CSC STUDY QUESTIONS AND ANSWERS
1. 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 tomog-
raphy (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)
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, ANS >>> 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 ANS >>> 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.
2. 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
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, d. Did not restart administration of the angiotensinconverting enzyme (ACE)
inhibitor (taken preoperatively) ANS >>> 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
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, to ventricular arrhythmias. Spasm (B) or occlusion of the RCA leads to bradyarrhyth-
mias, 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.
3. The nurse admits a patient after aortic valve replacement and notes the
following settings of the temporary pacemaker ANS >>> 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 ²-blocker ANS >>> 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 ²b
- lockers (D) were present, the complete heart block would have
been the underlying rhythm preoperatively.
4. 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 ANS
>>> 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
https://www.stuvia.com/user/CULTIVATED
1. 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 tomog-
raphy (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)
https://www.stuvia.com/user/CULTIVATED
, ANS >>> 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 ANS >>> 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.
2. 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
https://www.stuvia.com/user/CULTIVATED
, d. Did not restart administration of the angiotensinconverting enzyme (ACE)
inhibitor (taken preoperatively) ANS >>> 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
https://www.stuvia.com/user/CULTIVATED
, to ventricular arrhythmias. Spasm (B) or occlusion of the RCA leads to bradyarrhyth-
mias, 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.
3. The nurse admits a patient after aortic valve replacement and notes the
following settings of the temporary pacemaker ANS >>> 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 ²-blocker ANS >>> 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 ²b
- lockers (D) were present, the complete heart block would have
been the underlying rhythm preoperatively.
4. 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 ANS
>>> 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
https://www.stuvia.com/user/CULTIVATED
