AACN CSC REVIEW SESSION 5-8 TEST WITH CORRECT ANSWERS GRADE A CERTIFIED 2025/26

stroke - correct answercommon first presentation of PFO SOB; fainting; irregular heart rhythms; fatigue w/ mild activity; flow predominantly L-to-R but abt 15% of pts can have a paradoxical shunt - correct answers/s ASD TEE w/ bubble study; watching passage of bubbles from RA to LA - correct answerdx of PFO 10 years - correct answer75% of congenital VSDs close by _____ years of age ASD - correct answermost common congenital defect repaired in adults 5.5 cm - correct answerwhen is surgery recommended on an ascending aortic aneurysm? 6.5 cm - correct answerwhen is surgery recommended on a descending aortic aneurysm? aortic root dilation and functional AI - correct answeraortic root aneurysms commonly cause what 2 issues? incidentally via xray or echo - correct answerhow are aortic aneurysms commonly found? cool pts to lower temp than with other surgeries, and even stop the CPB machine during the surgery. mortality 5-10% - correct answerhow is CPB use for ascending aortic aneurysm repair different from other cardiac surgeries? LBBB - correct answerif a new, persistent __________________ block is present after cardiac surgery, it is indicative of a perioperative MI. especially after AVR 24 hours - correct answerheart blocks generally revolve _______ hours post-op atrial flutter w/ 2:1 conduction, or PSVT - correct answera tachycardia 130bpm after surgery is usually indicative of what arrhythmia? junctional tachycardia - correct answerhappens when junctional tissue has a faster intrinsic rate than the sinus node -generally at 70-130 bpm -loss of AV synchrony causes decreased CO -P-QRS relationship more evident in AEG. can see retrograde P waves atrial fib - correct answer-arrhythmia that occurs in 30-60% of postop pts and peaks at POD 2-3 -2 to 3 2-fold inc in post-op strokes -inc LOS up to 5 days increases - correct answeramiodarone (increases/decreases) defibrillation/cardioversion threshold. 24 hours - correct answerit's recommended by american college of cardiology (ACC) to anticoagulate a patient if they've been in afib for ____ hours VT or VF - correct answer25-50% of cardiac arrests following cardiac surgery are what rhythm? 1st shock: 75-78% 2nd: 35% 3rd: 14% 4th: 10% may have to reopen chest immediately if these are all unsuccessful. - correct answerchance of first and each subsequent defibrillation to be successful in cardiac surgery pts precordial leads V1-V4 - correct answerQT interval is usually the longest in what EKG leads? vfib - correct answermost common cause of cardiac arrest in cardiac surgery pts 4-6 hours; 24 hrs - correct answercardiac output typically declines about _______ hours after surgery and will normalize by _____ hours post-op progressive tachycardia and cool extremities - correct answersubtle finding of low cardiac output syndrome (LCOS) -poor peripheral perfusion with pale, cool extremities and diaphoresis -pulmonary congestion and poor oxygenation -impaired renal perfusion and oliguria -metabolic acidosis (i.e. lactate 5+) - correct answerLCOS clinical manifestations CVP - correct answerwhen a pt loses AV synchrony post-op resulting in loss of atrial kick, it's useful to look at the ______ waveform. increase - correct answerhypoxemia, hypercarbia, and acidemia (increase/decrease) RV afterload and PVR. pulsus paradoxus - correct answerSBP goes up by 10 mmHg with inspiration, drops by 10 mmHg w/ expiration hypotension (usually narrowed pulse pressure), JVD, muffled heart sounds - correct answerBeck's triad of cardiac tamponade CVP = PAD = PCWP b/c pressures are outside the heart in the pericardial space (high pressures, but we really have a hypovolemic heart) - correct answerequalization of intracardiac pressures w/ tamponade PVR - correct answerright ventricular afterload 20-50 joules - correct answerwhen using internal defib paddles directly on the heart in an open chest, how many joules do you deliver? right thoracotomy if full sternotomy needed and equipment not available, may need to return to OR - correct answereasiest way to open chest immediately in a minimally invasive post-op pt can cause a fire - correct answerwhy do you avoid defibrillating a pt on top of the ioban open chest dressing? 2-4 days; after negative fluid balance of several liters achieved - correct answersternal closure in an open chest pt is usually possible when? 30% - correct answerabout ____% of post-op pts require blood transfusions 4 days - correct answerwarfarin needs be stopped ____ days pre-op 5-7 days - correct answerplavix needs to be stopped ______ days pre-op 4 hours before - correct answershort-acting platelet inhibitors i.e. tirofiban (aggrastat) and ebtifibatide (integrilin) need to be stopped how long before surgery? 12-24 hours before - correct answerthe long-acting plt inhibitor abciximab (ReoPro) needs to be stopped how long before surgery? platelets - correct answer______ given within 6 hours of stopping plavix in an emergency surgery may be ineffective heparin rebound - correct answerhappens when heparin and protamine are metabolized at different rates; more likely to happen in pts who got heparin gtts pre-op or have a lot of adipose tissue fibrinolysis - destruction of the clot - correct answerlast step in the coagulation process to resolve bleeding intrinsic clotting cascade - correct answerclotting cascade activated when blood comes in contact w/ a foreign body, i.e. the CPB circuit extrinsic cascade - correct answerclotting cascade activated by tissue trauma intrinsic cascade - correct answerXII -- XI -- IX -- VIII -- X -- V -- II -- I PTT or aPTT - time