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CSC Study Questions with Correct Answers Following surgical repair of a thoracic aneurysm with an endoluminal graft, the patient is unable to move his lower extremities. The nurse should first a. Activate stroke team and prepare to do an urgent (STAT) computed tomography (CT) scan b. Prepare ...

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  • November 10, 2024
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  • 2024/2025
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CSC Study Questions with Correct
Answers

Following surgical repair of a thoracic aneurysm with an endoluminal graft, the

patient is unable to move his lower extremities. The nurse should first




a. Activate stroke team and prepare to do an urgent (STAT) computed tomography

(CT) scan




b. Prepare to return to surgery for exploration of femoral artery occlusion




c. Call surgeon to obtain a neurology consultation in the morning




d. Prepare for lumbar drain insertion to remove cerebrospinal fluid (CSF) -

ANSWER✔✔-D


Spinal cord ischemia is a complication from thoracic aneurysm repair for both open

and endoluminal repair. Spinal cord ischemia results from increased cerebral spinal

pressure that compresses the spinal nerves. Untreated spinal cord ischemia can lead
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to paraplegia. It is important to recognize the signs of spinal cord ischemia (loss of

lower extremity movement) promptly. Immediate insertion of a spinal drain can

reverse the spinal cord ischemia and prevent paraplegia. Bilateral leg paralysis is not

typically an initial symptom of stroke (A). Signs of femoral artery occlusion (B) are

the 5 Ps: pulselessness, pallor, pain, paresthesias, and paralysis. These symptoms

would be unilateral, not bilateral. Immediate insertion of a spinal drain is needed;

waiting until morning for the consultation (C) would be inappropriate.


A postoperative patient who had undergone coronary artery bypass graft and

ventricular aneurysm repair has a 15-beat run of ventricular tachycardia. The most

likely cause of the dysrhythmia is




a. Irritability of the ventricle from the aneurysm repair




b. Spasm of the right coronary artery graft




c. Potassium 4.8 mEq/dL and magnesium 2.1 mEq/L




d. Did not restart administration of the angiotensinconverting enzyme (ACE)

inhibitor (taken preoperatively) - ANSWER✔✔-A


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Patients with left ventricular aneurysm typically have depressed left ventricular (LV)

function. Depressed LV function may lead to increased ventricular arrhythmias. LV

aneurysm repair is indicated to improve symptoms of angina, heart failure, systemic

thromboembolism, or malignant arrhythmias. In the immediate postoperative phase,

the repaired ventricle continues to be depressed and has the added trauma of surgery

on the left ventricle. Both of these increase the irritability of the LV, leading to

ventricular arrhythmias. Spasm (B) or occlusion of the RCA leads to

bradyarrhythmias, not ventricular arrhythmias. The potassium and magnesium levels

in (C) are normal. Low potassium and magnesium levels increase the risk for

ventricular arrhythmias. ACE inhibitors (D) do not have any antiarrhythmic effect.


The nurse admits a patient after aortic valve replacement and notes the following

settings of the temporary pacemaker: DDD rate, 80/min; atrial MA, 10; ventricular

MA, 4. The underlying rhythm is complete heart block with ventricular escape

rhythm rate 30/min. The most likely cause of the complete heart block is


a. Spasm of the right coronary artery (RCA) graft


b. Damage of the atrioventricular (AV) node during repair of the aortic valve


c. Low potassium and magnesium levels


d. Toxic effects of β-blocker - ANSWER✔✔-B


The AV node and the bundle of His are near the aortic valve. During aortic valve

replacement, hemorrhage, edema, suturing, or debridement near the AV node and


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the bundle of His may cause heart blocks. Typically the epicardial pacing is only

needed for a few days until the edema resolves. If complete heart block persists after

a few days, a permanent pacemaker may be required. The RCA supplies oxygen to

the sinoatrial (SA) and AV nodes and spasm of the RCA graft (A) may cause

bradycardia and/or heart blocks. This patient did not have bypass surgery, so RCA

spasm would not be a postoperative complication. Low potassium and magnesium

levels (C) increase the risk for ventricular arrhythmias, not AV conduction defects. If

toxic effects of β-blockers (D) were present, the complete heart block would have

been the underlying rhythm preoperatively.


A postoperative coronary artery bypass graft and aortic valve replacement patient has

been in a normal sinus rhythm for 4 hours. The monitor is now showing P waves at a

rate of 73 beats per minute with no ventricular response. The best action would be to




a. Administer atropine 0.5 mg intravenous bolus (IV push)




b. Connect transcutaneous pacing pads to patient




c. Connect epicardial pacing wires to a temporary pacemaker




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