CSC Cardiac Surgery Exam | Comprehensive
Questions and Correct Answers
Question 1
What does the right coronary artery (RCA) perfuse?
Correct Answer
-Inferior Wall
-Right Atrium
-AV Node
-Right Ventricle
-Posterior portion of the septum
-Posterior wall (in 90% of population)
Page 1 of 326
,Question 2
What is a normal CVP?
Correct Answer
2-6 mmHg
Question 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
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)
Correct Answer
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.
Page 2 of 326
,Question 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
d. Did not restart administration of the angiotensinconverting enzyme (ACE)
inhibitor (taken preoperatively)
Correct Answer
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.
Page 3 of 326
, Question 3
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
Correct Answer
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.
Page 4 of 326
Questions and Correct Answers
Question 1
What does the right coronary artery (RCA) perfuse?
Correct Answer
-Inferior Wall
-Right Atrium
-AV Node
-Right Ventricle
-Posterior portion of the septum
-Posterior wall (in 90% of population)
Page 1 of 326
,Question 2
What is a normal CVP?
Correct Answer
2-6 mmHg
Question 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
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)
Correct Answer
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.
Page 2 of 326
,Question 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
d. Did not restart administration of the angiotensinconverting enzyme (ACE)
inhibitor (taken preoperatively)
Correct Answer
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.
Page 3 of 326
, Question 3
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
Correct Answer
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.
Page 4 of 326
