CARDIAC SURGERY CSC QUESTIONS AND ANSWERS
SURE A+
✔✔Management of postoperative hypertension includes which of the following:
A. Calcium channel blockers and inotropes.
B. Dobutamine and beta blockers.
C. Adequate sedation and pain management, and vasodilators.
D. All of the above. - ✔✔C. Pain and anxiety contribute to hypertension by causing
increased sympathetic nervous system activity. Adequate pain control and sedation with
drugs such as propofol, midazolam, morphine, or dexmedetomidine can be used to treat
early postoperative hypertension, especially in the ventilated patient. However,
antihypertensive agents are preferred over sedatives to facilitate early extubation. There
are several drugs that can be used as antihypertensive agents:
Nitroprusside is primarily an arterial dilator that causes relaxation of arterial smooth
muscle to reduce SVR, but it also dilates veins and reduces preload.
Calcium channel blockers, especially nicardipine and clevidipine, cause arterial
vasodilation and decrease SVR. They also dilate coronary arteries and slow the heart
rate which can be beneficial in improving myocardial perfusion and controlling
hypertension. Beta blockers decrease blood pressure by decreasing myocardial
contractility and heart rate, as well as decreasing renin activity. They are used to treat
hypertension in patients whose cardiac output is adequate, especially if tachycardia and
hyperdynamic contractility are present.
Dobutamine is a positive inotropic agent and is not indicated in treatment of
hypertension. Increased contractility that results from positive inotropes can increase
BP, not decrease it.
✔✔You are caring for a post CABG patient who received a large amount of contrast in
the cardiac cath lab prior to going to surgery for urgent revascularization. You expect
that this patient is likely to develop which of these postoperative complications:
A. Acute respiratory failure.
B. Acute kidney injury.
C. Excessive mediastinal bleeding.
D. Ischemic stroke. - ✔✔B. Acute kidney injury (AKI) increases mortality following
cardiac surgery, and any degree of preoperative renal dysfunction greatly increases the
risk for developing AKI postoperatively. Patients who receive nephrotoxic agents, such
, as large amounts of contrast during diagnostic or interventional cardiac cath
procedures, aminoglycosides, or metformin, are at increased risk for developing AKI.
Other preoperative factors that increase this risk include cardiogenic shock,
decompensated heart failure, or any preexisting renal disease. Medications that can
contribute to development of AKI include NSAIDS, ACE inhibitors, antibiotics,
furosemide, and cephalosporins. Postoperative sustained hypotension and low cardiac
output syndrome, vasoconstriction due to vasopressor drugs, renal embolization related
to IABP use, sepsis, and effects of nonpulsatile flow during CPB also increase the risk
of postoperative AKI.
Any cardiac surgery patient can develop mediastinal bleeding, respiratory failure, or
have a stroke, so the nurse must be vigilant for signs of these complications as well as
for AKI in all patients.
✔✔The diagnosis of perioperative MI in a cardiac surgery patient can be made by which
of the following:
A. New Q waves or LBBB on the postoperative ECG or new wall motion abnormalities
on echocardiogram.
B. Widespread ST depression on the postoperative ECG.
C. Any troponin I or CK-MB elevation postoperatively.
D. ST elevation on the post operative ECG. - ✔✔A. The diagnosis of perioperative MI is
often difficult to make after cardiac surgery because biomarkers (Troponin I, CK-MB)
are usually elevated secondary to the surgical procedure, and ST elevation (the ECG
sign of myocardial injury) can occur secondary to low graft flow or postoperative
pericarditis. The Society of Thoracic Surgeons recommends the following definition of
perioperative MI:
1) CKMB or troponin elevations > five times the 99th percentile of the normal reference
range during the first 72 h following CABG, plus
2) New pathological Q waves or new LBBB, or angiographically documented new graft
or native coronary artery occlusion, or imaging evidence of new loss of viable
myocardium.
ST depression is associated with myocardial ischemia or with non-ST elevation MI.
✔✔Which of these procedures carries the highest risk for development of acute kidney
injury (AKI) requiring dialysis:
A. Mitral valve replacement (MVR).
B. Aortic valve replacement + CABG.
C. Aortic valve replacement (AVR).
D. Mitral valve replacement (MVR) + CABG. - ✔✔D. The Society of Thoracic Surgeons
model for predicting the risk of needing dialysis after cardiac surgery assigns points for
known risk factors and uses the total point score to predict the risk of AKI requiring
dialysis. This model assigns 7 points for MVR + CABG, 5 points for AVR + CABG, 4
points for MVR alone, and 2 points for AVR alone. CABG alone receives no points in
this model.
✔✔Which of the following is the most common post operative cardiac arrhythmia
following any kind of cardiac surgery:
SURE A+
✔✔Management of postoperative hypertension includes which of the following:
A. Calcium channel blockers and inotropes.
B. Dobutamine and beta blockers.
C. Adequate sedation and pain management, and vasodilators.
D. All of the above. - ✔✔C. Pain and anxiety contribute to hypertension by causing
increased sympathetic nervous system activity. Adequate pain control and sedation with
drugs such as propofol, midazolam, morphine, or dexmedetomidine can be used to treat
early postoperative hypertension, especially in the ventilated patient. However,
antihypertensive agents are preferred over sedatives to facilitate early extubation. There
are several drugs that can be used as antihypertensive agents:
Nitroprusside is primarily an arterial dilator that causes relaxation of arterial smooth
muscle to reduce SVR, but it also dilates veins and reduces preload.
Calcium channel blockers, especially nicardipine and clevidipine, cause arterial
vasodilation and decrease SVR. They also dilate coronary arteries and slow the heart
rate which can be beneficial in improving myocardial perfusion and controlling
hypertension. Beta blockers decrease blood pressure by decreasing myocardial
contractility and heart rate, as well as decreasing renin activity. They are used to treat
hypertension in patients whose cardiac output is adequate, especially if tachycardia and
hyperdynamic contractility are present.
Dobutamine is a positive inotropic agent and is not indicated in treatment of
hypertension. Increased contractility that results from positive inotropes can increase
BP, not decrease it.
✔✔You are caring for a post CABG patient who received a large amount of contrast in
the cardiac cath lab prior to going to surgery for urgent revascularization. You expect
that this patient is likely to develop which of these postoperative complications:
A. Acute respiratory failure.
B. Acute kidney injury.
C. Excessive mediastinal bleeding.
D. Ischemic stroke. - ✔✔B. Acute kidney injury (AKI) increases mortality following
cardiac surgery, and any degree of preoperative renal dysfunction greatly increases the
risk for developing AKI postoperatively. Patients who receive nephrotoxic agents, such
, as large amounts of contrast during diagnostic or interventional cardiac cath
procedures, aminoglycosides, or metformin, are at increased risk for developing AKI.
Other preoperative factors that increase this risk include cardiogenic shock,
decompensated heart failure, or any preexisting renal disease. Medications that can
contribute to development of AKI include NSAIDS, ACE inhibitors, antibiotics,
furosemide, and cephalosporins. Postoperative sustained hypotension and low cardiac
output syndrome, vasoconstriction due to vasopressor drugs, renal embolization related
to IABP use, sepsis, and effects of nonpulsatile flow during CPB also increase the risk
of postoperative AKI.
Any cardiac surgery patient can develop mediastinal bleeding, respiratory failure, or
have a stroke, so the nurse must be vigilant for signs of these complications as well as
for AKI in all patients.
✔✔The diagnosis of perioperative MI in a cardiac surgery patient can be made by which
of the following:
A. New Q waves or LBBB on the postoperative ECG or new wall motion abnormalities
on echocardiogram.
B. Widespread ST depression on the postoperative ECG.
C. Any troponin I or CK-MB elevation postoperatively.
D. ST elevation on the post operative ECG. - ✔✔A. The diagnosis of perioperative MI is
often difficult to make after cardiac surgery because biomarkers (Troponin I, CK-MB)
are usually elevated secondary to the surgical procedure, and ST elevation (the ECG
sign of myocardial injury) can occur secondary to low graft flow or postoperative
pericarditis. The Society of Thoracic Surgeons recommends the following definition of
perioperative MI:
1) CKMB or troponin elevations > five times the 99th percentile of the normal reference
range during the first 72 h following CABG, plus
2) New pathological Q waves or new LBBB, or angiographically documented new graft
or native coronary artery occlusion, or imaging evidence of new loss of viable
myocardium.
ST depression is associated with myocardial ischemia or with non-ST elevation MI.
✔✔Which of these procedures carries the highest risk for development of acute kidney
injury (AKI) requiring dialysis:
A. Mitral valve replacement (MVR).
B. Aortic valve replacement + CABG.
C. Aortic valve replacement (AVR).
D. Mitral valve replacement (MVR) + CABG. - ✔✔D. The Society of Thoracic Surgeons
model for predicting the risk of needing dialysis after cardiac surgery assigns points for
known risk factors and uses the total point score to predict the risk of AKI requiring
dialysis. This model assigns 7 points for MVR + CABG, 5 points for AVR + CABG, 4
points for MVR alone, and 2 points for AVR alone. CABG alone receives no points in
this model.
✔✔Which of the following is the most common post operative cardiac arrhythmia
following any kind of cardiac surgery:
