Cardiovascular System | Cardiovascular Surgery care NCLEX Quiz 2

1. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?

Plaques obstruct the vein

Plaques obstruct the artery

Blood clots form outside the vessel wall

Hardened vessels dilate to allow blood to flow through

Option A: Arteries. not veins. supply the coronary arteries with oxygen and other nutrients.Option C: Atherosclerosis is a direct result of plaque formation in the artery.Option D: Hardened vessels can’t dilate properly and. therefore. constrict blood flow.

Explanation

Option A: Arteries. not veins. supply the coronary arteries with oxygen and other nutrients.Option C: Atherosclerosis is a direct result of plaque formation in the artery.Option D: Hardened vessels can’t dilate properly and. therefore. constrict blood flow.

2. A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery two (2) days ago. Which of the following surgical complications should the nurse suspect?

Left-sided heart failure

Aortic regurgitation

Complete heart block

Pericardial tamponade

A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade. a complication of CABG surgery. Option A: Left-sided heart failure can cause.Option A: Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat. with a regular rhythm).Option B: Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak).Option C: Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure).

Explanation

A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade. a complication of CABG surgery. Option A: Left-sided heart failure can cause.Option A: Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat. with a regular rhythm).Option B: Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak).Option C: Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure).

3. 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:

Degree of coronary artery stenosis

Peripheral arterial pressure

Pressure from fluid within the left ventricle

Oxygen and carbon dioxide concentration is the blood

The pulmonary artery pressures are used to assess the heart’s ability to receive and pump blood. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client.Option A: The degree of coronary artery stenosis is assessed during a cardiac catheterization.Option B: The peripheral arterial pressure is assessed with an arterial line.

Explanation

The pulmonary artery pressures are used to assess the heart’s ability to receive and pump blood. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client.Option A: The degree of coronary artery stenosis is assessed during a cardiac catheterization.Option B: The peripheral arterial pressure is assessed with an arterial line.

4. After open-heart surgery. a client develops a temperature of 102*F. The nurse notifies the physician because elevated temperatures:

Increase the cardiac output

May indicate cerebral edema

May be a forerunner of hemorrhage

Are related to diaphoresis and possible chilling

Temperatures of 102°F or greater lead to an increased metabolism and cardiac workload.

Explanation

Temperatures of 102°F or greater lead to an increased metabolism and cardiac workload.

5. 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. The affected leg is warm. and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is:

Normal because of increased blood flow through the leg

Slightly deteriorating and should be monitored for another hour

Moderately impaired. and the surgeon should be called

Adequate from an arterial approach. but venous complications are arising.

An expected outcome of surgery is warmth. redness. and edema in the surgical extremity because of increased blood flow.

Explanation

An expected outcome of surgery is warmth. redness. and edema in the surgical extremity because of increased blood flow.

6. 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?

46 mm Hg

80 mm Hg

95 mm Hg

90 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 = 95.33 or 95 mm HG

Explanation

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 = 95.33 or 95 mm HG

7. The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about:

Stroke volume

Cardiac output

Venous pressure

Left ventricular functioning

The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated.

Explanation

The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated.

8. For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery. which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion?

Ensure a liberal fluid intake

Provide an alkaline ash diet

Prevent constipation

Enrich the client’s diet with dairy products

In an immobilized client. calcium leaves the bone and concentrates in the ECF fluid. When a large amount of calcium passes through the kidneys. calcium can precipitate and form calculi. Nursing interventions that help prevent calculi include ensuring a liberal fluid intake (unless contraindicated).Option B: A diet rich in acid should be provided to keep the urine acidic. which increases the solubility of calcium.Option C: Preventing constipation is not associated with excessive calcium excretion.Option D: Limiting foods rich in calcium. such as dairy products. will help in preventing renal calculi.

Explanation

In an immobilized client. calcium leaves the bone and concentrates in the ECF fluid. When a large amount of calcium passes through the kidneys. calcium can precipitate and form calculi. Nursing interventions that help prevent calculi include ensuring a liberal fluid intake (unless contraindicated).Option B: A diet rich in acid should be provided to keep the urine acidic. which increases the solubility of calcium.Option C: Preventing constipation is not associated with excessive calcium excretion.Option D: Limiting foods rich in calcium. such as dairy products. will help in preventing renal calculi.

9. During a cardiac catheterization blood samples from the right atrium. right ventricle. and pulmonary artery are analyzed for their oxygen content. Normally:

All contain less CO2 than does pulmonary vein blood

All contain more oxygen than does pulmonary vein blood

The samples of blood all contain about the same amount of oxygen

Pulmonary artery blood contains more oxygen than the other samples

Blood samples from the right atrium. right ventricle. and pulmonary artery would all be about the same with regard to oxygen concentration. Such blood contains slightly less oxygen than does systemic arterial blood.

Explanation

Blood samples from the right atrium. right ventricle. and pulmonary artery would all be about the same with regard to oxygen concentration. Such blood contains slightly less oxygen than does systemic arterial blood.

10. When preparing a client for discharge after surgery for a CABG. the nurse should teach the client that there will be:

No further drainage from the incisions after hospitalizations

A mild fever and extreme fatigue for several weeks after surgery

Little incisional pain and tenderness after 3 to 4 weeks after surgery

Some increase in edema in the leg used for the donor graft when activity increases

The client is up more at home. so dependent edema usually increases. Serosanguineous drainage may persist after discharge.

Explanation

The client is up more at home. so dependent edema usually increases. Serosanguineous drainage may persist after discharge.