CH 41: Aortic Dissection

Question 1

A 60-year-old male with a history of hypertension presents to the emergency department with sudden-onset severe chest pain described as “tearing” and radiating to his back. His blood pressure is 190/110 mmHg in the right arm and 160/100 mmHg in the left arm. A chest x-ray shows a widened mediastinum. What is the priority nursing action?

A. Administer IV beta-blockers to lower blood pressure
B. Prepare the patient for emergency surgery
C. Obtain a 12-lead ECG to assess for myocardial infarction
D. Administer IV morphine for pain control

Answer 1

B. Prepare the patient for emergency surgery

Rationale: An acute Type A aortic dissection is a surgical emergency because it affects the ascending aorta, which supplies blood to the heart and brain. If left untreated, complications such as aortic rupture, cardiac tamponade, or end-organ ischemia can rapidly lead to death. Immediate surgical intervention is required to repair the dissection and restore vascular integrity.

Question 2

A nurse is caring for a patient diagnosed with an acute Type B aortic dissection. Which of the following interventions should the nurse anticipate? Select all that apply.

A. Continuous IV infusion of beta-blockers
B. Strict blood pressure and heart rate monitoring
C. Emergency surgical repair
D. Administration of opioids for pain relief
E. Serial imaging studies (CT or MRI)

Answer 2

A. Continuous IV infusion of beta-blockers
B. Strict blood pressure and heart rate monitoring
D. Administration of opioids for pain relief
E. Serial imaging studies (CT or MRI)

Rationale: Acute Type B aortic dissections originate in the descending aorta and are typically managed conservatively unless complications arise. Beta-blockers (A) help control blood pressure and heart rate, reducing shear stress on the aortic wall. Strict hemodynamic monitoring (B) is essential to prevent worsening dissection. Opioids (D) help manage the severe pain associated with dissection. Serial imaging (E) is required to monitor for expansion, rupture, or malperfusion syndrome. Surgery (C) is usually reserved for cases with complications such as organ ischemia or rupture.

Question 3

A nurse is monitoring a patient with an aortic dissection. Which finding would indicate a life-threatening complication requiring immediate intervention?

A. Blood pressure of 140/80 mmHg
B. Increased urine output
C. Sudden onset of altered mental status
D. Reports of decreased back pain

Answer 3

C. Sudden onset of altered mental status

Rationale: Altered mental status suggests compromised cerebral perfusion, which can result from a Type A aortic dissection extending into the aortic arch vessels. This can cause reduced blood flow to the brain, increasing the risk of stroke. Immediate intervention is required to restore perfusion and prevent permanent neurological damage.

Question 4

A patient with a chronic aortic dissection presents for a follow-up visit. The nurse provides education on lifestyle modifications to prevent dissection progression. Which instructions should the nurse include? Select all that apply.

A. Maintain a low-sodium, heart-healthy diet
B. Engage in high-intensity weightlifting to strengthen the heart
C. Adhere to prescribed antihypertensive medications
D. Avoid sudden emotional stress or extreme exertion
E. Monitor blood pressure regularly at home

Answer 4

A. Maintain a low-sodium, heart-healthy diet
C. Adhere to prescribed antihypertensive medications
D. Avoid sudden emotional stress or extreme exertion
E. Monitor blood pressure regularly at home

Rationale: Managing blood pressure (C, E) is the most critical intervention to prevent dissection progression. A low-sodium, heart-healthy diet (A) helps control hypertension. Avoiding extreme exertion and emotional stress (D) reduces surges in blood pressure that can worsen the dissection. High-intensity weightlifting (B) is contraindicated because it significantly increases blood pressure, which could lead to rupture.

Question 5

A nurse is assessing a patient admitted with suspected aortic dissection. The nurse understands that which risk factor is most strongly associated with the development of aortic dissection?

A. Hypertension
B. Tobacco use
C. Atherosclerosis
D. Connective tissue disorders

Answer 5

A. Hypertension

Rationale: Hypertension is the most important risk factor for aortic dissection because chronic high blood pressure weakens the elastic fibers in the arterial wall, making it more prone to tearing. This leads to the formation of a false lumen, which can rapidly progress to life-threatening complications.

Question 6

A nurse is caring for a patient with an acute aortic dissection. The nurse understands that the extension of the dissection may compromise blood flow to which organs? Select all that apply.

A. Brain
B. Kidneys
C. Spinal cord
D. Liver
E. Extremities

Answer 6

A. Brain
B. Kidneys
C. Spinal cord
E. Extremities

Rationale: Aortic dissection can extend and cut off blood supply to multiple organs. The brain (A) can be affected, leading to stroke or altered mental status. The kidneys (B) may experience acute kidney injury due to ischemia. The spinal cord (C) can suffer from reduced perfusion, potentially causing paralysis. The extremities (E) may develop ischemia or necrosis if major arteries are involved. The liver (D) is not directly affected, as it primarily receives blood from the portal vein rather than the aorta.

Question 7

A 72-year-old woman presents to the emergency department with complaints of sudden-onset chest pain and dizziness. Her daughter states that she has a history of hypertension and Marfan’s syndrome. Which pathophysiologic process is most likely contributing to her symptoms?

A. Atherosclerotic plaque rupture leading to myocardial infarction
B. Pulmonary embolism causing decreased oxygenation
C. Aortic dissection leading to arterial wall separation
D. Cardiac tamponade due to pericardial effusion

Answer 7

C. Aortic dissection leading to arterial wall separation

Rationale: Marfan’s syndrome is a connective tissue disorder that weakens the aortic wall, making it more prone to tearing and dissection. In this patient with hypertension and Marfan’s syndrome, the most likely cause of sudden chest pain and dizziness is aortic dissection, in which the arterial wall layers separate, creating a false lumen.

Question 8

A nurse is reviewing the mechanism of aortic dissection with a group of student nurses. Which statements are correct? Select all that apply.

A. A tear in the intimal layer allows blood to enter the media layer.
B. Each cardiac contraction worsens the dissection by increasing pressure on the damaged area.
C. The false lumen may rupture, causing fatal hemorrhage.
D. Aortic dissections occur only in the ascending aorta.
E. The dissected layers may cut off blood supply to vital organs.

Answer 8

A. A tear in the intimal layer allows blood to enter the media layer.
B. Each cardiac contraction worsens the dissection by increasing pressure on the damaged area.
C. The false lumen may rupture, causing fatal hemorrhage.
E. The dissected layers may cut off blood supply to vital organs.

Rationale: Aortic dissection begins with a tear in the intima (A), allowing blood to enter the media layer and creating a false lumen. Each heartbeat increases stress on the aortic wall, worsening the dissection (B). If the false lumen ruptures (C), the outcome is often fatal due to massive hemorrhage. Additionally, dissection may compromise blood flow (E) to critical organs, leading to ischemia. Dissections can occur in both the ascending and descending aorta, not just the ascending aorta, making D incorrect.

Question 8

Which patient is at the greatest risk for developing aortic dissection?

A. A 30-year-old male with a history of smoking and hyperlipidemia
B. A 35-year-old female with diabetes and a history of coronary artery disease
C. A 40-year-old female who recently underwent a C-section
D. A 67-year-old male with uncontrolled hypertension and a history of bicuspid aortic valve

Answer 8

D. A 67-year-old male with uncontrolled hypertension and a history of bicuspid aortic valve

Rationale: Uncontrolled hypertension is the most important risk factor for aortic dissection. Additionally, a bicuspid aortic valve is a congenital heart condition that increases susceptibility to aortic diseases, including dissection. The combination of these factors makes this patient the highest risk.

Question 9

A 50-year-old male with a history of cocaine use and hypertension is brought to the ER with severe chest pain radiating to his back. His BP is 200/120 mmHg, and his heart rate is 110 bpm. Which pathophysiologic mechanism is most likely responsible for his condition?

A. Coronary artery spasm leading to myocardial infarction
B. Cocaine-induced aortic dissection from increased shear stress
C. Hypertensive crisis leading to left ventricular failure
D. Pulmonary embolism causing obstruction of blood flow

Answer 9

B. Cocaine-induced aortic dissection from increased shear stress

Rationale: Cocaine use causes extreme surges in blood pressure and heart rate, increasing shear stress on the aortic wall. This can precipitate aortic dissection, especially in those with predisposing risk factors like hypertension. The patient’s severe chest pain radiating to the back and extremely high blood pressure strongly suggest aortic dissection rather than other conditions.

Question 10

A patient with suspected aortic dissection is undergoing an urgent assessment. The nurse recognizes that which diagnostic finding would most strongly indicate an aortic dissection?

A. ST-segment elevations on ECG
B. Decreased ejection fraction on echocardiogram
C. Widened mediastinum on chest X-ray
D. Hyperinflation of lungs on chest X-ray

Answer 10

C. Widened mediastinum on chest X-ray

Rationale: A widened mediastinum on chest X-ray is a key finding in aortic dissection, suggesting blood accumulation within the aortic wall. This finding warrants immediate further imaging, such as a CT angiogram, to confirm the diagnosis.

Question 11

A nurse is providing discharge teaching to a patient who survived an acute aortic dissection. Which instructions should the nurse include? Select all that apply.

A. Maintain tight blood pressure control with prescribed medications.
B. Avoid heavy lifting or strenuous exercise.
C. Monitor for new or worsening chest or back pain.
D. Consume a high-sodium diet to maintain vascular volume.
E. Follow up regularly for imaging studies.

Answer 11

A. Maintain tight blood pressure control with prescribed medications.
B. Avoid heavy lifting or strenuous exercise.
C. Monitor for new or worsening chest or back pain.
E. Follow up regularly for imaging studies.

Rationale: Blood pressure control (A) is essential to prevent re-dissection or rupture. Avoiding strenuous activity (B) helps reduce stress on the aortic wall. The patient should monitor for new symptoms (C) and seek immediate care if they occur. Regular imaging (E) ensures early detection of complications. A high-sodium diet (D) is contraindicated because it can worsen hypertension, increasing the risk of re-dissection.

Question 12

A nurse is assessing a patient with a suspected acute type A aortic dissection. Which clinical finding would most strongly support this diagnosis?

A. Severe chest pain described as “tearing” or “ripping”
B. Lower extremity weakness and diminished pedal pulses
C. Severe abdominal pain with rebound tenderness
D. Unilateral pleuritic chest pain and shortness of breath

Answer 12

A. Severe chest pain described as “tearing” or “ripping”

Rationale: Type A aortic dissection commonly presents with an abrupt onset of severe anterior chest pain, often described as “tearing” or “ripping”. The pain may radiate to the back or follow the path of the dissection as it progresses. This presentation is a hallmark symptom of ascending aortic dissection, requiring emergent intervention.

Question 13

A patient with a suspected aortic dissection reports severe back pain radiating to the abdomen. The nurse knows that which other assessment findings would be consistent with this condition? Select all that apply.

A. Unequal blood pressure between arms
B. Altered level of consciousness
C. Worsening neurological deficits
D. Sharp, “stabbing” pain that follows the dissection
E. Bilateral lower extremity edema and ascites

Answer 13

A. Unequal blood pressure between arms
B. Altered level of consciousness
C. Worsening neurological deficits
D. Sharp, “stabbing” pain that follows the dissection

Rationale: Aortic dissection can impair blood flow to major arteries, leading to unequal BP readings between arms (A) if the subclavian artery is affected. Altered level of consciousness (B) and worsening neurological deficits (C) occur if the aortic arch is involved, affecting cerebral circulation. Sharp, stabbing pain (D) that follows the dissection’s path is characteristic. Edema and ascites (E) are signs of chronic heart failure or liver disease, not acute aortic dissection.

Question 14

A 74-year-old male presents with vague chest discomfort, dizziness, and hypotension. The nurse notes a significant difference in blood pressure between his arms. Which additional assessment finding would most strongly indicate a type A aortic dissection?

A. Crackles in the lungs and jugular vein distention
B. Pain that improves with leaning forward
C. Fever, chills, and a pericardial friction rub
D. Widened mediastinum on chest X-ray

Answer 14

D. Widened mediastinum on chest X-ray

Rationale: A widened mediastinum on chest X-ray is a key diagnostic finding in aortic dissection, especially type A dissections, which involve the ascending aorta and arch. This structural change occurs due to blood accumulation in the aortic wall and is often the first radiographic sign of dissection.

Question 15

A nurse is assessing a patient with an aortic dissection that has progressed down the aorta. Which finding suggests decreased perfusion to abdominal organs and lower extremities?

A. Decreased urine output and abdominal tenderness
B. Bilateral crackles and elevated BNP levels
C. Pulsus paradoxus and distant heart sounds
D. Facial edema and jugular vein distention

Answer 15

A. Decreased urine output and abdominal tenderness

Rationale: As the dissection extends downward, it can compromise blood flow to the renal and mesenteric arteries, leading to renal ischemia (decreased urine output) and abdominal organ hypoperfusion (abdominal tenderness). These signs indicate end-organ damage, requiring immediate intervention.

Question 16

A patient with a type A aortic dissection is being monitored in the ICU. The nurse recognizes that which neurological signs may indicate worsening dissection? Select all that apply.

A. Altered level of consciousness
B. Unilateral facial droop
C. Difficulty speaking or understanding speech
D. New onset of syncope

Answer 16

all of the choice are correct

Rationale: Type A dissections may impair cerebral blood flow, leading to neurological deficits. Altered LOC (A), unilateral facial droop (B), and difficulty speaking (C) suggest ischemic brain involvement. New onset syncope (D) may indicate aortic rupture or significant cerebral hypoperfusion, requiring emergency intervention.

Question 17

A nurse is assessing a patient with a suspected subclavian artery involvement in aortic dissection. Which clinical finding should the nurse expect?

A. Blood pressure is significantly higher in both arms
B. Different blood pressure readings between arms
C. Decreased capillary refill in all extremities
D. Irregular heart rhythm and tachycardia

Answer 17

B. Different blood pressure readings between arms

If the subclavian artery is affected, blood flow to one arm may be reduced, leading to a lower BP reading in that arm compared to the other. This BP discrepancy is a hallmark sign of aortic dissection involving the subclavian artery.

Question 18

A 65-year-old woman presents to the ED with severe back pain and syncope. Her BP is 90/60 mmHg, HR 120 bpm, and she has weak femoral pulses. She denies chest pain. The nurse suspects an acute type B aortic dissection. Which diagnostic test should be performed immediately?

A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography
D. Cardiac enzyme panel

Answer 18

C. CT angiography

Rationale: CT angiography is the gold standard for diagnosing aortic dissection, providing detailed imaging of the aorta to determine the extent and location of the dissection. Immediate imaging is crucial to guide emergency management and prevent complications such as aortic rupture.

Question 19

A nurse is assessing a patient with an acute type A aortic dissection and suspects cardiac tamponade. Which assessment finding would most strongly support this complication?

A. Decreased urine output and abdominal distension
B. Widened pulse pressure and bounding pulses
C. Sudden onset of unilateral lower extremity paralysis
D. Muffled heart sounds and jugular venous distention

Answer 19

D. Muffled heart sounds and jugular venous distention

Rationale: Cardiac tamponade occurs when blood leaks into the pericardial sac, compressing the heart and reducing cardiac output. Hallmark findings include:
* Muffled heart sounds (due to fluid accumulation in the pericardium)
* Jugular venous distention (from impaired venous return to the heart)
* Hypotension and narrowed pulse pressure
* Pulsus paradoxus (a drop in SBP >10 mmHg during inspiration)

Question 20

A patient with an aortic dissection has developed spinal cord ischemia. Which clinical manifestations would the nurse expect? Select all that apply.

A. Weakness in lower extremities
B. Decreased sensation below the level of ischemia
C. Absent deep tendon reflexes
D. Unilateral facial droop
E. Sudden onset of lower extremity paralysis

Answer 20

A. Weakness in lower extremities
B. Decreased sensation below the level of ischemia
E. Sudden onset of lower extremity paralysis

Rationale: Spinal cord ischemia due to aortic dissection can cause neurological deficits:
* Weakness in lower extremities (A) due to impaired spinal cord perfusion
* Decreased sensation (B) below the affected level
* Sudden onset of paralysis (E) in severe cases
Absent deep tendon reflexes (C) are not a primary finding. Unilateral facial droop (D) suggests a stroke, not spinal cord ischemia.

Question 21

A patient with a ruptured aortic dissection is brought to the emergency department. The nurse notes hypotension, tachycardia, cool extremities, and altered mental status. What is the priority intervention?

A. Administer IV labetalol to lower blood pressure
B. Prepare for emergency surgical repair
C. Obtain a stat CT angiography
D. Administer IV fluids at a rapid rate

Answer 21

B. Prepare for emergency surgical repair

Rationale: Aortic rupture is fatal without immediate surgical intervention. The patient is exhibiting signs of hypovolemic shock due to massive hemorrhage. Emergency surgical repair is the only life-saving measure.
* IV fluids (D) may be cautiously given to maintain perfusion, but fluid resuscitation alone is not sufficient.
* CT angiography (C) confirms diagnosis but should not delay surgery in an unstable patient.
* Labetalol (A) is contraindicated in this case due to severe hypotension.

Question 22

A nurse is monitoring a patient with an aortic dissection for signs of renal ischemia. Which finding would indicate progressive kidney damage?

A. Urine output of 20 mL/hr
B. Blood pressure of 168/92 mmHg
C. Bilateral 2+ pitting edema in the lower extremities
D. Capillary refill of 3 seconds

Answer 22

A. Urine output of 20 mL/hr

Rationale: Renal ischemia due to aortic dissection can lead to acute kidney injury (AKI). A urine output <30 mL/hr is an early sign of decreased renal perfusion.
* Hypertension (B) is a risk factor but does not directly indicate ischemia.
* Edema (C) may occur in chronic kidney disease but is not an early sign of acute renal failure.
* Capillary refill (D) of 3 seconds is within normal limits.

Question 23

A patient with an acute aortic dissection develops abdominal (mesenteric) ischemia. The nurse should expect which clinical findings? Select all that apply.

A. Severe abdominal pain
B. Decreased bowel sounds
C. Persistent nausea and vomiting
D. Increased appetite and hunger
E. Hematochezia (bloody stools)

Answer 23

A. Severe abdominal pain
B. Decreased bowel sounds
C. Persistent nausea and vomiting
E. Hematochezia (bloody stools)

Rationale: Abdominal (mesenteric) ischemia results from decreased blood flow to the intestines, leading to:
* Severe abdominal pain (A) due to tissue hypoxia
* Decreased bowel sounds (B) from reduced perfusion
* Persistent nausea/vomiting (C) due to bowel dysfunction
* Hematochezia (E) in cases of bowel infarction
Increased appetite (D) is incorrect because intestinal ischemia often causes anorexia, not hunger.

Question 24

A patient presents with suspected aortic dissection. Which diagnostic study is most reliable for diagnosing aortic dissection in an unstable patient who has contraindications to CT or MRI (e.g., metal implants or allergies to contrast material)? A. Chest X-ray B. Transesophageal echocardiography (TEE) C. MRI D. Computed tomography (CT) scan with contrast

Answer 24

B. Transesophageal echocardiography (TEE) Rationale: Transesophageal echocardiography (TEE) is the preferred diagnostic study for unstable patients with suspected aortic dissection, particularly if they have contraindications to CT or MRI. TEE provides real-time, high-quality imaging of the aorta and can be performed at the bedside. It is especially useful for patients who cannot undergo CT or MRI due to reasons such as metal implants or contrast material allergies. This makes TEE the most reliable option for diagnosing acute aortic dissection in these patients.

Question 25

Which of the following diagnostic studies for aortic dissection is the most reliable in providing detailed information about the severity of the dissection and its related complications (e.g., pericardial effusions, carotid dissection)? A. Chest X-ray B. Transesophageal echocardiography (TEE) C. MRI D. Electrocardiogram (ECG)

Answer 25

C. MRI Rationale: MRI provides the most detailed information about the severity of aortic dissection and related complications. It can accurately visualize the aorta, detect any pericardial effusions, and identify complications such as carotid dissection. MRI has excellent soft tissue resolution, making it the most effective method for assessing the extent and severity of the dissection, especially for chronic or complicated cases.

Question 26

A patient with suspected aortic dissection is scheduled for a diagnostic test. Which of the following tests is least likely to be useful in diagnosing an acute aortic dissection? A. 3D CT scan B. Chest X-ray C. Electrocardiogram (ECG) D. Transesophageal echocardiography (TEE)

Answer 26

C. Electrocardiogram (ECG) Rationale: An ECG is primarily used to rule out cardiac ischemia, not specifically for diagnosing aortic dissection. While an ECG may be ordered to rule out other causes of chest pain, it is not reliable for detecting aortic dissection. On the other hand, a 3D CT scan, chest X-ray, and TEE are all reliable diagnostic tests for detecting aortic dissection. The ECG does not provide sufficient detail or imaging to diagnose or assess aortic dissection.

Question 27

A nurse is preparing a patient for a CT scan to evaluate an aortic dissection. The patient asks why an ECG is being performed in addition to the CT scan. What is the nurse’s best response? A. “The ECG will identify any neurological deficits caused by the dissection.” B. “The ECG will help rule out any possible heart attack or ischemia.” C. “The ECG will provide a more detailed image of the aortic wall.” D. “The ECG will determine if you are a candidate for surgery.”

Answer 27

B. “The ECG will help rule out any possible heart attack or ischemia.” Rationale: The ECG is performed to rule out cardiac ischemia or heart attack in patients with suspected aortic dissection. It helps differentiate between chest pain caused by ischemic events and those caused by aortic dissection. Although a CT scan is used to directly diagnose the dissection, the ECG plays a supporting role in excluding other potential causes of chest pain. The ECG does not directly provide information on the aortic wall or determine surgical candidacy.

Question 28

A patient with suspected aortic dissection is scheduled for a chest X-ray. What is the primary reason for this diagnostic study in the initial assessment of aortic dissection? A. To assess the size of the aorta and degree of dilation B. To evaluate for aortic rupture C. To rule out a myocardial infarction D. To detect widening of the mediastinum or pleural effusion

Answer 28

D. To detect widening of the mediastinum or pleural effusion Rationale: A chest X-ray is typically used as an initial screening tool to assess for signs of aortic dissection, such as widening of the mediastinum or pleural effusion, which can suggest the presence of a dissection. While a chest X-ray is not definitive for diagnosing aortic dissection, it may provide early clues that guide further diagnostic testing. It does not provide detailed information about the size of the aorta or detect aortic rupture or myocardial infarction directly.

Question 29

A 65-year-old male patient is admitted to the ICU with acute aortic dissection. The medical team aims to control his heart rate and blood pressure (BP) to reduce aortic wall stress. The nurse administers IV esmolol to achieve a target heart rate (HR) of 58 beats/min and a systolic BP (SBP) between 100-110 mm Hg. What is the primary goal of using IV esmolol in this patient? A. To reduce pain and anxiety B. To prevent the rupture of the aorta C. To decrease aortic wall stress by lowering HR and SBP D. To increase myocardial contractility and improve perfusion

Answer 29

C. To decrease aortic wall stress by lowering HR and SBP Rationale: The primary goal of using IV esmolol in the management of acute aortic dissection is to reduce aortic wall stress by controlling both heart rate (HR) and systolic blood pressure (SBP). By lowering these values, aortic wall stress is decreased, which helps to limit the extension of the dissection. Esmolol is a β-blocker that decreases myocardial contractility, which is critical in preventing further damage to the aortic wall.

Question 30

A patient with acute aortic dissection has been administered IV morphine for pain relief. Which of the following is the primary reason for using morphine in this patient? A. To increase the patient’s BP and reduce dissection B. To provide immediate relief from chest pain C. To decrease sympathetic nervous system stimulation and reduce pain D. To lower heart rate and prevent aortic rupture

Answer 30

C. To decrease sympathetic nervous system stimulation and reduce pain Rationale: Morphine is administered to decrease sympathetic nervous system stimulation, which can exacerbate pain and stress on the aorta. Additionally, it provides pain relief by acting as an analgesic. Decreasing sympathetic stimulation helps reduce heart rate and BP, which is beneficial in preventing further extension of the dissection and limiting aortic wall stress. This is a supportive treatment while preparing the patient for surgery.

Question 31

A 72-year-old male patient with acute aortic dissection is being treated in the ICU. The physician prescribes diltiazem instead of a β-blocker for heart rate control. What is the most likely reason for choosing diltiazem over a β-blocker? A. The patient has a contraindication to β-blockers, such as asthma B. The patient is experiencing an allergic reaction to morphine C. The patient requires more pain relief D. The patient has a history of hypertension but no cardiac conditions

Answer 31

A. The patient has a contraindication to β-blockers, such as asthma Rationale: Diltiazem, a calcium channel blocker, is an alternative for heart rate control when β-blockers are contraindicated. A common contraindication for β-blockers is a history of asthma or chronic obstructive pulmonary disease (COPD), as β-blockers can exacerbate bronchospasm. Diltiazem is effective in lowering heart rate in patients who cannot tolerate β-blockers, thus helping reduce aortic wall stress and controlling the dissection.

Question 32

A nurse is caring for a patient with acute aortic dissection in the ICU. The physician has ordered IV esmolol and morphine to manage the patient’s condition. Which of the following assessments should the nurse prioritize when monitoring this patient? A. Monitoring the patient’s oxygen saturation levels B. Assessing for signs of hyperkalemia C. Observing for signs of bradycardia and hypotension D. Checking the patient’s renal function every 4 hours

Answer 32

C. Observing for signs of bradycardia and hypotension Rationale: The nurse should prioritize monitoring for bradycardia and hypotension when administering IV esmolol (a β-blocker) and morphine. Esmolol can lower heart rate significantly, and morphine can cause hypotension due to its vasodilatory effects. These side effects are important to monitor closely, as they can compromise perfusion and worsen the patient’s condition. The nurse should be alert to changes in BP and HR to prevent further complications.

Question 33

A patient with acute aortic dissection is receiving supportive care with the goal of stabilizing their condition before surgery. Which of the following interventions are appropriate for the nurse to implement in the initial management of this patient? (Select all that apply.) A. Administer IV β-blockers to control heart rate B. Administer calcium channel blockers to lower heart rate if β-blockers are contraindicated C. Administer morphine for pain relief and to decrease sympathetic stimulation D. Increase IV fluids to promote circulatory volume E. Implement strict bed rest and limit physical activity

Answer 33

A. Administer IV β-blockers to control heart rate B. Administer calcium channel blockers to lower heart rate if β-blockers are contraindicated C. Administer morphine for pain relief and to decrease sympathetic stimulation E. Implement strict bed rest and limit physical activity Rationale: In the initial management of acute aortic dissection, IV β-blockers (such as esmolol) are used to control heart rate and reduce aortic wall stress. If β-blockers are contraindicated, calcium channel blockers (such as diltiazem) can be used as an alternative to lower heart rate. Morphine is also administered for pain relief and to reduce sympathetic nervous system stimulation. Strict bed rest and limiting physical activity are crucial in minimizing aortic stress.

Question 34

A patient is diagnosed with a chronic Type B aortic dissection that is currently uncomplicated. The healthcare provider decides on a conservative treatment approach. Which of the following interventions is most appropriate for managing this patient? A. Immediate surgery to repair the dissection B. Administration of IV fibrinolytics to dissolve any clots C. Pain relief, heart rate and blood pressure control, and cardiovascular risk factor modification D. Use of corticosteroids to reduce inflammation and swelling of the aorta

Answer 34

C. Pain relief, heart rate and blood pressure control, and cardiovascular risk factor modification Rationale: Conservative management for a chronic Type B aortic dissection without complications involves pain relief, controlling heart rate and blood pressure, and modifying cardiovascular disease (CVD) risk factors. These interventions aim to prevent the extension of the dissection and manage the stress on the aortic wall. Additionally, close surveillance with CT or MRI is important for monitoring the dissection’s progression. Surgery is generally reserved for cases with complications, not uncomplicated Type B dissections.

Question 35

A 60-year-old patient with an uncomplicated Type B aortic dissection is being managed conservatively. The nurse educates the patient on lifestyle changes to reduce cardiovascular risk. Which of the following modifications should the nurse recommend? A. Engage in strenuous exercise to improve circulation B. Reduce salt intake to lower blood pressure C. Increase dietary fat to promote a healthy weight D. Limit fluid intake to prevent fluid overload

Answer 35

B. Reduce salt intake to lower blood pressure Rationale: To manage cardiovascular risk, one of the key modifications is to reduce salt intake, as excess sodium can elevate blood pressure, which increases stress on the aortic wall and can worsen the dissection. Managing blood pressure through lifestyle changes such as dietary modifications is a cornerstone of conservative management for Type B aortic dissection. Strenuous exercise (A) and increasing dietary fat (C) are not appropriate for this patient, as they can raise blood pressure or worsen cardiovascular health. Limiting fluid intake (D) is generally not a necessary intervention unless fluid overload occurs.

Question 36

A patient with a chronic Type B aortic dissection is being managed conservatively with close surveillance. Which of the following interventions are appropriate for this patient? (Select all that apply.) A. Monitor blood pressure regularly to maintain it within target limits B. Initiate pain management to alleviate discomfort and reduce sympathetic stimulation C. Schedule regular imaging with CT or MRI to monitor the dissection’s progression D. Encourage smoking cessation to decrease the risk of further vascular damage E. Perform immediate surgery to repair the dissection if there are no complications

Answer 36

A. Monitor blood pressure regularly to maintain it within target limits B. Initiate pain management to alleviate discomfort and reduce sympathetic stimulation C. Schedule regular imaging with CT or MRI to monitor the dissection’s progression D. Encourage smoking cessation to decrease the risk of further vascular damage Rationale: For conservative management of a chronic Type B aortic dissection, it is important to monitor blood pressure regularly to ensure it remains within target limits, as high blood pressure can exacerbate the dissection. Pain management is also critical to reduce sympathetic nervous system stimulation, which could lead to increased blood pressure and aortic wall stress. Regular imaging with CT or MRI is necessary for surveillance of the dissection’s progression. Smoking cessation (D) is crucial to reduce the risk of further vascular damage. Immediate surgery (E) is not indicated in the absence of complications.

Question 37

A patient with an acute Type B aortic dissection and hemodynamic instability is scheduled for an endovascular repair. Which of the following is a key advantage of thoracic endovascular aortic repair (TEVAR) over traditional surgical approaches? A. TEVAR completely eliminates the risk of renal failure B. TEVAR is the only treatment for chronic Type B aortic dissection C. TEVAR prevents the risk of paraplegia and stroke D. TEVAR has fewer post-surgical complications

Answer 37

D. TEVAR has fewer post-surgical complications Rationale: TEVAR is preferred for patients with acute Type B aortic dissection and hemodynamic instability because it offers fewer post-surgical complications compared to traditional surgery. However, it does not eliminate the risk of renal failure, paraplegia, or stroke. These risks remain, and TEVAR should be carefully considered in patients with these concerns. TEVAR is also used for chronic Type B dissection with complications, but it is not the only treatment option.

Question 38

When managing a patient who undergoes thoracic endovascular aortic repair (TEVAR), which of the following should be prioritized to prevent neurologic complications? A. Encourage deep breathing exercises to improve oxygenation B. Administer antiplatelet therapy to reduce the risk of clot formation C. Insert a lumbar spinal drain to decrease the risk of spinal ischemia D. Restrict fluid intake to prevent fluid overload and renal failure

Answer 38

C. Insert a lumbar spinal drain to decrease the risk of spinal ischemia Rationale: To prevent neurologic complications such as spinal ischemia following TEVAR, the insertion of a lumbar spinal drain is a common intervention. This helps maintain cerebrospinal fluid (CSF) pressure and can reduce the risk of paraplegia. Strict aseptic technique is used during the procedure to avoid infection. Although antiplatelet therapy (B) may be used in some cases to prevent clot formation, it is not specifically aimed at preventing neurologic complications. Deep breathing exercises (A) and fluid restriction (D) are not focused on neurologic protection.

Question 39

A patient with a chronic Type B aortic dissection is being considered for thoracic endovascular aortic repair (TEVAR). Which of the following is a potential complication associated with the procedure? A. Complete resolution of peripheral ischemia B. Prevention of renal failure C. Development of paraplegia or stroke D. Elimination of the need for blood pressure control

Answer 39

C. Development of paraplegia or stroke Rationale: TEVAR can be highly effective in treating aortic dissections, but it does not eliminate the risk of serious complications such as paraplegia or stroke. These complications occur due to the manipulation of the aorta and the potential for ischemia in critical areas such as the spinal cord or brain. While TEVAR can improve blood flow and relieve symptoms of peripheral ischemia, it does not guarantee complete resolution. Additionally, the procedure does not prevent renal failure or eliminate the need for blood pressure control after surgery.

Question 40

Which of the following statements regarding thoracic endovascular aortic repair (TEVAR) are true? (Select all that apply.) A. TEVAR is used for both acute and chronic Type B aortic dissections with complications B. TEVAR has a higher incidence of post-surgical complications compared to traditional open surgery C. A lumbar spinal drain may be used to reduce the risk of neurologic complications D. TEVAR completely eliminates the risk of renal failure, paraplegia, and stroke E. TEVAR is less invasive than traditional open surgery, leading to fewer complications

Answer 40

A. TEVAR is used for both acute and chronic Type B aortic dissections with complications C. A lumbar spinal drain may be used to reduce the risk of neurologic complications E. TEVAR is less invasive than traditional open surgery, leading to fewer complications Rationale: TEVAR is a preferred treatment for both acute and chronic Type B aortic dissections with complications such as peripheral ischemia and hemodynamic instability (A). It is less invasive than traditional open surgery, reducing the risk of complications (E), though it does not eliminate the risk of serious issues like renal failure, paraplegia, or stroke (D). The use of a lumbar spinal drain is indicated in some cases to help prevent neurologic complications (C). However, TEVAR generally has fewer post-surgical complications compared to traditional surgery, not more (B).

Question 41

An acute Type A aortic dissection is diagnosed in a patient who presents with symptoms. What is the most appropriate initial treatment for this patient? A. Immediate open surgical repair B. Conservative therapy with strict blood pressure control C. Pain management and monitoring in a regular medical ward D. Endovascular repair using a stent graft

Answer 41

A. Immediate open surgical repair Rationale: An acute Type A aortic dissection is considered a surgical emergency due to the high mortality rate (50% within 48 hours of symptom onset). The most appropriate treatment for such patients is immediate open surgical repair, as prompt intervention is critical to prevent fatal complications such as aortic rupture. Conservative therapy (B) may be used for stable, chronic cases but is not appropriate in acute presentations. Pain management (C) and endovascular repair (D) are not the first-line treatments for acute Type A dissection.

Question 42

Which of the following patients with a chronic aortic dissection would be a candidate for open surgical repair? A. A 55-year-old with a history of Marfan syndrome and an aortic aneurysm measuring 6.0 cm B. A 60-year-old with a normal aorta and controlled hypertension C. A 45-year-old with a bicuspidi aortic valve and an aneurysm measuring 4.0 cm D. A 75-year-old with atherosclerosis and an aneurysm measuring 4.5 cm

Answer 42

A. A 55-year-old with a history of Marfan syndrome and an aortic aneurysm measuring 6.0 cm Rationale: Patients with a chronic aortic dissection and a connective tissue disorder, such as Marfan syndrome, or with an aneurysm greater than 5.5 cm, are candidates for open surgical repair due to the increased risk of rupture and complications. In contrast, patients with smaller aneurysms or well-controlled risk factors, such as hypertension or atherosclerosis, do not meet the threshold for surgery unless other complications arise.

Question 43

A patient who underwent surgical repair for a Type A aortic dissection presents with sudden-onset severe abdominal pain and is hypotensive. Which of the following is a likely complication? A. Mesenteric ischemia B. Peripheral ischemia C. Spinal cord ischemia D. Renal failure

Answer 43

A. Mesenteric ischemia Rationale: Mesenteric ischemia is a common and life-threatening complication following aortic dissection surgery, particularly when there is interruption of blood supply to the mesenteric arteries. Abdominal pain and hypotension are key symptoms of this complication. Other complications such as peripheral ischemia (B), spinal cord ischemia (C), and renal failure (D) are possible but less likely to present with these specific symptoms in this context.

Question 44

A 60-year-old patient with chronic aortic dissection and a 5.8 cm aneurysm is scheduled for open surgical repair. What is the primary concern during the postoperative period? A. Aortic rupture B. Stroke or MI C. Mesenteric ischemia D. Infection

Answer 44

B. Stroke or MI Rationale: After open surgical repair for a chronic aortic dissection, patients are at high risk for complications like stroke and myocardial infarction (MI) due to the manipulation of the aorta, which can disrupt blood flow to critical organs. Aortic rupture (A) is a risk prior to surgery, but it becomes less of a concern postoperatively. Mesenteric ischemia (C) is also a risk but tends to present earlier and is more common during the acute phase of dissection. Infection (D) is a concern in any surgical procedure, but it is not as common or immediate as stroke or MI in the post-op period.

Question 45

Which of the following is a potential cause of death in a patient with acute aortic dissection despite surgical intervention? A. Aortic rupture B. Paraplegia C. Chronic renal failure D. Cerebral aneurysm

Answer 45

A. Aortic rupture Rationale: Aortic rupture remains a leading cause of death in patients with acute aortic dissection even after surgical repair. Despite surgery, rupture can occur due to the fragility of the aorta and other complicating factors. Paraplegia (B) and chronic renal failure (C) can be serious complications but are less likely to be fatal compared to aortic rupture. Cerebral aneurysm (D) is not a typical complication of aortic dissection and is not commonly a cause of death in these patients.

Question 46

What is the primary reason for delaying surgery in patients with an acute aortic dissection? A. To allow time for blood clotting in the false lumen B. To reduce the risk of cardiac tamponade C. To stabilize blood pressure with medication D. To decrease the risk of infection postoperatively

Answer 46

A. To allow time for blood clotting in the false lumen Rationale: In patients with acute aortic dissection, surgery is sometimes delayed to allow blood clotting in the false lumen, which can help stabilize the aorta before performing surgery. This approach may reduce the risk of further extension of the dissection. Cardiac tamponade (B) is a possible complication but does not typically prompt a delay in surgery. Blood pressure stabilization (C) and infection risk reduction (D) are part of preoperative care but not the primary reason for delaying surgery.

Question 47

A 65-year-old male patient with a history of hypertension is admitted with an acute aortic dissection. His blood pressure is 175/110 mm Hg, and his heart rate is 110 beats/min. The healthcare provider orders the following interventions: intravenous esmolol and blood pressure monitoring. The nurse is preparing to manage this patient in the ICU. Which of the following actions should the nurse prioritize to manage this patient’s acute condition effectively? A. Placing the patient in a semi-Fowler’s position B. Administering morphine to relieve pain C. Increasing the patient’s fluid intake to increase blood volume D. Preparing for surgery as the patient is unstable

Answer 47

A. Placing the patient in a semi-Fowler’s position Rationale: Placing the patient in a semi-Fowler’s position reduces stress on the aorta, improving perfusion and reducing the risk of further dissection. This position helps stabilize the patient’s condition by decreasing the workload on the heart and lowering aortic wall stress. It is crucial in managing aortic dissection before surgical intervention.

Question 48

A nurse is preparing to administer esmolol to a patient with acute aortic dissection. The nurse should monitor which of the following parameters most closely? A. Blood glucose levels B. Heart rate and blood pressure C. Respiratory rate and oxygen saturation D. Renal function

Answer 48

B. Heart rate and blood pressure Rationale: Esmolol is a beta-blocker used to control heart rate and blood pressure in patients with acute aortic dissection. Close monitoring of these parameters ensures that the medication is effective in reducing aortic wall stress and preventing further dissection or complications. Adjustments to the medication may be needed if HR or BP falls outside the targeted range.

Question 49

A nurse is preparing to discharge a patient who has had surgery for an aortic dissection. Which of the following patient teaching points should the nurse emphasize? (Select all that apply.) A. “You will need to take your antihypertensive medications daily for the rest of your life.” B. “It is okay to stop taking your medications if you feel well.” C. “Regular follow-up imaging with CT or MRI is essential.” D. “You should expect some temporary pain at the incision site, but it should resolve in a few days.” E. “You should monitor your blood pressure at home and report any significant changes.”

Answer 49

A. “You will need to take your antihypertensive medications daily for the rest of your life.” C. “Regular follow-up imaging with CT or MRI is essential.” E. “You should monitor your blood pressure at home and report any significant changes.” Rationale: * A is correct: Patients need to continue taking antihypertensive medications daily to control HR and BP, which reduces the risk of further dissection or aneurysm formation. * C is correct: Regular follow-up imaging (CT or MRI) is necessary to monitor for potential complications like redissection or aneurysm formation. * E is correct: Home blood pressure monitoring is important to ensure BP control and reduce the risk of complications. * B is incorrect: Stopping medications without consulting a healthcare provider can result in uncontrolled BP and HR, increasing the risk of complications. * D is incorrect: While pain at the incision site is common post-surgery, it should be managed and monitored to avoid complications like infection or delayed healing.

Question 50

Which of the following is the most important intervention when managing a patient with acute aortic dissection preoperatively? A. Administering IV fluids to maintain hydration B. Positioning the patient in a supine position for optimal blood flow C. Administering pain relief and sedatives as prescribed D. Encouraging the patient to cough and deep breathe to prevent atelectasis

Answer 50

C. Administering pain relief and sedatives as prescribed Rationale: Administering pain relief and sedatives helps reduce sympathetic nervous system activation, which can worsen the dissection. Pain and anxiety can increase HR and BP, exacerbating the stress on the aorta. Proper pain management is essential to stabilize the patient preoperatively.

Question 51

A nurse is caring for a patient with an acute aortic dissection in the ICU. The patient is being treated with esmolol to control HR and BP. The nurse notices a significant drop in the patient’s heart rate to 45 beats/min. What should the nurse do first? A. Administer atropine to increase the heart rate B. Notify the healthcare provider immediately C. Decrease the esmolol infusion rate D. Increase the rate of IV fluids to improve perfusion

Answer 51

C. Decrease the esmolol infusion rate Rationale: A significant decrease in heart rate (HR) to 45 beats/min in a patient on esmolol requires prompt action to prevent bradycardia-induced complications. The first action should be to decrease the esmolol infusion rate, as it is likely contributing to the low HR. The nurse should then closely monitor the patient’s HR and BP and notify the healthcare provider if necessary.

Question 52

A patient who had surgery for an acute aortic dissection is being prepared for discharge. The nurse is teaching the patient and caregiver about post-discharge care. Which of the following should be emphasized? A. “You can resume your regular activities once you feel better, even without follow-up appointments.” B. “It’s important to continue taking your medications even if you feel no symptoms.” C. “You will not need any follow-up imaging unless you experience symptoms.” D. “If you experience pain or symptoms similar to before, try to rest and avoid medical attention.”

Answer 52

B. “It’s important to continue taking your medications even if you feel no symptoms.” Rationale: The patient must continue taking antihypertensive medications daily to control BP and HR, even in the absence of symptoms. This is essential to prevent redissection or aneurysm formation. Stopping medications could lead to complications. Regular follow-up imaging is necessary to monitor for potential issues.

Question 53

A patient with a history of aortic dissection has been stable for several months. Which of the following interventions is most crucial during the long-term follow-up? A. Encouraging the patient to stop all medications to reduce side effects B. Reassuring the patient that no further monitoring is necessary C. Regularly scheduling follow-up imaging with CT or MRI D. Teaching the patient to increase physical activity to strengthen the aorta

Answer 53

C. Regularly scheduling follow-up imaging with CT or MRI Rationale: Regular follow-up imaging with CT or MRI is essential for detecting redissection or aneurysm formation, which are common causes of death in long-term survivors. It is important to monitor the aorta even after surgery to ensure early detection of any complications.

Question 54

A patient with an acute aortic dissection is being prepped for surgery. Which of the following are essential preoperative nursing interventions? (Select all that apply.) A. Maintain continuous ECG and arterial BP monitoring B. Encourage the patient to cough and deep breathe C. Administer opioids and sedatives as prescribed D. Ensure the patient is placed in a semi-Fowler’s position E. Start IV fluids to increase blood volume

Answer 54

A. Maintain continuous ECG and arterial BP monitoring C. Administer opioids and sedatives as prescribed D. Ensure the patient is placed in a semi-Fowler’s position Rationale: * A is correct: Continuous ECG and BP monitoring are essential for real-time assessment of the patient’s condition and to adjust interventions as needed. * C is correct: Opioids and sedatives are necessary for pain and anxiety management, which helps lower HR and BP, reducing stress on the aorta. * D is correct: Semi-Fowler’s position is important to reduce aortic wall stress and optimize perfusion. * B is incorrect: Coughing and deep breathing are not recommended during preoperative management, as they may increase aortic stress. * E is incorrect: IV fluids are typically restricted in this setting to avoid increasing blood volume and BP, which could worsen the dissection.

Question 55

A patient who underwent surgery for acute aortic dissection is receiving postoperative care. The nurse notices that the patient’s BP is 150/90 mm Hg, and their HR is 105 beats/min. What should the nurse do next? A. Administer a dose of IV morphine to reduce pain B. Increase the rate of the esmolol infusion to control HR and BP C. Notify the healthcare provider of the changes in vital signs D. Place the patient in a Trendelenburg position

Answer 55

B. Increase the rate of the esmolol infusion to control HR and BP Rationale: The patient’s BP and HR are elevated, which increases stress on the aorta. Esmolol, a beta-blocker, should be titrated to bring the HR and BP within the target range (HR < 60 beats/min, BP 100-120 mm Hg) to minimize the risk of further dissection. Increasing the esmolol infusion rate is the most appropriate immediate intervention to achieve better control of HR and BP. Once stable, the nurse should continue to monitor vital signs closely and adjust medications as needed.

Question 56

A 72-year-old male patient with a history of chronic hypertension is admitted for management of an acute aortic dissection. The healthcare provider prescribes IV antihypertensive therapy to achieve a target systolic blood pressure (SBP) of 110 mm Hg. The nurse is concerned about the patient’s current SBP of 140 mm Hg. What should the nurse do next? A. Administer IV fluids to increase blood pressure and improve perfusion B. Immediately notify the healthcare provider about the elevated SBP C. Place the patient in a supine position to encourage blood return to the heart D. Increase the dose of IV antihypertensive medications to lower the SBP

Answer 56

D. Increase the dose of IV antihypertensive medications to lower the SBP Rationale: In patients with acute aortic dissection, controlling SBP to the target range (usually 100-120 mm Hg) is crucial to prevent further stress on the aortic wall. If the SBP is higher than the target, the nurse should increase the dose of IV antihypertensive medications (as ordered by the healthcare provider) to achieve the desired BP. Monitoring and titration of the medications should be done carefully to avoid overly rapid BP reduction, which could also be harmful.

Question 57

Which goal is the first priority of interprofessional care for a patient with a suspected acute aortic dissection? a. Reduce anxiety b. Monitor chest pain c. Control blood pressure d. Increase myocardial contractility

Answer 57

c. Control blood pressure

Question 58

The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider? a. Weak pedal pulses b. Absent bowel sounds c. Blood pressure of 148/88 mm Hg d. 25 mL of urine output over the past hour

Answer 58

c. Blood pressure of 148/88 mm Hg Rationale: The systolic blood pressure is typically kept between 100- and 110-mmHg to minimize extension of the dissection. The nurse will need to notify the health care provider so that b-blockers or other antihypertensive drugs can be prescribed. The other findings are typical with aortic dissection and would also be reported but do not require immediate action.