CSC Study Questions ALL QUESTIONS AND 100% CORRECT ANSWER ALREADY GRADED A+/ LATEST AND COMPLETE UPDATE 2025 WITH VERIFIED SOLUTIONS /ASSURED PASS

CSC Study Questions ALL QUESTIONS AND 100% CORRECT ANSWER ALREADY GRADED A+/ LATEST AND COMPLETE UPDATE 2025 WITH VERIFIED SOLUTIONS /ASSURED PASS Following surgical repair of a thoracic aneurysm with an endoluminal graft, the patient is unable to move his lower extremities. The nurse should first a. Activate stroke team and prepare to do an urgent (STAT) computed tomography (CT) scan b. Prepare to return to surgery for exploration of femoral artery occlusion c. Call surgeon to obtain a neurology consultation in the morning d. Prepare for lumbar drain insertion to remove cerebrospinal fluid (CSF) D Spinal cord ischemia is a complication from thoracic aneurysm repair for both open and endoluminal repair. Spinal cord ischemia results from increased cerebral spinal pressure that compresses the spinal nerves. Untreated spinal cord ischemia can lead to paraplegia. It is important to recognize the signs of spinal cord ischemia (loss of lower extremity movement) promptly. Immediate insertion of a spinal drain can reverse the spinal cord ischemia and prevent paraplegia. Bilateral leg paralysis is not typically an initial symptom of stroke (A). Signs of femoral artery occlusion (B) are the 5 Ps: pulselessness, pallor, pain, paresthesias, and paralysis. These symptoms would be unilateral, not bilateral. Immediate insertion of a spinal drain is needed; waiting until morning for the consultation (C) would be inappropriate. A postoperative patient who had undergone coronary artery bypass graft and ventricular aneurysm repair has a 15-beat run of ventricular tachycardia. The most likely cause of the dysrhythmia is a. Irritability of the ventricle from the aneurysm repair b. Spasm of the right coronary artery graft c. Potassium 4.8 mEq/dL and magnesium 2.1 mEq/L d. Did not restart administration of the angiotensinconverting enzyme (ACE) inhibitor (taken preoperatively) A Patients with left ventricular aneurysm typically have depressed left ventricular (LV) function. Depressed LV function may lead to increased ventricular arrhythmias. LV aneurysm repair is indicated to improve symptoms of angina, heart failure, systemic thromboembolism, or malignant arrhythmias. In the immediate postoperative phase, the repaired ventricle continues to be depressed and has the added trauma of surgery on the left ventricle. Both of these increase the irritability of the LV, leading to ventricular arrhythmias. Spasm (B) or occlusion of the RCA leads to bradyarrhythmias, not ventricular arrhythmias. The potassium and magnesium levels in (C) are normal. Low potassium and magnesium levels increase the risk for ventricular arrhythmias. ACE inhibitors (D) do not have any antiarrhythmic effect. The nurse admits a patient after aortic valve replacement and notes the following settings of the temporary pacemaker: DDD rate, 80/min; atrial MA, 10; ventricular MA, 4. The underlying rhythm is complete heart block with ventricular escape rhythm rate 30/min. The most likely cause of the complete heart block is a. Spasm of the right coronary artery (RCA) graft b. Damage of the atrioventricular (AV) node during repair of the aortic valve c. Low potassium and magnesium levels d. Toxic effects of β-blocker B The AV node and the bundle of His are near the aortic valve. During aortic valve replacement, hemorrhage, edema, suturing, or debridement near the AV node and the bundle of His may cause heart blocks. Typically the epicardial pacing is only needed for a few days until the edema resolves. If complete heart block persists after a few days, a permanent pacemaker may be required. The RCA supplies oxygen to the sinoatrial (SA) and AV nodes and spasm of the RCA graft (A) may cause bradycardia and/or heart blocks. This patient did not have bypass surgery, so RCA spasm would not be a postoperative complication. Low potassium and magnesium levels (C) increase the risk for ventricular arrhythmias, not AV conduction defects. If toxic effects of β-blockers (D) were present, the complete heart block would have been the underlying rhythm preoperatively. A postoperative coronary artery bypass graft and aortic valve replacement patient has been in a normal sinus rhythm for 4 hours. The monitor is now showing P waves at a rate of 73 beats per minute with no ventricular response. The best action would be to a. Administer atropine 0.5 mg intravenous bolus (IV push) b. Connect transcutaneous pacing pads to patient c. Connect epicardial pacing wires to a temporary pacemaker d. Administer epinephrine 1 mg IV push and start epinephrine infusion C The AV node and the bundle of His are near the aortic valve. During aortic valve replacement, hemorrhage, edema, suturing, or debridement near the AV node and the bundle of His may cause heart blocks. Pacing is needed to treat the conduction defect caused by the surgery. Atropine (A) and epinephrine (D) will not work because the conduction problem is with the AV node and/or the bundle of His. Transcutaneous (external) pacing (B) would be the next best option if epicardial wires were not present. The heart rate should be greater than 45/min and less than 80/min. One hour after extubation, a diabetic coronary artery bypass surgery patient is becoming slightly lethargic. Arterial blood gas (ABG) analysis yielded the following results: pH, 7.33; PaO2, 80 mm Hg; PaCO2, 50 mm Hg; SaO2, 95%; HCO3, 28 mEq/L; base excess, 0.5. The nurse should first a. Obtain a blood glucose level b. Obtain a 12-lead ECG c. Treat metabolic acidosis d. Stimulate patient to breathe D After extubation, cardiac surgery patients should be assessed for adequate ventilation. Pain medications, atelectasis, and immobility may lead to hypoventilation. Hypoventilation is a cause of respiratory acidosis. High carbon dioxide levels cause lethargy. The patient is in the early phase of respiratory acidosis. Stimulation and encouragement of incentive spirometry should prevent further hypoventilation and reintubation. A, B, and C are actions or interventions for metabolic acidosis. One hour after surgery, a coronary artery bypass graft (CABG) patient starts to wake up and the mixed venous oxygen saturation ( SvO2) decreases from 60% to 45%. The change is most likely the result of which of the following? A. Increase in oxygen consumption B. Increase in hemoglobin C. Increase in cardiac output D. Increase in arterial saturation A SvO2 represents the oxygenation at the tissue level. The value reflects the tissue oxygen delivery and consumption. Four factors influence SvO2 : hemoglobin, cardiac output, arterial saturation, and oxygen consumption. An increase in oxygen consumption will extract more oxygen at the tissue level and decrease the SvO2. Oxygen consumption could be increased by pain, shivering, or exercise. A decrease in oxygen consumption will provide more oxygen to the tissue level and increase the SvO2 . Oxygen consumption might be reduced by hypothermia or anesthesia. In addition to a decreasing BP, which of the following assessment findings is consistent with cardiac tamponade? A. Urine output of 42 to 50 mL/h B. Central venous pressure (CVP) of 11 to 20 mm Hg C. Cardiac output 4.0 to 5.1 L/min D. SvO2 58% to 65% B The accumulation of fluid around the heart compresses the atria, causing elevated right atrial filling pressures. The decreased cardiac output leads to hypoperfusion of the kidney, resulting in a sudden decrease in urine output or oliguria. The compression of the atria constricts venous return to the heart, leading to a decreased cardiac output. The decreased cardiac output and low hemoglobin level due to the bleeding lead to decreased SvO2 . After CABG, a patient weighing 70 kg and receiving mechanical ventilation has orders to be weaned and extubated when stable. Which parameter indicates the patient is ready to extubate? A. RR 28/min B. Vital capacity (VC) 500 mL C. Able to sustain a head lift for at least 5 seconds D. Minute volume 12 L C Parameters for readiness to wean are negative inspiratory pressure (NIP) −25 cm H2O, RR 25/min, HR 140/min, minute volume 10 L, VC 10 to 15 mL/kg. This patient's RR needs to be 25/min; VC, 700 to 1050 mL/kg; and minute volume, 10 L. Adequate respiratory muscle strength is indicated by the ability to sustain a head lift for at least 5 seconds. Which of the following assessment findings is a contraindication to extubation? A. Chest tube bleeding less than 50 mL/h B. Chronic atrial fibrillation C. Labile/fluctuating blood pressure D. Minimal vasoactive support C Criteria for extubation include hemodynamical stability and neurologic and respiratory readiness. Chest tube bleeding in excess of 100 mL/h, new arrhythmias, and labile blood pressure reflect hemodynamic instability. The following hemodynamic profile is noted upon admission in a postoperative CABG patient: BP, 91/38 mm Hg; mean arterial pressure (MAP), 58 mm Hg; HR, 108/min; core temperature, 36.5°C; pulmonary arterial pressure (PAP), 20/12 mm Hg; CVP, 6 mm Hg; SvO2, 59%; cardiac output, 3.6 L/min; cardiac index, 1.8; systemic vascular resistance, 1006 dyne ⋅ sec ⋅ cm−5; stroke volume, 33 mL; pulse oximetry (SpO2), 93% saturation; urine and chest tube output both 100 mL in the past hour; and hemoglobin level is 10 g/dL. The nurse should first do which of the following? A. Continue with admission procedure (catheters, chest radiographs, laboratory values)—no treatment needed at this point B. Administer fluid because the patient is hypovolemic C. Administer calcium chloride to increase contractility D. Start dopamine to increase BP and contractility B Hypovolemia is noted by the low stroke volume, low CVP, and low pulmonary artery diastolic pressure, cardiac output, and cardiac index. The CVP and pulmonary artery diastolic pressure would be high if the patient needed an intervention to increase contractility. A patient was planning to undergo Mitral valve replacement surgery. He was on warfarin therapy for Atrial Fibrillation. What modification should the nurse do with the anticoagulant medication? A. Stop warfarin on the day of surgery B. Stop warfarin 4-5 days before surgery C. Stop warfarin 4-5 days prior to surgery; admit and start on IV heparin; stop IV heparin 2-3 hours pre-op D. Continue warfarin therapy C For patients taking anticoagulants like warfarin, stop 4-5 days prior to surgery; admit and start on IV heparin if high risk for thrombosis (large left atrium, atrial fibrillation, mitral valve prosthesis). IV heparin should be stopped 2-3 hours pre-op (unless on IABP support). A patient presents with acute arterial occlusion of one of his upper limbs. Which of the following drugs should the nurse prepare to administer to the patient? A. Streptokinase B. Heparin C. Warfarin D. Urokinase B Management of acute arterial occlusion is immediate heparinization with 5000 unit bolus and continuous infusion to maintain PTT 60. What are the contraindications of percutaneous transluminal angioplasty of the lower extremity? A. Hypertensive patient of poor ventricular function B. Patients having dyslipidemia C. Medically unstable, diabetic patient, long arterial occlusion, poor distal run off D. Patient who has undergone coronary angioplasty C Percutaneous transluminal angioplasty of the lower extremity is contraindicated in patients who are medically unstable, have long arterial occlusion, have poor distal run off, or who have diabetes. Which of the following signs and symptoms would the attending nurse expect in a patient with aneurysmal rupture? A. Abdominal pain, hypertension, bradycardia B. Hypotension, tachycardia, nausea, vomiting, shortness of breath, chest pain/lower back/abdominal pain C. Headache, nausea, vomiting, vertigo D. Hypertension, chest pain, syncope B Signs and symptoms of aneurysmal rupture include hypotension, tachycardia, lightheadedness, fainting, snausea, vomiting, sweating, shortness of breath, chest pain/lower back/abdominal pain, and dizziness. The nurse receives the blood test reports for a patient admitted to the hospital with complaints of chest pain. The report shows an elevated CKMB. What does this signify in this patient? A. Damage to myocardium B. Damage to intercostal muscles C. Liver damage D. None of the above A Cardiac enzymes get elevated in conditions of damage to the myocardium. CKMB is one of the important cardiac enzymes used to assess damage to the myocardium. Which systematic complications are associated with peripheral thrombolectomy? A. Vasospasm, bleeding, hematoma formation, compartment syndrome B. Renal failure, rhabdomyolysis, vasospasm, hemorrhage C. Edema, hyperkalemia, cardiac arrhythmia, renal failure, rhabdomyolysis D. Vasospasm, thrombus formation, artery dissection, compartment syndrome C Complications associated with peripheral thrombolectomy include thrombus formation, vessel vasospasm, bleeding, hematoma formation, artery dissection, compartment syndrome, venous thrombosis, edema, hyperkalemia, cardiac arrhythmia, renal failure, and rhabdomyolysis. A male smoker presents with pain in his extremities after exercise. He also complains of color changes in his digits when exposed to cold. Which of the following diseases needs to be ruled out before considering a diagnosis of Buerger's disease? A. Systemic lupus erythematosus, diabetes, hypercoagulable conditions, scleroderma B. Bleeding disorders, dyslipidemia, systemic lupus erythematosus C. Bleeding disorders, diabetes, hypertension, vasculitis D. Hypercoagulable states, disorders of lipid metabolism, polyarteritis nodosa A Blood tests are used as screening tools to aid in the diagnosis of Buerger's disease. Tests are done to rule out scleroderma, lupus, diabetes, and other bleeding conditions. Allen test is used to assess blood flow to the hands and feet. Angiography, ultrasound, and echocardiography can be used to assess vascular flow. An obese 70-year-old man with a history of atrial fibrillation is recovering from open-heart surgery for aortic valve replacement. To decrease the risk of developing postoperative atrial fibrillation, which of the following medications is most commonly administered for prophylaxis? A. Metoprolol or atenolol B. Amiodarone C. Sotalol D. Magnesium sulfate A Low-dose beta-blockers, such as metoprolol (25-50 mg twice daily) or atenolol (25 mg daily), are the most common drugs to prevent atrial fibrillation (Afib), decreasing the incidence of Afib by up to 65%. Atrial flutter ( 380 bpm) and Afib ( 380 bpm) occur in up to 30% of patients with open heart surgery. Risk factors include obesity, chronic obstructive pulmonary disease, valve surgery, and a history of Afib. Amiodarone is sometimes given alone or with beta-blockers. Sotalol is an effective negative inotrope but has a number adverse effects. Magnesium sulfate is most effective if administered with beta-blockers and with low serum magnesium levels When emergent chest reopening and internal defibrillation are necessary in the intensive care unit (ICU), the primary responsibility of the sterile cardiac ICU nurse is A. removing dressings and Steri-strips. B. preparing medications and gathering equipment. C. ensuring strict sterile technique. D. preparing the defibrillator machine C When the intensive care unit is used as an operating room, a sterile nurse must ensure that strict sterile technique is followed. A nonsterile nurse may remove the dressing and Steri-strips, but the scrub (usually with povidone iodine poured over the chest) should be done by the sterile nurse. The paddles for the internal defibrillator are maintained in sterile coverings, but the machine is not. During the procedure, one nurse should be responsible for recording details of the procedure, another for administration of medications and fluids, and another (circulator) to get necessary equipment or prepare medications while the sterile nurse assists with sterile procedures. Patients with nasogastric tubes inserted during surgery for gastric decompression should receive which of the following medications by instillation during the first 12-24 hours? A. H2-blocker (ranitidine) B. Proton-pump inhibitor (omeprazole) C. Promotility agent (metoclopramide) D. Antiulcer drug (sucralfate) D Antiulcer drugs, such as sucralfate, should be instilled into nasogastric or orogastric tubes in the first 12-24 hours to reduce the incidence of stress ulcers. Other drugs, such as H2-blockers and proton-pump inhibitors, increase gastric pH and should be avoided; however, if patients are very high risk, a proton-pump inhibitor may be given in conjunction with sucralfate. Metoclopramide is sometimes used to reduce nausea and vomiting when an nasogastric tube is inserted into a patient who is awake. A postoperative patient is evaluated for extubation in the intensive care unit. Which of the following findings regarding respiratory mechanics meets extubation criteria? A. Vital capacity: 8 mL/kg B. Negative inspiratory force: 23 cm H2O C. Spontaneous respiratory rate: 28 breaths/min D. Tidal volume: 6 mL/kg. D A tidal volume of 6 mL/kg meets extubation criteria in the initial postoperative period. Extubation should be done after the patient meets weaning criteria. Extubation can be done from continuous positive airway pressure (CPAP) or T-piece. Criteria include awake state without stimulation and acceptable respiratory mechanics and blood gases (on ??5 cm CPAP or partial specific volume): Tidal volume: more than 5 mL/kg Negative inspiratory force: more than 25 cm H2O. Vital capacity: more than 10-15 mL/kg Respirations (spontaneous): less than 25 breaths/min Partial pressure of oxygen in arterial blood: more than 70 torr (on fraction of inspired oxygen = 0.5) Partial pressure of carbon dioxide: less than 48 torr pH: 7.3297.45 Postoperative administration of aspirin after coronary artery bypass grafting surgery is specifically indicated to prevent occlusion of A. internal thoracic artery grafts. B. gastroepiploic artery grafts. C. saphenous vein grafts. D. radial artery grafts. C Postoperative administration of aspirin is indicated to prevent occlusion of saphenous vein grafts. Aspirin has not been shown to improve patency of arterial grafts. Postoperative aspirin (75- 100 mg) should be administered within 24 hours after surgery, usually starting at 6 hours. Although the beneficial effects of aspirin on patency are not evident after a year, ongoing use of aspirin in recommended for all graft recipients to prevent further coronary artery disease. Two hours following a CABG procedure of 5 vessels the patient suddenly dumps 750 mL into the chest tube reservoir. The most likely cause is A. heparin rebound. B. sternal wire breakage. C. thrombocytopenia. D. bleeding at the anastomosis. D A patient undergoes an emergency CABG for failed percutaneous coronary intervention. The patient has received PRBC and a 250 mL fluid bolus. Telemetry - SR with no ectopy, HR 88, BP 92/54, MAP 67, CO 3.5, CI 1.8, SVR 1200, PAD 22. The nurse should A. administer more fluids. B. infuse inotropes. C. anticipate IABP placement. D. begin ventricular pacing. B Which of the following would most likely be a contributing factor to the development of regurgitation of the tricuspid valve? A. drinking alcohol B. injecting heroin C. snorting cocaine D. smoking marijuana B The patient returns from the OR following a 3 vessel CABG. The patient is receiving epinepherine 1.2 mcg/kg/min and dobutamine 5 mcg/kg/min. The patient is in sinus rhythm. HR 88, BP 92/54, CO 4.1, CI 2.0, The nurse should respond first by: A. increasing the vasopressor B. increasing the inotrope C. administering a crystalloid fluid bolus D. administering albumin A On postoperative day 1 the nurse notes a significantly low serum sodium level. The nurse would anticipate that the A. CVP is high and the PAOP is normal. B. CVP is low and the PAOP is high. C. CVP is high and the PAOP is high. D. CVP is normal and the PAOP is low. C A postoperative CABG patient is taken to the ICU. Four hours postoperatively, the patient is noted to be restless, short of breath and has developed jugular vein distention. Vital signs are as follows: BP 80/45 HR 125 RR 30 CVP 16 The patient's chest tube output has been minimal during the last hour. These symptoms would most likely be indicative of which of the following? A. cardiac tamponade B. pulmonary contusion C. cardiogenic shock D. fluid volume overload A The most important therapy ordered for a postoperative CABG patient who has received an arterial graft as an alternative conduit is the use of A. beta-blockers to prevent tachycardia. B. calcium channel-blockers to prevent artery spasm. C. anticoagulants to prevent thrombus formation. D. phenylephrine (Neosynephrine) to maintain MAP greater than 75. B A patient with newly diagnosed aortic regurgitation will have which of the following? a. Increased pulmonary artery occlusive pressure b. Decreased sympathetic tone c. Decreased cardiac output d. Widening pulse pressure D Which type of prosthetic valve requires long-term anticoagulation therapy? a. Mechanical b. Biologic c. Bovine d. Porcine A Patients who are postoperative aortic regurgitation repair may require administration of which of the following? A. Dopamine B. Neosynephrine C. Milrinone D. Judicious intravenous fluids C The primary symptom of mitral stenosis is a. chest pain. b. hypertension. c. exertional dyspnea. d. syncope. C Patients with mitral stenosis will likely present with which of the following signs? a. Decreased ejection fraction b. Elevated left ventricular end-diastolic pressure c. Elevated pulmonary artery pressure d. Decreased left atrial pressure C The nurse caring for a patient immediately following surgical repair of mitral stenosis should observe for which of the following? a. Elevated central venous pressure b. Pulmonary hypertension c. Decreased pulmonary vascular resistance d. Increased cardiac output A The nurse caring for a patient immediately following surgical repair of mitral regurgitation should observe for which of the following? a. Increased left atrial pressure b. Increased systemic vascular resistance c. Decreased pulmonary artery systolic pressure d. Decreased ejection fraction B An open surgical procedure that repairs the valve by suturing the torn leaflets, chordae tendinae, or papillary muscles is called a. angioplasty. b. valve replacement. c. valvuloplasty. d. coronary artery bypass grafting (CABG). C Your patient requires mitral valve replacement and is contemplating which type of valve to select. a. "If you receive a mechanical valve, it will not last as long as a biologic valve." b. "If you receive a mechanical valve, you will need to take a blood thinner over the long term." c. "You should probably also consider valve repair, as many surgeons have been interested in that procedure." d. "Both types of valves are equally good, because the papillary muscles and annulus are retained when either valve is used." B Which of the following acute valve disorders is most likely to constitute a medical emergency? a. Mitral valve prolapse b. Aortic valve stenosis c. Aortic valve regurgitation d. Mitral valve stenosis C Which of the following is not an advantage of MICS over traditional CABG? a. Shorter operative time b. Breastbone not retracted c. Less blood loss d. Better cosmetic results A A patient who has undergone a MIDCAB procedure asks you when he should be able to return to work. Which of the following time frames should you give him? a. 4-5 days after discharge from hospital b. 2 weeks c. 2-3 months d. 6-10 months B Which of the following statements is true regarding minimally invasive valve surgery? a. It doesn't require being placed on a bypass machine. b. There is a decreased chance of infection. c. Patients who are obese may be good candidates for this approach. d. It is the ideal approach for patients with multiple forms of valve disease. B An advantage of robotic surgery over other forms of MICS may include: a. experience is not as essential since the surgeon is not actively doing the procedure b. there is a decreased chance of blood loss c. cosmetic results d. lower risk of infection D Which of the following statements is true regarding MICS procedures? a. No bone cartilage is removed. b. The ascending aorta is manipulated. c. Use of a cardiac stabilizer is required. d. The heart temporarily loses pericardial support. C Valve procedures require cardiopulmonary bypass because a. of the anatomic location involved. b. of surgeon preference. c. there is less risk of postoperative bleeding. d. comorbidities associated with valve disease. A Which of the following is a potential manifestation of a patient experiencing postoperative shivering following MICS? a. Increased SvO2 b. Decreased CVP c. Increased pCO2 d. Decreased sympathetic stimulation C One advantage associated with endovascular "keyhole" procedures is a. increased accuracy of depth perception. b. less experience is required because the procedure is less invasive. c. increased degree of motion of the surgeon's hands. d. enhanced visibility D Which of the following patients is a good candidate for MICS? a. Male, age 80, 70% circumflex occlusion, inpatient, cardiogenic shock b. Female, age 50, morbid obesity, day 2 s/p inferior lateral MI, IABP c. Male, age 63, mitral valve regurgitation, EF 60%, plays golf 3 times a week d. Female, age 40, s/p bilateral mastectomy, 3-vessel CAD C A benefit of the Cox/Maze III procedure for atrial fibrillation is a. this procedure uses ablation so return of AF is unlikely. b. this procedure does not require the patient to go on cardiopulmonary bypass. c. incisions are made on both atria to stop irregular electrical activity. d. no sternotomy incision is required. C Off-pump bypass has been associated with reduced rates for which of the following complications? a. Renal failure, sepsis, and death b. Liver failure, bleeding, and decreased cognitive function c. Stroke, infection, and atrial fibrillation d. SIRS, renal failure, and microemboli formation C Patients with which of the following characteristics are more likely to have a protamine reaction? a. Allergy to fish b. Renal failure, on dialysis c. Type II diabetes, taking Glucophage d. Bleeding disorder A Contraindications to radial artery graft harvest include which of the following? CONTINUED...