Cardiac Cath Lab RN A - Prophecy/Relias 2026
Practice Exam | 100% Accurate | Get It Right!!
DOMAIN 1: ARTERIAL & VENOUS ACCESS MANAGEMENT (10 Questions)
Question 1 (Multiple-Choice)
A patient returns to the recovery bay following a transradial cardiac catheterization. The TR
Band is in place, and the nurse is assessing for patent hemostasis. Which action by the nurse
demonstrates the correct technique?
A. Apply the TR Band with maximum pressure and remove it after 2 hours regardless of bleeding
B. Deflate the TR Band balloon by 1-2 mL while monitoring the radial pulse with pulse oximetry
on the index finger
C. Remove the TR Band immediately upon arrival to assess the puncture site
D. Instruct the patient to keep the wrist fully flexed to maintain pressure on the site
[CORRECT: B]
Rationale: Patent hemostasis is the gold-standard technique for transradial access site
management, endorsed by the Relias Cardiac Cath Lab competency framework. The correct
technique involves gradual deflation of the TR Band balloon (by 1-2 mL) while simultaneously
monitoring the radial pulse and pulse oximetry waveform on the index finger. If the pulse
oximetry plethysmographic waveform remains present and the radial pulse is palpable,
hemostasis is achieved with the minimum necessary pressure, preserving distal radial artery
flow and preventing radial artery occlusion (RAO). This approach balances hemostasis with
perfusion. The critical safety factor is real-time monitoring during deflation—if the waveform
disappears, the balloon is reinflated slightly. Removing the band too early (Option C) risks
bleeding; maximum pressure (Option A) causes RAO; wrist flexion (Option D) displaces the band
and increases bleeding risk.
Question 2 (Select-All-That-Apply)
The nurse is preparing to remove a radial arterial sheath in the cardiac cath lab recovery area.
Which components of the "bleeding bundle" checklist must be verified prior to removal? (Select
all that apply)
,A. Activated clotting time (ACT) is ≤ 180 seconds
B. The patient has received a loading dose of aspirin within the last 24 hours
C. Hemoglobin is stable compared to the pre-procedure baseline
D. The patient can maintain the wrist in a neutral, extended position
E. A tourniquet or compression device (TR Band) is available at the bedside
F. The patient has a palpable radial pulse and capillary refill < 3 seconds in the ipsilateral hand
[CORRECT: A, C, D, E, F]
Rationale: The bleeding bundle checklist for radial arterial sheath removal, per Relias Cath Lab
RN standards and SCAI (Society for Cardiovascular Angiography and Interventions) guidelines,
requires verification of: (A) ACT ≤ 180 seconds (or per institutional protocol, typically <150-180
sec) to ensure adequate clotting function; (C) stable hemoglobin to rule out occult bleeding
during the procedure; (D) patient ability to maintain wrist position for compression device
application; (E) immediate availability of the compression device (TR Band) to achieve rapid
hemostasis; and (F) baseline distal perfusion assessment (radial pulse and capillary refill) to
establish a pre-removal baseline for post-procedure comparison. Option B (aspirin loading) is
not a prerequisite for sheath removal—it is part of the antiplatelet protocol but does not affect
the mechanical safety of sheath removal.
Question 3 (Multiple-Choice)
A post-cardiac cath patient with a femoral arteriotomy site develops sudden hypotension (SBP
drops from 128 to 82 mmHg), diaphoresis, and complains of acute lower back and flank pain.
The nurse observes mild ecchymosis at the groin site. What is the priority nursing intervention?
A. Apply a pressure dressing to the groin site and administer oral fluids
B. Activate the rapid response team, initiate large-bore IV access, and prepare for emergent CT
abdomen/pelvis with contrast
C. Administer a bolus of normal saline and reassess in 30 minutes
D. Remove the femoral closure device to inspect the arteriotomy site
[CORRECT: B]
Rationale: The clinical triad of sudden hypotension, diaphoresis, and acute flank/back pain in a
post-femoral cardiac cath patient is pathognomonic for retroperitoneal hemorrhage—one of
the most lethal vascular complications of femoral access. Cullen's sign (periumbilical
ecchymosis) and Grey Turner's sign (flank ecchymosis) may be late findings; the absence of
significant groin hematoma does not rule out retroperitoneal bleeding because blood tracks
along the retroperitoneal space. Per Relias emergency management standards, the priority is
, immediate activation of the rapid response team, establishment of large-bore IV access (14-16
gauge) for aggressive volume resuscitation, and emergent CT abdomen/pelvis (with contrast if
renal function permits) to confirm the diagnosis. The critical timing factor is minutes—
retroperitoneal bleeds can cause hemorrhagic shock rapidly. Option A is insufficient for
hemodynamic instability; Option C delays definitive intervention; Option D is contraindicated
and could worsen bleeding.
Question 4 (Multiple-Choice)
The nurse is assessing a patient 4 hours post-transradial catheterization. The TR Band was
removed 30 minutes ago. The patient reports new onset numbness and tingling in the thumb
and index finger. The hand is cool to touch, and the radial pulse is absent. What is the nurse's
immediate action?
A. Reapply the TR Band with increased pressure and notify the physician
B. Elevate the hand above heart level and apply warm compresses
C. Perform the Barbeau test (pulse oximetry with compression) and notify the interventional
cardiologist immediately
D. Document the findings and reassess in 1 hour
[CORRECT: C]
Rationale: New-onset numbness/tingling in the thumb and index finger (median nerve
distribution), cool skin, and absent radial pulse following transradial access strongly suggest
radial artery occlusion (RAO) or acute limb ischemia. The Barbeau test (pulse oximetry
waveform assessment during ulnar artery compression) is the immediate bedside assessment to
determine if ulnar collateral flow is sufficient to perfuse the hand. If the pulse oximetry
waveform disappears with ulnar compression, the hand is dependent on the radial artery, and
RAO is a limb-threatening emergency requiring immediate notification of the interventional
cardiologist for possible angiographic evaluation and intervention (e.g., thrombectomy or intra-
arterial vasodilator administration). The critical safety factor is time—acute limb ischemia
beyond 4-6 hours risks irreversible nerve and muscle damage. Option A worsens ischemia;
Option B is supportive but delays definitive diagnosis; Option D is unsafe given the time-
sensitive nature of limb salvage.
Question 5 (Multiple-Choice)
A patient has a 6-French venous sheath in the right femoral vein following a right heart
catheterization. The nurse notes the patient's right lower extremity is swollen, warm, and
Practice Exam | 100% Accurate | Get It Right!!
DOMAIN 1: ARTERIAL & VENOUS ACCESS MANAGEMENT (10 Questions)
Question 1 (Multiple-Choice)
A patient returns to the recovery bay following a transradial cardiac catheterization. The TR
Band is in place, and the nurse is assessing for patent hemostasis. Which action by the nurse
demonstrates the correct technique?
A. Apply the TR Band with maximum pressure and remove it after 2 hours regardless of bleeding
B. Deflate the TR Band balloon by 1-2 mL while monitoring the radial pulse with pulse oximetry
on the index finger
C. Remove the TR Band immediately upon arrival to assess the puncture site
D. Instruct the patient to keep the wrist fully flexed to maintain pressure on the site
[CORRECT: B]
Rationale: Patent hemostasis is the gold-standard technique for transradial access site
management, endorsed by the Relias Cardiac Cath Lab competency framework. The correct
technique involves gradual deflation of the TR Band balloon (by 1-2 mL) while simultaneously
monitoring the radial pulse and pulse oximetry waveform on the index finger. If the pulse
oximetry plethysmographic waveform remains present and the radial pulse is palpable,
hemostasis is achieved with the minimum necessary pressure, preserving distal radial artery
flow and preventing radial artery occlusion (RAO). This approach balances hemostasis with
perfusion. The critical safety factor is real-time monitoring during deflation—if the waveform
disappears, the balloon is reinflated slightly. Removing the band too early (Option C) risks
bleeding; maximum pressure (Option A) causes RAO; wrist flexion (Option D) displaces the band
and increases bleeding risk.
Question 2 (Select-All-That-Apply)
The nurse is preparing to remove a radial arterial sheath in the cardiac cath lab recovery area.
Which components of the "bleeding bundle" checklist must be verified prior to removal? (Select
all that apply)
,A. Activated clotting time (ACT) is ≤ 180 seconds
B. The patient has received a loading dose of aspirin within the last 24 hours
C. Hemoglobin is stable compared to the pre-procedure baseline
D. The patient can maintain the wrist in a neutral, extended position
E. A tourniquet or compression device (TR Band) is available at the bedside
F. The patient has a palpable radial pulse and capillary refill < 3 seconds in the ipsilateral hand
[CORRECT: A, C, D, E, F]
Rationale: The bleeding bundle checklist for radial arterial sheath removal, per Relias Cath Lab
RN standards and SCAI (Society for Cardiovascular Angiography and Interventions) guidelines,
requires verification of: (A) ACT ≤ 180 seconds (or per institutional protocol, typically <150-180
sec) to ensure adequate clotting function; (C) stable hemoglobin to rule out occult bleeding
during the procedure; (D) patient ability to maintain wrist position for compression device
application; (E) immediate availability of the compression device (TR Band) to achieve rapid
hemostasis; and (F) baseline distal perfusion assessment (radial pulse and capillary refill) to
establish a pre-removal baseline for post-procedure comparison. Option B (aspirin loading) is
not a prerequisite for sheath removal—it is part of the antiplatelet protocol but does not affect
the mechanical safety of sheath removal.
Question 3 (Multiple-Choice)
A post-cardiac cath patient with a femoral arteriotomy site develops sudden hypotension (SBP
drops from 128 to 82 mmHg), diaphoresis, and complains of acute lower back and flank pain.
The nurse observes mild ecchymosis at the groin site. What is the priority nursing intervention?
A. Apply a pressure dressing to the groin site and administer oral fluids
B. Activate the rapid response team, initiate large-bore IV access, and prepare for emergent CT
abdomen/pelvis with contrast
C. Administer a bolus of normal saline and reassess in 30 minutes
D. Remove the femoral closure device to inspect the arteriotomy site
[CORRECT: B]
Rationale: The clinical triad of sudden hypotension, diaphoresis, and acute flank/back pain in a
post-femoral cardiac cath patient is pathognomonic for retroperitoneal hemorrhage—one of
the most lethal vascular complications of femoral access. Cullen's sign (periumbilical
ecchymosis) and Grey Turner's sign (flank ecchymosis) may be late findings; the absence of
significant groin hematoma does not rule out retroperitoneal bleeding because blood tracks
along the retroperitoneal space. Per Relias emergency management standards, the priority is
, immediate activation of the rapid response team, establishment of large-bore IV access (14-16
gauge) for aggressive volume resuscitation, and emergent CT abdomen/pelvis (with contrast if
renal function permits) to confirm the diagnosis. The critical timing factor is minutes—
retroperitoneal bleeds can cause hemorrhagic shock rapidly. Option A is insufficient for
hemodynamic instability; Option C delays definitive intervention; Option D is contraindicated
and could worsen bleeding.
Question 4 (Multiple-Choice)
The nurse is assessing a patient 4 hours post-transradial catheterization. The TR Band was
removed 30 minutes ago. The patient reports new onset numbness and tingling in the thumb
and index finger. The hand is cool to touch, and the radial pulse is absent. What is the nurse's
immediate action?
A. Reapply the TR Band with increased pressure and notify the physician
B. Elevate the hand above heart level and apply warm compresses
C. Perform the Barbeau test (pulse oximetry with compression) and notify the interventional
cardiologist immediately
D. Document the findings and reassess in 1 hour
[CORRECT: C]
Rationale: New-onset numbness/tingling in the thumb and index finger (median nerve
distribution), cool skin, and absent radial pulse following transradial access strongly suggest
radial artery occlusion (RAO) or acute limb ischemia. The Barbeau test (pulse oximetry
waveform assessment during ulnar artery compression) is the immediate bedside assessment to
determine if ulnar collateral flow is sufficient to perfuse the hand. If the pulse oximetry
waveform disappears with ulnar compression, the hand is dependent on the radial artery, and
RAO is a limb-threatening emergency requiring immediate notification of the interventional
cardiologist for possible angiographic evaluation and intervention (e.g., thrombectomy or intra-
arterial vasodilator administration). The critical safety factor is time—acute limb ischemia
beyond 4-6 hours risks irreversible nerve and muscle damage. Option A worsens ischemia;
Option B is supportive but delays definitive diagnosis; Option D is unsafe given the time-
sensitive nature of limb salvage.
Question 5 (Multiple-Choice)
A patient has a 6-French venous sheath in the right femoral vein following a right heart
catheterization. The nurse notes the patient's right lower extremity is swollen, warm, and
