → Defibrillate immediately
Rationale: V-fib is a shockable, pulseless rhythm; early defibrillation improves survival.
Key clinical sign of pericarditis?
Pericardial friction rub
Rationale: High-pitched, scratching sound best heard at left lower sternal border.
Digoxin toxicity early signs include…
Anorexia, nausea, visual changes (yellow halos).
Rationale: Especially in hypokalemia, digoxin toxicity risk ↑.
Post-MI patient develops new loud systolic murmur. What is the likely complication?
Papillary muscle rupture → acute mitral regurgitation
Rationale: Surgical emergency.
During cardiac auscultation, a nurse hears an S3 gallop in an adult patient. Which condition is this most associated with?
Heart failure / volume overload
Rationale: S3 occurs in early diastole; in adults, it indicates ventricular volume overload (e.g., HF).
A client develops symptomatic bradycardia (HR 40, hypotensive). What is the first-line drug therapy?
Atropine 0.5 mg IV
Rationale: Atropine is the first-line medication for unstable bradycardia per ACLS.
Infective endocarditis hallmark physical finding?
New murmur + petechiae/splinter hemorrhages
Rationale: Bacterial vegetations damage valves, causing murmurs and embolic signs.
Which drug class improves survival in heart failure by reducing afterload and remodeling?
ACE inhibitors / ARBs
Rationale: They lower afterload, improve CO, and blunt ventricular remodeling.
Post-CABG patient suddenly shows muffled heart sounds, hypotension, and JVD. What is the priority action?
Suspect cardiac tamponade → notify surgeon / prepare for pericardiocentesis.
Rationale: Beck’s triad = tamponade.