AACN CSC (CSC) PRACTICE TEST | QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | ALREADY GRADED A+ | LATEST EXAM
You are caring for a patient with an intra-aortic balloon pump and note blood in
the tubing. Your initial action should be:
A. Stop the balloon pump and notify the physician.
B. Administer 100% oxygen to help displace the helium and notify the
physician
C. Leave the IABP running and notify the physician.
D. Purge the IABP manually to clear the blood from the tubing. -
CORRECT ANSWER -A. Blood in the IABP tubing indicates a balloon
rupture which can cause gas embolus. However, helium is thought to be easily
absorbed in the presence of balloon rupture and oxygen is not generally
indicated. The appropriate action is to disconnect the balloon from the console
or turn it on standby so the movement of helium is stopped and notify the
physician. The nurse will need to prepare for IABP removal and replacement if
needed.
When caring for a patient immediately post CABG the nurse recognizes that the
most likely cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent
> 12 hours.
B. LV failure requiring an inotrope as first line treatment for any
hypotension.
C. Decreased circulating volume representing the need for increased fluid
administration.
D. LV failure requiring an assist device. - CORRECT ANSWER -C.
Hypotension in the immediate postoperative period is usually caused by low
circulating volume and responds to treatment with fluids. Volume is the first line
treatment for hypotension. If there is no immediate response to volume
administration, 500 mg of IV calcium chloride is often given. Existing
vasopressors, such as norepinephrine, can also be adjusted. It is important for
,hypotension to be promptly treated. Persistent hypotension can result in
hypoperfusion and end organ damage.
LV failure is not the most common cause of hypotension in the immediate post-
operative period and therefore inotropic agents are not first line agents used in
the treatment of hypotension. Hypotension that does not respond to fluid
administration may require an inotrope.
Preoperative clopidogrel should be held for how many days in the elective
surgery patient:
A. It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days. - CORRECT ANSWER -C. Clopidogrel inhibits the P2Y12
receptor on the platelet for the lifetime of the platelet (10 days). Inhibited
platelets cannot participate in clotting, so the risk of bleeding increases with
antiplatelet drugs. Most clinical trials have identified an increased risk in
bleeding, transfusion, and re-exploration when clopidogrel is taken within 5
days of surgery, and no increase in bleeding or transfusions when clopidogrel is
stopped for > 5 days prior to surgery. Therefore, clopidogrel should be stopped
for 5 to 7 days prior to elective surgery. Emergent surgery can be done
regardless of when the
last dose of clopidogrel was taken, but will be associated with increased
bleeding and need for platelet transfusions.
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days. -
CORRECT ANSWER -B. OPCAB refers to off-pump coronary artery bypass.
Surgery is done without CPB but it still involves a median sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a
beating heart without CPB and without the use of a median sternotomy.
,MIDCAB is commonly done through an anterior thoracotomy incision and is
used to bypass the mid to distal LAD with a left internal mammary artery
(LIMA) graft. A ministernotomy can also be used to gain access during
MIDCAB.
Which of the following patients is at highest risk for neurological complications
after CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history
of hypertension - CORRECT ANSWER -B. Severe atherosclerosis of the
aorta, advanced age, use of CPB, aortic cross-clamping, diabetes, hypertension,
female sex, and history of stroke place patients at high risk for neurological
complications following cardiac surgery. Other factors contributing to
neurological complications include alcohol abuse, heart failure, arrhythmias,
and hyperglycemia.
The nurse caring for the post operative cardiac surgery patient recognizes the
following as potential contributors to post-operative vasodilation that can cause
hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of
vasodilators post op.
B. Use of norepinephrine or dopamine to support BP immediately post-op.
C. Inflammatory response due to CPB and use of norepinephrine to support
BP
D. Rewarming that occurs after return to the ICU, and the inflammatory
response to use of cardiopulmonary bypass during surgery - CORRECT
ANSWER -D. Intraoperative cooling results in vasoconstriction; rewarming
after surgery causes vasodilation and can contribute to hypotension if volume
administration is inadequate for the increased size of the vascular space caused
by vasodilation. The use of CPB stimulates an inflammatory response that
results in vasodilation that contributes to hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not
vasodilation.
, A characteristic of a fast-track pathway after CABG would include:
A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the
ventilator weaning
process.
D. extubation by the third post-op day - CORRECT ANSWER -C. Low-
risk patients can be selected for fast tracking after CABG. These patients are
targeted for early extubation, early ambulation, and early discharge. Patients
who are fast tracked receive sedation and analgesia to allow for early
extubation. Pharmacological strategies to prevent atrial fibrillation and early
phase I cardiac rehabilitation are also key components of fast tracking.
You are caring for an early post-operative CABG patient who remains
hypotensive despite treatment with adequate fluid administration and an alpha
constricting agent. You know that one potential post-operative complication
responsible for this persistent hypotension could be:
A. Acute kidney injury.
B. Acute saphenous vein graft closure.
C. Acute respiratory distress syndrome (ARDS).
D. Vasoplegia. - CORRECT ANSWER -D. Vasoplegia is a form of
vasodilatory shock that can occur after separation from CPB. It is characterized
by significant hypotension despite adequate fluid resuscitation, low SVR(due to
vasodilation), and is resistant to vasopressors. When vasopressors
(norepinephrine, epinephrine, high dose dopamine, or vasopressin) are not able
to maintain blood pressure in the presence of adequate filling pressures, then
vasoplegia may be present. There are several theories behind the cause of
vasoplegia, including leukocyte activation and the release of pro-inflammatory
mediators during cardiopulmonary bypass, and vasoplegia has been associated
with long-term use of ACE inhibitors, calcium channel blockers, amiodarone,
and heparin. Patients with EF
<35%, heart failure and diabetes are at higher risk. Vasoplegia can also be seen
after OPCAB.
WELL DETAILED ANSWERS | ALREADY GRADED A+ | LATEST EXAM
You are caring for a patient with an intra-aortic balloon pump and note blood in
the tubing. Your initial action should be:
A. Stop the balloon pump and notify the physician.
B. Administer 100% oxygen to help displace the helium and notify the
physician
C. Leave the IABP running and notify the physician.
D. Purge the IABP manually to clear the blood from the tubing. -
CORRECT ANSWER -A. Blood in the IABP tubing indicates a balloon
rupture which can cause gas embolus. However, helium is thought to be easily
absorbed in the presence of balloon rupture and oxygen is not generally
indicated. The appropriate action is to disconnect the balloon from the console
or turn it on standby so the movement of helium is stopped and notify the
physician. The nurse will need to prepare for IABP removal and replacement if
needed.
When caring for a patient immediately post CABG the nurse recognizes that the
most likely cause of hypotension in the immediate post-operative period is
A. Decreased circulating volume requiring no intervention unless persistent
> 12 hours.
B. LV failure requiring an inotrope as first line treatment for any
hypotension.
C. Decreased circulating volume representing the need for increased fluid
administration.
D. LV failure requiring an assist device. - CORRECT ANSWER -C.
Hypotension in the immediate postoperative period is usually caused by low
circulating volume and responds to treatment with fluids. Volume is the first line
treatment for hypotension. If there is no immediate response to volume
administration, 500 mg of IV calcium chloride is often given. Existing
vasopressors, such as norepinephrine, can also be adjusted. It is important for
,hypotension to be promptly treated. Persistent hypotension can result in
hypoperfusion and end organ damage.
LV failure is not the most common cause of hypotension in the immediate post-
operative period and therefore inotropic agents are not first line agents used in
the treatment of hypotension. Hypotension that does not respond to fluid
administration may require an inotrope.
Preoperative clopidogrel should be held for how many days in the elective
surgery patient:
A. It does not need to be held.
B. 1-2 days.
C. 5-7 days.
D. 30 days. - CORRECT ANSWER -C. Clopidogrel inhibits the P2Y12
receptor on the platelet for the lifetime of the platelet (10 days). Inhibited
platelets cannot participate in clotting, so the risk of bleeding increases with
antiplatelet drugs. Most clinical trials have identified an increased risk in
bleeding, transfusion, and re-exploration when clopidogrel is taken within 5
days of surgery, and no increase in bleeding or transfusions when clopidogrel is
stopped for > 5 days prior to surgery. Therefore, clopidogrel should be stopped
for 5 to 7 days prior to elective surgery. Emergent surgery can be done
regardless of when the
last dose of clopidogrel was taken, but will be associated with increased
bleeding and need for platelet transfusions.
The term OPCAB refers to:
A. combination open heart surgery and percutaneous procedure.
B. CABG surgery without the use of cardiopulmonary bypass (CPB).
C. the use of thoracotomy instead of sternotomy.
D. patients who are fast tracked to be discharged in less than 5 days. -
CORRECT ANSWER -B. OPCAB refers to off-pump coronary artery bypass.
Surgery is done without CPB but it still involves a median sternotomy.
MIDCAB (minimally invasive direct coronary artery bypass) is performed on a
beating heart without CPB and without the use of a median sternotomy.
,MIDCAB is commonly done through an anterior thoracotomy incision and is
used to bypass the mid to distal LAD with a left internal mammary artery
(LIMA) graft. A ministernotomy can also be used to gain access during
MIDCAB.
Which of the following patients is at highest risk for neurological complications
after CABG?
A. A 63-year- old patient with a BMI of 30 undergoing OPCAB
B. A 85-year-old patient with an atherosclerotic aorta undergoing CPB
C. A previously healthy 50-year-old woman undergoing CPB
D. A 67-year-old man having a MIDCAB to the LAD with no known history
of hypertension - CORRECT ANSWER -B. Severe atherosclerosis of the
aorta, advanced age, use of CPB, aortic cross-clamping, diabetes, hypertension,
female sex, and history of stroke place patients at high risk for neurological
complications following cardiac surgery. Other factors contributing to
neurological complications include alcohol abuse, heart failure, arrhythmias,
and hyperglycemia.
The nurse caring for the post operative cardiac surgery patient recognizes the
following as potential contributors to post-operative vasodilation that can cause
hypotension:
A. Cooling that occurs while on cardiopulmonary bypass, and use of
vasodilators post op.
B. Use of norepinephrine or dopamine to support BP immediately post-op.
C. Inflammatory response due to CPB and use of norepinephrine to support
BP
D. Rewarming that occurs after return to the ICU, and the inflammatory
response to use of cardiopulmonary bypass during surgery - CORRECT
ANSWER -D. Intraoperative cooling results in vasoconstriction; rewarming
after surgery causes vasodilation and can contribute to hypotension if volume
administration is inadequate for the increased size of the vascular space caused
by vasodilation. The use of CPB stimulates an inflammatory response that
results in vasodilation that contributes to hypotension.
Norepinephrine and dopamine cause peripheral vasoconstriction, not
vasodilation.
, A characteristic of a fast-track pathway after CABG would include:
A. anticipated discharge between post-op days 7 and 8.
B. a defined medication strategy to prevent postoperative atrial fibrillation.
C. liberal use of opioid medications to increase patient comfort during the
ventilator weaning
process.
D. extubation by the third post-op day - CORRECT ANSWER -C. Low-
risk patients can be selected for fast tracking after CABG. These patients are
targeted for early extubation, early ambulation, and early discharge. Patients
who are fast tracked receive sedation and analgesia to allow for early
extubation. Pharmacological strategies to prevent atrial fibrillation and early
phase I cardiac rehabilitation are also key components of fast tracking.
You are caring for an early post-operative CABG patient who remains
hypotensive despite treatment with adequate fluid administration and an alpha
constricting agent. You know that one potential post-operative complication
responsible for this persistent hypotension could be:
A. Acute kidney injury.
B. Acute saphenous vein graft closure.
C. Acute respiratory distress syndrome (ARDS).
D. Vasoplegia. - CORRECT ANSWER -D. Vasoplegia is a form of
vasodilatory shock that can occur after separation from CPB. It is characterized
by significant hypotension despite adequate fluid resuscitation, low SVR(due to
vasodilation), and is resistant to vasopressors. When vasopressors
(norepinephrine, epinephrine, high dose dopamine, or vasopressin) are not able
to maintain blood pressure in the presence of adequate filling pressures, then
vasoplegia may be present. There are several theories behind the cause of
vasoplegia, including leukocyte activation and the release of pro-inflammatory
mediators during cardiopulmonary bypass, and vasoplegia has been associated
with long-term use of ACE inhibitors, calcium channel blockers, amiodarone,
and heparin. Patients with EF
<35%, heart failure and diabetes are at higher risk. Vasoplegia can also be seen
after OPCAB.
