NCLEX EXAM: CARDIOVASCULAR SURGERY CARE QUESTIONS AND ANSWERS WITH RSTIONALES 100% CORRECT.

1. Atherosclerosis impedes coronary blood flow by which of the following mechanisms? 1. Plaques obstruct the vein 2. Plaques obstruct the artery 3. Blood clots form outside the vessel wall 4. Hardened vessels dilate to allow blood to flow through Answer: 2. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in the artery. Hardened vessels can’t dilate properly and, therefore, constrict blood flow. 2. A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery 2 days ago. Which of the following surgical complications should the nurse suspect? 1. Left-sided heart failure 2. Aortic regurgitation 3. Complete heart block 4. Pericardial tamponade Answer: 4. A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat, with a regular rhythm). Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak). Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure). 3. After cardiac surgery, a client’s blood pressure measures 126/80. The nurse determines that the mean arterial pressure (MAP) is which of the following? 1. 46 mm Hg 2. 80 mm Hg 3. 95 mm Hg 4. 90 mm Hg Answer: 3. Check with Dani if you have issues with this problem. 4. A woman with severe mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The physician orders pulmonary artery pressure monitoring, including pulmonary capillary wedge pressures. The purpose of this is to help assess the: 1. Degree of coronary artery stenosis 2. Peripheral arterial pressure 3. Pressure from fluid within the left ventricle 4. Oxygen and carbon dioxide concentration is the blood Answer: 3. The pulmonary artery pressures are used to assess the heart’s ability to receive and pump blood. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client. The degree of coronary artery stenosis is assessed during a cardiac catherization. The peripheral arterial pressure is assessed with an arterial line. 5. For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery, which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion? 1. Ensure a liberal fluid intake 2. Provide an alkaline-ash diet 3. Prevent constipation 4. Enrich the client’s diet with dairy products Answer: 1. In an immobilized client, calcium leaves the bone and concentrates in the ECF fluid. When a large amount of calcium passes through the kidneys, calcium can precipitate and form calculi. Nursing interventions that help prevent calculi include ensuring a liberal fluid intake (unless contraindicated). A diet rich in acid should be provided to keep the urine acidic, which increases the solubility of calcium. Preventing constipation is not associated with excessive calcium excretion. Limiting foods rich in calcium, such as dairy products, will help on preventing renal calculi.