CSC Study Ques ons AND ANSWERS With complete
solu on RATED A+ NEW!
Following surgical repair of a thoracic aneurysm with an endoluminal gra , the pa ent is unable
to move his lower extremi es. The nurse should first
a. Ac vate stroke team and prepare to do an urgent (STAT) computed tomography (CT) scan
b. Prepare to return to surgery for explora on of femoral artery occlusion
c. Call surgeon to obtain a neurology consulta on in the morning
d. Prepare for lumbar drain inser on to remove cerebrospinal fluid (CSF) - Ans D
Spinal cord ischemia is a complica on 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 inser on of a spinal drain can reverse the spinal cord ischemia and
prevent paraplegia. Bilateral leg paralysis is not typically an ini al 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 inser on of a spinal
drain is needed; wai ng un l morning for the consulta on (C) would be inappropriate.
A postopera ve pa ent who had undergone coronary artery bypass gra 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 gra
c. Potassium 4.8 mEq/dL and magnesium 2.1 mEq/L
d. Did not restart administra on of the angiotensinconver ng enzyme (ACE) inhibitor (taken
preopera vely) - Ans A
Pa ents with le ventricular aneurysm typically have depressed le ventricular (LV) func on.
Depressed LV func on 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 postopera ve phase, the repaired ventricle con nues
to be depressed and has the added trauma of surgery on the le 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 an arrhythmic effect.
The nurse admits a pa ent a er aor c valve replacement and notes the following se;ngs 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) gra
b. Damage of the atrioventricular (AV) node during repair of the aor c valve
c. Low potassium and magnesium levels
d. Toxic effects of β-blocker - Ans B
The AV node and the bundle of His are near the aor c valve. During aor c 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 un l the edema
resolves. If complete heart block persists a er 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
gra (A) may cause bradycardia and/or heart blocks. This pa ent did not have bypass surgery,
so RCA spasm would not be a postopera ve complica on. Low potassium and magnesium levels
(C) increase the risk for ventricular arrhythmias, not AV conduc on defects. If toxic effects of β-
,blockers (D) were present, the complete heart block would have been the underlying rhythm
preopera vely.
A postopera ve coronary artery bypass gra and aor c valve replacement pa ent 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 ac on would be to
a. Administer atropine 0.5 mg intravenous bolus (IV push)
b. Connect transcutaneous pacing pads to pa ent
c. Connect epicardial pacing wires to a temporary pacemaker
d. Administer epinephrine 1 mg IV push and start epinephrine infusion - Ans C
The AV node and the bundle of His are near the aor c valve. During aor c 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 conduc on defect caused by the surgery.
Atropine (A) and epinephrine (D) will not work because the conduc on problem is with the AV
node and/or the bundle of His. Transcutaneous (external) pacing (B) would be the next best
op on if epicardial wires were not present. The heart rate should be greater than 45/min and
less than 80/min.
One hour a er extuba on, a diabe c coronary artery bypass surgery pa ent 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. S mulate pa ent to breathe - Ans D
A er extuba on, cardiac surgery pa ents should be assessed for adequate ven la on. Pain
medica ons, atelectasis, and immobility may lead to hypoven la on. Hypoven la on is a cause
of respiratory acidosis. High carbon dioxide levels cause lethargy. The pa ent is in the early
phase of respiratory acidosis. S mula on and encouragement of incen ve spirometry should
prevent further hypoven la on and reintuba on. A, B, and C are ac ons or interven ons for
metabolic acidosis.
One hour a er surgery, a coronary artery bypass gra (CABG) pa ent starts to wake up and the
mixed venous oxygen satura on ( SvO2) decreases from 60% to 45%. The change is most likely
the result of which of the following?
A. Increase in oxygen consump on
B. Increase in hemoglobin
C. Increase in cardiac output
D. Increase in arterial satura on - Ans A
SvO2 represents the oxygena on at the ssue level. The value reflects the ssue oxygen
delivery and consump on. Four factors influence SvO2 : hemoglobin, cardiac output, arterial
satura on, and oxygen consump on. An increase in oxygen consump on will extract more
oxygen at the ssue level and decrease the SvO2. Oxygen consump on could be increased by
pain, shivering, or exercise. A decrease in oxygen consump on will provide more oxygen to the
ssue level and increase the SvO2 . Oxygen consump on might be reduced by hypothermia or
anesthesia.
In addi on to a decreasing BP, which of the following assessment findings is consistent with
cardiac tamponade?
A. Urine output of 42 to 50 mL/h
solu on RATED A+ NEW!
Following surgical repair of a thoracic aneurysm with an endoluminal gra , the pa ent is unable
to move his lower extremi es. The nurse should first
a. Ac vate stroke team and prepare to do an urgent (STAT) computed tomography (CT) scan
b. Prepare to return to surgery for explora on of femoral artery occlusion
c. Call surgeon to obtain a neurology consulta on in the morning
d. Prepare for lumbar drain inser on to remove cerebrospinal fluid (CSF) - Ans D
Spinal cord ischemia is a complica on 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 inser on of a spinal drain can reverse the spinal cord ischemia and
prevent paraplegia. Bilateral leg paralysis is not typically an ini al 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 inser on of a spinal
drain is needed; wai ng un l morning for the consulta on (C) would be inappropriate.
A postopera ve pa ent who had undergone coronary artery bypass gra 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 gra
c. Potassium 4.8 mEq/dL and magnesium 2.1 mEq/L
d. Did not restart administra on of the angiotensinconver ng enzyme (ACE) inhibitor (taken
preopera vely) - Ans A
Pa ents with le ventricular aneurysm typically have depressed le ventricular (LV) func on.
Depressed LV func on 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 postopera ve phase, the repaired ventricle con nues
to be depressed and has the added trauma of surgery on the le 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 an arrhythmic effect.
The nurse admits a pa ent a er aor c valve replacement and notes the following se;ngs 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) gra
b. Damage of the atrioventricular (AV) node during repair of the aor c valve
c. Low potassium and magnesium levels
d. Toxic effects of β-blocker - Ans B
The AV node and the bundle of His are near the aor c valve. During aor c 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 un l the edema
resolves. If complete heart block persists a er 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
gra (A) may cause bradycardia and/or heart blocks. This pa ent did not have bypass surgery,
so RCA spasm would not be a postopera ve complica on. Low potassium and magnesium levels
(C) increase the risk for ventricular arrhythmias, not AV conduc on defects. If toxic effects of β-
,blockers (D) were present, the complete heart block would have been the underlying rhythm
preopera vely.
A postopera ve coronary artery bypass gra and aor c valve replacement pa ent 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 ac on would be to
a. Administer atropine 0.5 mg intravenous bolus (IV push)
b. Connect transcutaneous pacing pads to pa ent
c. Connect epicardial pacing wires to a temporary pacemaker
d. Administer epinephrine 1 mg IV push and start epinephrine infusion - Ans C
The AV node and the bundle of His are near the aor c valve. During aor c 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 conduc on defect caused by the surgery.
Atropine (A) and epinephrine (D) will not work because the conduc on problem is with the AV
node and/or the bundle of His. Transcutaneous (external) pacing (B) would be the next best
op on if epicardial wires were not present. The heart rate should be greater than 45/min and
less than 80/min.
One hour a er extuba on, a diabe c coronary artery bypass surgery pa ent 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. S mulate pa ent to breathe - Ans D
A er extuba on, cardiac surgery pa ents should be assessed for adequate ven la on. Pain
medica ons, atelectasis, and immobility may lead to hypoven la on. Hypoven la on is a cause
of respiratory acidosis. High carbon dioxide levels cause lethargy. The pa ent is in the early
phase of respiratory acidosis. S mula on and encouragement of incen ve spirometry should
prevent further hypoven la on and reintuba on. A, B, and C are ac ons or interven ons for
metabolic acidosis.
One hour a er surgery, a coronary artery bypass gra (CABG) pa ent starts to wake up and the
mixed venous oxygen satura on ( SvO2) decreases from 60% to 45%. The change is most likely
the result of which of the following?
A. Increase in oxygen consump on
B. Increase in hemoglobin
C. Increase in cardiac output
D. Increase in arterial satura on - Ans A
SvO2 represents the oxygena on at the ssue level. The value reflects the ssue oxygen
delivery and consump on. Four factors influence SvO2 : hemoglobin, cardiac output, arterial
satura on, and oxygen consump on. An increase in oxygen consump on will extract more
oxygen at the ssue level and decrease the SvO2. Oxygen consump on could be increased by
pain, shivering, or exercise. A decrease in oxygen consump on will provide more oxygen to the
ssue level and increase the SvO2 . Oxygen consump on might be reduced by hypothermia or
anesthesia.
In addi on to a decreasing BP, which of the following assessment findings is consistent with
cardiac tamponade?
A. Urine output of 42 to 50 mL/h
