CSC Study Questions with Answers
100% Solved
FollowingMsurgicalMrepairMofMaMthoracicManeurysmMwithManMendoluminalMgraft,MtheMpa
tientMisMunableMtoMmoveMhisMlowerMextremities.MTheMnurseMshouldMfirst
a.MActivateMstrokeMteamMandMprepareMtoMdoManMurgentM(STAT)McomputedMtomograph
yM(CT)Mscan
b.MPrepareMtoMreturnMtoMsurgeryMforMexplorationMofMfemoralMarteryMocclusion
c.MCallMsurgeonMtoMobtainMaMneurologyMconsultationMinMtheMmorning
d.MPrepareMforMlumbarMdrainMinsertionMtoMremoveMcerebrospinalMfluidM(CSF)M-
MAnswerMD
SpinalMcordMischemiaMisMaMcomplicationMfromMthoracicManeurysmMrepairMforMbothMope
nMandMendoluminalMrepair.MSpinalMcordMischemiaMresultsMfromMincreasedMcerebralMspin
alMpressureMthatMcompressesMtheMspinalMnerves.MUntreatedMspinalMcordMischemiaMcan
MleadMtoMparaplegia.MItMisMimportantMtoMrecognizeMtheMsignsMofMspinalMcordMischemi
aM(lossMofMlowerMextremityMmovement)Mpromptly.MImmediateMinsertionMofMaMspinalMdr
ainMcanMreverseMtheMspinalMcordMischemiaMandMpreventMparaplegia.MBilateralMlegMparal
ysisMisMnotMtypicallyManMinitialMsymptomMofMstrokeM(A).MSignsMofMfemoralMarteryMoccl
usionM(B)MareMtheM5MPs:Mpulselessness,Mpallor,Mpain,Mparesthesias,MandMparalysis.MThes
eMsymptomsMwouldMbeMunilateral,MnotMbilateral.MImmediateMinsertionMofMaMspinalMdrai
nMisMneeded;MwaitingMuntilMmorningMforMtheMconsultationM(C)MwouldMbeMinappropriate
.
AMpostoperativeMpatientMwhoMhadMundergoneMcoronaryMarteryMbypassMgraftMandMventr
icularManeurysmMrepairMhasMaM15-
beatMrunMofMventricularMtachycardia.MTheMmostMlikelyMcauseMofMtheMdysrhythmiaMis
a.MIrritabilityMofMtheMventricleMfromMtheManeurysmMrepair
b.MSpasmMofMtheMrightMcoronaryMarteryMgraft
c.MPotassiumM4.8MmEq/dLMandMmagnesiumM2.1MmEq/L
,d.MDidMnotMrestartMadministrationMofMtheMangiotensinconvertingMenzymeM(ACE)Minhibitor
M(takenMpreoperatively)M-MAnswerMA
PatientsMwithMleftMventricularManeurysmMtypicallyMhaveMdepressedMleftMventricularM(LV)
Mfunction.MDepressedMLVMfunctionMmayMleadMtoMincreasedMventricularMarrhythmias.MLV
ManeurysmMrepairMisMindicatedMtoMimproveMsymptomsMofMangina,MheartMfailure,Msyste
micMthromboembolism,MorMmalignantMarrhythmias.MInMtheMimmediateMpostoperativeMpha
se,MtheMrepairedMventricleMcontinuesMtoMbeMdepressedMandMhasMtheMaddedMtraumaMo
fMsurgeryMonMtheMleftMventricle.MBothMofMtheseMincreaseMtheMirritabilityMofMtheMLV,M
leadingMtoMventricularMarrhythmias.MSpasmM(B)MorMocclusionMofMtheMRCAMleadsMtoMbr
adyarrhythmias,MnotMventricularMarrhythmias.MTheMpotassiumMandMmagnesiumMlevelsMin
M(C)MareMnormal.MLowMpotassiumMandMmagnesiumMlevelsMincreaseMtheMriskMforMventri
cularMarrhythmias.MACEMinhibitorsM(D)MdoMnotMhaveManyMantiarrhythmicMeffect.
TheMnurseMadmitsMaMpatientMafterMaorticMvalveMreplacementMandMnotesMtheMfollowing
MsettingsMofMtheMtemporaryMpacemaker:MDDDMrate,M80/min;MatrialMMA,M10;Mventricula
rMMA,M4.MTheMunderlyingMrhythmMisMcompleteMheartMblockMwithMventricularMescapeMr
hythmMrateM30/min.MTheMmostMlikelyMcauseMofMtheMcompleteMheartMblockMis
a.MSpasmMofMtheMrightMcoronaryMarteryM(RCA)Mgraft
b.MDamageMofMtheMatrioventricularM(AV)MnodeMduringMrepairMofMtheMaorticMvalve
c.MLowMpotassiumMandMmagnesiumMlevels
d.MToxicMeffectsMofMβ-blockerM-MAnswerMB
TheMAVMnodeMandMtheMbundleMofMHisMareMnearMtheMaorticMvalve.MDuringMaorticMval
veMreplacement,Mhemorrhage,Medema,Msuturing,MorMdebridementMnearMtheMAVMnodeMa
ndMtheMbundleMofMHisMmayMcauseMheartMblocks.MTypicallyMtheMepicardialMpacingMisMo
nlyMneededMforMaMfewMdaysMuntilMtheMedemaMresolves.MIfMcompleteMheartMblockMper
sistsMafterMaMfewMdays,MaMpermanentMpacemakerMmayMbeMrequired.MTheMRCAMsupplie
sMoxygenMtoMtheMsinoatrialM(SA)MandMAVMnodesMandMspasmMofMtheMRCAMgraftM(A)M
mayMcauseMbradycardiaMand/orMheartMblocks.MThisMpatientMdidMnotMhaveMbypassMsurg
ery,MsoMRCAMspasmMwouldMnotMbeMaMpostoperativeMcomplication.MLowMpotassiumMand
MmagnesiumMlevelsM(C)MincreaseMtheMriskMforMventricularMarrhythmias,MnotMAVMconduc
tionMdefects.MIfMtoxicMeffectsMofMβ-
blockersM(D)MwereMpresent,MtheMcompleteMheartMblockMwouldMhaveMbeenMtheMunderly
ingMrhythmMpreoperatively.
AMpostoperativeMcoronaryMarteryMbypassMgraftMandMaorticMvalveMreplacementMpatientM
hasMbeenMinMaMnormalMsinusMrhythmMforM4Mhours.MTheMmonitorMisMnowMshowingMP
MwavesMatMaMrateMofM73MbeatsMperMminuteMwithMnoMventricularMresponse.MTheMbes
tMactionMwouldMbeMto
a.MAdministerMatropineM0.5MmgMintravenousMbolusM(IVMpush)
,b.MConnectMtranscutaneousMpacingMpadsMtoMpatient
c.MConnectMepicardialMpacingMwiresMtoMaMtemporaryMpacemaker
d.MAdministerMepinephrineM1MmgMIVMpushMandMstartMepinephrineMinfusionM-
MAnswerMC
TheMAVMnodeMandMtheMbundleMofMHisMareMnearMtheMaorticMvalve.MDuringMaorticMval
veMreplacement,Mhemorrhage,Medema,Msuturing,MorMdebridementMnearMtheMAVMnodeMa
ndMtheMbundleMofMHisMmayMcauseMheartMblocks.MPacingMisMneededMtoMtreatMtheMco
nductionMdefectMcausedMbyMtheMsurgery.MAtropineM(A)MandMepinephrineM(D)MwillMnotM
workMbecauseMtheMconductionMproblemMisMwithMtheMAVMnodeMand/orMtheMbundleMof
MHis.MTranscutaneousM(external)MpacingM(B)MwouldMbeMtheMnextMbestMoptionMifMepicar
dialMwiresMwereMnotMpresent.MTheMheartMrateMshouldMbeMgreaterMthanM45/minMandM
lessMthanM80/min.
OneMhourMafterMextubation,MaMdiabeticMcoronaryMarteryMbypassMsurgeryMpatientMisMbe
comingMslightlyMlethargic.MArterialMbloodMgasM(ABG)ManalysisMyieldedMtheMfollowingMres
ults:MpH,M7.33;MPaO2,M80MmmMHg;MPaCO2,M50MmmMHg;MSaO2,M95%;MHCO3,M28MmE
q/L;MbaseMexcess,M0.5.MTheMnurseMshouldMfirst
a.MObtainMaMbloodMglucoseMlevel
b.MObtainMaM12-leadMECG
c.MTreatMmetabolicMacidosis
d.MStimulateMpatientMtoMbreatheM-MAnswerMD
AfterMextubation,McardiacMsurgeryMpatientsMshouldMbeMassessedMforMadequateMventilatio
n.MPainMmedications,Matelectasis,MandMimmobilityMmayMleadMtoMhypoventilation.MHypove
ntilationMisMaMcauseMofMrespiratoryMacidosis.MHighMcarbonMdioxideMlevelsMcauseMletharg
y.MTheMpatientMisMinMtheMearlyMphaseMofMrespiratoryMacidosis.MStimulationMandMencou
ragementMofMincentiveMspirometryMshouldMpreventMfurtherMhypoventilationMandMreintuba
tion.MA,MB,MandMCMareMactionsMorMinterventionsMforMmetabolicMacidosis.
OneMhourMafterMsurgery,MaMcoronaryMarteryMbypassMgraftM(CABG)MpatientMstartsMtoMw
akeMupMandMtheMmixedMvenousMoxygenMsaturationM(MSvO2)MdecreasesMfromM60%Mto
M45%.MTheMchangeMisMmostMlikelyMtheMresultMofMwhichMofMtheMfollowing?
, A.MIncreaseMinMoxygenMconsumption
B.MIncreaseMinMhemoglobin
C.MIncreaseMinMcardiacMoutput
D.MIncreaseMinMarterialMsaturationM-MAnswerMA
SvO2MrepresentsMtheMoxygenationMatMtheMtissueMlevel.MTheMvalueMreflectsMtheMtissue
MoxygenMdeliveryMandMconsumption.MFourMfactorsMinfluenceMSvO2M:Mhemoglobin,Mcardia
cMoutput,MarterialMsaturation,MandMoxygenMconsumption.MAnMincreaseMinMoxygenMconsu
mptionMwillMextractMmoreMoxygenMatMtheMtissueMlevelMandMdecreaseMtheMSvO2.MOxyg
enMconsumptionMcouldMbeMincreasedMbyMpain,Mshivering,MorMexercise.MAMdecreaseMinM
oxygenMconsumptionMwillMprovideMmoreMoxygenMtoMtheMtissueMlevelMandMincreaseMthe
MSvO2M.MOxygenMconsumptionMmightMbeMreducedMbyMhypothermiaMorManesthesia.
InMadditionMtoMaMdecreasingMBP,MwhichMofMtheMfollowingMassessmentMfindingsMisMcon
sistentMwithMcardiacMtamponade?
A.MUrineMoutputMofM42MtoM50MmL/h
B.MCentralMvenousMpressureM(CVP)MofM11MtoM20MmmMHg
C.MCardiacMoutputM4.0MtoM5.1ML/min
D.MSvO2M58%MtoM65%M-MAnswerMB
TheMaccumulationMofMfluidMaroundMtheMheartMcompressesMtheMatria,McausingMelevated
MrightMatrialMfillingMpressures.MTheMdecreasedMcardiacMoutputMleadsMtoMhypoperfusionM
ofMtheMkidney,MresultingMinMaMsuddenMdecreaseMinMurineMoutputMorMoliguria.MTheMco
mpressionMofMtheMatriaMconstrictsMvenousMreturnMtoMtheMheart,MleadingMtoMaMdecreas
edMcardiacMoutput.MTheMdecreasedMcardiacMoutputMandMlowMhemoglobinMlevelMdueMto
MtheMbleedingMleadMtoMdecreasedMSvO2M.
AfterMCABG,MaMpatientMweighingM70MkgMandMreceivingMmechanicalMventilationMhasMord
ersMtoMbeMweanedMandMextubatedMwhenMstable.MWhichMparameterMindicatesMtheMpati
entMisMreadyMtoMextubate?
A.MRRM28/min
B.MVitalMcapacityM(VC)M500MmL
100% Solved
FollowingMsurgicalMrepairMofMaMthoracicManeurysmMwithManMendoluminalMgraft,MtheMpa
tientMisMunableMtoMmoveMhisMlowerMextremities.MTheMnurseMshouldMfirst
a.MActivateMstrokeMteamMandMprepareMtoMdoManMurgentM(STAT)McomputedMtomograph
yM(CT)Mscan
b.MPrepareMtoMreturnMtoMsurgeryMforMexplorationMofMfemoralMarteryMocclusion
c.MCallMsurgeonMtoMobtainMaMneurologyMconsultationMinMtheMmorning
d.MPrepareMforMlumbarMdrainMinsertionMtoMremoveMcerebrospinalMfluidM(CSF)M-
MAnswerMD
SpinalMcordMischemiaMisMaMcomplicationMfromMthoracicManeurysmMrepairMforMbothMope
nMandMendoluminalMrepair.MSpinalMcordMischemiaMresultsMfromMincreasedMcerebralMspin
alMpressureMthatMcompressesMtheMspinalMnerves.MUntreatedMspinalMcordMischemiaMcan
MleadMtoMparaplegia.MItMisMimportantMtoMrecognizeMtheMsignsMofMspinalMcordMischemi
aM(lossMofMlowerMextremityMmovement)Mpromptly.MImmediateMinsertionMofMaMspinalMdr
ainMcanMreverseMtheMspinalMcordMischemiaMandMpreventMparaplegia.MBilateralMlegMparal
ysisMisMnotMtypicallyManMinitialMsymptomMofMstrokeM(A).MSignsMofMfemoralMarteryMoccl
usionM(B)MareMtheM5MPs:Mpulselessness,Mpallor,Mpain,Mparesthesias,MandMparalysis.MThes
eMsymptomsMwouldMbeMunilateral,MnotMbilateral.MImmediateMinsertionMofMaMspinalMdrai
nMisMneeded;MwaitingMuntilMmorningMforMtheMconsultationM(C)MwouldMbeMinappropriate
.
AMpostoperativeMpatientMwhoMhadMundergoneMcoronaryMarteryMbypassMgraftMandMventr
icularManeurysmMrepairMhasMaM15-
beatMrunMofMventricularMtachycardia.MTheMmostMlikelyMcauseMofMtheMdysrhythmiaMis
a.MIrritabilityMofMtheMventricleMfromMtheManeurysmMrepair
b.MSpasmMofMtheMrightMcoronaryMarteryMgraft
c.MPotassiumM4.8MmEq/dLMandMmagnesiumM2.1MmEq/L
,d.MDidMnotMrestartMadministrationMofMtheMangiotensinconvertingMenzymeM(ACE)Minhibitor
M(takenMpreoperatively)M-MAnswerMA
PatientsMwithMleftMventricularManeurysmMtypicallyMhaveMdepressedMleftMventricularM(LV)
Mfunction.MDepressedMLVMfunctionMmayMleadMtoMincreasedMventricularMarrhythmias.MLV
ManeurysmMrepairMisMindicatedMtoMimproveMsymptomsMofMangina,MheartMfailure,Msyste
micMthromboembolism,MorMmalignantMarrhythmias.MInMtheMimmediateMpostoperativeMpha
se,MtheMrepairedMventricleMcontinuesMtoMbeMdepressedMandMhasMtheMaddedMtraumaMo
fMsurgeryMonMtheMleftMventricle.MBothMofMtheseMincreaseMtheMirritabilityMofMtheMLV,M
leadingMtoMventricularMarrhythmias.MSpasmM(B)MorMocclusionMofMtheMRCAMleadsMtoMbr
adyarrhythmias,MnotMventricularMarrhythmias.MTheMpotassiumMandMmagnesiumMlevelsMin
M(C)MareMnormal.MLowMpotassiumMandMmagnesiumMlevelsMincreaseMtheMriskMforMventri
cularMarrhythmias.MACEMinhibitorsM(D)MdoMnotMhaveManyMantiarrhythmicMeffect.
TheMnurseMadmitsMaMpatientMafterMaorticMvalveMreplacementMandMnotesMtheMfollowing
MsettingsMofMtheMtemporaryMpacemaker:MDDDMrate,M80/min;MatrialMMA,M10;Mventricula
rMMA,M4.MTheMunderlyingMrhythmMisMcompleteMheartMblockMwithMventricularMescapeMr
hythmMrateM30/min.MTheMmostMlikelyMcauseMofMtheMcompleteMheartMblockMis
a.MSpasmMofMtheMrightMcoronaryMarteryM(RCA)Mgraft
b.MDamageMofMtheMatrioventricularM(AV)MnodeMduringMrepairMofMtheMaorticMvalve
c.MLowMpotassiumMandMmagnesiumMlevels
d.MToxicMeffectsMofMβ-blockerM-MAnswerMB
TheMAVMnodeMandMtheMbundleMofMHisMareMnearMtheMaorticMvalve.MDuringMaorticMval
veMreplacement,Mhemorrhage,Medema,Msuturing,MorMdebridementMnearMtheMAVMnodeMa
ndMtheMbundleMofMHisMmayMcauseMheartMblocks.MTypicallyMtheMepicardialMpacingMisMo
nlyMneededMforMaMfewMdaysMuntilMtheMedemaMresolves.MIfMcompleteMheartMblockMper
sistsMafterMaMfewMdays,MaMpermanentMpacemakerMmayMbeMrequired.MTheMRCAMsupplie
sMoxygenMtoMtheMsinoatrialM(SA)MandMAVMnodesMandMspasmMofMtheMRCAMgraftM(A)M
mayMcauseMbradycardiaMand/orMheartMblocks.MThisMpatientMdidMnotMhaveMbypassMsurg
ery,MsoMRCAMspasmMwouldMnotMbeMaMpostoperativeMcomplication.MLowMpotassiumMand
MmagnesiumMlevelsM(C)MincreaseMtheMriskMforMventricularMarrhythmias,MnotMAVMconduc
tionMdefects.MIfMtoxicMeffectsMofMβ-
blockersM(D)MwereMpresent,MtheMcompleteMheartMblockMwouldMhaveMbeenMtheMunderly
ingMrhythmMpreoperatively.
AMpostoperativeMcoronaryMarteryMbypassMgraftMandMaorticMvalveMreplacementMpatientM
hasMbeenMinMaMnormalMsinusMrhythmMforM4Mhours.MTheMmonitorMisMnowMshowingMP
MwavesMatMaMrateMofM73MbeatsMperMminuteMwithMnoMventricularMresponse.MTheMbes
tMactionMwouldMbeMto
a.MAdministerMatropineM0.5MmgMintravenousMbolusM(IVMpush)
,b.MConnectMtranscutaneousMpacingMpadsMtoMpatient
c.MConnectMepicardialMpacingMwiresMtoMaMtemporaryMpacemaker
d.MAdministerMepinephrineM1MmgMIVMpushMandMstartMepinephrineMinfusionM-
MAnswerMC
TheMAVMnodeMandMtheMbundleMofMHisMareMnearMtheMaorticMvalve.MDuringMaorticMval
veMreplacement,Mhemorrhage,Medema,Msuturing,MorMdebridementMnearMtheMAVMnodeMa
ndMtheMbundleMofMHisMmayMcauseMheartMblocks.MPacingMisMneededMtoMtreatMtheMco
nductionMdefectMcausedMbyMtheMsurgery.MAtropineM(A)MandMepinephrineM(D)MwillMnotM
workMbecauseMtheMconductionMproblemMisMwithMtheMAVMnodeMand/orMtheMbundleMof
MHis.MTranscutaneousM(external)MpacingM(B)MwouldMbeMtheMnextMbestMoptionMifMepicar
dialMwiresMwereMnotMpresent.MTheMheartMrateMshouldMbeMgreaterMthanM45/minMandM
lessMthanM80/min.
OneMhourMafterMextubation,MaMdiabeticMcoronaryMarteryMbypassMsurgeryMpatientMisMbe
comingMslightlyMlethargic.MArterialMbloodMgasM(ABG)ManalysisMyieldedMtheMfollowingMres
ults:MpH,M7.33;MPaO2,M80MmmMHg;MPaCO2,M50MmmMHg;MSaO2,M95%;MHCO3,M28MmE
q/L;MbaseMexcess,M0.5.MTheMnurseMshouldMfirst
a.MObtainMaMbloodMglucoseMlevel
b.MObtainMaM12-leadMECG
c.MTreatMmetabolicMacidosis
d.MStimulateMpatientMtoMbreatheM-MAnswerMD
AfterMextubation,McardiacMsurgeryMpatientsMshouldMbeMassessedMforMadequateMventilatio
n.MPainMmedications,Matelectasis,MandMimmobilityMmayMleadMtoMhypoventilation.MHypove
ntilationMisMaMcauseMofMrespiratoryMacidosis.MHighMcarbonMdioxideMlevelsMcauseMletharg
y.MTheMpatientMisMinMtheMearlyMphaseMofMrespiratoryMacidosis.MStimulationMandMencou
ragementMofMincentiveMspirometryMshouldMpreventMfurtherMhypoventilationMandMreintuba
tion.MA,MB,MandMCMareMactionsMorMinterventionsMforMmetabolicMacidosis.
OneMhourMafterMsurgery,MaMcoronaryMarteryMbypassMgraftM(CABG)MpatientMstartsMtoMw
akeMupMandMtheMmixedMvenousMoxygenMsaturationM(MSvO2)MdecreasesMfromM60%Mto
M45%.MTheMchangeMisMmostMlikelyMtheMresultMofMwhichMofMtheMfollowing?
, A.MIncreaseMinMoxygenMconsumption
B.MIncreaseMinMhemoglobin
C.MIncreaseMinMcardiacMoutput
D.MIncreaseMinMarterialMsaturationM-MAnswerMA
SvO2MrepresentsMtheMoxygenationMatMtheMtissueMlevel.MTheMvalueMreflectsMtheMtissue
MoxygenMdeliveryMandMconsumption.MFourMfactorsMinfluenceMSvO2M:Mhemoglobin,Mcardia
cMoutput,MarterialMsaturation,MandMoxygenMconsumption.MAnMincreaseMinMoxygenMconsu
mptionMwillMextractMmoreMoxygenMatMtheMtissueMlevelMandMdecreaseMtheMSvO2.MOxyg
enMconsumptionMcouldMbeMincreasedMbyMpain,Mshivering,MorMexercise.MAMdecreaseMinM
oxygenMconsumptionMwillMprovideMmoreMoxygenMtoMtheMtissueMlevelMandMincreaseMthe
MSvO2M.MOxygenMconsumptionMmightMbeMreducedMbyMhypothermiaMorManesthesia.
InMadditionMtoMaMdecreasingMBP,MwhichMofMtheMfollowingMassessmentMfindingsMisMcon
sistentMwithMcardiacMtamponade?
A.MUrineMoutputMofM42MtoM50MmL/h
B.MCentralMvenousMpressureM(CVP)MofM11MtoM20MmmMHg
C.MCardiacMoutputM4.0MtoM5.1ML/min
D.MSvO2M58%MtoM65%M-MAnswerMB
TheMaccumulationMofMfluidMaroundMtheMheartMcompressesMtheMatria,McausingMelevated
MrightMatrialMfillingMpressures.MTheMdecreasedMcardiacMoutputMleadsMtoMhypoperfusionM
ofMtheMkidney,MresultingMinMaMsuddenMdecreaseMinMurineMoutputMorMoliguria.MTheMco
mpressionMofMtheMatriaMconstrictsMvenousMreturnMtoMtheMheart,MleadingMtoMaMdecreas
edMcardiacMoutput.MTheMdecreasedMcardiacMoutputMandMlowMhemoglobinMlevelMdueMto
MtheMbleedingMleadMtoMdecreasedMSvO2M.
AfterMCABG,MaMpatientMweighingM70MkgMandMreceivingMmechanicalMventilationMhasMord
ersMtoMbeMweanedMandMextubatedMwhenMstable.MWhichMparameterMindicatesMtheMpati
entMisMreadyMtoMextubate?
A.MRRM28/min
B.MVitalMcapacityM(VC)M500MmL
