CSC STUDY QUESTIONS WITH
CORRECT ANSWERS
Following lsurgical lrepair lof la lthoracic laneurysm lwith lan lendoluminal lgraft, lthe lpatient
lis lunable lto lmove lhis llower lextremities. lThe lnurse lshould lfirst
a. lActivate lstroke lteam land lprepare lto ldo lan lurgent l(STAT) lcomputed ltomography
l(CT) lscan
b. lPrepare lto lreturn lto lsurgery lfor lexploration lof lfemoral lartery locclusion
c. lCall lsurgeon lto lobtain la lneurology lconsultation lin lthe lmorning
d. lPrepare lfor llumbar ldrain linsertion lto lremove lcerebrospinal lfluid l(CSF) l- lcorrect
lanswers l-D
Spinal lcord lischemia lis la lcomplication lfrom lthoracic laneurysm lrepair lfor lboth lopen
land lendoluminal lrepair. lSpinal lcord lischemia lresults lfrom lincreased lcerebral lspinal
,lpressure lthat lcompresses lthe lspinal lnerves. lUntreated lspinal lcord lischemia lcan llead
lto lparaplegia. lIt lis limportant lto lrecognize lthe lsigns lof lspinal lcord lischemia l(loss lof
llower lextremity lmovement) lpromptly. lImmediate linsertion lof la lspinal ldrain lcan
lreverse lthe lspinal lcord lischemia land lprevent lparaplegia. lBilateral lleg lparalysis lis lnot
ltypically lan linitial lsymptom lof lstroke l(A). lSigns lof lfemoral lartery locclusion l(B) lare
lthe l5 lPs: lpulselessness, lpallor, lpain, lparesthesias, land lparalysis. lThese lsymptoms
lwould lbe lunilateral, lnot lbilateral. lImmediate linsertion lof la lspinal ldrain lis lneeded;
lwaiting luntil lmorning lfor lthe lconsultation l(C) lwould lbe linappropriate.
A lpostoperative lpatient lwho lhad lundergone lcoronary lartery lbypass lgraft land
lventricular laneurysm lrepair lhas la l15-beat lrun lof lventricular ltachycardia. lThe lmost
llikely lcause lof lthe ldysrhythmia lis
a. lIrritability lof lthe lventricle lfrom lthe laneurysm lrepair
b. lSpasm lof lthe lright lcoronary lartery lgraft
c. lPotassium l4.8 lmEq/dL land lmagnesium l2.1 lmEq/L
d. lDid lnot lrestart ladministration lof lthe langiotensinconverting lenzyme l(ACE) linhibitor
l(taken lpreoperatively) l- lcorrect lanswers l-A
Patients lwith lleft lventricular laneurysm ltypically lhave ldepressed lleft lventricular l(LV)
lfunction. lDepressed lLV lfunction lmay llead lto lincreased lventricular larrhythmias. lLV
laneurysm lrepair lis lindicated lto limprove lsymptoms lof langina, lheart lfailure, lsystemic
lthromboembolism, lor lmalignant larrhythmias. lIn lthe limmediate lpostoperative lphase,
lthe lrepaired lventricle lcontinues lto lbe ldepressed land lhas lthe ladded ltrauma lof
lsurgery lon lthe lleft lventricle. lBoth lof lthese lincrease lthe lirritability lof lthe lLV, lleading
lto lventricular larrhythmias. lSpasm l(B) lor locclusion lof lthe lRCA lleads lto
lbradyarrhythmias, lnot lventricular larrhythmias. lThe lpotassium land lmagnesium llevels
lin l(C) lare lnormal. lLow lpotassium land lmagnesium llevels lincrease lthe lrisk lfor
lventricular larrhythmias. lACE linhibitors l(D) ldo lnot lhave lany lantiarrhythmic leffect.
The lnurse ladmits la lpatient lafter laortic lvalve lreplacement land lnotes lthe lfollowing
lsettings lof lthe ltemporary lpacemaker: lDDD lrate, l80/min; latrial lMA, l10; lventricular
lMA, l4. lThe lunderlying lrhythm lis lcomplete lheart lblock lwith lventricular lescape lrhythm
lrate l30/min. lThe lmost llikely lcause lof lthe lcomplete lheart lblock lis
a. lSpasm lof lthe lright lcoronary lartery l(RCA) lgraft
b. lDamage lof lthe latrioventricular l(AV) lnode lduring lrepair lof lthe laortic lvalve
c. lLow lpotassium land lmagnesium llevels
d. lToxic leffects lof lβ-blocker l- lcorrect lanswers l-B
The lAV lnode land lthe lbundle lof lHis lare lnear lthe laortic lvalve. lDuring laortic lvalve
lreplacement, lhemorrhage, ledema, lsuturing, lor ldebridement lnear lthe lAV lnode land
lthe lbundle lof lHis lmay lcause lheart lblocks. lTypically lthe lepicardial lpacing lis lonly
lneeded lfor la lfew ldays luntil lthe ledema lresolves. lIf lcomplete lheart lblock lpersists
lafter la lfew ldays, la lpermanent lpacemaker lmay lbe lrequired. lThe lRCA lsupplies
loxygen lto lthe lsinoatrial l(SA) land lAV lnodes land lspasm lof lthe lRCA lgraft l(A) lmay
,lcause lbradycardia land/or lheart lblocks. lThis lpatient ldid lnot lhave lbypass lsurgery, lso
lRCA lspasm lwould lnot lbe la lpostoperative lcomplication. lLow lpotassium land
lmagnesium llevels l(C) lincrease lthe lrisk lfor lventricular larrhythmias, lnot lAV lconduction
ldefects. lIf ltoxic leffects lof lβ-blockers l(D) lwere lpresent, lthe lcomplete lheart lblock
lwould lhave lbeen lthe lunderlying lrhythm lpreoperatively.
A lpostoperative lcoronary lartery lbypass lgraft land laortic lvalve lreplacement lpatient lhas
lbeen lin la lnormal lsinus lrhythm lfor l4 lhours. lThe lmonitor lis lnow lshowing lP lwaves lat
la lrate lof l73 lbeats lper lminute lwith lno lventricular lresponse. lThe lbest laction lwould lbe
lto
a. lAdminister latropine l0.5 lmg lintravenous lbolus l(IV lpush)
b. lConnect ltranscutaneous lpacing lpads lto lpatient
c. lConnect lepicardial lpacing lwires lto la ltemporary lpacemaker
d. lAdminister lepinephrine l1 lmg lIV lpush land lstart lepinephrine linfusion l- lcorrect
lanswers l-C
The lAV lnode land lthe lbundle lof lHis lare lnear lthe laortic lvalve. lDuring laortic lvalve
lreplacement, lhemorrhage, ledema, lsuturing, lor ldebridement lnear lthe lAV lnode land
lthe lbundle lof lHis lmay lcause lheart lblocks. lPacing lis lneeded lto ltreat lthe lconduction
ldefect lcaused lby lthe lsurgery. lAtropine l(A) land lepinephrine l(D) lwill lnot lwork
lbecause lthe lconduction lproblem lis lwith lthe lAV lnode land/or lthe lbundle lof lHis.
lTranscutaneous l(external) lpacing l(B) lwould lbe lthe lnext lbest loption lif lepicardial
lwires lwere lnot lpresent. lThe lheart lrate lshould lbe lgreater lthan l45/min land lless lthan
l80/min.
One lhour lafter lextubation, la ldiabetic lcoronary lartery lbypass lsurgery lpatient lis
lbecoming lslightly llethargic. lArterial lblood lgas l(ABG) lanalysis lyielded lthe lfollowing
lresults: lpH, l7.33; lPaO2, l80 lmm lHg; lPaCO2, l50 lmm lHg; lSaO2, l95%; lHCO3, l28
lmEq/L; lbase lexcess, l0.5. lThe lnurse lshould lfirst
a. lObtain la lblood lglucose llevel
b. lObtain la l12-lead lECG
c. lTreat lmetabolic lacidosis
d. lStimulate lpatient lto lbreathe l- lcorrect lanswers l-D
After lextubation, lcardiac lsurgery lpatients lshould lbe lassessed lfor ladequate
lventilation. lPain lmedications, latelectasis, land limmobility lmay llead lto lhypoventilation.
lHypoventilation lis la lcause lof lrespiratory lacidosis. lHigh lcarbon ldioxide llevels lcause
llethargy. lThe lpatient lis lin lthe learly lphase lof lrespiratory lacidosis. lStimulation land
lencouragement lof lincentive lspirometry lshould lprevent lfurther lhypoventilation land
lreintubation. lA, lB, land lC lare lactions lor linterventions lfor lmetabolic lacidosis.
, One lhour lafter lsurgery, la lcoronary lartery lbypass lgraft l(CABG) lpatient lstarts lto lwake
lup land lthe lmixed lvenous loxygen lsaturation l( lSvO2) ldecreases lfrom l60% lto l45%.
lThe lchange lis lmost llikely lthe lresult lof lwhich lof lthe lfollowing?
A. lIncrease lin loxygen lconsumption
B. lIncrease lin lhemoglobin
C. lIncrease lin lcardiac loutput
D. lIncrease lin larterial lsaturation l- lcorrect lanswers l-A
SvO2 lrepresents lthe loxygenation lat lthe ltissue llevel. lThe lvalue lreflects lthe ltissue
loxygen ldelivery land lconsumption. lFour lfactors linfluence lSvO2 l: lhemoglobin, lcardiac
loutput, larterial lsaturation, land loxygen lconsumption. lAn lincrease lin loxygen
lconsumption lwill lextract lmore loxygen lat lthe ltissue llevel land ldecrease lthe lSvO2.
lOxygen lconsumption lcould lbe lincreased lby lpain, lshivering, lor lexercise. lA ldecrease
lin loxygen lconsumption lwill lprovide lmore loxygen lto lthe ltissue llevel land lincrease lthe
lSvO2 l. lOxygen lconsumption lmight lbe lreduced lby lhypothermia lor lanesthesia.
In laddition lto la ldecreasing lBP, lwhich lof lthe lfollowing lassessment lfindings lis
lconsistent lwith lcardiac ltamponade?
A. lUrine loutput lof l42 lto l50 lmL/h
B. lCentral lvenous lpressure l(CVP) lof l11 lto l20 lmm lHg
C. lCardiac loutput l4.0 lto l5.1 lL/min
D. lSvO2 l58% lto l65% l- lcorrect lanswers l-B
The laccumulation lof lfluid laround lthe lheart lcompresses lthe latria, lcausing lelevated
lright latrial lfilling lpressures. lThe ldecreased lcardiac loutput lleads lto lhypoperfusion lof
lthe lkidney, lresulting lin la lsudden ldecrease lin lurine loutput lor loliguria. lThe
lcompression lof lthe latria lconstricts lvenous lreturn lto lthe lheart, lleading lto la
ldecreased lcardiac loutput. lThe ldecreased lcardiac loutput land llow lhemoglobin llevel
ldue lto lthe lbleeding llead lto ldecreased lSvO2 l.
After lCABG, la lpatient lweighing l70 lkg land lreceiving lmechanical lventilation lhas
lorders lto lbe lweaned land lextubated lwhen lstable. lWhich lparameter lindicates lthe
lpatient lis lready lto lextubate?
A. lRR l28/min
B. lVital lcapacity l(VC) l500 lmL
C. lAble lto lsustain la lhead llift lfor lat lleast l5 lseconds
D. lMinute lvolume l12 lL l- lcorrect lanswers l-C
Parameters lfor lreadiness lto lwean lare lnegative linspiratory lpressure l(NIP) l> l−25 lcm
lH2O, lRR l<25/min, lHR l<140/min, lminute lvolume l<10 lL, lVC l>10 lto l15 lmL/kg. lThis
CORRECT ANSWERS
Following lsurgical lrepair lof la lthoracic laneurysm lwith lan lendoluminal lgraft, lthe lpatient
lis lunable lto lmove lhis llower lextremities. lThe lnurse lshould lfirst
a. lActivate lstroke lteam land lprepare lto ldo lan lurgent l(STAT) lcomputed ltomography
l(CT) lscan
b. lPrepare lto lreturn lto lsurgery lfor lexploration lof lfemoral lartery locclusion
c. lCall lsurgeon lto lobtain la lneurology lconsultation lin lthe lmorning
d. lPrepare lfor llumbar ldrain linsertion lto lremove lcerebrospinal lfluid l(CSF) l- lcorrect
lanswers l-D
Spinal lcord lischemia lis la lcomplication lfrom lthoracic laneurysm lrepair lfor lboth lopen
land lendoluminal lrepair. lSpinal lcord lischemia lresults lfrom lincreased lcerebral lspinal
,lpressure lthat lcompresses lthe lspinal lnerves. lUntreated lspinal lcord lischemia lcan llead
lto lparaplegia. lIt lis limportant lto lrecognize lthe lsigns lof lspinal lcord lischemia l(loss lof
llower lextremity lmovement) lpromptly. lImmediate linsertion lof la lspinal ldrain lcan
lreverse lthe lspinal lcord lischemia land lprevent lparaplegia. lBilateral lleg lparalysis lis lnot
ltypically lan linitial lsymptom lof lstroke l(A). lSigns lof lfemoral lartery locclusion l(B) lare
lthe l5 lPs: lpulselessness, lpallor, lpain, lparesthesias, land lparalysis. lThese lsymptoms
lwould lbe lunilateral, lnot lbilateral. lImmediate linsertion lof la lspinal ldrain lis lneeded;
lwaiting luntil lmorning lfor lthe lconsultation l(C) lwould lbe linappropriate.
A lpostoperative lpatient lwho lhad lundergone lcoronary lartery lbypass lgraft land
lventricular laneurysm lrepair lhas la l15-beat lrun lof lventricular ltachycardia. lThe lmost
llikely lcause lof lthe ldysrhythmia lis
a. lIrritability lof lthe lventricle lfrom lthe laneurysm lrepair
b. lSpasm lof lthe lright lcoronary lartery lgraft
c. lPotassium l4.8 lmEq/dL land lmagnesium l2.1 lmEq/L
d. lDid lnot lrestart ladministration lof lthe langiotensinconverting lenzyme l(ACE) linhibitor
l(taken lpreoperatively) l- lcorrect lanswers l-A
Patients lwith lleft lventricular laneurysm ltypically lhave ldepressed lleft lventricular l(LV)
lfunction. lDepressed lLV lfunction lmay llead lto lincreased lventricular larrhythmias. lLV
laneurysm lrepair lis lindicated lto limprove lsymptoms lof langina, lheart lfailure, lsystemic
lthromboembolism, lor lmalignant larrhythmias. lIn lthe limmediate lpostoperative lphase,
lthe lrepaired lventricle lcontinues lto lbe ldepressed land lhas lthe ladded ltrauma lof
lsurgery lon lthe lleft lventricle. lBoth lof lthese lincrease lthe lirritability lof lthe lLV, lleading
lto lventricular larrhythmias. lSpasm l(B) lor locclusion lof lthe lRCA lleads lto
lbradyarrhythmias, lnot lventricular larrhythmias. lThe lpotassium land lmagnesium llevels
lin l(C) lare lnormal. lLow lpotassium land lmagnesium llevels lincrease lthe lrisk lfor
lventricular larrhythmias. lACE linhibitors l(D) ldo lnot lhave lany lantiarrhythmic leffect.
The lnurse ladmits la lpatient lafter laortic lvalve lreplacement land lnotes lthe lfollowing
lsettings lof lthe ltemporary lpacemaker: lDDD lrate, l80/min; latrial lMA, l10; lventricular
lMA, l4. lThe lunderlying lrhythm lis lcomplete lheart lblock lwith lventricular lescape lrhythm
lrate l30/min. lThe lmost llikely lcause lof lthe lcomplete lheart lblock lis
a. lSpasm lof lthe lright lcoronary lartery l(RCA) lgraft
b. lDamage lof lthe latrioventricular l(AV) lnode lduring lrepair lof lthe laortic lvalve
c. lLow lpotassium land lmagnesium llevels
d. lToxic leffects lof lβ-blocker l- lcorrect lanswers l-B
The lAV lnode land lthe lbundle lof lHis lare lnear lthe laortic lvalve. lDuring laortic lvalve
lreplacement, lhemorrhage, ledema, lsuturing, lor ldebridement lnear lthe lAV lnode land
lthe lbundle lof lHis lmay lcause lheart lblocks. lTypically lthe lepicardial lpacing lis lonly
lneeded lfor la lfew ldays luntil lthe ledema lresolves. lIf lcomplete lheart lblock lpersists
lafter la lfew ldays, la lpermanent lpacemaker lmay lbe lrequired. lThe lRCA lsupplies
loxygen lto lthe lsinoatrial l(SA) land lAV lnodes land lspasm lof lthe lRCA lgraft l(A) lmay
,lcause lbradycardia land/or lheart lblocks. lThis lpatient ldid lnot lhave lbypass lsurgery, lso
lRCA lspasm lwould lnot lbe la lpostoperative lcomplication. lLow lpotassium land
lmagnesium llevels l(C) lincrease lthe lrisk lfor lventricular larrhythmias, lnot lAV lconduction
ldefects. lIf ltoxic leffects lof lβ-blockers l(D) lwere lpresent, lthe lcomplete lheart lblock
lwould lhave lbeen lthe lunderlying lrhythm lpreoperatively.
A lpostoperative lcoronary lartery lbypass lgraft land laortic lvalve lreplacement lpatient lhas
lbeen lin la lnormal lsinus lrhythm lfor l4 lhours. lThe lmonitor lis lnow lshowing lP lwaves lat
la lrate lof l73 lbeats lper lminute lwith lno lventricular lresponse. lThe lbest laction lwould lbe
lto
a. lAdminister latropine l0.5 lmg lintravenous lbolus l(IV lpush)
b. lConnect ltranscutaneous lpacing lpads lto lpatient
c. lConnect lepicardial lpacing lwires lto la ltemporary lpacemaker
d. lAdminister lepinephrine l1 lmg lIV lpush land lstart lepinephrine linfusion l- lcorrect
lanswers l-C
The lAV lnode land lthe lbundle lof lHis lare lnear lthe laortic lvalve. lDuring laortic lvalve
lreplacement, lhemorrhage, ledema, lsuturing, lor ldebridement lnear lthe lAV lnode land
lthe lbundle lof lHis lmay lcause lheart lblocks. lPacing lis lneeded lto ltreat lthe lconduction
ldefect lcaused lby lthe lsurgery. lAtropine l(A) land lepinephrine l(D) lwill lnot lwork
lbecause lthe lconduction lproblem lis lwith lthe lAV lnode land/or lthe lbundle lof lHis.
lTranscutaneous l(external) lpacing l(B) lwould lbe lthe lnext lbest loption lif lepicardial
lwires lwere lnot lpresent. lThe lheart lrate lshould lbe lgreater lthan l45/min land lless lthan
l80/min.
One lhour lafter lextubation, la ldiabetic lcoronary lartery lbypass lsurgery lpatient lis
lbecoming lslightly llethargic. lArterial lblood lgas l(ABG) lanalysis lyielded lthe lfollowing
lresults: lpH, l7.33; lPaO2, l80 lmm lHg; lPaCO2, l50 lmm lHg; lSaO2, l95%; lHCO3, l28
lmEq/L; lbase lexcess, l0.5. lThe lnurse lshould lfirst
a. lObtain la lblood lglucose llevel
b. lObtain la l12-lead lECG
c. lTreat lmetabolic lacidosis
d. lStimulate lpatient lto lbreathe l- lcorrect lanswers l-D
After lextubation, lcardiac lsurgery lpatients lshould lbe lassessed lfor ladequate
lventilation. lPain lmedications, latelectasis, land limmobility lmay llead lto lhypoventilation.
lHypoventilation lis la lcause lof lrespiratory lacidosis. lHigh lcarbon ldioxide llevels lcause
llethargy. lThe lpatient lis lin lthe learly lphase lof lrespiratory lacidosis. lStimulation land
lencouragement lof lincentive lspirometry lshould lprevent lfurther lhypoventilation land
lreintubation. lA, lB, land lC lare lactions lor linterventions lfor lmetabolic lacidosis.
, One lhour lafter lsurgery, la lcoronary lartery lbypass lgraft l(CABG) lpatient lstarts lto lwake
lup land lthe lmixed lvenous loxygen lsaturation l( lSvO2) ldecreases lfrom l60% lto l45%.
lThe lchange lis lmost llikely lthe lresult lof lwhich lof lthe lfollowing?
A. lIncrease lin loxygen lconsumption
B. lIncrease lin lhemoglobin
C. lIncrease lin lcardiac loutput
D. lIncrease lin larterial lsaturation l- lcorrect lanswers l-A
SvO2 lrepresents lthe loxygenation lat lthe ltissue llevel. lThe lvalue lreflects lthe ltissue
loxygen ldelivery land lconsumption. lFour lfactors linfluence lSvO2 l: lhemoglobin, lcardiac
loutput, larterial lsaturation, land loxygen lconsumption. lAn lincrease lin loxygen
lconsumption lwill lextract lmore loxygen lat lthe ltissue llevel land ldecrease lthe lSvO2.
lOxygen lconsumption lcould lbe lincreased lby lpain, lshivering, lor lexercise. lA ldecrease
lin loxygen lconsumption lwill lprovide lmore loxygen lto lthe ltissue llevel land lincrease lthe
lSvO2 l. lOxygen lconsumption lmight lbe lreduced lby lhypothermia lor lanesthesia.
In laddition lto la ldecreasing lBP, lwhich lof lthe lfollowing lassessment lfindings lis
lconsistent lwith lcardiac ltamponade?
A. lUrine loutput lof l42 lto l50 lmL/h
B. lCentral lvenous lpressure l(CVP) lof l11 lto l20 lmm lHg
C. lCardiac loutput l4.0 lto l5.1 lL/min
D. lSvO2 l58% lto l65% l- lcorrect lanswers l-B
The laccumulation lof lfluid laround lthe lheart lcompresses lthe latria, lcausing lelevated
lright latrial lfilling lpressures. lThe ldecreased lcardiac loutput lleads lto lhypoperfusion lof
lthe lkidney, lresulting lin la lsudden ldecrease lin lurine loutput lor loliguria. lThe
lcompression lof lthe latria lconstricts lvenous lreturn lto lthe lheart, lleading lto la
ldecreased lcardiac loutput. lThe ldecreased lcardiac loutput land llow lhemoglobin llevel
ldue lto lthe lbleeding llead lto ldecreased lSvO2 l.
After lCABG, la lpatient lweighing l70 lkg land lreceiving lmechanical lventilation lhas
lorders lto lbe lweaned land lextubated lwhen lstable. lWhich lparameter lindicates lthe
lpatient lis lready lto lextubate?
A. lRR l28/min
B. lVital lcapacity l(VC) l500 lmL
C. lAble lto lsustain la lhead llift lfor lat lleast l5 lseconds
D. lMinute lvolume l12 lL l- lcorrect lanswers l-C
Parameters lfor lreadiness lto lwean lare lnegative linspiratory lpressure l(NIP) l> l−25 lcm
lH2O, lRR l<25/min, lHR l<140/min, lminute lvolume l<10 lL, lVC l>10 lto l15 lmL/kg. lThis
