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CARDIAC SURGERY CSC EXAM SOLUTION
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CARDIACSURGERY CSC
EXAM SOLUTION
A 72-year-old male 4 days status post CABG complains of substernal
chest pain when lying down. On cardiac auscultation you note a friction
rub. What is the most likely cause of the patient's discomfort:
A. Angina.
B. Pulmonary embolism.
C. Incisional pain.
D. Pericarditis. - answer ✅✅D. Pericarditis can occur early or late
following cardiac surgery and presents as pain that can mimic angina in
,presentation. Pericardial pain is usually positional and can often be
relieved by leaning the patient forward. The presence of a friction rub is
indicative of the inflammation of pericarditis. Pericardial friction rubs are
transient and only present about 50% of the time in pericarditis.
Anginal pain can be similar to the pain of pericarditis but it is not
positional and is not relieved by changes in position. Angina is not
associated with a friction rub unless there happens to be pericarditis
present as well.
Incisional pain can be positional but is not associated with a friction rub.
Pulmonary embolism can cause chest pain but is not associated with a
cardiac friction rub.
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 - 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.
,A complication seen in patients who have received a CABG using the
LIMA or a radial artery graft that is not seen with saphenous vein grafts is:
A. Acute MI due to graft thrombosis.
B. Bleeding at graft suture lines.
C. Graft aneurysm.
D. Graft spasm. - answer ✅✅D. Arterial conduits, such as the LIMA,
RIMA, or radial artery are prone to spasm because of their thicker arterial
walls. All grafts can thrombose or bleed at suture lines, and aneurysm
formation is more common in veins harvested from the arms. IMA grafts
have excellent long term patency and are preferred conduits in most
patients.
A complication seen in patients who have received a CABG using the
LIMA or a radial artery graft that is not seen with saphenous vein grafts is:
A. Graft aneurysm.
B. Bleeding at graft suture lines.
C. Graft spasm.
D. Acute MI due to graft thrombosis. - answer ✅✅C. Arterial conduits,
such as the LIMA, RIMA, or radial artery are prone to spasm because of
their thicker arterial walls. All grafts can thrombose or bleed at suture
lines, and aneurysm formation is more common in veins harvested from
the arms. IMA grafts have excellent long term patency and are preferred
conduits in most patients.
A patient with epicardial atrial and ventricular pacing wires post cardiac
surgery displays the rhythm seen in the lead II strip (top strip) on the
bedside monitor. The nurse on the previous shift documented the rhythm
, as junctional rhythm because no P waves were seen in Lead II on the
monitor. You decide to obtain an atrial electrogram and record the
bottom strip (labeled AEG). .(P WAVES BEFORE EVERY QRS) You
document the rhythm as:
A. Normal sinus rhythm.
B. Atrial flutter.
C. Junctional rhythm.
D. Accelerated ventricular rhythm. - answer ✅✅A. The atrial
electrogram in the bottom strip clearly shows atrial activity preceding each
QRS complex.
A patient with epicardial atrial and ventricular pacing wires post cardiac
surgery displays the rhythm seen in the lead II strip (top strip) on the
bedside monitor. The nurse on the previous shift documented the rhythm
as junctional rhythm because no P waves were seen in Lead II on the
monitor. You decide to obtain an atrial electrogram and record the
bottom strip (labeled AEG). You document the rhythm as: )P WAVES
BEFORE QRS)
A. Atrial flutter.
B. Junctional rhythm.
C. Normal sinus rhythm.
D. Accelerated ventricular rhythm. - answer ✅✅C. The atrial
electrogram in the bottom strip clearly shows atrial activity preceding each
QRS complex.
A patient with epicardial atrial and ventricular pacing wires post cardiac
surgery has a change in his rhythm on the bedside monitor. Which of the
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