Chapter 22- Cardiac Surgery My Nursing Test Banks

 

1.

A patient is recovering in the CCU following carotid endarterectomy. What intervention should the nurse make to ensure that a hematoma is not forming in the patients neck?

A)

Assess neck size by comparing operative side with nonoperative side.

B)

Monitor pupil reactivity.

C)

Assess hand grip.

D)

Monitor blood pressure.

2.

A patient who recently underwent carotid endarterectomy is exhibiting signs of stroke. Which intervention or interventions should the nurse take to assess this patients neurological function? Select all that apply.

A)

Measure chest tube output.

B)

Assess eye movement.

C)

Monitor level of consciousness.

D)

Assess urine output.

3.

A patient with left main coronary artery disease (CAD) experiences persistent angina. She would like to exercise more, but is limited by shortness of breath and angina. Her physician believes that she is a good candidate for coronary artery bypass graft. The nurse recognizes that which of the following are indications for coronary artery bypass graft (CABG) surgery in this situation?

A)

Having left main CAD

B)

Being a good candidate for angioplasty and stenting

C)

Having persistent angina

D)

Availability of new effective CAD medication

E)

Limited exercise tolerance

F)

The patients spouse was successfully treated with CABG

4.

A patient in the CCU is recovering from coronary artery bypass graft (CABG) surgery. He has had multiple graft surgeries in the past. For this latest surgery, the patients radial artery was used in the graft. What complication should the nurse most expect to observe in this patient?

A)

Occlusion

B)

Infection

C)

Arterial spasm

D)

Internal hemorrhaging

5.

A patient is recovering in the CCU following off-pump coronary artery bypass graft (OPCABG) surgery involving the internal mammary artery graft. What nursing intervention is most important for the first 48 hours following surgery for this patient?

A)

Administration of anticoagulant therapy

B)

Administration of calcium channel blockers

C)

Monitoring of fluid status

D)

Assessment for hematoma

6.

A patient with moderate mitral stenosis with minimal calcification and regurgitation is preparing to have surgery. Which procedure would be most appropriate to restore normal function to this patient?

A)

Annuloplasty

B)

Valve replacement with biological valve

C)

Valve replacement with caged ball valve

D)

Commissurotomy

7.

A patient recovering from cardiopulmonary bypass surgery is shivering. For what reason should the nurse be concerned about the shivering?

A)

Shivering is a sign of cardiogenic shock

B)

Shivering is a sign that the patient has a fever

C)

Shivering increases myocardial workload

D)

Shivering can cause sutures to rupture

8.

A patient recovering in the CCU following coronary artery bypass graft (CABG) surgery complains of pain in his chest. The patient underwent a sternotomy incision during the surgery. Which of the following types of pain would indicate anginawhich may indicate graft failureas opposed to typical pain resulting from the sternotomy?

A)

Radiates to arms

B)

Is worse with deep breathing

C)

Is worse with movement

D)

Is sharp

9.

A patient in the CCU is experiencing premature atrial contractions following coronary artery bypass graft surgery. Which of the following would be the most appropriate nursing intervention?

A)

Administration of anticoagulants

B)

Administration of potassium and magnesium

C)

Administration of dopamine

D)

Administration of epinephrine

10.

A patient who underwent carotid endarterectomy is being discharged from the CCU. Which of the following instructions should the nurse give to the patient?

A)

Avoid rotating your head.

B)

Bruising and discoloration of the neck are not normal and should be reported immediately.

C)

Eat a low-fat diet.

D)

Avoid washing the incision site.

11.

A patient with severe coronary artery disease is scheduled for coronary artery bypass graft surgery. As part of the preoperative teaching, the nurse explains the surgery. Which of the following statements about this procedure is true?

A)

The diseased artery will be removed and replaced with a graft from another artery.

B)

A piece of the saphenous vein will be used to go around the diseased part of the artery.

C)

After removal of the diseased artery, the remaining ends will be anastomosed.

D)

The wall of the heart will be incised to create a new pathway for blood flow.

12.

The patient is scheduled for coronary artery bypass surgery using the off-pump technique. During preoperative teaching, the nurse explains that using the off-pump procedure has what advantage over the on-pump procedure?

A)

There is a lower risk of a cerebral embolus.

B)

The patient can anticipate a shorter hospital stay.

C)

There will be less need for anticoagulation therapy.

D)

The procedure will be less painful.

13.

A patient with severe coronary artery disease has persistent angina that is refractory to medical management at maximum drug doses and has severe compromise of activities of daily living from the angina. The patient has had several coronary artery bypass surgeries and has been told that he is not a candidate for any further surgeries or percutaneous interventions such as stents. In discussing options for further therapy, what should the nurse include that would offer the patient the most hope?

A)

Unless a new medication is invented, there is nothing that can be done.

B)

Discussion of hospice and palliative support for end-of-life care

C)

Referral to the social worker for financial assistance

D)

Referral to the transmyocardial laser revascularization program for evaluation

14.

The patient has been diagnosed with severe mitral valve stenosis. What physical changes would the nurse expect to find as a result of the stenosis?

A)

Prolonged capillary refill

B)

Normal left atrial and ventricular pressures

C)

Clear lung sounds

D)

Angina pectoris

15.

The patient has been diagnosed with mitral valve insufficiency and left ventricular hypertrophy. What effect would the nurse expect from the left ventricular hypertrophy?

A)

Improved cardiac output from increased left ventricular contractility

B)

No appreciable signs or symptoms or effects until late in the disease process

C)

A more obvious and easier-to-auscultate mitral valve regurgitant murmur

D)

Early onset of pulmonary edema and right-sided congestive heart failure

16.

The patient has been diagnosed with severe aortic valve stenosis. Considering the most common symptoms caused by aortic valve stenosis, what is the most important nursing intervention?

A)

Document characteristics of the aortic stenosis murmur.

B)

Teach patient to rise slowly from a supine position.

C)

Assess peripheral circulation more frequently.

D)

Assess for and document pulmonary adventitious sounds.

17.

The patient has developed acute aortic valve insufficiency after experiencing blunt chest trauma. What symptom, if found by the nurse, is indicative of a counterproductive compensatory mechanism that should be treated?

A)

Low cardiac output

B)

Pulmonary edema

C)

Elevated blood pressure

D)

Aortic insufficiency murmur

18.

The patient has had coronary artery bypass surgery involving the cardiopulmonary bypass pump, systemic hypothermia, topical cardiac hypothermia, and cold cardioplegia. As a result of the various hypothermic therapies, numerous postoperative complications may ensue. What collaborative postoperative intervention is specifically directed at ameliorating one or more of these complications?

A)

Use of intravenous pain and sedation medications

B)

Mechanical ventilation and supplemental oxygen therapy

C)

Vital signs every hour until stable or transferred to step-down unit

D)

Management of mediastinal chest tube drainage

19.

The nurse is caring for a patient who has just had coronary artery bypass grafting. As part of the admission procedure to the critical care unit immediately after surgery, what nursing assessment has the highest priority?

A)

Urine output

B)

Cardiac index measurement

C)

Chest tube drainage measurement

D)

Core body temperature

20.

After coronary artery bypass surgery, the patient experiences significant fluid volume shifts and losses. What nursing assessment would be most indicative of fluid volume deficit?

A)

Low central venous pressure

B)

Urine output 40 mL/hr

C)

Brisk capillary refill

D)

Diminished core body temperature

21.

A patient who has just has coronary artery bypass surgery has developed tachycardia, a low-grade fever, and an elevated total white blood cell count. What additional sign or symptom would support the nurses suspicion of a postoperative infection?

A)

Purulent drainage from the chest incision

B)

Chest incision edges are red and swollen.

C)

Elevated immature neutrophils or bands

D)

Severe incisional pain with cough

22.

The nurse is caring for a patient who has just had coronary artery bypass grafting and is experiencing significant hypotension. What nursing assessment would best confirm that the hypotension is related to blood loss?

A)

Low hemoglobin and hematocrit, with high central venous pressure

B)

Chest tube drainage in excess of 200 mL/hr

C)

Urine output 40 to 50 mL/hr

D)

Chest tube drainage less than 30 mL/hr

Answer Key

1.

A

2.

B, C

3.

A, C, E

4.

C

5.

A

6.

D

7.

C

8.

A

9.

B

10.

C

11.

B

12.

B

13.

D

14.

A

15.

C

16.

B

17.

C

18.

B

19.

B

20.

A

21.

A

22.

B

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