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AACN Cardiac Surgery (Adult)
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A patient undergoes minimally invasive cardiac surgery for the repair of a non- congenital heart defect. Postoperatively, the nurse assesses the patient and notes diminished breath sounds on the left side and tracheal deviation to the right. The nurse suspects:
eural effusion.
nsion pneumothorax. ulmonary embolism.
wer: C
anation: In a patient who has undergone minimally invasive cardiac ery and presents with diminished breath sounds on one side and trache ation to the opposite side, the nurse should suspect tension pneumotho ion pneumothorax occurs when air accumulates in the pleural space, ng lung collapse and displacement of the mediastinum. This can resul ratory distress and hemodynamic compromise. Immediate interventio ed, such as needle decompression followed by chest tube placement, t ve the tension and restore lung function. Options A, B, and D are less
in this scenario based on the presented symptoms.
acute respiratory failure.
pl
te
p Ans
Expl
surg al
devi rax.
Tens
causi t in
respi n is
need o
relie likely
A patient who underwent cardiac surgery is experiencing acute respiratory distress syndrome (ARDS). Which of the following interventions should the nurse prioritize?
Implementing prone positioning
Initiating continuous positive airway pressure (CPAP)
Administering anticoagulants
Administering bronchodilators Answer: A
ng the patient onto their abdomen, has been shown to improve oxygen utcomes in ARDS. Administering bronchodilators may be beneficial fic cases, but it is not the primary intervention for ARDS. Continuous ive airway pressure (CPAP) is not typically used in the management o DS. Anticoagulants may be considered for prophylaxis against venous mboembolism but are not a priority intervention for ARDS.
tient who underwent repair of a non-congenital heart defect develops chest pain, and pericardial friction rub in the postoperative period. T suspects:
ght heart failure. ysrhythmias. yocardial infarction. ericarditis.
Explanation: Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure characterized by widespread inflammation and damage to the lungs. The mainstay of treatment for ARDS is supportive care, including mechanical ventilation. Implementing prone positioning, which involves
turni ation
and o in
speci
posit f
AR
thro
A pa
fever, he
nurse
ri
d
m
p Answer: D
Explanation: In a patient who has undergone repair of a non-congenital heart defect and presents with fever, chest pain, and pericardial friction rub in the postoperative period, the nurse should suspect pericarditis. Pericarditis is inflammation of the pericardium, the sac surrounding the heart, and can occur as a complication of cardiac surgery. It is characterized by chest pain that
worsens with inspiration, fever, and pericardial friction rub on auscultation. Prompt recognition and appropriate management, such as anti-inflammatory medications or pericardial drainage if necessary, are important in treating pericarditis. Options B, C, and D are less likely causes in this scenario.
tient who underwent coronary artery bypass surgery (CABG) with opulmonary bypass develops oliguria, hypotension, and decreased car ut in the immediate postoperative period. The MOST LIKELY cause
ardiogenic shock. ypovolemia. ypervolemia. yocardial stunning.
wer: A
anation: In a patient who has undergone CABG with cardiopulmonary ss and presents with oliguria, hypotension, and decreased cardiac out mmediate postoperative period, the most likely cause is cardiogenic s iogenic shock occurs when the heart is unable to pump enough blood the body's demands, resulting in inadequate tissue perfusion. It can b plication of cardiac surgery and is characterized by systemic hypotensi eased cardiac output, and end-organ dysfunction. Prompt recognition a
A pa
cardi diac
outp is:
c
h
h
m Ans
Expl
bypa put in
the i hock.
Card to
meet e a
com on,
decr nd
management, including hemodynamic support and addressing the underlying cause, are crucial in treating cardiogenic shock. Options A, C, and D are less likely causes in this scenario.
ST-segment elevation on the electrocardiogram (ECG), and elevated cardiac biomarkers. These findings are indicative of:
Dysrhythmias
Myocardial stunning
Pericarditis
wer: D
anation: The combination of persistent chest pain, ST-segment elevati e ECG, and elevated cardiac biomarkers (such as troponin) is consiste a diagnosis of myocardial infarction (heart attack). Myocardial stunni to temporary myocardial dysfunction following ischemia, but it does ally present with persistent chest pain or ST-segment elevation. arditis is characterized by chest pain that is typically sharp and worse nspiration, and it is not associated with ST-segment elevation. hythmias may occur as a complication of myocardial infarction but ar rimary findings in this scenario.
tient who underwent cardiac surgery develops a sudden drop in blood ure, tachycardia, and signs of inadequate tissue perfusion. The nurse ects cardiogenic shock. Which of the following interventions should b ted first?
Myocardial infarction Ans
Expl on
on th nt
with ng
refers not
typic
Peric ns
with i
Dysr e not
the p
A pa press
susp e
initia
Administering vasopressors
Administering intravenous fluids
Initiating intra-aortic balloon pump (IABP) therapy
Initiating mechanical ventilation
vention.
tient who underwent coronary artery bypass surgery (CABG) without opulmonary bypass develops sudden hypotension in the immediate operative period. The MOST LIKELY cause is:
yocardial infarction. ypovolemia.
ardiac tamponade.
ystemic inflammatory response syndrome (SIRS). wer: C
anation: In a patient who has undergone CABG without cardiopulmo ss, sudden hypotension in the immediate postoperative period may in ac tamponade. Cardiac tamponade occurs when fluid or blood accum
Explanation: Cardiogenic shock is a life-threatening condition characterized by inadequate cardiac output and tissue perfusion. The initial management of cardiogenic shock involves optimizing preload with intravenous fluids to improve cardiac filling and perfusion. Administering vasopressors may be necessary if fluid resuscitation alone is insufficient to restore blood pressure. Initiating intra-aortic balloon pump (IABP) therapy and mechanical ventilation may be considered in severe cases, but fluid resuscitation is the first-line
inter
A pa cardi post
m
h
c
s Ans
Expl nary
bypa dicate
cardi ulates
in the pericardial sac, compressing the heart and impairing cardiac function. This can lead to decreased cardiac output and hypotension. Prompt recognition and intervention are crucial, as cardiac tamponade is a life-threatening emergency that requires immediate pericardial drainage. While options A (myocardial infarction), B (hypovolemia), and D (SIRS) can also cause hypotension, the sudden onset in the postoperative period is more indicative of cardiac tamponade in this scenario.
A patient who underwent a cardiac surgery develops sudden chest pain, dyspnea, and hypotension. The nurse suspects cardiac tamponade. Which of the following assessments would be most indicative of this condition?
creased urine output
ugular venous distention (JVD) yperresonance on percussion of the chest
wer: C
anation: Cardiac tamponade is characterized by the accumulation of fl ood in the pericardial sac, which compresses the heart and impairs its y to fill properly. Jugular venous distention (JVD) is a classic sign of ac tamponade, as the increased pressure in the pericardial sac leads to flow of blood into the jugular veins, resulting in visible distention. ased urine output is not typically associated with cardiac tamponade. otension, rather than elevated blood pressure, is commonly observed d promised cardiac output. Hyperresonance on percussion of the chest is fic to cardiac tamponade and may be seen in other conditions such as mothorax.
Elevated blood pressure
In
J
H
Ans
Expl uid
or bl abilit
cardi a
back Incre
Hyp ue to
com not
speci pneu
A patient develops acute respiratory distress syndrome (ARDS) following cardiac surgery. The PRIMARY pathophysiological process underlying ARDS is:
increased pulmonary vascular resistance.
alveolar collapse.
impaired alveolar fluid clearance.
surfactant deficiency. Answer: B
mmation in the lungs, leading to increased permeability of the alveola lary membrane. This results in the accumulation of fluid in the alveoli ired gas exchange, and alveolar collapse. Options A, B, and D are ndary processes that can contribute to the development or progression DS, but alveolar collapse is the primary abnormality in this condition.
tient with a history of atrial fibrillation presents with recurrent episod nea, palpitations, and fatigue. The MOST APPROPRIATE interventio atient is:
urgical valve repair or replacement. anscatheter valve replacement (TAVR). ox maze and modified maze procedure. ectrical cardioversion.
wer: C
Explanation: In a patient who develops acute respiratory distress syndrome (ARDS) following cardiac surgery, the primary pathophysiological process underlying ARDS is alveolar collapse. ARDS is characterized by widespread infla r-
capil ,
impa
seco of
AR
A pa es of
dysp n for
this p
s
tr
C
el Ans
Explanation: In a patient with a history of atrial fibrillation and recurrent symptoms, the most appropriate intervention would be the Cox maze and modified maze procedure. This surgical procedure is designed to treat atrial fibrillation by creating a pattern of scar tissue in the atria, which redirects the electrical impulses and restores normal sinus rhythm. It has been shown to be effective in eliminating or significantly reducing atrial fibrillation in many
patients. Options A, C, and D are not the primary interventions for atrial fibrillation and are more relevant for other cardiac conditions.
eeding.
yocardial infarction. ght heart failure. ardiac tamponade.
wer: D
anation: In a patient who has undergone surgical valve repair or cement and presents with sudden chest pain, dyspnea, and hypotensio mmediate postoperative period, the nurse should suspect cardiac onade. Cardiac tamponade can occur as a complication of cardiac sur is characterized by the accumulation of fluid or blood in the pericardia ng to compression of the heart and impaired cardiac function. This ca
in symptoms such as chest pain, dyspnea, and hypotension. Prompt gnition and intervention, such as pericardial drainage, are necessary to ve the tamponade and restore cardiac function. Options A, B, and D a ikely causes in this scenario.
A patient who underwent surgical valve repair or replacement develops sudden chest pain, dyspnea, and hypotension in the immediate postoperative period. The nurse suspects:
bl
m
ri
c Ans
Expl
repla n in
the i
tamp gery
and l sac,
leadi n
result reco
relie re
less l
A patient who underwent minimally invasive cardiac surgery develops sudden onset tachycardia, hypotension, and altered mental status in the postoperative period. The nurse suspects:
vascular complications.
hypovolemia.
myocardial infarction.
bleeding. Answer: D
ery and presents with sudden onset tachycardia, hypotension, and alter al status in the postoperative period, the nurse should suspect bleedin ding can occur as a complication of cardiac surgery and can lead to volemia, resulting in tachycardia, hypotension, and decreased perfusi rain, leading to altered mental status. Prompt recognition, assessment xtent of bleeding, and appropriate intervention, such as surgical oration or blood product transfusion, are necessary to address the blee tabilize the patient. Options B, C, and D are less likely causes in this ario.
tient undergoing cardiac surgery receives a blood transfusion and equently develops acute respiratory failure. The MOST LIKELY caus espiratory failure is:
ansfusion-associated circulatory overload (TACO). ansfusion-related acute lung injury (TRALI).
Explanation: In a patient who has undergone minimally invasive cardiac surg ed
ment g.
Blee
hypo on to
the b of
the e
expl ding
and s scen
A pa
subs e of
the r
tr
tr
anaphylactic reaction to blood products.
septic transfusion reaction. Answer: B
Explanation: In a patient who develops acute respiratory failure following a blood transfusion, the most likely cause is transfusion-related acute lung injury
(TRALI). TRALI is a severe immune-mediated reaction that occurs within six hours of transfusion and is characterized by acute respiratory distress, hypoxemia, and bilateral pulmonary infiltrates. It is thought to be caused by donor antibodies reacting with the recipient's leukocytes, leading to the release of inflammatory mediators and lung injury. Prompt recognition and supportive care, including respiratory support, are essential in managing TRALI.