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CARDIOVASCULAR SURGERY

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
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
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
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:

Increase the cardiac output 2. which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion? 1. Slightly deteriorating and should be monitored for another hour 3. For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery. The nurse notifies the physician. The pedal pulse is palpable and unchanged from admission. Degree of coronary artery stenosis 2. After open-heart surgery a client develops a temperature of 102*F. Peripheral arterial pressure 3. Adequate from an arterial approach. and the nurse notes redness and edema. but venous complications are arising. Provide an alkaline-ash diet 3. Prevent constipation 4. Enrich the client’s diet with dairy products 6. Oxygen and carbon dioxide concentration is the blood 5. Normal because of increased blood flow through the leg 2. 7. May indicate cerebral edema . The nurse interprets that the neurovascular status is: 1. because elevated temperatures: 1. A nurse is assessing the neurovascular of a client who has returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. and the surgeon should be called 4. Ensure a liberal fluid intake 2. Moderately impaired.1. The affected leg is warm. Pressure from fluid within the left ventricle 4.

3. the nurse should teach the client that there will be: 1. Little incisional pain and tenderness after 3 to 4 weeks after surgery 4. Left ventricular functioning 10. Cardiac output 3. When preparing a client for discharge after surgery for a CABG. A mild fever and extreme fatigue for several weeks after surgery 3. Normally: 1. and pulmonary artery are analyzed for their oxygen content. right ventricle. May be a forerunner of hemorrhage 4. Are related to diaphoresis and possible chilling 8. The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). All contain more oxygen than does pulmonary vein blood 3. During a cardiac catheterization blood samples from the right atrium. Stroke volume 2. All contain less CO2 than does pulmonary vein blood 2. Venous pressure 4. No further drainage from the incisions after hospitalizations 2. Pulmonary artery blood contains more oxygen than the other samples 9. The nurse teaches the client that the catheter will be inserted to provide information about: 1. What is the most important nursing action when measuring a pulmonary capillary wedge pressure (PCWP)? . The samples of blood all contain about the same amount of oxygen 4. Some increase in edema in the leg used for the donor graft when activity increases 11.

Incisional pain 2. 1. The nurse will know the medication is working if the client’s: 1. PCWP rises . Hypertension 3. Flush the catheter with heparin solution after the PCWP is determined.1. The most important assessment for the nurse to make after a client has had a femoropopliteal bypass for peripheral vascular disease would be: 1. Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? Check all that apply. Jugular vein distention 14. Increased urine output 5. Deflate the balloon as soon as the PCWP is measured 3. Cardiac index falls 4. Tachycardia 2. Degree of hair growth 13. A client has the diagnosis of left ventricular failure and a high pulmonary capillary wedge pressure (PCWP). Increased CVP 4. Pedal pulse rate 3. 12. Capillary refill time 4. Blood pressure rises 2. Blood pressure decreases 3. The physician orders dopamine to improve ventricular function. Place the client in a supine position before measuring the PCWP 4. Have the client bear down when measuring the PCWP 2.

supply the coronary arteries with oxygen and other nutrients. BP 90 mm Hg systolic. 2. admitted through the ER. skin cold and pale. Atherosclerosis is a direct result of plaque formation in the artery. A 35-year-old male was knifed in the street fight. Plaques obstruct the artery Arteries. constrict blood flow. not veins. An assessment of his condition reveals the following symptoms: respirations shallow and rapid. Analyzing these symptoms. Cardiac tamponade 3. Learn more about the question by reading the rationale. Answer: 4. Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic . Hypovolemic shock 2. Hardened vessels can’t dilate properly and. Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat. Wound dehiscence 4. urinary output 60-100 mL/hr for the last 2 hours. therefore. a complication of CABG surgery. and is now in the ICU. Pericardial tamponade A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade. CVP 15 cm H2O. Atelectasis Answers and Rationale Gauge your performance by counter checking your answers to the answers below. the nurse will base a nursing diagnosis on the conclusion that the client has which of the following conditions? 1. please direct them to the comments section.15. with a regular rhythm). Answer: 2. 1. If you have any disputes or questions.

Answer: 3. 6. Answer: 1. The peripheral arterial pressure is assessed with an arterial line. When a large amount of calcium passes through the kidneys. 3. calcium can precipitate and form calculi. 95 mm Hg MAP = (2 times the diastolic + systolic)/3 or (2d + s)/3 where d is diastolic and s is systolic = 2 (80) + 126 / 3 = 160 + 126 / 3 = 286 / 3 = 95. A diet rich in acid should be provided to keep the urine acidic. Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure). Pressure from fluid within the left ventricle The pulmonary artery pressures are used to assess the heart’s ability to receive and pump blood. Limiting foods rich in calcium. which increases the solubility of calcium. such as dairy products. will help on preventing renal calculi. Answer: 1. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client.peak). calcium leaves the bone and concentrates in the ECF fluid.33 or 95 mm HG 4. Normal because of increased blood flow through the leg . The degree of coronary artery stenosis is assessed during a cardiac catherization. Answer: 3. Preventing constipation is not associated with excessive calcium excretion. Ensure a liberal fluid intake In an immobilized client. Nursing interventions that help prevent calculi include ensuring a liberal fluid intake (unless contraindicated). 5.

Such blood contains slightly less oxygen than does systemic arterial blood. 11. leaving the balloon inflated will interfere with blood flow to the lung. 8. Bearing down will increase intrathoracic pressure and alter the reading. 7. Some increase in edema in the leg used for the donor graft when activity increases The client is up more at home. Answer: 3. right ventricle. 9. . Increase the cardiac output Temperatures of 102*F or greater lead to an increased metabolism and cardiac workload.An expected outcome of surgery is warmth. Answer: 2. 10. Left ventricular functioning The catheter is placed in the pulmonary artery. Agency protocols relative to flushing of unused ports must be followed. Answer: 4. and pulmonary artery would all be about the same with regard to oxygen concentration. Answer: 4. so dependent edema usually increases. and edema in the surgical extremity because of increased blood flow. The samples of blood all contain about the same amount of oxygen Blood samples from the right atrium. redness. While a supine position is preferred. Deflate the balloon as soon as the PCWP is measured While the balloon must be inflated to measure the capillary wedge pressure. it is not essential. Answer: 1. Information regarding left ventricular function is obtained when the catheter balloon is inflated. Serosanguineous drainage may persist after discharge.

Answer: 1. but increase renal perfusion and the blood pressure will rise. 5. The cardiac index will also rise and the PCWP should decrease. Cardiac tamponade All of the client’s symptoms are found in both cardiac tamponade and hypovolemic shock except the increase in urinary output. it will cause vasoconstriction peripherally. As the tamponade increases. it is not necessary to count the rate. there is a decrease in kidney perfusion and therefore urine output. pressure on the heart interferes with the ejection of blood from the left ventricle. .12. While the presence and quality of the pedal pulse provide data about peripheral circulation. 3. resulting in an increased pressure in the right side of the heart and the systemic circulation. 14. Answer: 1. 15. Capillary refill time Checking capillary refill provides data about current perfusion of the extremity. this leads to a rapid thready pulse. Blood in the pericardial sac compresses the heart so the ventricles cannot fill. The increased venous pressure caused JVD. Tamponade causes hypotension and a narrowed pulse pressure. Blood pressure rises If dopamine as a positive effect. 13. Answer: 3. Answer: 2. As the heart because more inefficient.