Question 1

A cardiac care nurse is explaining a triple bypass surgery and obtaining consent for the surgery. Which of the following should the nurse ensure have been explained to the patient and the family?

Accepted Answer

The nurse should ensure that the risks, the benefits and the possible serious complications of the surgery such as stroke, myocardial infarction, or death have been explained. Hospital ethics boards have determined that this information is necessary to ensure that the patient and the patient's family are fully aware of the benefits and risks of the operation.

Question 2

A patient presents with post-operative hemorrhage after cardiac surgery. What initial steps should the attending nurse take?

Accepted Answer

The first step is to make sure the patient is normothermic. Next, measure clotting factors stat: INR, PTT, fibrinogen, platelet count, and activated clotting time. A bolus of tranexamic acid can be given if the output from the chest tube is excessive. Fresh frozen plasma, cryoprecipitate, platelets, DDAVP, or protamine to reverse heparinization can all be used as needed. Initiate the transfusion reaction protocol if a transfusion reaction is suspected.

Question 3

A patient known to have AF (atrial fibrillation) presents with acute pain in his left lower limb and over the course of several hours he experiences a loss of sensation in the area and the limb becomes numb and cold. What is the first treatment the nurse should take?

Accepted Answer

A patient with AF who has evidence of circulatory compromise, e.g., pain, loss of sensation, etc., should be given a 5000 IU bolus of heparin, IV. This should be followed by a continuous IV infusion of heparin to maintain the aPTT at 1.5-2.5 times the control.

Question 4

A patient presents with post-operative hemorrhage after undergoing cardiac surgery. Which of the following should prompt the attending nurse to consult the cardiothoracic surgeon for surgical exploration?

Accepted Answer

Excess mediastinal tube output is an indication of bleeding and the need for surgical exploration of post-operative hemorrhage.

Question 5

A patient recovering from CABG surgery develops renal failure. What measures should the attending nurse take to maintain urine output?

Accepted Answer

The attending nurse should administer low-dose dopamine (1-3 µg/kg/h) and furosemide by IV bolus or continuous infusion. Ethacrynic acid, an IV infusion of mannitol, and IV fluids as needed can also be used after assessing the volume status and cardiac function of patient.

Question 6

A patient is scheduled to undergo CABG surgery. Which of the following tests would the nurse not order as a part of pre-operative assessment?

Accepted Answer

The nurse would not order a test for occult blood in the stool; bleeding would assessed be using the CBS and coagulation studies. Pre-operative tests should include CBC, PTT, INR, electrolytes, glucose, BUN, creatinine, and other blood tests as needed. A urinalysis, PA and lateral CXR (and possibly a CT of the chest in cases of re-operations), and an ECG should also be done.

Question 7

A patient is scheduled to have mitral valve replacement surgery. He has been taking warfarin therapy because he has atrial fibrillation (AF). What changes to the patient's anticoagulant therapy should the nurse consider?

Accepted Answer

The nurse should consider stopping warfarin 4-5 days prior to the surgery and administering a heparin product preoperatively as a "bridge" if there is a high risk of thrombosis (e.g., if the patient has a large left atrium, atrial fibrillation, or a mitral valve prosthesis).

Question 8

A patient has undergone aortic valve replacement surgery. An EKG done post-operatively demonstrates a junctional rhythm. What parameters should the nurse assess before consulting a cardiologist to consider A-V sequential pacing?

Accepted Answer

If a junctional rhythm is present, the nurse should check for the presence of digoxin toxicity and/or myocardial ischemia. Ajunctional rhythm does not need to be treated if the patient is asymptomatic.

Question 9

A patient presents to an emergency room with acute pain in abdomen; there is a high degree of suspicion that he has a ruptured abdominal aortic aneurysm. What measures should be initiated immediately?

Accepted Answer

If there is a strong suspicion that the patient has a ruptured abdominal aortic aneurysm, start initial resuscitation and obtain vascular access. Typing and cross matching can be done next, followed by surgery.

Question 10

A 64-year-old male patient was scheduled to undergo CABG surgery after a coronary angiogram. During pre-cardiac surgery education, the nurse should explain to the patient that the objective of the bypass surgery is:

Accepted Answer

The nurse should explain to the patient that the objective of CABG surgery is revascularization of selected areas of the myocardium. Arteries with severe stenoses (> 70%) are bypassed, except those of small caliber (<1mm in diameter).

Question 11

A nurse is taking care of a 50-year-old patient who has undergone mitral valve replacement surgery. The patient develops a perioperative myocardial infarction, and the doctor orders a continuous IV infusion of nitroglycerin. Which of the following is the most important action to be taken by this nurse?

Accepted Answer

The most important nursing action in this situation would be regular monitoring of the patient's blood pressure. Hypotension is a common side effect of IV nitroglycerin.

Question 12

A patient who has undergone mitral valve replacement surgery complains of bleeding from the surgical incision. Which of the following medications should the attending nurse be prepared to administer to the patient?

Accepted Answer

The nurse should be prepared to administer protamine sulfate. Post-operative bleeding can also be corrected with fresh frozen plasma, Vitamin K, cryoprecipitate, platelets, or DDAVP. An IV bolus of tranexamic acid can be given if there is excessive drainage from the chest tube. .

Question 13

A patient presents to an emergency room after trauma to his left lower limb. Which of the following is the most important P of the 6 Ps that are used to assess the severity of trauma to an extremity?

Accepted Answer

The most important of the 6 Ps (pain, paralysis, pallor, parasthesia, pulselessness, and poikilothermia)is paralysis because it indicates a non-viable limb. Pain is absent in 20% of cases because of prompt onset of anesthesia and paralysis. Pallor is replaced by mottling and cyanosis within a few hours. Parasthesia is an early sign of trauma. Do not expect all of the 6 Ps to be present, and do not rely on assessment of pulses.

Question 14

A patient presents with acute arterial occlusion of one of his upper limbs. Which of the following drugs should the nurse prepared to administer to the patient?

Accepted Answer

The nurse should be prepared to administer a bolus dose of heparin, followed by a continuous IV infusion.

Question 15

The patient was on cardiopulmonary bypass while undergoing CABG surgery. What should be the first parameter the nurse should assess before weaning the patient from cardiopulmonary bypass?

Accepted Answer

The first parameter the nurse should assess is the patient's body temperature. Attaining normothermia is the first step in preparation for weaning a patient from cardiopulmonary bypass. Other important assessment steps/parameters can be remembered with the mnemonic LAMPS: lLaboratory data, aAnesthesia, mMonitors (cardiac and pulmonary) pump, and patient sSupport.

Question 16

A patient with history of arterial trauma presents to emergency with severe pain in right lower limb. Which of the following findings during the nursing assessment indicates arterial occlusion?

Accepted Answer

All of the findings listed above indicate arterial occlusion and the nursing assessment for arterial occlusion should check for each one, as well as for the presence/absence of all of the other 6 Ps: pallor, paresthesia, paralysis, pain, pulselessness, and poikilothermic.

Question 17

A nurse is planning to give pre-procedure teaching to a patient about the benefits of percutaneous transluminal coronary angioplasty (PTCA ). Which of the following is the most important for the patient to be taught?

Accepted Answer

The most important fact for the patient to know is that the goal of PTCA is to increase blood flow to the coronary arteries by reducing plaque build-up. The procedure involves the use of a catheter introduced through the femoral, brachial, or radial artery into the diseased coronary artery and balloon pressure is applied to the area of plaque formation to decrease plaque size and/or stretch the vessel wall. A stent is often placed after opening the vessels.

Question 18

A 60-year-old patient had undergone embolectomy for arterial emboli. What anticoagulant drug modification should the attending nurse do post-operatively?

Accepted Answer

The attending nurse should continue heparin in the post-operative period and start warfarin post-operatively when ordered to do so.

Question 19

A patient with venous insufficiency has questions about the anatomy of venous system. What are the important parts of venous system that the nurse should explain?

Accepted Answer

The nurse should tell the patient about all the parts of venous system. The venous system is divided into 4 general areas: the superficial venous system, the communicating venous system,, the deep venous system, and the venous valves.

Question 20

A patient is being discharged from the hospital after undergoing PTCA. What advice should the nurse give to the patient about follow up tests?

Accepted Answer

The nurse should inform the patient that cardiac stress testing should be done 2-6 months post-procedure. Prior to patient release, perform a physical assessment and perform laboratory tests such as hematocrit, potassium level, and serum creatinine level

Quiz 1: Intervention