CH 37: Diagnostics and Intervention Studies

Question 1

A 58-year-old male with a history of hypertension and hyperlipidemia presents to the emergency department with complaints of new-onset chest pain that started 30 minutes ago while he was watching television. He describes the pain as “pressure-like,” radiating to his left arm. His vitals are: BP 145/88 mmHg, HR 92 bpm, RR 20/min, SpO₂ 97% on room air. The 12-lead ECG shows normal sinus rhythm with no ST-segment elevations or depressions. Initial troponin levels are within normal limits.

Which of the following is the most appropriate next step in the management of this patient?

A. Discharge the patient home with instructions to take aspirin if the pain returns.

B. Perform an exercise stress test with imaging to assess myocardial perfusion.

C. Administer thrombolytic therapy to prevent infarction.

D. Schedule an elective coronary artery bypass graft (CABG).

Answer 1

B. Perform an exercise stress test with imaging to assess myocardial perfusion.

Rationale: Since the patient’s ECG and initial cardiac biomarkers are negative, but he presents with chest pain suggestive of CAD, further risk stratification is needed. An exercise stress test with imaging helps evaluate for ischemia, especially if CAD is suspected. A thrombolytic (C) is not indicated as there is no evidence of an ST-elevation myocardial infarction (STEMI). CABG (D) is not immediately necessary without confirmation of significant coronary artery disease. Discharging the patient (A) without further evaluation would be inappropriate.

Question 2

A 65-year-old female with a past medical history of diabetes mellitus and obesity presents to her primary care provider for evaluation of chest discomfort that occurs with exertion and resolves with rest. A 12-lead ECG at rest is normal. The provider orders laboratory tests.
Which laboratory tests would be most appropriate for assessing her risk of coronary artery disease? Select all that apply.

A. High-sensitivity C-reactive protein (CRP)
B. Serum troponin
C. Lipid profile
D. Brain natriuretic peptide (BNP)
E. Hemoglobin A1C

Answer 2

A. High-sensitivity C-reactive protein (CRP)
C. Lipid profile
E. Hemoglobin A1C

Rationale: High-sensitivity CRP (A) is an inflammatory marker that can indicate an increased risk for CAD. A lipid profile (C) is essential for evaluating cholesterol levels, which contribute to atherosclerosis. Hemoglobin A1C (E) assesses long-term glucose control, as diabetes is a significant risk factor for CAD. Serum troponin (B) is used to diagnose acute coronary syndrome rather than assess long-term CAD risk. BNP (D) is primarily used to evaluate heart failure rather than CAD risk.

Question 3

A 54-year-old male undergoes an exercise stress test with echocardiography due to exertional chest pain. During the test, he develops ST-segment depressions and wall motion abnormalities on echocardiography.
What do these findings indicate?

A. Normal stress test results
B. Pulmonary hypertension
C. Right ventricular hypertrophy
D. Evidence of coronary artery disease

Answer 3

D. Evidence of coronary artery disease

Rationale: ST-segment depressions and wall motion abnormalities during an exercise stress test indicate myocardial ischemia, suggestive of CAD. Normal test results (A) would show no ECG changes and normal wall motion. Pulmonary hypertension (C) is not typically diagnosed with a stress test. Right ventricular hypertrophy (D) is usually diagnosed with ECG or echocardiography but is not the primary concern in this case.

Question 4

A 60-year-old female with stable angina undergoes a pharmacologic stress test with nuclear imaging, which reveals a perfusion defect in the left anterior descending artery territory.
Which diagnostic test should be performed next?

A. Repeat stress test in six months
B. Coronary computed tomography angiography (CCTA)
C. Coronary angiography
D. Cardiac MRI

Answer 4

C. Coronary angiography

Rationale: Coronary angiography is the gold standard for assessing the severity of coronary artery stenosis after an abnormal stress test. A CCTA (B) is less definitive than angiography. Repeating a stress test in six months (A) is inappropriate given the current findings. Cardiac MRI (D) is used for structural heart disease evaluation but is not the next step here.

Question 5

A 59-year-old male presents to the ED with chest pain that started 3 hours ago. His ECG shows no ST-segment elevation. His initial troponin is 0.03 ng/mL (normal < 0.04 ng/mL).
What is the best next step?

A. Discharge the patient if symptoms improve.
B. Repeat the troponin in 3-6 hours.
C. Perform an emergency coronary angiography.
D. Administer thrombolytic therapy.

Answer 5

B. Repeat the troponin in 3-6 hours.

Rationale: Troponin levels may not be elevated early in myocardial injury. Serial testing at 3-6 hour intervals is required for accurate diagnosis. Discharging the patient (A) without serial markers is inappropriate. Emergency angiography (C) is reserved for high-risk cases. Thrombolytic therapy (D) is indicated for STEMI, not for suspected NSTEMI with negative initial biomarkers.

Question 6

A patient with suspected CAD undergoes a chest x-ray, which reveals pulmonary congestion and aortic calcifications.
What do these findings suggest?

A. Pulmonary embolism
B. Left ventricular dysfunction
C. Normal age-related changes
D. Mitral valve stenosis

Answer 6

B. Left ventricular dysfunction

Rationale: Pulmonary congestion suggests increased left-sided heart pressures, which can occur with CAD and left ventricular dysfunction. Pulmonary embolism (A) is more likely to present with clear lung fields unless severe. Aortic calcifications can be age-related (C) but are also associated with CAD. Mitral stenosis (D) can cause pulmonary congestion but is not the most likely finding in CAD.

Question 7

A patient with severe osteoarthritis is unable to perform a treadmill stress test.
Which alternative diagnostic test is most appropriate?

A. Dobutamine stress echocardiography
B. Repeat ECG in 24 hours
C. Exercise stress test with imaging
D. Right heart catheterization

Answer 7

A. Dobutamine stress echocardiography

Rationale: Dobutamine stress echocardiography mimics exercise by increasing heart rate and myocardial oxygen demand. A repeat ECG (B) does not provide functional data. An exercise test (C) is not feasible due to physical limitations. Right heart catheterization (D) is used for pulmonary hypertension and heart failure assessment, not for diagnosing CAD.

Question 8

A nuclear stress test shows abnormal findings. Which level of coronary blockage is most likely present? (SATA)

A. 30% stenosis in the right coronary artery
B. 50% stenosis in the left main coronary artery
C. 60% stenosis in a small branch artery
D. 70% stenosis in the right coronary artery

Answer 8

B. 50% stenosis in the left main coronary artery
D. 70% stenosis in the right coronary artery

Rationale: A stress test with imaging is typically abnormal when a patient has ≥50% stenosis in the left main coronary artery or ≥70% stenosis in other coronary vessels. A 30% stenosis (A) or 60% stenosis in a small branch (C) is usually not significant enough to cause ischemia on a stress test.

Question 9

A 58-year-old male with a history of hypertension and hyperlipidemia presents with increasing exertional angina. His ECG shows ST-segment depression and T-wave inversion in leads II, III, and aVF. His cardiac biomarkers are negative. A stress test reveals ischemic changes. The cardiologist recommends cardiac catheterization.
Which of the following findings would indicate the need for percutaneous coronary intervention (PCI) during catheterization?

A. A normal coronary angiogram with no obstructive lesions
B. A coronary blockage of 30% in the right coronary artery
C. A 75% blockage in the left anterior descending artery with reduced perfusion
D. Normal stress echocardiography with no regional wall motion abnormalities

Answer 9

C. A 75% blockage in the left anterior descending artery with reduced perfusion

Rationale: A ≥70% blockage in a major coronary artery (or ≥50% in the left main coronary artery) with evidence of ischemia is an indication for PCI. This level of obstruction significantly impairs blood flow and increases the risk of myocardial infarction.

Question 10

A patient undergoes a PCI with drug-eluting stent (DES) placement. The nurse is providing discharge teaching. Which of the following statements should be included in patient education?
Select all that apply.

A. “You will need to take dual antiplatelet therapy (DAPT) for at least 12 months.”

B. “Aspirin therapy should be continued indefinitely.”

C. “If you develop chest pain, ignore it as it is common after PCI.”

D. “You should report any signs of bleeding, such as black stools or easy bruising.”

E. “You will not require follow-up appointments as PCI completely fixes coronary artery disease.”

Answer 10

A. “You will need to take dual antiplatelet therapy (DAPT) for at least 12 months.”
B. “Aspirin therapy should be continued indefinitely.”
D. “You should report any signs of bleeding, such as black stools or easy bruising.”

Rationale:
* DAPT is required for at least 12 months to prevent thrombosis after a DES.
* Aspirin is continued indefinitely for secondary prevention of CAD.
* Patients on DAPT are at increased risk for bleeding, so reporting signs of bleeding is essential.

Question 11

A patient develops hypotension, tachycardia, and severe back pain 2 hours after femoral artery PCI. Which complication does the nurse suspect?

A. Acute stent thrombosis
B. Retroperitoneal hemorrhage
C. Coronary artery spasm
D. Contrast-induced nephropathy

Answer 11

B. Retroperitoneal hemorrhage

Rationale: Retroperitoneal hemorrhage is a serious vascular complication of femoral artery PCI. Blood accumulates in the retroperitoneal space, leading to hypotension, tachycardia, severe back or flank pain, and possible anemia.

Question 12

A 67-year-old patient with diabetes undergoes cardiac catheterization, revealing 3-vessel CAD with 80% stenosis in the left main coronary artery. What is the most appropriate next step?

A. Proceed with PCI and place multiple drug-eluting stents
B. Manage with optimal medical therapy and lifestyle modifications
C. Discharge the patient with instructions for an exercise stress test
D. Schedule the patient for coronary artery bypass graft (CABG) surgery

Answer 12

D. Schedule the patient for coronary artery bypass graft (CABG) surgery

Rationale: CABG is the preferred revascularization strategy for left main CAD and multi-vessel disease, especially in diabetic patients. It improves long-term survival and reduces major cardiac events compared to PCI.

Question 13

The nurse is monitoring a patient post-cardiac catheterization. Which complications should the nurse assess for? (SATA)

A. Coronary artery dissection
B. Contrast-induced nephropathy
C. Stroke
D. Pulmonary embolism
E. Infection

Answer 13

A. Coronary artery dissection
B. Contrast-induced nephropathy
C. Stroke
E. Infection

Rationale:
* Coronary artery dissection can lead to abrupt vessel closure and ischemia.
* Contrast-induced nephropathy is a risk due to nephrotoxic contrast dye.
* Stroke can occur from embolization of thrombi or air bubbles.
* Infection may develop at the catheter insertion site, requiring monitoring.

Question 14

A patient who had PCI with a drug-eluting stent 6 hours ago suddenly develops crushing chest pain. The ECG shows ST-segment elevation. What is the nurse’s priority action?

A. Obtain a stat troponin level
B. Administer sublingual nitroglycerin
C. Notify the provider immediately
D. Encourage deep breathing exercises

Answer 14

C. Notify the provider immediately

Rationale: Acute stent thrombosis is a medical emergency that can cause an MI within hours of PCI. Immediate intervention, such as emergency repeat PCI or CABG, is required to restore perfusion.

Question 15

A 72-year-old male with a history of peripheral artery disease and chronic kidney disease is scheduled for PCI. Which pre-procedure intervention is most important?

A. Administer IV contrast dye before the procedure
B. Encourage increased oral fluid intake before the procedure
C. Ensure the patient is on NPO status for at least 12 hours
D. Pre-medicate with acetylcysteine and IV hydration

Answer 15

D. Pre-medicate with acetylcysteine and IV hydration

Rationale: Patients with chronic kidney disease are at high risk for contrast-induced nephropathy. Acetylcysteine and IV hydration help protect renal function by reducing oxidative stress and enhancing dye excretion.

Question 16

The nurse is reviewing the medications used in PCI. Which drugs are commonly used to prevent stent thrombosis and complications? (SATA)

A. Unfractionated heparin
B. Clopidogrel
C. Metoprolol
D. Eptifibatide
E. Atorvastatin

Answer 16

A. Unfractionated heparin
B. Clopidogrel
D. Eptifibatide

Rationale:
* Unfractionated heparin (UH) prevents clot formation during PCI.
* Clopidogrel (Plavix) is part of DAPT to prevent in-stent thrombosis.
* Eptifibatide (Integrilin) is a GP IIb/IIIa inhibitor that inhibits platelet aggregation, reducing clot risk during PCI.

Question 17

A patient with a bare-metal stent (BMS) placed two months ago presents with exertional chest pain. Which of the following is the most likely cause of their symptoms?

A. In-stent restenosis
B. Acute stent thrombosis
C. Coronary artery dissection
D. Aortic aneurysm

Answer 17

A. In-stent restenosis

Rationale: Bare-metal stents (BMS) have a higher risk of in-stent restenosis (ISR) due to neointimal hyperplasia. ISR typically occurs within a few months to a year after stent placement and presents as recurrent angina.

Question 18

PCI may not be feasible for certain patients. Which conditions would likely exclude a patient from undergoing PCI?
Select all that apply.

A. Significant left main coronary artery disease
B. Triple-vessel coronary artery disease
C. A 50% blockage in the right coronary artery
D. Prior history of stroke
E. Uncontrolled diabetes with chronic kidney disease

Answer 18

A. Significant left main coronary artery disease
B. Triple-vessel coronary artery disease
E. Uncontrolled diabetes with chronic kidney disease

Rationale:
* Significant left main coronary artery disease and triple-vessel disease are best treated with CABG, not PCI.
* Patients with uncontrolled diabetes and CKD often have diffuse coronary disease, making PCI less effective than CABG.

Question 19

A nurse is monitoring a patient in the cardiac ICU immediately after PCI. Which of the following ECG changes would be most concerning?

A. Premature atrial contractions (PACs) in leads corresponding to the treated vessel
B. Occasional sinus bradycardia in leads corresponding to the treated vessel
C. ST-segment elevation in leads corresponding to the treated vessel
D. Sinus tachycardia at 100 bpm in leads corresponding to the treated vessel

Answer 19

C. ST-segment elevation in leads corresponding to the treated vessel

Rationale: ST-segment elevation after PCI suggests acute stent thrombosis or abrupt vessel closure, which can lead to MI. This is an emergency requiring immediate intervention.

Question 20

A patient asks how to prevent further heart problems after having PCI with stent placement. What should the nurse include in teaching?
Select all that apply.

A. Take all prescribed medications, including dual antiplatelet therapy (DAPT).
B. Follow a heart-healthy diet and exercise regularly.
C. Stop taking aspirin once symptoms resolve.
D. Manage risk factors such as hypertension and diabetes.
E. Avoid all physical activity for at least six months.

Answer 20

A. Take all prescribed medications, including dual antiplatelet therapy (DAPT).
B. Follow a heart-healthy diet and exercise regularly.
D. Manage risk factors such as hypertension and diabetes.

Rationale:
* Adhering to DAPT therapy prevents stent thrombosis.
* Lifestyle modifications help prevent further plaque buildup.
* Managing underlying risk factors (e.g., hypertension, diabetes) reduces progression of CAD.

Question 21

A 60-year-old patient who underwent PCI via the femoral artery 4 hours ago suddenly develops severe groin pain, swelling at the puncture site, and a drop in blood pressure. What is the nurse’s priority intervention?

A. Elevate the affected leg and reassess in 15 minutes
B. Apply firm pressure to the femoral site and notify the provider
C. Administer IV fluids and continue to monitor
D. Place the patient in high Fowler’s position to reduce discomfort

Answer 21

B. Apply firm pressure to the femoral site and notify the provider

Rationale: A rapidly developing hematoma with hypotension suggests arterial bleeding, requiring immediate pressure application to prevent further hemorrhage.

Question 22

A patient with chronic kidney disease underwent cardiac catheterization. Which of the following would indicate the development of contrast-induced nephropathy (CIN)?

A. Increased urine output
B. Serum creatinine increase of 0.5 mg/dL within 48 hours
C. A sudden increase in blood pressure
D. A decreased respiratory rate

Answer 22

B. Serum creatinine increase of 0.5 mg/dL within 48 hours

Rationale: CIN is diagnosed when there is an acute rise in serum creatinine following contrast exposure, indicating renal impairment.

Question 23

Which nursing interventions should be implemented immediately after a PCI procedure?
Select all that apply.

A. Monitor for chest pain and ECG changes
B. Check vital signs and peripheral pulses frequently
C. Encourage early ambulation within the first hour post-procedure
D. Assess for signs of bleeding at the catheter insertion site
E. Instruct the patient to hold their breath when moving to prevent bleeding

Answer 23

A. Monitor for chest pain and ECG changes
B. Check vital signs and peripheral pulses frequently
D. Assess for signs of bleeding at the catheter insertion site

Rationale:
* Monitoring for chest pain and ECG changes helps detect complications such as stent thrombosis.
* Frequent vital signs and pulse checks detect bleeding and hemodynamic instability.
* Assessing the catheter site helps identify hematoma or retroperitoneal bleeding early.

Question 24

A patient with chronic stable angina is being evaluated for coronary revascularization. Which of the following conditions would make CABG the preferred intervention over PCI?

A. A single-vessel blockage in the right coronary artery
B. Left main coronary artery disease
C. Mild chest pain relieved by nitroglycerin
D. A 40% stenosis in the left anterior descending (LAD) artery

Answer 24

B. Left main coronary artery disease

Rationale: CABG is the preferred treatment for significant left main coronary artery disease or triple-vessel disease, as PCI is often not feasible in these cases.

Question 25

Which of the following patients would be a candidate for CABG surgery? Select all that apply. A. A patient with severe 3-vessel disease and chronic stable angina B. A patient who had PCI 6 months ago and continues to have angina C. A patient with a history of diabetes and significant left main coronary artery disease D. A patient with a single 70% blockage in the right coronary artery E. A patient who refuses to take dual antiplatelet therapy (DAPT) after PCI

Answer 25

A. A patient with severe 3-vessel disease and chronic stable angina B. A patient who had PCI 6 months ago and continues to have angina C. A patient with a history of diabetes and significant left main coronary artery disease Rationale: * Triple-vessel disease, left main disease, and failed PCI are indications for CABG. * Diabetes patients with significant CAD often benefit more from CABG than PCI.

Question 26

A 58-year-old patient is scheduled for CABG. The surgeon plans to use an arterial graft for long-term patency. Which vessel is most commonly used for this purpose? A. Saphenous vein B. Radial artery C. Internal mammary artery D. Gastroepiploic artery

Answer 26

C. Internal mammary artery Rationale: The internal mammary artery (IMA) is the preferred graft due to its long-term patency and resistance to atherosclerosis.

Question 27

A patient with diabetes and CKD is undergoing evaluation for CAD treatment. The cardiologist recommends CABG. Why is CABG preferred over PCI for this patient? A. PCI is more invasive than CABG B. CABG provides better long-term survival in diabetics with multivessel disease C. PCI increases the risk of arrhythmias in diabetic patients D. Diabetics do not respond well to antiplatelet therapy

Answer 27

B. CABG provides better long-term survival in diabetics with multivessel disease Rationale: Diabetic patients with multivessel CAD have better long-term outcomes with CABG, as it reduces mortality and recurrent MI compared to PCI.

Question 28

Which of the following are priority assessments for a patient immediately after CABG surgery? Select all that apply. A. Monitor chest tube output and assess for bleeding B. Check for signs of cardiac tamponade C. Encourage early ambulation within 1 hour after surgery D. Assess for changes in neurological status E. Monitor for dysrhythmias

Answer 28

A. Monitor chest tube output and assess for bleeding B. Check for signs of cardiac tamponade D. Assess for changes in neurological status E. Monitor for dysrhythmias Rationale: * Bleeding and cardiac tamponade are major post-CABG complications. * Neurological changes may indicate a post-op stroke. * Dysrhythmias (e.g., atrial fibrillation) are common after CABG.

Question 29

A nurse is educating a patient about CABG. The patient asks which type of graft has the best long-term patency. What is the nurse’s best response? A. The internal mammary artery B. The saphenous vein C. The radial artery D. The gastroepiploic artery

Answer 29

A. The internal mammary artery Rationale: The internal mammary artery (IMA) has the best long-term patency, often lasting more than 10 years.

Question 30

A post-CABG patient has a chest tube output of 250 mL in the first hour. The nurse should: A. Notify the provider immediately B. Document the finding as normal C. Clamp the chest tube to prevent further blood loss D. Encourage deep breathing and coughing

Answer 30

A. Notify the provider immediately Rationale: Chest tube output >150 mL/hr may indicate post-op hemorrhage and requires immediate evaluation.

Question 31

The nurse is educating a patient about potential complications of CABG surgery. Which complications should be included? Select all that apply. A. Stroke B. Renal failure C. Graft occlusion D. Deep vein thrombosis (DVT) E. Peripheral neuropathy

Answer 31

A. Stroke B. Renal failure C. Graft occlusion D. Deep vein thrombosis (DVT) Rationale: * CABG complications include stroke, renal failure (from decreased perfusion), and graft occlusion. * DVT risk increases due to immobility post-surgery.

Question 32

A post-CABG patient develops new-onset atrial fibrillation (AF) with a heart rate of 140 bpm. What is the priority nursing action? A. Encourage the patient to bear down (Valsalva maneuver) B. Increase IV fluid rate to improve cardiac output C. Notify the provider and anticipate administration of beta-blockers D. Place the patient in Trendelenburg position

Answer 32

C. Notify the provider and anticipate administration of beta-blockers Rationale: Atrial fibrillation is common after CABG and increases stroke risk. Beta-blockers help control rate and reduce complications.

Question 33

A patient who had CABG surgery asks how to prevent further heart problems. What should the nurse include? Select all that apply. A. Follow a heart-healthy diet low in saturated fats B. Take prescribed medications, including aspirin or statins C. Exercise regularly as tolerated D. Avoid all physical activity to prevent graft failure E. Stop smoking and manage stress

Answer 33

A. Follow a heart-healthy diet low in saturated fats B. Take prescribed medications, including aspirin or statins C. Exercise regularly as tolerated E. Stop smoking and manage stress Rationale: Lifestyle modifications, medication adherence, and smoking cessation are crucial for preventing graft failure and further coronary disease progression.

Question 34

A nurse is monitoring a patient who recently underwent conventional coronary artery bypass graft (CABG) surgery. Which postoperative complication is the patient at highest risk for due to cardiopulmonary bypass (CPB)? A. Hypoglycemia B. Atrial fibrillation C. Pulmonary embolism D. Myocardial infarction

Answer 34

B. Atrial fibrillation Rationale: CPB is associated with a high risk of dysrhythmias, particularly atrial fibrillation, due to myocardial ischemia, systemic inflammatory response, and electrolyte imbalances.

Question 35

A nurse is teaching a patient scheduled for CABG surgery about graft selection. Which statement by the patient indicates the need for further teaching? A. “The left internal mammary artery (LIMA) is commonly used because it has the best long-term patency.” B. “The saphenous vein from my leg might be used, but it has a higher risk of narrowing over time.” C. “The radial artery is another option, but it tends to have better patency rates than the LIMA.” D. “I may need to take calcium channel blockers if my radial artery is used to prevent spasms.”

Answer 35

C. “The radial artery is another option, but it tends to have better patency rates than the LIMA.” Rationale: The LIMA has the highest long-term patency rate compared to other grafts. The radial artery has better patency than the saphenous vein but is not superior to the LIMA.

Question 36

A nurse is assessing a patient post-CABG who had both the right and left internal mammary arteries (IMAs) used as grafts. Which postoperative complication is this patient at increased risk for? A. Pulmonary embolism B. Sternal wound infection C. Stroke D. Graft occlusion

Answer 36

B. Sternal wound infection Rationale: Using both IMAs increases the risk of sternal wound infection, particularly in patients with diabetes or obesity, due to compromised blood supply to the sternum.

Question 37

A nurse is preparing discharge instructions for a patient after CABG surgery. Which statement should be included to help maintain graft patency? A. “Avoid antiplatelet therapy to prevent excessive bleeding.” B. “You should stop taking statins since your blood flow has been restored.” C. “It is important to manage your cholesterol and continue prescribed antiplatelet therapy.” D. “Graft occlusion is unlikely, so dietary changes are unnecessary.”

Answer 37

C. “It is important to manage your cholesterol and continue prescribed antiplatelet therapy.” Rationale: Antiplatelet and statin therapy are essential for maintaining vein graft patency and preventing atherosclerosis from affecting the grafts.

Question 38

A patient who had a CABG with a radial artery graft reports numbness and tingling in the hand. How should the nurse respond? A. “This is an expected side effect that usually resolves over time.” B. “This is a serious complication, and you should seek immediate medical attention.” C. “You may have a blood clot; I will notify the provider immediately.” D. “You should stop taking your calcium channel blockers immediately.”

Answer 38

A. “This is an expected side effect that usually resolves over time.” Rationale: Paresthesias and impaired sensation are common after radial artery harvest, but serious complications like hand ischemia are rare.

Question 39

A patient with diabetes and a BMI of 35 is scheduled for CABG. What is the primary concern regarding this patient’s surgical outcome? A. Increased risk of sternal wound infection B. Higher incidence of graft occlusion C. Poor response to anesthesia D. Lower success rate of bypass surgery

Answer 39

A. Increased risk of sternal wound infection Rationale: Obesity and diabetes significantly increase the risk of sternal wound infection, particularly when bilateral IMAs are used for grafting.

Question 40

A nurse is evaluating a post-CABG patient for complications. Which finding is most concerning? A. Decreased urine output and elevated creatinine B. Mild chest discomfort at the incision site C. Intermittent nausea and loss of appetite D. Fatigue and reduced activity tolerance

Answer 40

A. Decreased urine output and elevated creatinine Rationale: CABG patients are at risk for renal complications due to CPB. Decreased urine output and increased creatinine indicate potential acute kidney injury.

Question 41

A patient who underwent CABG surgery with a saphenous vein graft asks why the vein was taken from their leg. What is the best response by the nurse? A. “The saphenous vein is easier to remove and has the best long-term patency.” B. “Using a leg vein does not affect circulation, so it is the safest option.” C. “The saphenous vein is a commonly used graft but has a higher risk of narrowing over time. D. “The saphenous vein is the only option available for bypass surgery.”

Answer 41

C. “The saphenous vein is a commonly used graft but has a higher risk of narrowing over time. Rationale: Saphenous vein grafts are more prone to intimal hyperplasia, stenosis, and occlusion compared to the IMA.

Question 42

A nurse is reviewing the differences in coronary artery disease (CAD) presentation between men and women. Why do women have higher mortality and morbidity rates after CABG surgery? A. Women receive earlier intervention than men. B. Women are less likely to have significant co-morbidities. C. Women have smaller coronary arteries and are referred for procedures later than men. D. Women tend to develop CAD at a younger age, leading to worse outcomes.

Answer 42

C. Women have smaller coronary arteries and are referred for procedures later than men. Rationale: Women are diagnosed with CAD later, have smaller arteries, and often have more co-morbidities, leading to higher mortality and morbidity post-CABG.

Question 43

Which patient undergoing CABG with a radial artery graft is most at risk for graft failure? A. A patient taking calcium channel blockers B. A patient with hypertension on beta-blockers C. A patient with a normal Allen’s test D. A patient with a history of Raynaud’s disease

Answer 43

D. A patient with a history of Raynaud’s disease Rationale: The radial artery is a muscular artery prone to spasm. Patients with conditions like Raynaud’s disease have an increased risk of graft failure due to vasospasm.

Question 44

Which factor is most important for long-term graft patency after CABG surgery? A. Smoking cessation B. Daily aspirin therapy C. Strict adherence to a low-fat diet D. Routine follow-up with a cardiologist

Answer 44

A. Smoking cessation Rationale: Smoking accelerates atherosclerosis and increases the risk of graft occlusion.

Question 45

A patient scheduled for CABG with a saphenous vein graft asks about long-term outcomes. What is the best response? A. “Saphenous vein grafts have the best long-term patency rates.” B. “You may need additional procedures in the future due to vein narrowing.” C. “Once the bypass is done, you won’t have to worry about blockages again.” D. “Saphenous veins are only used as a last resort.”

Answer 45

B. “You may need additional procedures in the future due to vein narrowing.” Rationale: Saphenous vein grafts are prone to hyperplasia and occlusion, often requiring future interventions.

Question 46

A patient asks why the LIMA is preferred for CABG. What is the best explanation? A. “It is easier to harvest than other grafts.” B. “It is less likely to develop spasms than the radial artery.” C. “It has the highest long-term patency rate.” D. “It has a larger diameter than the saphenous vein.”

Answer 46

C. “It has the highest long-term patency rate.” Rationale: The LIMA has superior long-term patency rates compared to other grafts.

Question 47

A patient undergoing a minimally invasive direct coronary artery bypass (MIDCAB) asks why a sternotomy is not needed for this procedure. What is the nurse’s best response? A. “This technique allows the heart to be stopped during surgery without opening the chest.” B. “Small incisions between the ribs provide access to the coronary arteries, eliminating the need for a sternotomy.” C. “A sternotomy is only required when using the saphenous vein or radial artery as a graft.” D. “The use of cardiopulmonary bypass (CPB) requires a sternotomy, but MIDCAB does not involve CPB.”

Answer 47

B. “Small incisions between the ribs provide access to the coronary arteries, eliminating the need for a sternotomy.” Rationale: MIDCAB avoids the need for a sternotomy by utilizing small incisions between the ribs or a mini-thoracotomy. This approach allows access to the coronary arteries without opening the chest cavity.

Question 48

A nurse is preparing a patient for MIDCAB surgery. Which statement by the patient indicates a need for further teaching? A. “This procedure will require an open-chest incision through my breastbone.” B. “I will not be placed on a heart-lung machine during this surgery.” C. “A mechanical stabilizer will be used to keep the operative site steady.” D. “My left internal mammary artery will be used as a graft.”

Answer 48

A. “This procedure will require an open-chest incision through my breastbone.” Rationale: MIDCAB does not require a sternotomy; instead, small incisions or a mini-thoracotomy are made between the ribs. If a patient believes an open-chest incision is required, further education is needed.

Question 49

A nurse is reviewing the advantages of MIDCAB over conventional CABG. Which statement accurately describes an advantage of MIDCAB? A. “It can be used in all patients who require coronary artery bypass surgery.” B. “It is the preferred technique for patients requiring multivessel coronary revascularization.” C. “The right internal mammary artery is the most commonly used graft in this procedure.” D. “It has fewer postoperative complications due to the elimination of cardiopulmonary bypass.”

Answer 49

D. “It has fewer postoperative complications due to the elimination of cardiopulmonary bypass.” Rationale: MIDCAB avoids the use of CPB, which reduces the risk of CPB-related complications such as neurologic impairment, renal dysfunction, and systemic inflammatory response syndrome. However, MIDCAB is not suitable for all patients, is typically used for single-vessel disease, and the left internal mammary artery (LIMA) is more commonly used than the right IMA.

Question 50

The nurse is caring for a patient who underwent a hybrid revascularization procedure involving MIDCAB and percutaneous coronary intervention (PCI). What is the primary goal of this hybrid approach? A. To reduce the need for mechanical stabilization during surgery B. To prevent the need for long-term antiplatelet therapy C. To allow staged treatment of multiple coronary artery lesions D. To allow simultaneous bypass grafting of all diseased vessels

Answer 50

C. To allow staged treatment of multiple coronary artery lesions Rationale: A hybrid approach combines MIDCAB with PCI to treat multiple coronary arteries in a staged manner. This allows patients to benefit from minimally invasive bypass surgery for the LAD while addressing additional blockages with PCI.

Question 51

A patient with diabetes is scheduled for MIDCAB using the left internal mammary artery (LIMA). The nurse should be most concerned about which postoperative complication? A. Sternal wound infection B. Myocardial infarction C. Pneumothorax D. Radial artery spasm

Answer 51

C. Pneumothorax Rationale: Because MIDCAB is performed through small incisions between the ribs, there is an increased risk of pneumothorax due to the surgical approach. Unlike conventional CABG, MIDCAB does not involve a sternotomy, reducing the risk of sternal wound infection.

Question 52

A nurse is educating a patient about MIDCAB. Which statement by the patient demonstrates correct understanding? A. “I will need a heart-lung machine to circulate my blood during the procedure.” B. “My right internal mammary artery will be used as a graft because it is easier to access.” C. “This procedure is usually performed on patients with multivessel coronary artery disease.” D. “If I need additional coronary arteries treated, I may require a PCI later.”

Answer 52

D. “If I need additional coronary arteries treated, I may require a PCI later.” Rationale: MIDCAB is often used for patients with LAD disease, but if additional arteries require revascularization, PCI may be performed as part of a hybrid approach. The right IMA is more difficult to access via MIDCAB, and this procedure does not use CPB.

Question 53

A nurse is educating a patient scheduled for an off-pump coronary artery bypass (OPCAB) procedure. Which statement by the patient indicates a need for further teaching? A. “My heart will continue to beat during the surgery.” B. “I will not need a heart-lung machine for this procedure.” C. “I will not require a median sternotomy since this is a minimally invasive procedure.” D. “Mechanical stabilizers will be used to keep my heart steady during surgery.”

Answer 53

C. “I will not require a median sternotomy since this is a minimally invasive procedure.” Rationale: OPCAB still requires a median sternotomy to access all coronary vessels, even though it avoids cardiopulmonary bypass (CPB). The procedure is performed on a beating heart using mechanical stabilizers to maintain a stable operative field.

Question 54

A patient who underwent OPCAB asks the nurse about the benefits of this procedure compared to conventional CABG. Which of the following is the most appropriate response? A. “OPCAB is associated with reduced risk of postoperative renal dysfunction and neurologic complications.” B. “OPCAB eliminates the need for an open-chest incision, reducing pain and recovery time.” C. “OPCAB allows for the use of percutaneous coronary intervention (PCI) at the same time.” D. “OPCAB completely prevents the risk of atrial fibrillation after surgery.”

Answer 54

A. “OPCAB is associated with reduced risk of postoperative renal dysfunction and neurologic complications.” Rationale: OPCAB avoids CPB, which reduces risks associated with CPB-related complications, including renal dysfunction and neurologic issues. However, it still requires a median sternotomy and does not eliminate the risk of postoperative atrial fibrillation, though the risk is lower compared to conventional CABG.

Question 55

Which patient would most benefit from an OPCAB procedure instead of conventional CABG? A. A patient with a history of transient ischemic attacks and chronic kidney disease B. A patient requiring multivessel revascularization for extensive coronary artery disease C. A patient who needs a heart-lung machine due to severe left ventricular dysfunction D. A patient with diabetes and a small body surface area requiring multiple bypass grafts

Answer 55

A. A patient with a history of transient ischemic attacks and chronic kidney disease Rationale: Patients with preexisting neurologic conditions (e.g., history of TIAs) and chronic kidney disease may benefit from OPCAB due to its reduced risk of CPB-related complications, including neurologic impairment and renal dysfunction. OPCAB is not ideal for patients requiring complex multivessel revascularization, and it does not use CPB, which is necessary for severe LV dysfunction.

Question 56

A nurse is providing preoperative education to a patient scheduled for a totally endoscopic coronary artery bypass (TECAB). Which statement by the patient indicates correct understanding of the procedure? A. “This procedure will require a large chest incision to access my coronary arteries.” B. “There is a chance that a heart-lung machine may still be used during surgery.” C. “This procedure has a higher risk of sternal wound infection compared to traditional CABG.” D. “Since this procedure is robotic-assisted, there will be more blood loss than conventional CABG.”

Answer 56

B. “There is a chance that a heart-lung machine may still be used during surgery.” Rationale: TECAB can be performed either with or without cardiopulmonary bypass (CPB), using femoral access if CPB is needed. It is a minimally invasive approach that requires only small instrument ports, reducing blood loss and risk of sternal wound infection.

Question 57

The nurse is assessing a patient recovering from a TECAB procedure. Which postoperative outcome is most likely compared to traditional CABG? A. Increased need for blood transfusions due to higher blood loss B. Increased pain and prolonged recovery time C. Reduced risk of sternal wound infection and shorter hospital stay D. Higher risk of multiorgan dysfunction due to the use of robotic technology

Answer 57

C. Reduced risk of sternal wound infection and shorter hospital stay Rationale: TECAB is a minimally invasive procedure that avoids a sternotomy, leading to less postoperative pain, a lower risk of sternal wound infection, and a shorter recovery time compared to traditional CABG.

Question 58

Which patient would be the best candidate for a TECAB procedure? A. A patient requiring a single-vessel bypass who desires a quicker recovery B. A patient with extensive three-vessel disease requiring multiple grafts C. A patient with severe left ventricular dysfunction needing full CPB support D. A patient with significant peripheral artery disease and poor femoral circulation

Answer 58

A. A patient requiring a single-vessel bypass who desires a quicker recovery Rationale: TECAB is best suited for patients requiring single-vessel bypass, as it is a minimally invasive technique. It is not ideal for patients needing complex multivessel grafting or those with severe LV dysfunction requiring CPB. Femoral access may be used if CPB is needed, so severe peripheral artery disease could be a contraindication.

Question 59

The nurse is preparing discharge instructions for a patient who underwent TECAB. Which statement should be included in the teaching? A. “You will have a larger chest incision that requires close monitoring for infection.” B. “You may experience more pain than with conventional CABG due to the robotic approach.” C. “You are at a higher risk for postoperative bleeding, so limit your movement for several weeks.” D. “Your recovery time may be shorter compared to traditional CABG.”

Answer 59

D. “Your recovery time may be shorter compared to traditional CABG.” Rationale: TECAB is associated with a shorter recovery time, less pain, and a lower risk of sternal wound infection due to its minimally invasive nature. The procedure requires small instrument ports rather than a large chest incision, and blood loss is generally lower than with traditional CABG.

Question 60

The nurse is caring for a patient with advanced coronary artery disease (CAD) who is scheduled for transmyocardial laser revascularization (TMR). The nurse understands that this procedure is indicated for which patient? A. A patient with single-vessel disease who is a candidate for percutaneous coronary intervention (PCI) B. A patient with left main coronary artery disease requiring immediate revascularization C. A patient with stable angina responding well to medical therapy D. A patient with advanced CAD who is not a candidate for conventional CABG surgery

Answer 60

D. A patient with advanced CAD who is not a candidate for conventional CABG surgery Rationale: TMR is used for patients with advanced CAD who are not candidates for CABG surgery and have persistent angina despite maximum medical therapy. It is an alternative revascularization method when bypass grafting is not feasible.

Question 61

A patient undergoing transmyocardial laser revascularization (TMR) asks how the procedure improves blood flow to the heart muscle. What is the best response by the nurse? A. “The laser removes blockages in your coronary arteries, restoring blood flow.” B. “TMR places new grafts to bypass the blocked arteries and restore circulation.” C. “The laser creates small channels in the heart muscle to improve blood supply to ischemic areas.” D. “The laser seals off damaged arteries to prevent further ischemia.”

Answer 61

C. “The laser creates small channels in the heart muscle to improve blood supply to ischemic areas.” Rationale: TMR improves myocardial perfusion by using a high-energy laser to create channels in the heart muscle, allowing blood to flow to ischemic areas. It does not remove blockages or place grafts.

Question 62

The nurse is educating a patient scheduled for transmyocardial laser revascularization (TMR). Which statement by the patient indicates a need for further teaching? A. “This procedure will open up my blocked coronary arteries.” B. “The laser will create new channels in my heart muscle to improve blood flow.” C. “This procedure may be done if bypass grafts cannot be placed.” D. “TMR can be combined with CABG surgery for better outcomes.”

Answer 62

A. “This procedure will open up my blocked coronary arteries.” Rationale: TMR does not open blocked coronary arteries; instead, it creates channels in the myocardium to improve perfusion to ischemic areas. This misconception requires further clarification.

Question 63

A patient with severe coronary artery disease (CAD) and refractory angina is not a candidate for CABG or PCI. The healthcare provider recommends transmyocardial laser revascularization (TMR). What should the nurse emphasize when educating the patient about this procedure? A. “TMR is a curative procedure that will eliminate the need for further treatment.” B. “This procedure is often used in combination with CABG if grafts cannot be placed.” C. “TMR is a minimally invasive procedure that does not require an incision.” D. “TMR primarily treats heart failure rather than ischemic heart disease.”

Answer 63

B. “This procedure is often used in combination with CABG if grafts cannot be placed.” Rationale: TMR is often used in combination with CABG when graft placement is not possible. It is not a curative procedure, requires a left thoracotomy, and is specifically used for refractory angina due to ischemic heart disease.

Question 64

Which postoperative complication is the nurse most concerned about in a patient recovering from transmyocardial laser revascularization (TMR)? A. Acute limb ischemia B. Ventricular dysrhythmias C. Pericardial tamponade D. Pulmonary embolism

Answer 64

B. Ventricular dysrhythmias Rationale: Ventricular dysrhythmias are a common complication after TMR due to myocardial irritation from the laser. While pericardial tamponade is a concern in cardiac procedures, dysrhythmias are more likely with TMR.

Question 65

The nurse is preparing discharge instructions for a patient who underwent transmyocardial laser revascularization (TMR). Which statement should be included in the teaching? A. “You may still experience some angina, but it should gradually improve.” B. “Your angina will immediately disappear after the procedure.” C. “TMR completely reverses the effects of coronary artery disease.” D. “This procedure eliminates the need for any further cardiac medications.”

Answer 65

A. “You may still experience some angina, but it should gradually improve.” Rationale: Patients may continue to experience some angina after TMR, but symptoms typically improve over time. TMR does not cure CAD or eliminate the need for medications.

Question 66

A nurse is monitoring a patient in the ICU after coronary artery bypass graft (CABG) surgery. Which finding requires the most immediate intervention? A. Chest tube drainage of 90 mL in the first hour B. Blood pressure of 100/70 mm Hg C. Serum potassium level of 3.2 mEq/L D. Core body temperature of 97°F (36.1°C)

Answer 66

C. Serum potassium level of 3.2 mEq/L Rationale: Hypokalemia (potassium < 3.5 mEq/L) increases the risk of postoperative dysrhythmias, particularly atrial fibrillation. Immediate intervention is needed to prevent complications.

Question 67

A patient who underwent CABG surgery has mediastinal and pleural chest tubes in place. The nurse should be most concerned if which assessment finding is noted? A. Serosanguineous drainage of 150 mL/hr from the chest tube B. Continuous bubbling in the water seal chamber C. Drainage tube positioned below the level of the patient’s chest D. The presence of tidaling in the water seal chamber

Answer 67

A. Serosanguineous drainage of 150 mL/hr from the chest tube Rationale: Chest tube drainage > 150 mL/hr is concerning for excessive postoperative bleeding and requires immediate notification of the provider.

Question 68

A nurse is caring for a patient after CABG surgery. Which intervention is a priority in preventing postoperative venous thromboembolism (VTE)? A. Administering aspirin and clopidogrel as prescribed B. Limiting ambulation to avoid stress on the sternotomy C. Encouraging deep breathing and incentive spirometry D. Applying sequential compression devices (SCDs) to the legs

Answer 68

D. Applying sequential compression devices (SCDs) to the legs Rationale: Applying SCDs helps prevent deep vein thrombosis (DVT) by promoting venous return. Early ambulation is also key in VTE prevention.

Question 69

The nurse is preparing to extubate a patient after CABG surgery. Which assessment finding requires delaying the extubation? A. Spontaneous tidal volume of 350 mL B. PaO₂ of 85 mm Hg on 40% FiO₂ C. Negative inspiratory force of -35 cm H₂O D. Respiratory rate of 14 breaths per minute

Answer 69

A. Spontaneous tidal volume of 350 mL Rationale: A tidal volume < 5 mL/kg (typically < 300-400 mL in adults) indicates inadequate respiratory muscle strength, requiring continued mechanical ventilation.

Question 70

A patient who had a radial artery graft for CABG surgery reports numbness and tingling in the hand. What is the nurse’s best action? A. Notify the provider immediately B. Elevate the arm on a pillow C. Assess capillary refill and hand circulation D. Apply warm compresses to the hand

Answer 70

C. Assess capillary refill and hand circulation Rationale: Radial artery spasm can occur after CABG. The nurse should assess circulation and motor function before determining the next steps.

Question 71

A patient recovering from CABG surgery develops new-onset atrial fibrillation. What is the nurse’s priority intervention? A. Prepare for immediate cardioversion B. Administer a β-blocker as prescribed C. Monitor for a drop in blood pressure D. Obtain a 12-lead ECG

Answer 71

B. Administer a β-blocker as prescribed Rationale: β-Blockers reduce the incidence of postoperative atrial fibrillation and are recommended within 24 hours post-surgery unless contraindicated.

Question 72

The nurse is caring for a patient who underwent CABG surgery. Which assessment finding requires immediate intervention? A. Chest incision is slightly reddened at the edges B. Urine output is 20 mL/hr for the past 2 hours C. The patient reports pain at the leg incision site D. Fine crackles are heard at the lung bases

Answer 72

B. Urine output is 20 mL/hr for the past 2 hours Rationale: Urine output < 30 mL/hr suggests poor perfusion, which may indicate low cardiac output or renal dysfunction.

Question 73

The nurse is caring for a patient after CABG surgery. Which intervention is most effective in preventing postoperative respiratory complications? A. Administering scheduled nebulizer treatments B. Keeping the patient NPO for 24 hours C. Encouraging the use of an incentive spirometer D. Limiting fluid intake to prevent pulmonary edema

Answer 73

C. Encouraging the use of an incentive spirometer Rationale: Incentive spirometry, deep breathing, and coughing help prevent postoperative respiratory complications such as atelectasis and pneumonia.

Question 74

The nurse notes that a patient recovering from CABG surgery has become tearful and withdrawn. Which action is most appropriate? A. Explain that postoperative depression is common B. Request a psychiatric consultation C. Encourage the patient to participate in physical therapy D. Increase opioid administration for pain control

Answer 74

A. Explain that postoperative depression is common Rationale: Depression is common after CABG surgery. The nurse should provide reassurance and monitor for worsening symptoms.

Question 75

Which finding in a patient after CABG surgery requires immediate notification of the provider? A. Blood glucose of 180 mg/dL B. Incisional pain of 6/10 C. Temperature of 101.5°F (38.6°C) D. Atrial fibrillation with a rate of 92 bpm

Answer 75

C. Temperature of 101.5°F (38.6°C) Rationale: A fever > 101°F may indicate infection or systemic inflammatory response syndrome (SIRS) due to cardiopulmonary bypass.

Question 76

A patient recovering from CABG surgery is prescribed a calcium channel blocker. The nurse understands this is primarily to prevent which complication? A. Myocardial infarction B. Radial artery spasm C. Pulmonary embolism D. Postoperative bleeding

Answer 76

B. Radial artery spasm Rationale: Calcium channel blockers reduce arterial spasm, particularly in patients with radial artery grafts.

Question 77

The nurse is caring for a patient after CABG surgery. Which intervention best reduces the risk of postoperative cognitive dysfunction (POCD)? A. Allowing uninterrupted sleep B. Encouraging early mobility C. Administering sedatives as prescribed D. Keeping the room dark and quiet

Answer 77

B. Encouraging early mobility Rationale: Early mobility helps prevent POCD by promoting circulation and reducing delirium risk.

Question 78

A patient is recovering from CABG surgery with a median sternotomy incision. The nurse should provide which discharge instruction? A.“Use a pillow to splint your chest when coughing.” B. “You may resume driving in 2 weeks.” C. “You should avoid lifting anything over 20 pounds for 2 months.” D. “If you feel chest pain, take another dose of your β-blocker.”

Answer 78

A. “Use a pillow to splint your chest when coughing.” Rationale: Splinting reduces pain and protects the sternotomy during coughing and deep breathing.

Question 79

The nurse is teaching a patient after CABG surgery about pain management. Which statement indicates understanding? A. “I will take opioids only if the pain is unbearable.” B. “I should take my pain medication before my pain gets severe.” C. “Pain means something is wrong, and I should call my provider.” D. “If I feel pain, I should limit my movement to avoid complications.”

Answer 79

B. “I should take my pain medication before my pain gets severe.” Rationale: Preemptive pain management allows for better mobility and prevents complications like pneumonia.

Question 80

The nurse is assessing a patient after CABG surgery. Which finding suggests a developing sternal wound infection? A. Mild bruising around the incision B. Drainage with a foul odor from the incision C. Redness at the lower edges of the incision D. Decreased pain at the incision site

Answer 80

B. Drainage with a foul odor from the incision Rationale: Purulent drainage with a foul odor suggests infection and requires immediate intervention.

Question 81

A patient who has just undergone CABG surgery is at high risk for postoperative bleeding. Which action by the nurse is most appropriate to prevent this complication? A. Administering anticoagulants as prescribed B. Applying pressure to the groin site C. Checking chest tube drainage every hour D. Restricting fluid intake

Answer 81

C. Checking chest tube drainage every hour Rationale: Monitoring chest tube drainage hourly helps detect excessive bleeding early, which is essential for preventing hemorrhage.

Question 82

The nurse is preparing a patient for discharge after CABG surgery. Which statement by the patient indicates a need for further teaching regarding post-discharge activity? A. “I can walk around the block after a week.” B. “I should avoid lifting heavy objects for a few months.” C. “I need to make a follow-up appointment with my cardiologist.” D. “I can return to work after 1-2 weeks, depending on how I feel.”

Answer 82

A. “I can walk around the block after a week.” Rationale: Walking is encouraged post-discharge, but the patient should gradually increase activity. Walking around the block after just one week may be too strenuous.

Question 83

The nurse is educating a patient about signs of a potential sternal wound infection after CABG surgery. Which of the following is a key sign that should prompt the patient to contact their healthcare provider immediately? A. Slight redness at the edges of the incision B. Mild bruising around the incision C. A small amount of clear drainage from the incision D. Swelling and warmth at the incision site

Answer 83

D. Swelling and warmth at the incision site Rationale: Swelling and warmth at the incision site can indicate infection and requires prompt medical evaluation.

Question 84

A patient who underwent CABG surgery reports feeling anxious and worried about their recovery. The nurse identifies that the patient may be at risk for postoperative depression. Which intervention is most appropriate? A. Reassure the patient that depression is normal and will resolve B. Administer a prescribed sedative to calm the patient C. Encourage the patient to attend support groups for CABG recovery D. Limit family visits to allow the patient to rest

Answer 84

C. Encourage the patient to attend support groups for CABG recovery Rationale: Encouraging participation in support groups provides emotional support and reduces feelings of isolation and anxiety, which are common post-CABG.

Question 85

The nurse is assessing a patient after CABG surgery who is being considered for discharge. Which of the following should be included in the discharge teaching for this patient to reduce the risk of complications? A. “You should avoid all physical activity for at least 6 weeks.” B. “You may resume smoking once you’re feeling better.” C. “Avoid following up with your cardiologist unless you have major concerns. D. “Take your medications as prescribed, even if you feel fine.”

Answer 85

D. “Take your medications as prescribed, even if you feel fine.” Rationale: Continuing prescribed medications, especially cardiovascular drugs, is essential for preventing complications and improving recovery after CABG surgery.

Question 86

A patient with refractory chronic stable angina is being considered for enhanced external counterpulsation (EECP) therapy. Which of the following conditions would contraindicate the use of EECP for this patient? A. Stable heart failure with reduced ejection fraction B. Severe peripheral arterial disease C. Mild aortic insufficiency D. Controlled hypertension

Answer 86

B. Severe peripheral arterial disease Rationale: EECP is contraindicated in patients with severe peripheral arterial disease because the therapy may exacerbate the condition by further impeding blood flow.

Question 87

A patient undergoing EECP therapy for refractory angina reports feeling discomfort in their legs during the treatment. Which action by the nurse is most appropriate? A. Increase the inflation pressure to reduce discomfort B. Notify the healthcare provider immediately to stop the treatment C. Reassure the patient that some discomfort is normal during treatment D. Decrease the inflation pressure and continue the treatment

Answer 87

D. Decrease the inflation pressure and continue the treatment Rationale: Decreasing the inflation pressure can help alleviate discomfort while continuing the therapy. It’s important to manage discomfort without halting treatment unless contraindicated.

Question 88

The nurse is teaching a patient about enhanced external counterpulsation (EECP) therapy for refractory angina. Which of the following statements by the patient indicates a need for further education? A. “The treatment will help increase coronary perfusion and improve circulation.” B. “I will need 35 treatments, with five sessions each week.” C. “I can expect immediate relief from angina after just a few sessions.” D. “The cuffs will inflate during diastole and deflate during systole.”

Answer 88

C. “I can expect immediate relief from angina after just a few sessions.” Rationale: While EECP therapy is effective in improving circulation and coronary perfusion, it does not provide immediate relief from angina, and patients should understand that results can take several sessions.

Question 89

A patient with refractory chronic stable angina has been referred for EECP therapy. Which of the following is a primary mechanism by which EECP improves coronary perfusion? A. It increases systemic blood pressure B. It augments diastolic blood pressure C. It decreases myocardial oxygen demand D. It increases heart rate

Answer 89

B. It augments diastolic blood pressure Rationale: EECP augments diastolic blood pressure, which increases coronary perfusion and improves left ventricular filling during diastole, enhancing collateral circulation.

Question 90

A patient with refractory chronic stable angina is undergoing EECP therapy. The nurse is assessing for possible complications. Which of the following would be most concerning? A. Decreased peripheral pulses in the lower extremities B. Mild bruising on the legs after treatment C. Sudden shortness of breath and chest pain during treatment D. Slight dizziness after treatment

Answer 90

C. Sudden shortness of breath and chest pain during treatment Rationale: Sudden shortness of breath and chest pain during EECP therapy are concerning signs and may indicate a serious cardiovascular complication, such as an exacerbation of angina or a myocardial event. Immediate medical evaluation is necessary.

Question 91

After completing a series of EECP treatments, a patient with refractory chronic stable angina reports feeling less frequent chest pain. Which of the following should the nurse emphasize during follow-up care? A. Continuing pharmacologic therapy as prescribed, including nitrates B. Gradual return to high-intensity physical activity C. Stopping medications since EECP has resolved symptoms D. Avoiding follow-up care with a cardiologist

Answer 91

A. Continuing pharmacologic therapy as prescribed, including nitrates Rationale: The patient should continue pharmacologic therapy as prescribed, including nitrates, even after EECP therapy, to manage angina and prevent further complications.

Question 92

The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed? a. “They will circulate my blood with a machine during surgery.” b. “I will have incisions in my leg where they will remove the vein.” c. “They will use an artery near my heart to go around the area that is blocked.” d. “I will need to take aspirin every day after the surgery to keep the graft open.”

Answer 92

b. “I will have incisions in my leg where they will remove the vein.” Rationale: When the internal mammary artery is used, there is no need to have a saphenous vein removed from the leg. The other statements by the patient are accurate and indicate that the teaching has been effective.

Question 93

A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse? a. Report of chest pain b. Heart rate 102 beats/min c. Pedal pulses 1+ bilaterally d. Blood pressure 103/54 mm Hg

Answer 93

a. Report of chest pain Rationale: The patient‘s chest pain indicates that restenosis of the coronary artery may be occurring and requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse. The other information indicates a need for ongoing assessments by the nurse.