CSC STUDY QUESTIONS AND ANSWERS | NEW 2026
UPDATE | WITH COMPLETE SOLUTION!!
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)
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.
,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) 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.
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 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.
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 Answer
-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 defect caused by the surgery. Atropine (A) and epinephrine (D) will
, not work because the conduction problem is with the AV node and/or the
bundle of His. Transcutaneous (external) pacing (B) would be the next best
option if epicardial wires were not present. The heart rate should be greater
than 45/min and less than 80/min.
One hour after extubation, a diabetic coronary artery bypass surgery patient is
becoming slightly lethargic. Arterial blood gas (ABG) analysis yielded the
following results: pH, 7.33; PaO2, 80 mm Hg; PaCO2, 50 mm Hg; SaO2, 95%;
HCO3, 28 mEq/L; base excess, 0.5. The nurse should first
a. Obtain a blood glucose level
b. Obtain a 12-lead ECG
c. Treat metabolic acidosis
d. Stimulate patient to breathe Answer - D
After extubation, cardiac surgery patients should be assessed for adequate
ventilation. Pain medications, atelectasis, and immobility may lead to
hypoventilation. Hypoventilation is a cause of respiratory acidosis. High carbon
dioxide levels cause lethargy. The patient is in the early phase of respiratory
acidosis. Stimulation and encouragement of incentive spirometry should
prevent further hypoventilation and reintubation. A, B, and C are actions or
interventions for metabolic acidosis.
One hour after surgery, a coronary artery bypass graft (CABG) patient starts to
wake up and the mixed venous oxygen saturation ( SvO2) decreases from 60%
to 45%. The change is most likely the result of which of the following?
A. Increase in oxygen consumption
B. Increase in hemoglobin
UPDATE | WITH COMPLETE SOLUTION!!
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)
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.
,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) 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.
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 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.
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 Answer
-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 defect caused by the surgery. Atropine (A) and epinephrine (D) will
, not work because the conduction problem is with the AV node and/or the
bundle of His. Transcutaneous (external) pacing (B) would be the next best
option if epicardial wires were not present. The heart rate should be greater
than 45/min and less than 80/min.
One hour after extubation, a diabetic coronary artery bypass surgery patient is
becoming slightly lethargic. Arterial blood gas (ABG) analysis yielded the
following results: pH, 7.33; PaO2, 80 mm Hg; PaCO2, 50 mm Hg; SaO2, 95%;
HCO3, 28 mEq/L; base excess, 0.5. The nurse should first
a. Obtain a blood glucose level
b. Obtain a 12-lead ECG
c. Treat metabolic acidosis
d. Stimulate patient to breathe Answer - D
After extubation, cardiac surgery patients should be assessed for adequate
ventilation. Pain medications, atelectasis, and immobility may lead to
hypoventilation. Hypoventilation is a cause of respiratory acidosis. High carbon
dioxide levels cause lethargy. The patient is in the early phase of respiratory
acidosis. Stimulation and encouragement of incentive spirometry should
prevent further hypoventilation and reintubation. A, B, and C are actions or
interventions for metabolic acidosis.
One hour after surgery, a coronary artery bypass graft (CABG) patient starts to
wake up and the mixed venous oxygen saturation ( SvO2) decreases from 60%
to 45%. The change is most likely the result of which of the following?
A. Increase in oxygen consumption
B. Increase in hemoglobin
