Cardiac Surgery CSC, AACN CSC- Therapeutic
Interventions Version 2 Final Exam Preparation Newest
With Complete 100 Questions And Correct Detailed
Answers| Brand New Version!
When caring for a patient immediately post CABG the nurse recognizes that the most likely
cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent > 12 hours.
B. LV failure requiring an inotrope as first line treatment for any hypotension.
C. Decreased circulating volume representing the need for increased fluid administration.
D. LV failure requiring an assist device. - Correct Answer -C. Hypotension in the immediate
postoperative period is usually caused by low circulating volume and responds to treatment
with fluids. Volume is the first line treatment for hypotension. If there is no immediate
response to volume administration, 500 mg of IV calcium chloride is often given. Existing
vasopressors, such as norepinephrine, can also be adjusted. It is important for hypotension to
be promptly treated. Persistent hypotension can result in hypoperfusion and end organ
damage.
LV failure is not the most common cause of hypotension in the immediate post-operative
period and therefore inotropic agents are not first line agents used in the treatment of
hypotension. Hypotension that does not respond to fluid administration may require an
inotrope.
Preoperative clopidogrel should be held for how many days in the elective surgery patient:
A.It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days. - Correct Answer -C. Clopidogrel inhibits the P2Y12 receptor on the platelet for the
lifetime of the platelet (10 days). Inhibited platelets cannot participate in clotting, so the risk of
bleeding increases with antiplatelet drugs. Most clinical trials have identified an increased risk
in bleeding, transfusion, and re-exploration when clopidogrel is taken within 5 days of surgery,
and no increase in bleeding or transfusions when clopidogrel is stopped for > 5 days prior to
surgery. Therefore, clopidogrel should be stopped for 5 to 7 days prior to elective surgery.
1
,Emergent surgery can be done regardless of when the last dose of clopidogrel was taken, but
will be associated with increased bleeding and need for platelet transfusions.
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days. - Correct Answer -B.
OPCAB refers to off-pump coronary artery bypass. Surgery is done without CPB but it still
involves a median sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a beating heart
without CPB and without the use of a median sternotomy. MIDCAB is commonly done through
an anterior thoracotomy incision and is used to bypass the mid to distal LAD with a left internal
mammary artery (LIMA) graft. A ministernotomy can also be used to gain access during
MIDCAB.
Which of the following patients is at highest risk for neurological complications after CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history of hypertension -
Correct Answer -B. Severe atherosclerosis of the aorta, advanced age, use of CPB, aortic cross-
clamping, diabetes, hypertension, female sex, and history of stroke place patients at high risk
for neurological complications following cardiac surgery. Other factors contributing to
neurological complications include alcohol abuse, heart failure, arrhythmias, and
hyperglycemia.
The nurse caring for the post operative cardiac surgery patient recognizes the following as
potential contributors to post-operative vasodilation that can cause hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of vasodilators post op.
B. Use of norepinephrine or dopamine to support BP immediately post-op.
2
,C. Inflammatory response due to CPB and use of norepinephrine to support BP
D. Rewarming that occurs after return to the ICU, and the inflammatory response to use of
cardiopulmonary bypass during surgery - Correct Answer -D. Intraoperative cooling results in
vasoconstriction; rewarming after surgery causes vasodilation and can contribute to
hypotension if volume administration is inadequate for the increased size of the vascular space
caused by vasodilation. The use of CPB stimulates an inflammatory response that results in
vasodilation that contributes to hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not vasodilation.
A characteristic of a fast-track pathway after CABG would include:
A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the ventilator weaning
process.
D. extubation by the third post-op day - Correct Answer -C. Low-risk patients can be selected for
fast tracking after CABG. These patients are targeted for early extubation, early ambulation,
and early discharge. Patients who are fast tracked receive sedation and analgesia to allow for
early extubation. Pharmacological strategies to prevent atrial fibrillation and early phase I
cardiac rehabilitation are also key components of fast tracking.
You are caring for an early post-operative CABG patient who remains hypotensive despite
treatment with adequate fluid administration and an alpha constricting agent. You know that
one potential post-operative complication responsible for this persistent hypotension could be:
A. Acute kidney injury.
B. Acute saphenous vein graft closure.
C. Acute respiratory distress syndrome (ARDS).
D. Vasoplegia. - Correct Answer -D. Vasoplegia is a form of vasodilatory shock that can occur
after separation from CPB. It is characterized by significant hypotension despite adequate fluid
resuscitation, low SVR(due to vasodilation), and is resistant to vasopressors. When vasopressors
(norepinephrine, epinephrine, high dose dopamine, or vasopressin) are not able to maintain
blood pressure in the presence of adequate filling pressures, then vasoplegia may be present.
There are several theories behind the cause of vasoplegia, including leukocyte activation and
the release of pro-inflammatory mediators during cardiopulmonary bypass, and vasoplegia has
3
, been associated with long-term use of ACE inhibitors, calcium channel blockers, amiodarone,
and heparin. Patients with EF <35%, heart failure and diabetes are at higher risk. Vasoplegia can
also be seen after OPCAB.
When caring for a patient who is post CABG the nurse knows the following is true regarding
hypertension in the immediate post operative period:
A. Hypertension increases myocardial oxygen demand.
B. Hypertension increases left ventricular afterload.
C. Hypertension increases the risk of bleeding.
D. All of the above. - Correct Answer -D. Hypertension increases the risk of graft dehiscence at
the anastomoses site, bleeding, myocardial ischemia, stroke, and cardiac arrhythmias.
Myocardial oxygen demand is affected by the same parameters that affect cardiac output
(preload, afterload, contractility, and heart rate). An increase in any one of these four
parameters will increase myocardial oxygen demand and consumption.
Atrial fibrillation is an arrhythmia often seen in post-operative patients undergoing CABG.
Preoperative therapy for the reduction of post-operative atrial fibrillation includes the
following:
A. Preoperative administration of a calcium channel blocker and a beta blocker.
B. Preoperative administration of sotalol and amiodarone.
C. Preoperative administration of a statin and digoxin.
D. Preoperative administration of a beta blocker or amiodarone, and a statin. - Correct Answer -
D. The standard therapy for the reduction of postoperative atrial fibrillation is the initiation of
beta blockers preoperatively. Amiodarone can be used for prophylaxis in high risk patients who
are unable to receive beta blockers, but due to inconsistent clinical trial results, amiodarone is
not recommended as a routine strategy for the prevention of postoperative atrial fibrillation.
Preoperative statin therapy is known to reduce the risk of postoperative atrial fibrillation and is
also associated with a reduction in mortality associated with postoperative atrial fibrillation.
Post-operative wound infection is a serious complication resulting in increased post-operative
mortality. Patient characteristics that place the patient at high risk for the development of post-
operative wound infections include all of the following EXCEPT:
A. Diabetes.
4
Interventions Version 2 Final Exam Preparation Newest
With Complete 100 Questions And Correct Detailed
Answers| Brand New Version!
When caring for a patient immediately post CABG the nurse recognizes that the most likely
cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent > 12 hours.
B. LV failure requiring an inotrope as first line treatment for any hypotension.
C. Decreased circulating volume representing the need for increased fluid administration.
D. LV failure requiring an assist device. - Correct Answer -C. Hypotension in the immediate
postoperative period is usually caused by low circulating volume and responds to treatment
with fluids. Volume is the first line treatment for hypotension. If there is no immediate
response to volume administration, 500 mg of IV calcium chloride is often given. Existing
vasopressors, such as norepinephrine, can also be adjusted. It is important for hypotension to
be promptly treated. Persistent hypotension can result in hypoperfusion and end organ
damage.
LV failure is not the most common cause of hypotension in the immediate post-operative
period and therefore inotropic agents are not first line agents used in the treatment of
hypotension. Hypotension that does not respond to fluid administration may require an
inotrope.
Preoperative clopidogrel should be held for how many days in the elective surgery patient:
A.It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days. - Correct Answer -C. Clopidogrel inhibits the P2Y12 receptor on the platelet for the
lifetime of the platelet (10 days). Inhibited platelets cannot participate in clotting, so the risk of
bleeding increases with antiplatelet drugs. Most clinical trials have identified an increased risk
in bleeding, transfusion, and re-exploration when clopidogrel is taken within 5 days of surgery,
and no increase in bleeding or transfusions when clopidogrel is stopped for > 5 days prior to
surgery. Therefore, clopidogrel should be stopped for 5 to 7 days prior to elective surgery.
1
,Emergent surgery can be done regardless of when the last dose of clopidogrel was taken, but
will be associated with increased bleeding and need for platelet transfusions.
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days. - Correct Answer -B.
OPCAB refers to off-pump coronary artery bypass. Surgery is done without CPB but it still
involves a median sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a beating heart
without CPB and without the use of a median sternotomy. MIDCAB is commonly done through
an anterior thoracotomy incision and is used to bypass the mid to distal LAD with a left internal
mammary artery (LIMA) graft. A ministernotomy can also be used to gain access during
MIDCAB.
Which of the following patients is at highest risk for neurological complications after CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history of hypertension -
Correct Answer -B. Severe atherosclerosis of the aorta, advanced age, use of CPB, aortic cross-
clamping, diabetes, hypertension, female sex, and history of stroke place patients at high risk
for neurological complications following cardiac surgery. Other factors contributing to
neurological complications include alcohol abuse, heart failure, arrhythmias, and
hyperglycemia.
The nurse caring for the post operative cardiac surgery patient recognizes the following as
potential contributors to post-operative vasodilation that can cause hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of vasodilators post op.
B. Use of norepinephrine or dopamine to support BP immediately post-op.
2
,C. Inflammatory response due to CPB and use of norepinephrine to support BP
D. Rewarming that occurs after return to the ICU, and the inflammatory response to use of
cardiopulmonary bypass during surgery - Correct Answer -D. Intraoperative cooling results in
vasoconstriction; rewarming after surgery causes vasodilation and can contribute to
hypotension if volume administration is inadequate for the increased size of the vascular space
caused by vasodilation. The use of CPB stimulates an inflammatory response that results in
vasodilation that contributes to hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not vasodilation.
A characteristic of a fast-track pathway after CABG would include:
A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the ventilator weaning
process.
D. extubation by the third post-op day - Correct Answer -C. Low-risk patients can be selected for
fast tracking after CABG. These patients are targeted for early extubation, early ambulation,
and early discharge. Patients who are fast tracked receive sedation and analgesia to allow for
early extubation. Pharmacological strategies to prevent atrial fibrillation and early phase I
cardiac rehabilitation are also key components of fast tracking.
You are caring for an early post-operative CABG patient who remains hypotensive despite
treatment with adequate fluid administration and an alpha constricting agent. You know that
one potential post-operative complication responsible for this persistent hypotension could be:
A. Acute kidney injury.
B. Acute saphenous vein graft closure.
C. Acute respiratory distress syndrome (ARDS).
D. Vasoplegia. - Correct Answer -D. Vasoplegia is a form of vasodilatory shock that can occur
after separation from CPB. It is characterized by significant hypotension despite adequate fluid
resuscitation, low SVR(due to vasodilation), and is resistant to vasopressors. When vasopressors
(norepinephrine, epinephrine, high dose dopamine, or vasopressin) are not able to maintain
blood pressure in the presence of adequate filling pressures, then vasoplegia may be present.
There are several theories behind the cause of vasoplegia, including leukocyte activation and
the release of pro-inflammatory mediators during cardiopulmonary bypass, and vasoplegia has
3
, been associated with long-term use of ACE inhibitors, calcium channel blockers, amiodarone,
and heparin. Patients with EF <35%, heart failure and diabetes are at higher risk. Vasoplegia can
also be seen after OPCAB.
When caring for a patient who is post CABG the nurse knows the following is true regarding
hypertension in the immediate post operative period:
A. Hypertension increases myocardial oxygen demand.
B. Hypertension increases left ventricular afterload.
C. Hypertension increases the risk of bleeding.
D. All of the above. - Correct Answer -D. Hypertension increases the risk of graft dehiscence at
the anastomoses site, bleeding, myocardial ischemia, stroke, and cardiac arrhythmias.
Myocardial oxygen demand is affected by the same parameters that affect cardiac output
(preload, afterload, contractility, and heart rate). An increase in any one of these four
parameters will increase myocardial oxygen demand and consumption.
Atrial fibrillation is an arrhythmia often seen in post-operative patients undergoing CABG.
Preoperative therapy for the reduction of post-operative atrial fibrillation includes the
following:
A. Preoperative administration of a calcium channel blocker and a beta blocker.
B. Preoperative administration of sotalol and amiodarone.
C. Preoperative administration of a statin and digoxin.
D. Preoperative administration of a beta blocker or amiodarone, and a statin. - Correct Answer -
D. The standard therapy for the reduction of postoperative atrial fibrillation is the initiation of
beta blockers preoperatively. Amiodarone can be used for prophylaxis in high risk patients who
are unable to receive beta blockers, but due to inconsistent clinical trial results, amiodarone is
not recommended as a routine strategy for the prevention of postoperative atrial fibrillation.
Preoperative statin therapy is known to reduce the risk of postoperative atrial fibrillation and is
also associated with a reduction in mortality associated with postoperative atrial fibrillation.
Post-operative wound infection is a serious complication resulting in increased post-operative
mortality. Patient characteristics that place the patient at high risk for the development of post-
operative wound infections include all of the following EXCEPT:
A. Diabetes.
4
