CSC Cardiac
Surgery
Certification AACN
2024 Exam Review
Questions with
Answers Rationale
100% Pass CSC Cardiac Surgery Certification AACN
2024 Exam Review Questions with
Answers Rationale 100% Pass
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 isch emia 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 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
Patients with le ft 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 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
d. Administer epinephrine 1 mg IV push and start epinephrine infusion - Answer>> C
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 the bundle of His may cause heart blocks. Pacing is needed to treat the conduction defect caused by the surgery. Atropine (A) and epinephrine (D) will not
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller StarScoreGrades. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.99. You're not tied to anything after your purchase.
