MSN Exam for Cardiovascular Surgical Care

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1. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?

1. Plaques obstruct the vein
2. Plaques obstruct the artery
3. Blood clots form outside the vessel wall
4. Hardened vessels dilate to allow blood to flow through

2. A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery 2 days ago. Which of the following surgical complications should the nurse suspect?

1. Left-sided heart failure
2. Aortic regurgitation
3. Complete heart block
4. Pericardial tamponade

3. After cardiac surgery, a client’s blood pressure measures 126/80. The nurse determines that the mean arterial pressure (MAP) is which of the following?

1. 46 mm Hg
2. 80 mm Hg
3. 95 mm Hg
4. 90 mm Hg

4. A woman with severe mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The physician orders pulmonary artery pressure monitoring, including pulmonary capillary wedge pressures. The purpose of this is to help assess the:

1. Degree of coronary artery stenosis
2. Peripheral arterial pressure
3. Pressure from fluid within the left ventricle
4. Oxygen and carbon dioxide concentration is the blood

5. For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery, which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion?

1. Ensure a liberal fluid intake
2. Provide an alkaline-ash diet
3. Prevent constipation
4. Enrich the client’s diet with dairy products

6. A nurse is assessing the neurovascular of a client who has returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is:

1. Normal because of increased blood flow through the leg
2. Slightly deteriorating and should be monitored for another hour
3. Moderately impaired, and the surgeon should be called
4. Adequate from an arterial approach, but venous complications are arising.

7. After open-heart surgery a client develops a temperature of 102*F. The nurse notifies the physician, because elevated temperatures:

1. Increase the cardiac output
2. May indicate cerebral edema
3. May be a forerunner of hemorrhage
4. Are related to diaphoresis and possible chilling

8. During a cardiac catherization blood samples from the right atrium, right ventricle, and pulmonary artery are analyzed for their oxygen content. Normally:

1. All contain less CO₂ than does pulmonary vein blood
2. All contain more oxygen than does pulmonary vein blood
3. The samples of blood all contain about the same amount of oxygen
4. Pulmonary artery blood contains more oxygen than the other samples

9. The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about:

1. Stroke volume
2. Cardiac output
3. Venous pressure
4. Left ventricular functioning

10. When preparing a client for discharge after surgery for a CABG, the nurse should teach the client that there will be:

1. No further drainage from the incisions after hospitalizations
2. A mild fever and extreme fatigue for several weeks after surgery
3. Little incisional pain and tenderness after 3 to 4 weeks after surgery
4. Some increase in edema in the leg used for the donor graft when activity increases

11. What is the most important nursing action when measuring a pulmonary capillary wedge pressure (PCWP)?

1. Have the client bear down when measuring the PCWP
2. Deflate the balloon as soon as the PCWP is measured
3. Place the client in a supine position before measuring the PCWP
4. Flush the catheter with heparin solution after the PCWP is determined.

12. The most important assessment for the nurse to make after a client has had a femeropopiteal bypass for peripheral vascular disease would be:

1. Incisional pain
2. Pedal pulse rate
3. Capillary refill time
4. Degree of hair growth

13. Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? Check all that apply.

1. Tachycardia
2. Hypertension
3. Increased CVP
4. Increased urine output
5. Jugular vein distention

14. A client has the diagnosis of left ventricular failure and a high pulmonary capillary wedge pressure (PCWP). The physician orders dopamine to improve ventricular function. The nurse will know the medication is working if the client’s:

1. Blood pressure rises
2. Blood pressure decreases
3. Cardiac index falls
4. PCWP rises

15. A 35-year-old male was knifed in the street fight, admitted through the ER, and is now in the ICU. An assessment of his condition reveals the following symptoms: respirations shallow and rapid, CVP 15 cm H₂O, BP 90 mm Hg systolic, skin cold and pale, urinary output 60-100 mL/hr for the last 2 hours. Analyzing these symptoms, the nurse will base a nursing diagnosis on the conclusion that the client has which of the following conditions?

1. Hypovolemic shock
2. Cardiac tamponade
3. Wound dehiscence
4. Atelectasis

Answers and Rationales

1. B. Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in the artery. Hardened vessels can’t dilate properly and, therefore, constrict blood flow.
2. D. A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat, with a regular rhythm). Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak). Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure).
3. C. MAP = (2 times the diastolic + systolic)/3 or (2d + s)/3 where 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 pressures are used to assess the heart’s ability to receive and pump blood. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client. The degree of coronary artery stenosis is assessed during a cardiac catherization. The peripheral arterial pressure is assessed with an arterial line.
5. A. In an immobilized client, calcium leaves the bone and concentrates in the ECF fluid. When a large amount of calcium passes through the kidneys, calcium can precipitate and form calculi. Nursing interventions that help prevent calculi include ensuring a liberal fluid intake (unless contraindicated). A diet rich in acid should be provided to keep the urine acidic, which increases the solubility of calcium. Preventing constipation is not associated with excessive calcium excretion. Limiting foods rich in calcium, such as dairy products, will help on preventing renal calculi.
6. A. An expected outcome of surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow.
7. A. Temperatures of 102*F or greater lead to an increased metabolism and cardiac workload.
8. C. Blood samples from the right atrium, right ventricle, and pulmonary artery would all be about the same with regard to oxygen concentration. Such blood contains slightly less oxygen than does systemic arterial blood.
9. D. The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated.
10. D. The client is up more at home, so dependent edema usually increases. Serosanguineous drainage may persist after discharge.
11. B. While the balloon must be inflated to measure the capillary wedge pressure, leaving the balloon inflated will interfere with blood flow to the lung. Bearing down will increase intrathoracic pressure and alter the reading. While a supine position is preferred; it is not essential. Agency protocols relative to flushing of unused ports must be followed.
12. C. Checking capillary refill provides data about current perfusion of the extremity. While the presence and quality of the pedal pulse provide data about peripheral circulation, it is not necessary to count the rate.
13. A, C, E. Blood in the pericardial sac compresses the heart so the ventricles cannot fill; this leads to a rapid thready pulse. Tamponade causes hypotension and a narrowed pulse pressure. As the tamponade increases, pressure on the heart interferes with the ejection of blood from the left ventricle, resulting in an increased pressure in the right side of the heart and the systemic circulation. As the heart because more inefficient, there is a decrease in kidney perfusion and therefore urine output. The increased venous pressure caused JVD.
14. A. If dopamine as a positive effect, it will cause vasoconstriction peripherally, but increase renal perfusion and the blood pressure will rise. The cardiac index will also rise and the PCWP should decrease.
15. B. All of the client’s symptoms are found in both cardiac tamponade and hypovolemic shock except the increase in urinary output.