ATI MED SURG PROCTORED EXAM 2024
ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS COMPLETE SOLUTION
How could you simply describe the CABG surgery to a patient? - Answer-a surgical
procedure in which a blood vessel from another part of the patient's body is grafted
distal to the coronary artery lesion, bypassing the obstruction
What are the vessels usually used as a source in CABG? Which is the most preferred
vessel and why? - Answer--internal mammary artery (PREFERRED) because excellent
patency rate, more durable than venous grafts (do not develop atherosclerotic changes
as quickly as vein grafts) & remain patent longer
*detaches distal end of artery from chest wall & grafted to coronary artery distal to
occlusion
-greater saphenous vein
-lesser saphenous vein
*for greater & lesser - vein removed from leg & grafted to ascending aorta & to coronary
artery distal to lesion
*lower extremity edema adverse effect
-synthetic grafts may be used instead
What are the major indications for CABG? - Answer--angina w greater than 50%
occlusion of left main coronary artery that cannot be stented
-unstable angina w 2-vessel disease, mod 3-vessel disease, or small-vessel disease in
which stents can't be used
-ischemia with heart failure
-acute MI with cardiogenic shock
-signs of ischemia or impending MI after angiography or percutaneous coronary
intervention
-valvular disease
-coronary vessels not suitable for PCI
What is the name of the machine used to ensure a motionless bloodless surgical field
during CABG? What the machine does to the patient blood during the surgery? -
Answer-cardiopulmonary bypass (CPB) system]
circulates & oxygenates blood for the body while bypassing heart & lungs
able to stop the heart during surgery while maintaining perfusion to body organ &
tissues, allows for surgical field
,*process - cannula in R atrium/vena cava or femoral vein to draw out blood, cannula
connected to tubing with isotonic crystalloid solution (hemodilution) which dilutes blood.
blood then filtered, oxygenated & heparinized by machine & returned to body
How is blood clotting prevented during the use of CPB machine for CABG? - Answer-
the heparinization
- prevent clotting & thrombus formation when blood contacts surface of tubing
What medication is an antidote for heparin? - Answer-at the end of the procedure,
protamine sulfate reverses effects of heparin
What is the cardioplegic solution used during traditional CABG and why it is used? -
Answer-Potassium-rich cardioplegia solution
-to avoid myocardial damage - causes electromechanical arrest which reduces
myocardial oxygen consumption
-flushed from the heart after procedure, regains rate & rhythm
What is the difference between traditional and nontraditional CABG surgeries? Which
one involves median sternotomy and the use of a CPB machine? - Answer-Traditional -
surgeon performs a MEDIAN STERNOTOMY and connects the patient to the CPB
machine
-next the graft is created & cardiopulmonary bypass is discontinued, chest tubes placed,
epicardial wires placed & incision closed
Nontraditional - alternative procedures:
-off-pump coronary artery bypass (OPCAP) surgery - standard MEDIAN
STERNOTOMY incision, but performed without CPB
-heart not stopped but slowed w beta blocker
-use of myocardial stabilization device for graft into artery
-minimally invasive surgical techniques - ELIMINATES MEDIAN STERNOTOMY
-endoscopic technique uses smaller incisions & robotic system to replace bypass grafts
-placed on CPB via femoral vessels
-minimally invasive heart surgery - alternative to conventional CABG - recover earlier,
fewer transfusions & infections
T or F: ₋ CABG surgery may be planned as an elective procedure or performed as an
emergency - Answer-true
What are essential interventions to decrease the risk of surgical site infection? -
Answer--treat underlying infections prior to procedure
-IV antibiotics 1 hr before procedure
-have pt shower with 4% chlorhexidine gluconate (CHG) night before surgery
-if hair removal necessary, clip prior to procedure & apply CHG with isopropyl alcohol
(0.5 or 2%)
-maintain glucose levels below 200, even if history DM
,-maintain surgical asepsis/sterile technique when changing sternal or donor-site
dressings
What are collaborative interventions for decreasing the risk of perioperative MI in
patients undergoing cardiac surgeries? - Answer--pt with angina usually responds to
nitroglycerin
-some pts require oxygen & IV nitroglycerin infusions
-if pt unstable, may require preop management in critical care
-beta-blockers when given at least 1 day before CABG reduce risk of atrial fibrillation
A patient scheduled for CABG complained of chest pain. An MI was suspected, which
medications the nurse anticipate being prescribed for the patient? - Answer-MONA
(Morphine, Oxygen, Nitroglycerine, Aspirin)
When caring for a post-CABG patient, how the nurse differentiates between sternotomy
incisional pain and anginal pain? - Answer-incisional pain increases with coughing and
deep breathing.
The nurse administered nitroglycerin as ordered to relieve anginal pain in a preoperative
CABG patient. The nurse should monitor the patient which side effects of nitroglycerin?
- Answer-headache, dizziness, lightheadedness, fainting, burning/tingling on tongue,
dark urine, fever, pale skin, rapid hr, sore throat, unusual bleeding/bruising
What should the nurse say or do when a patient scheduled for CABG expresses fear of
death? - Answer-The nurse should provide emotional support and assure the patient
and family that this fear is normal and further explore their feelings.
What essential preoperative and postoperative patient and family education specific to
patients undergoing CABG surgery? - Answer--nurse should educate on what to expect
(sternal incision, equipment, tubes, IV lines, chest tubes & catheter) after surgery
-means of communication if remain intubated for hours after surgery
-demonstrate and have the patient return a demonstration of how to splint the chest
incision, cough, deep breathe, incentive spirometry and perform arm and leg exercises.
-pt report any pain
-reduce fear & anxiety by communicating w patient about concerns/determine coping
methods
In which unit do the cardiac surgery patients receive care in the immediate
postoperative period? - Answer-cardiac surgery ICU
*focus on maintaining hemodynamic stability & recovery from general anesthesia
-once cardiac & respiratory status stable, transferred to surgical progressive care unit
with telemetry (cont ECG monitoring)
The pulse intensity is graded on a scale of 0 to 4 +. Describe this grading scale and how
the nurse assess the peripheral vascular status? What is the nurse priority action if the
, assessment of post CABG patient revealed absence or diminished peripheral pulse? -
Answer-0 - no palpable pulse
1+ - faint, but detectable pulse
2+ - slightly more diminished pulse than normal
3+ - normal
4+ - bounding pulse
Assessing vascular status: peripheral pulses, skin color, nail beds, mucosa, lips &
earlobes, skin temp, edema, condition of dressings & invasive lines
*immediately report absent or diminished pulse - can be due to thromboembolic
obstruction or air embolism
What are the complications of CABG surgery, related assessment findings and
management? - Answer-Hypovolemia
-assessment - arterial hypotension, tachy, low CVP, low PAWP
-management -fluid replacement, fluids include colloid (albumin), packed RBCs, or
crystalloid (NS, LR)
Persistent bleeding
-assessment - measurement of wound bleeding & chest tube blood (should decrease &
stop within a few days, progressing from serosanguineous to serous), hemo, hemato,
coagulation studies
-management - administration of blood products, packed RBCs, fresh frozen plasma, plt
concentrate, recombinant factor VII, protamine sulfate to neutralize heparin,
desmopressin acetate (DDAVP) to enhance plt function, pt may return to OR if persists
Cardiac tamponade
-assessment - arterial hypotension, tachy, decreased urine output, increased CVP.
arterial pressure waveform may show pulsus paradoxus (decrease of more than 10mm
Hg systolic BP during inspiration)
-management - chest drainage system checked to eliminate kinks or obstructions in
tubing, chest x-ray may show widening mediastinum, emergency medical management
needed (may return to surgery)
Fluid overload
-assessment - high CVP & pulmonary artery pressures, crackles
-management - diuretics, rate of IV fluid reduced, cont. renal replacement therapy &
dialysis
Hypothermia
-assessment - vasoconstriction from low body temp, shivering, arterial hypertension
-management - pt rewarmed gradually after surgery
HTN
-management - vasodilators (nitroglycerin, nitroprusside) administered cautiously
ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS COMPLETE SOLUTION
How could you simply describe the CABG surgery to a patient? - Answer-a surgical
procedure in which a blood vessel from another part of the patient's body is grafted
distal to the coronary artery lesion, bypassing the obstruction
What are the vessels usually used as a source in CABG? Which is the most preferred
vessel and why? - Answer--internal mammary artery (PREFERRED) because excellent
patency rate, more durable than venous grafts (do not develop atherosclerotic changes
as quickly as vein grafts) & remain patent longer
*detaches distal end of artery from chest wall & grafted to coronary artery distal to
occlusion
-greater saphenous vein
-lesser saphenous vein
*for greater & lesser - vein removed from leg & grafted to ascending aorta & to coronary
artery distal to lesion
*lower extremity edema adverse effect
-synthetic grafts may be used instead
What are the major indications for CABG? - Answer--angina w greater than 50%
occlusion of left main coronary artery that cannot be stented
-unstable angina w 2-vessel disease, mod 3-vessel disease, or small-vessel disease in
which stents can't be used
-ischemia with heart failure
-acute MI with cardiogenic shock
-signs of ischemia or impending MI after angiography or percutaneous coronary
intervention
-valvular disease
-coronary vessels not suitable for PCI
What is the name of the machine used to ensure a motionless bloodless surgical field
during CABG? What the machine does to the patient blood during the surgery? -
Answer-cardiopulmonary bypass (CPB) system]
circulates & oxygenates blood for the body while bypassing heart & lungs
able to stop the heart during surgery while maintaining perfusion to body organ &
tissues, allows for surgical field
,*process - cannula in R atrium/vena cava or femoral vein to draw out blood, cannula
connected to tubing with isotonic crystalloid solution (hemodilution) which dilutes blood.
blood then filtered, oxygenated & heparinized by machine & returned to body
How is blood clotting prevented during the use of CPB machine for CABG? - Answer-
the heparinization
- prevent clotting & thrombus formation when blood contacts surface of tubing
What medication is an antidote for heparin? - Answer-at the end of the procedure,
protamine sulfate reverses effects of heparin
What is the cardioplegic solution used during traditional CABG and why it is used? -
Answer-Potassium-rich cardioplegia solution
-to avoid myocardial damage - causes electromechanical arrest which reduces
myocardial oxygen consumption
-flushed from the heart after procedure, regains rate & rhythm
What is the difference between traditional and nontraditional CABG surgeries? Which
one involves median sternotomy and the use of a CPB machine? - Answer-Traditional -
surgeon performs a MEDIAN STERNOTOMY and connects the patient to the CPB
machine
-next the graft is created & cardiopulmonary bypass is discontinued, chest tubes placed,
epicardial wires placed & incision closed
Nontraditional - alternative procedures:
-off-pump coronary artery bypass (OPCAP) surgery - standard MEDIAN
STERNOTOMY incision, but performed without CPB
-heart not stopped but slowed w beta blocker
-use of myocardial stabilization device for graft into artery
-minimally invasive surgical techniques - ELIMINATES MEDIAN STERNOTOMY
-endoscopic technique uses smaller incisions & robotic system to replace bypass grafts
-placed on CPB via femoral vessels
-minimally invasive heart surgery - alternative to conventional CABG - recover earlier,
fewer transfusions & infections
T or F: ₋ CABG surgery may be planned as an elective procedure or performed as an
emergency - Answer-true
What are essential interventions to decrease the risk of surgical site infection? -
Answer--treat underlying infections prior to procedure
-IV antibiotics 1 hr before procedure
-have pt shower with 4% chlorhexidine gluconate (CHG) night before surgery
-if hair removal necessary, clip prior to procedure & apply CHG with isopropyl alcohol
(0.5 or 2%)
-maintain glucose levels below 200, even if history DM
,-maintain surgical asepsis/sterile technique when changing sternal or donor-site
dressings
What are collaborative interventions for decreasing the risk of perioperative MI in
patients undergoing cardiac surgeries? - Answer--pt with angina usually responds to
nitroglycerin
-some pts require oxygen & IV nitroglycerin infusions
-if pt unstable, may require preop management in critical care
-beta-blockers when given at least 1 day before CABG reduce risk of atrial fibrillation
A patient scheduled for CABG complained of chest pain. An MI was suspected, which
medications the nurse anticipate being prescribed for the patient? - Answer-MONA
(Morphine, Oxygen, Nitroglycerine, Aspirin)
When caring for a post-CABG patient, how the nurse differentiates between sternotomy
incisional pain and anginal pain? - Answer-incisional pain increases with coughing and
deep breathing.
The nurse administered nitroglycerin as ordered to relieve anginal pain in a preoperative
CABG patient. The nurse should monitor the patient which side effects of nitroglycerin?
- Answer-headache, dizziness, lightheadedness, fainting, burning/tingling on tongue,
dark urine, fever, pale skin, rapid hr, sore throat, unusual bleeding/bruising
What should the nurse say or do when a patient scheduled for CABG expresses fear of
death? - Answer-The nurse should provide emotional support and assure the patient
and family that this fear is normal and further explore their feelings.
What essential preoperative and postoperative patient and family education specific to
patients undergoing CABG surgery? - Answer--nurse should educate on what to expect
(sternal incision, equipment, tubes, IV lines, chest tubes & catheter) after surgery
-means of communication if remain intubated for hours after surgery
-demonstrate and have the patient return a demonstration of how to splint the chest
incision, cough, deep breathe, incentive spirometry and perform arm and leg exercises.
-pt report any pain
-reduce fear & anxiety by communicating w patient about concerns/determine coping
methods
In which unit do the cardiac surgery patients receive care in the immediate
postoperative period? - Answer-cardiac surgery ICU
*focus on maintaining hemodynamic stability & recovery from general anesthesia
-once cardiac & respiratory status stable, transferred to surgical progressive care unit
with telemetry (cont ECG monitoring)
The pulse intensity is graded on a scale of 0 to 4 +. Describe this grading scale and how
the nurse assess the peripheral vascular status? What is the nurse priority action if the
, assessment of post CABG patient revealed absence or diminished peripheral pulse? -
Answer-0 - no palpable pulse
1+ - faint, but detectable pulse
2+ - slightly more diminished pulse than normal
3+ - normal
4+ - bounding pulse
Assessing vascular status: peripheral pulses, skin color, nail beds, mucosa, lips &
earlobes, skin temp, edema, condition of dressings & invasive lines
*immediately report absent or diminished pulse - can be due to thromboembolic
obstruction or air embolism
What are the complications of CABG surgery, related assessment findings and
management? - Answer-Hypovolemia
-assessment - arterial hypotension, tachy, low CVP, low PAWP
-management -fluid replacement, fluids include colloid (albumin), packed RBCs, or
crystalloid (NS, LR)
Persistent bleeding
-assessment - measurement of wound bleeding & chest tube blood (should decrease &
stop within a few days, progressing from serosanguineous to serous), hemo, hemato,
coagulation studies
-management - administration of blood products, packed RBCs, fresh frozen plasma, plt
concentrate, recombinant factor VII, protamine sulfate to neutralize heparin,
desmopressin acetate (DDAVP) to enhance plt function, pt may return to OR if persists
Cardiac tamponade
-assessment - arterial hypotension, tachy, decreased urine output, increased CVP.
arterial pressure waveform may show pulsus paradoxus (decrease of more than 10mm
Hg systolic BP during inspiration)
-management - chest drainage system checked to eliminate kinks or obstructions in
tubing, chest x-ray may show widening mediastinum, emergency medical management
needed (may return to surgery)
Fluid overload
-assessment - high CVP & pulmonary artery pressures, crackles
-management - diuretics, rate of IV fluid reduced, cont. renal replacement therapy &
dialysis
Hypothermia
-assessment - vasoconstriction from low body temp, shivering, arterial hypertension
-management - pt rewarmed gradually after surgery
HTN
-management - vasodilators (nitroglycerin, nitroprusside) administered cautiously
