BSN 445: CARDIOVASCULAR THERAPEUTIC MANAGEMENT: TEST
QUESTIONS WITH COMPLETE SOLUTIONS
1) When caring for a patient post procedure following a percutaneous coronary
intervention with radial access, which finding would the nurse report immediately
to the health care provider? Select all that apply. One, some, or all responses may
be correct.
− Discoloration of the fingers
− +2 brachial pulse
− Tingling in the hand
− Mild pain at the access site
− 5-second capillary refill -- Correct Answer ✔✔ Discoloration of the
fingers
Discoloration of the fingers indicates decreased perfusion that can occur
following arterial access. This finding should be reported to the health care
provider immediately.
Tingling in the hand
Tingling in the hand could indicate perfusion complications. The nurse should
ensure the splint is not too tight, if one is in place, and should report this finding
immediately to the health care provider.
5-second capillary refill
, A delayed capillary refill (more than 3 seconds) indicates a perfusion deficit and is
a concerning finding. The nurse should perform additional circulation assessments
and should immediately report the findings to the health care provider.
2) The nurse provides teaching for a patient who is being discharged following
percutaneous coronary intervention with drug-eluting stent placement. Which
patient statement shows the need for additional education?
− "I will continue taking my lipid-lowering medications in the evening."
− "I will monitor for bleeding or drainage from the access site."
− "I will report chest pain or shortness of breath to my health care
provider."
− "I will reduce my tobacco use to one or two cigarettes a day." --
Correct Answer ✔✔ I will reduce my tobacco use to one or two
cigarettes a day."
Tobacco use can lead to vasoconstriction and continued cardiac damage. The
patient should be educated on the need for complete smoking cessation and
should be provided with tobacco cessation resources.
3) Which prosthetic cardiac valve would be best for an 84-year-old woman with
aortic valve disease and heart failure who lives alone and has fallen four times in
the last year?
− Tilting-disk
− Bileaflet
− Self-expandable percutaneous
− Homograft -- Correct Answer ✔✔ Homograft
A homograft is a bioprosthetic heart valve that does not require anticoagulation.
Additionally, bioprosthetic valves have a reduced longevity and may be chosen for
an older adult patient.
4) Which medication would the nurse anticipate administering during an off-pump
coronary artery bypass graft (CABG) surgery?
− Glucagon
− Diltiazem
− Alteplase
, − Furosemide -- Correct Answer ✔✔ Diltiazem
Diltiazem is a calcium channel blocker that is used to temporarily decrease heart
rate to assist with stabilization of the cardiac wall motion at the site of the
anastomosis.
5) Which nursing intervention would be implemented to control heart rate during
the postoperative period after coronary artery bypass graft (CABG) surgery?
Select all that apply. One, some, or all responses may be correct.
− Administering crystalloid fluids
− Initiating temporary epicardial pacing
− Monitoring and correcting hypokalemia
− Monitoring and correcting hypernatremia
− Administering intravenous beta-blocker medications -- Correct
Answer ✔✔ initiating temporary epicardial pacing
Epicardial pacing is usually instituted when the heart rate drops below 60 beats
per minute and is a treatment for postoperative bradycardia.
Monitoring and correcting hypokalemia
Hypokalemia can lead to postoperative rhythm changes, decreasing cardiac
output. The nurse should closely monitor for hypokalemia and administer
potassium replacement as needed.
Administering intravenous beta-blocker medications
Beta-blocker medications can be administered prophylactically to prevent atrial
fibrillation, which is a common complication after CABG. These medications can
also help decrease and control tachycardia postoperatively.
6) Which condition can occur as a result of hypothermia related to cardiac surgery?
− Atrial fibrillation
− Increased clotting
− Higher cardiac output
− Increased systemic vascular resistance -- Correct Answer ✔✔
Increased systemic vascular resistance
, Increased systemic vascular resistance results from vasoconstriction.
Hypothermia after cardiac surgery causes vasoconstriction and can lead to
increased systemic vascular resistance.
7) The nurse is caring for a patient who is experiencing postoperative bleeding after
on-pump coronary artery bypass graft (CABG) surgery. The patient has had 600
mL of bloody drainage in the chest tube over the past 2 hours. Which
intervention would the nurse anticipate implementing for this patient? Select all
that apply. One, some, or all responses may be correct.
− Administer positive inotropes to increase blood pressure.
− Prepare the patient for reexploration of the surgical site.
− Monitor partial thromboplastin time and fibrinogen.
− Implement hypothermia protocol.
− Administer protamine sulfate. -- Correct Answer ✔✔ Prepare the
patient for reexploration of the surgical site.
Patients with blood loss greater than 500 mL in 1 hour or 300 mL/h for 2
consecutive hours should return to the operating room for reexploration of the
surgical site.
Monitor partial thromboplastin time and fibrinogen.
Patients who experience bleeding postoperatively should have frequent
laboratory assessments to help guide the selection of appropriate factors or
medications. These assessments should include partial thromboplastin time,
fibrinogen, prothrombin time, and platelets.
Administer protamine sulfate.
Patients require systemic heparinization while on the bypass machine during
CABG. Protamine sulfate neutralizes the anticoagulant effects of heparin and
could help control postoperative bleeding.
8) Which nursing intervention will help to decrease the risk of infection following
coronary artery bypass grafting?
− Encouraging bed rest and limited movement
− Changing the sternal dressing every 4 hours
− Placing the urinary catheter bag on the floor next to the bed
QUESTIONS WITH COMPLETE SOLUTIONS
1) When caring for a patient post procedure following a percutaneous coronary
intervention with radial access, which finding would the nurse report immediately
to the health care provider? Select all that apply. One, some, or all responses may
be correct.
− Discoloration of the fingers
− +2 brachial pulse
− Tingling in the hand
− Mild pain at the access site
− 5-second capillary refill -- Correct Answer ✔✔ Discoloration of the
fingers
Discoloration of the fingers indicates decreased perfusion that can occur
following arterial access. This finding should be reported to the health care
provider immediately.
Tingling in the hand
Tingling in the hand could indicate perfusion complications. The nurse should
ensure the splint is not too tight, if one is in place, and should report this finding
immediately to the health care provider.
5-second capillary refill
, A delayed capillary refill (more than 3 seconds) indicates a perfusion deficit and is
a concerning finding. The nurse should perform additional circulation assessments
and should immediately report the findings to the health care provider.
2) The nurse provides teaching for a patient who is being discharged following
percutaneous coronary intervention with drug-eluting stent placement. Which
patient statement shows the need for additional education?
− "I will continue taking my lipid-lowering medications in the evening."
− "I will monitor for bleeding or drainage from the access site."
− "I will report chest pain or shortness of breath to my health care
provider."
− "I will reduce my tobacco use to one or two cigarettes a day." --
Correct Answer ✔✔ I will reduce my tobacco use to one or two
cigarettes a day."
Tobacco use can lead to vasoconstriction and continued cardiac damage. The
patient should be educated on the need for complete smoking cessation and
should be provided with tobacco cessation resources.
3) Which prosthetic cardiac valve would be best for an 84-year-old woman with
aortic valve disease and heart failure who lives alone and has fallen four times in
the last year?
− Tilting-disk
− Bileaflet
− Self-expandable percutaneous
− Homograft -- Correct Answer ✔✔ Homograft
A homograft is a bioprosthetic heart valve that does not require anticoagulation.
Additionally, bioprosthetic valves have a reduced longevity and may be chosen for
an older adult patient.
4) Which medication would the nurse anticipate administering during an off-pump
coronary artery bypass graft (CABG) surgery?
− Glucagon
− Diltiazem
− Alteplase
, − Furosemide -- Correct Answer ✔✔ Diltiazem
Diltiazem is a calcium channel blocker that is used to temporarily decrease heart
rate to assist with stabilization of the cardiac wall motion at the site of the
anastomosis.
5) Which nursing intervention would be implemented to control heart rate during
the postoperative period after coronary artery bypass graft (CABG) surgery?
Select all that apply. One, some, or all responses may be correct.
− Administering crystalloid fluids
− Initiating temporary epicardial pacing
− Monitoring and correcting hypokalemia
− Monitoring and correcting hypernatremia
− Administering intravenous beta-blocker medications -- Correct
Answer ✔✔ initiating temporary epicardial pacing
Epicardial pacing is usually instituted when the heart rate drops below 60 beats
per minute and is a treatment for postoperative bradycardia.
Monitoring and correcting hypokalemia
Hypokalemia can lead to postoperative rhythm changes, decreasing cardiac
output. The nurse should closely monitor for hypokalemia and administer
potassium replacement as needed.
Administering intravenous beta-blocker medications
Beta-blocker medications can be administered prophylactically to prevent atrial
fibrillation, which is a common complication after CABG. These medications can
also help decrease and control tachycardia postoperatively.
6) Which condition can occur as a result of hypothermia related to cardiac surgery?
− Atrial fibrillation
− Increased clotting
− Higher cardiac output
− Increased systemic vascular resistance -- Correct Answer ✔✔
Increased systemic vascular resistance
, Increased systemic vascular resistance results from vasoconstriction.
Hypothermia after cardiac surgery causes vasoconstriction and can lead to
increased systemic vascular resistance.
7) The nurse is caring for a patient who is experiencing postoperative bleeding after
on-pump coronary artery bypass graft (CABG) surgery. The patient has had 600
mL of bloody drainage in the chest tube over the past 2 hours. Which
intervention would the nurse anticipate implementing for this patient? Select all
that apply. One, some, or all responses may be correct.
− Administer positive inotropes to increase blood pressure.
− Prepare the patient for reexploration of the surgical site.
− Monitor partial thromboplastin time and fibrinogen.
− Implement hypothermia protocol.
− Administer protamine sulfate. -- Correct Answer ✔✔ Prepare the
patient for reexploration of the surgical site.
Patients with blood loss greater than 500 mL in 1 hour or 300 mL/h for 2
consecutive hours should return to the operating room for reexploration of the
surgical site.
Monitor partial thromboplastin time and fibrinogen.
Patients who experience bleeding postoperatively should have frequent
laboratory assessments to help guide the selection of appropriate factors or
medications. These assessments should include partial thromboplastin time,
fibrinogen, prothrombin time, and platelets.
Administer protamine sulfate.
Patients require systemic heparinization while on the bypass machine during
CABG. Protamine sulfate neutralizes the anticoagulant effects of heparin and
could help control postoperative bleeding.
8) Which nursing intervention will help to decrease the risk of infection following
coronary artery bypass grafting?
− Encouraging bed rest and limited movement
− Changing the sternal dressing every 4 hours
− Placing the urinary catheter bag on the floor next to the bed
