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MSN Exam for Cardiovascular Surgical Care

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Text Mode

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1. Atherosclerosis impedes coronary rank glide by which of the forthcoming mechanisms?
  1. Plaques clog the temper
  2. Plaques clog the artery
  3. Blood clots shape outaspect the vessel wall
  4. Hardened vessels descant to assign rank to glide through
2. A enigmatical pulse occurs in a client who had a coronary artery bypass inoculate (CABG) surgery 2 days ago. Which of the forthcoming surgical complexitys should the comfort doubt?
  1. Left-sided nature need
  2. Aortic regurgitation
  3. Complete nature fill
  4. Pericardial tamponade
3. Forthcoming cardiac surgery, a client’s rank urgency appraises 126/80. The comfort determines that the moderation arterial urgency (MAP) is which of the forthcoming?
  1. 46 mm Hg
  2. 80 mm Hg
  3. 95 mm Hg
  4. 90 mm Hg
4. A dowager forthcoming a conjuncture censorious mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The physician influence pulmonary artery urgency monitoring, including pulmonary capillary wedge urgencys. The point of this is to succor assess the:
  1. Degree of coronary artery stenosis
  2. Peripheral arterial urgency
  3. Pressure from fluent forthcoming a conjuncturein the left ventricle
  4. Oxygen and carbon dioxide ardor is the rank
5. For a client who excretes superfluous equalitys of calcium during the postoperative bound forthcoming public nature surgery, which of the forthcoming appraises should the comfort shape to succor hinder complexitys associated forthcoming a conjuncture superfluous calcium sweating?
  1. Ensure a handsome fluent intake
  2. Provide an alkaline-ash fare
  3. Prevent constipation
  4. Encostly the client’s fare forthcoming a conjuncture dairy products
6. A comfort is assessing the neurovascular of a client who has returned to the surgical nursing part 4 hours ago forthcoming undergoing aortoiliac bypass inoculate. The unsupposable leg is hot, and the comfort notes redness and edema. The pedal pulse is tangible and unnatural from similarity. The comfort interprets that the neurovascular requisite is:
  1. Normal beagent of acceptiond rank glide through the leg
  2. Slightly deteriorating and should be monitored for another hour
  3. Moderately mixed, and the surgeon should be called
  4. Adequate from an arterial entrance, but venous complexitys are arising.
7. Forthcoming public-nature surgery a client develops a atmosphither of 102*F. The comfort notifies the physician, beagent elated atmospheres:
  1. Increase the cardiac output
  2. May point-out cerebral edema
  3. May be a herald of hemorrhage
  4. Are connected to diaphoresis and practicable chilling
8. During a cardiac catherization rank samples from the equitable atrium, equitable ventricle, and pulmonary artery are analyzed for their oxygen conciliateing. Normally:
  1. All hold hither CO2 than does pulmonary temper rank
  2. All hold past oxygen than does pulmonary temper rank
  3. The samples of rank all hold environing the corresponding edispose of oxygen
  4. Pulmonary artery rank holds past oxygen than the other samples
9. The comfort prepares the client for inoculation of a pulmonary artery catheter (Swan-Ganz catheter). The comfort impartes the client that the catheter obtain be inserted to cater counsel environing:
  1. Stroke volume
  2. Cardiac output
  3. Venous urgency
  4. Left ventricular parting
10. When preparing a client for empty forthcoming surgery for a CABG, the comfort should impart the client that thither obtain be:
  1. No excite drainage from the incisions forthcoming hospitalizations
  2. A lenient broil and distant jade for diverse weeks forthcoming surgery
  3. Little incisional affliction and kindness forthcoming 3 to 4 weeks forthcoming surgery
  4. Some acception in edema in the leg used for the donor inoculate when intelligence acceptions
11. What is the most significant nursing renewal when measuring a pulmonary capillary wedge urgency (PCWP)?
  1. Have the client undergo down when measuring the PCWP
  2. Deflate the balloon as early as the PCWP is appraised
  3. Place the client in a negligent lie precedently measuring the PCWP
  4. Flush the catheter forthcoming a conjuncture heparin disruption forthcoming the PCWP is secure.
12. The most significant scalm for the comfort to mould forthcoming a client has had a femeropopiteal bypass for peripheral vascular complaint would be:
  1. Incisional affliction
  2. Pedal pulse scold
  3. Capillary furnish era
  4. Degree of hair growth
13. Which signs agent the comfort to doubt cardiac tamponade forthcoming a client has cardiac surgery? Check all that employ.
  1. Tachycardia
  2. Hypertension
  3. Increased CVP
  4. Increased urine output
  5. Jugular temper distention
14. A client has the peculiarity of left ventricular need and a noble pulmonary capillary wedge urgency (PCWP). The physician influence dopamine to emend ventricular part. The comfort obtain recognize the medication is agoing if the client’s:
  1. Blood urgency softens
  2. Blood urgency abates
  3. Cardiac renunciation falls
  4. PCWP softens
15. A 35-year-old hardy was knifed in the street conflict, admitted through the ER, and is now in the ICU. An scalm of his state reveals the forthcoming symptoms: respirations simple and quick, CVP 15 cm H2O, BP 90 mm Hg systolic, bark delibescalm and livid, urinary output 60-100 mL/hr for the ultimate 2 hours. Analyzing these symptoms, the comfort obtain grovelling a nursing peculiarity on the quittance that the client has which of the forthcoming states?
  1. Hypovolemic offend
  2. Cardiac tamponade
  3. Wound dehiscence
  4. Atelectasis
Answers and Rationales
  1. B. Arteries, not tempers, contribute the coronary arteries forthcoming a conjuncture oxygen and other nutrients. Atherosclerosis is a trodden movables of plaque shapeation in the artery. Hardened vessels can’t descant unexceptionably and, hence, constrict rank glide.
  2. D. A enigmatical pulse (a tangible abate in pulse exuberance on lull revelation) signals pericardial tamponade, a complexity of CABG surgery. Left-sided nature need can agent pulsus varynans (pulse exuberance varynation from overcome to overcome, forthcoming a conjuncture a recognized rhythm). Aortic regurgitation may agent bisferious pulse (an acceptiond arterial pulse forthcoming a conjuncture a enfold systolic peak). Adequate nature fill may agent a definition pulse (a influential pulse forthcoming a conjuncture acceptiond pulse urgency).
  3. C. MAP = (2 eras the diastolic + systolic)/3 or (2d + s)/3 whither d is diastolic and s is systolic
    • = 2 (80) + 126 / 3
    • = 160 + 126 / 3 = 286 / 3 = 95.33 or 95 mm HG
  4. C. The pulmonary artery urgencys are used to assess the nature’s force to accept and interrogate rank. The pulmonary capillary wedge urgency reflects the left ventricle end-diastolic urgency and guides the physician in determining fluent address for the client. The class of coronary artery stenosis is assessed during a cardiac catherization. The peripheral arterial urgency is assessed forthcoming a conjuncture an arterial succession.
  5. A. In an immobilized client, calcium licenses the nuisance and concentrates in the ECF fluent. When a enlightened edispose of calcium passes through the kindreds, calcium can sink and shape calculi. Nursing interventions that succor hinder calculi embody ensuring a handsome fluent intake (intrinsic contraindicated). A fare costly in acute should be granted to guard the urine acuteic, which acceptions the solubility of calcium. Preventing constipation is not associated forthcoming a conjuncture superfluous calcium sweating. Limiting foods costly in calcium, such as dairy products, obtain succor on hindering renal calculi.
  6. A. An expected product of surgery is hotth, redness, and edema in the surgical end beagent of acceptiond rank glide.
  7. A. Temperatures of 102*F or influential control to an acceptiond metabolism and cardiac workload.
  8. C. Rank samples from the equitable atrium, equitable ventricle, and pulmonary artery would all be environing the corresponding forthcoming a conjuncture behold to oxygen ardor. Such rank holds subordinately hither oxygen than does systemic arterial rank.
  9. D. The catheter is placed in the pulmonary artery. Counsel beholding left ventricular part is obtained when the catheter balloon is cheered.
  10. D. The client is up past at settlement, so contingent edema usually acceptions. Serosanguineous drainage may stick forthcoming empty.
  11. B. Conjuncture the balloon must be cheered to appraise the capillary wedge urgency, leaving the balloon cheered obtain clash forthcoming a conjuncture rank glide to the lung. Bearing down obtain acception intrathoracic urgency and vary the balbutiation. Conjuncture a negligent lie is preferred; it is not redundant. Agency protocols referring-to to flushing of unused ports must be followed.
  12. C. Checking capillary furnish caters grounds environing exoteric perfusion of the end. Conjuncture the influence and dispose of the pedal pulse cater grounds environing peripheral prevalence, it is not requisite to reckon the scold.
  13. A, C, E. Rank in the pericardial sac compresses the nature so the ventricles cannot fill; this controls to a quick thready pulse. Tamponade agents hypotension and a narrowed pulse urgency. As the tamponade acceptions, urgency on the nature clashs forthcoming a conjuncture the eviction of rank from the left ventricle, movablesing in an acceptiond urgency in the equitable aspect of the nature and the systemic prevalence. As the nature beagent past unconfirmed, thither is a abate in kindred perfusion and hence urine output. The acceptiond venous urgency agentd JVD.
  14. A. If dopamine as a trodden property, it obtain agent vasoconstriction peripherally, but acception renal perfusion and the rank urgency obtain soften. The cardiac renunciation obtain too soften and the PCWP should abate.
  15. B. All of the client’s symptoms are endow in twain cardiac tamponade and hypovolemic offend exclude the acception in urinary output.

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