Aortic Disease
A 70-year-old male smoker presents with a pulsatile abdominal mass and back pain. What is the nurse’s priority action?
A. Palpate the mass to assess its size.
B. Obtain a set of bilateral blood pressures.
C. Notify the provider immediately.
D. Administer a beta-blocker.
C. Notify the provider immediately.
Rationale: A pulsatile abdominal mass with pain suggests possible abdominal aortic aneurysm (AAA) expansion or rupture. Palpation could cause rupture—notify the provider and prepare for imaging and hemodynamic monitoring.
A patient with a small, stable AAA is being discharged. Which instruction is most important?
A. Avoid aspirin use.
B. Increase sodium intake to support BP.
C. Stop smoking and control blood pressure.
D. Begin heavy resistance exercise.
C. Stop smoking and control blood pressure.
Rationale: Smoking cessation and BP control are the most effective measures to slow aneurysm growth and prevent rupture.
Which assessment finding is most consistent with severe aortic stenosis?
A. Bounding peripheral pulses
B. Muffled heart tones and hypotension
C. Dyspnea, syncope, and angina on exertion
D. Low-grade fever and petechiae
C. Dyspnea, syncope, and angina on exertion
Rationale: The classic triad (“SAD”) of aortic stenosis is exertional syncope, angina, and dyspnea due to LV outflow obstruction.
The nurse suspects embolic complications in a patient with IE. Which assessment supports this?
A. Diminished pedal pulses and pallor in one leg
B. Elevated jugular venous pressure
C. Productive cough
D. Bradycardia with irregular rhythm
A. Diminished pedal pulses and pallor in one leg
Rationale: Embolization of vegetations can occlude peripheral arteries, causing ischemia or stroke symptoms.
A patient is brought to the ED after a house fire. He has singed nasal hairs, facial burns, and hoarseness. What is the nurse’s priority action?
A. Insert a large-bore IV for fluid resuscitation.
B. Apply cool compresses to the face.
C. Assess for airway patency and prepare for intubation.
D. Administer high-dose pain medication.
C. Assess for airway patency and prepare for intubation.
Rationale: Inhalation injury causes airway edema that can rapidly obstruct breathing. Early intubation prevents airway compromise. Circulation and fluids follow once the airway is secure.
The nurse notes differing blood pressures in both arms and reports of “tearing chest pain.” What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
B. Aortic dissection
Rationale: Aortic dissection presents with sudden, ripping pain and unequal arm BPs due to impaired blood flow. It is a life-threatening emergency requiring BP control and surgical evaluation.
The nurse monitors a patient after endovascular aneurysm repair (EVAR). Which finding requires immediate provider notification?
A. Mild groin bruising
B. Pain at puncture site
C. Diminished pedal pulses and cool legs
D. Clear urine output 60 mL/hr
C. Diminished pedal pulses and cool legs
Rationale: May indicate graft occlusion or limb ischemia, an emergent complication after EVAR.
The nurse reviews a patient’s echocardiogram showing tricuspid regurgitation. Which clinical findings are expected?
A. Pedal edema, fatigue, and elevated BNP
B. Crackles and orthopnea
C. Bounding carotid pulse
D. Dry mucous membranes and tachycardia
A. Pedal edema, fatigue, and elevated BNP
Rationale: Right-sided heart failure from tricuspid regurgitation leads to systemic venous congestion—manifesting as edema, ascites, and fatigue. BNP elevation reflects volume overload.
A patient presents with sharp, pleuritic chest pain and muffled heart tones. Which additional finding would confirm pericardial tamponade?
A. Crackles in both lungs
B. Bounding pulse and hypertension
C. Pulsus paradoxus and hypotension
D. Diaphoresis and bradycardia
C. Pulsus paradoxus and hypotension
Rationale: Pericarditis can progress to tamponade, characterized by Beck’s triad: hypotension, muffled heart sounds, and jugular venous distension—plus pulsus paradoxus (drop in SBP >10 mmHg on inspiration).
The nurse is performing the primary survey of a burn patient. Which assessment step has highest priority?
A. Evaluate neurologic status using the GCS.
B. Remove burned clothing and jewelry.
C. Assess airway patency while maintaining cervical spine immobilization.
D. Insert urinary catheter for output monitoring.
C. Assess airway patency while maintaining cervical spine immobilization.
Rationale: Airway (“A”) is always first in the A–B–C–D–E trauma sequence. Burns to the face or neck require immediate airway evaluation and stabilization with spinal precautions.
Which clinical finding is most concerning in a patient with a known thoracic aortic dissection?
A. Nausea and vomiting
B. Diminished peripheral pulses and elevated troponin
C. Mild back pain
D. Hypertension with anxiety
B. Diminished peripheral pulses and elevated troponin
Rationale: Low perfusion from the dissection can decrease coronary flow, causing myocardial ischemia and elevated troponin levels. Diminished pulses indicate progression of the tear and impaired circulation.
Which medication goal is correct for managing aortic dissection?
A. Maintain systolic BP <90 mmHg with beta-blockers.
B. Increase heart rate to promote perfusion.
C. Administer fluids to elevate BP.
D. Begin anticoagulation therapy.
A. Maintain systolic BP <90 mmHg with beta-blockers.
Rationale: Beta-blockers (e.g., esmolol) decrease shear stress on the aortic wall by lowering heart rate and blood pressure, reducing risk of extension or rupture.
Which diagnostic test confirms severity and mechanism of valvular disease?
A. 12-lead ECG
B. Chest X-ray
C. Echocardiogram
D. Cardiac enzymes
C. Echocardiogram
Rationale: The echocardiogram provides direct visualization of valve structure, regurgitant flow, and chamber enlargement.
The nurse caring for a patient with aortic stenosis scheduled for TAVR (Transcatheter Aortic Valve Replacement) understands the purpose of this procedure is to:
A. Replace the diseased valve via catheter without open surgery.
B. Repair the existing valve using a balloon dilation.
C. Replace the mitral valve through thoracotomy.
D. Correct regurgitation by suturing leaflets
A. Replace the diseased valve via catheter without open surgery.
Rationale: TAVR is a minimally invasive replacement option for high-risk patients with severe aortic stenosis.
Which patient meets American Burn Association criteria for referral to a burn center?
A. 42-year-old with 5% superficial sunburn to the back
B. 60-year-old with 8% partial-thickness scald to the thigh
C. 35-year-old with electrical burn to the right arm
D. 22-year-old with minor grease burn to the hand
C. 35-year-old with electrical burn to the right arm.
Rationale: Electrical burns carry hidden internal injury and cardiac risk and must be managed in a specialized burn center regardless of TBSA percentage.
Which vital sign pattern should prompt immediate concern for abdominal aortic aneurysm rupture?
A. BP 150/88, HR 80
B. BP 118/60, HR 72
C. BP 78/48, HR 132
D. BP 130/84, HR 58
C. BP 78/48, HR 132
Rationale: Hypotension and tachycardia indicate hypovolemic shock from internal hemorrhage due to AAA rupture, a surgical emergency.
A patient recovering from open aortic repair suddenly develops decreased urine output and lower-extremity paralysis. What is the nurse’s interpretation?
A. Normal postoperative pain response
B. Possible spinal cord ischemia
C. Fluid overload
D. Medication side effect
B. Possible spinal cord ischemia
Rationale: Aortic cross-clamping can reduce spinal or renal perfusion. Sudden paralysis and oliguria signal ischemic complications—requires urgent evaluation.
A patient with a mechanical mitral valve is prescribed warfarin. What should the nurse include in discharge teaching?
A. Avoid leafy green vegetables completely.
B. INR goal is 1.0–2.0.
C. Report any signs of bleeding or bruising.
D. Stop warfarin before dental cleanings.
C. Report any signs of bleeding or bruising.
Rationale: Mechanical valves require lifelong anticoagulation; bleeding precautions and regular INR monitoring (goal 2.5–3.5) are essential.
Which laboratory test is most useful for evaluating inflammation in acute pericarditis?
A. BNP
B. CRP
C. Troponin
D. INR
B. CRP
Rationale: C-reactive protein (CRP) is elevated in inflammatory conditions like pericarditis, along with fever and pericardial friction rub.
During fluid resuscitation for a patient with 40% total body surface area burns, the nurse notes a urine output of 10 mL/hr and dark red urine. Which complication should the nurse suspect?
A. Dehydration from inadequate fluids
B. Acute tubular necrosis from hypoperfusion
C. Myoglobinuria secondary to electrical burn injury
D. Curling’s ulcer
C. Myoglobinuria secondary to electrical burn injury.
Rationale: Electrical burns damage deep muscle tissue, releasing myoglobin, which colors urine red-brown and can obstruct renal tubules. Maintain aggressive hydration and alkalinize urine to prevent renal failure.
Following AAA rupture and repair, which finding indicates a potential postoperative complication?
A. Urine output 40 mL/hr
B. Serum creatinine 2.8 mg/dL
C. Mild incisional pain
D. Hemoglobin 13.5 g/dL
B. Serum creatinine 2.8 mg/dL
Rationale: Acute renal failure can develop from decreased perfusion or graft occlusion. Urine output and creatinine levels must be monitored closely.
The nurse educates a patient with a thoracic aortic aneurysm about activity. Which statement shows understanding?
A. “I should avoid heavy lifting or straining.”
B. “I’ll exercise by lifting weights daily.”
C. “I don’t need to monitor my blood pressure at home.”
D. “Aspirin is not safe for me to take.”
A. “I should avoid heavy lifting or straining.”
Rationale: Straining increases intra-abdominal pressure, which can raise the risk of aneurysm rupture.
Which symptom is most characteristic of infective endocarditis?
A. Sudden tearing chest pain
B. Fever and new heart murmur with confusion
C. Pleuritic chest pain relieved by leaning forward
D. Jugular vein distention and muffled heart sounds
B. Fever and new heart murmur with confusion
Rationale: Infective endocarditis (IE) causes fever, elevated WBCs, new murmurs, and sometimes stroke-like confusion due to septic emboli.
A patient with pericarditis has a temperature of 101°F and complains of chest pain that improves when sitting up. Which nursing intervention is most appropriate?
A. Place the patient supine and give opioids.
B. Administer NSAIDs and monitor cardiac rhythm.
C. Begin IV fluids and elevate legs.
D. Prepare for defibrillation.
B. Administer NSAIDs and monitor cardiac rhythm.
Rationale: Pericarditis pain improves when upright and worsens supine. NSAIDs or colchicine relieve inflammation, and rhythm monitoring detects complications such as pericardial effusion or tamponade.
The nurse assesses a patient with circumferential full-thickness burns of both lower legs who reports increasing pain and numbness. Pedal pulses are weak. What should the nurse do first?
A. Elevate the legs above the heart.
B. Apply ice packs to decrease swelling.
C. Notify the provider; prepare for escharotomy.
D. Administer IV morphine for pain.
C. Notify the provider; prepare for escharotomy.
Rationale: Circumferential full-thickness burns can cause compartment syndrome by restricting blood flow as edema increases. Escharotomy relieves pressure and restores distal perfusion—this is an emergency intervention.