Valvular heard disease, CABG, cardiac tamponade, pericarditis, endocarditis

After cardiac surgery, a client's blood pressure measures 126/80. Calculate the patient's MAP

95 mm Hg MAP = (2 times the diastolic + systolic)/3 or (2d + s)/3 where d is diastolic and s is systolic = 2 (80) + 126 / 3 = 160 + 126 / 3 = 286 / 3 = 95.33 or 95 mm HG We learned this concept with Shock, but discussed it with cardiac surgery and neuro as well.

Which of the following complications is indicated by a third heart sound (S3)? a. Ventricular dilation b. Systemic hypertension c. Aortic valve malfunction d. Increased atrial contractions

A The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in left-sided heart failure, fluid accumulates in the interstitial & alveolar spaces in the lungs & causes crackles. Pulmonic & tricuspid valve malfunction causes right sided heart failure

The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: A Stroke volume B Cardiac output C Venous pressure D Left ventricular functioning

Answer: A Increase the cardiac output Temperatures of 102*F or greater lead to an increased metabolism and cardiac workload

Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? Select all that apply. a. Tachycardia b. Hypertension c. Increased CVP d. Increased urine output e. Jugular vein distention

Answer: A, C, E Blood in the pericardial sac compresses the heart so the ventricles cannot fill; this leads to a rapid thready pulse. Tamponade causes hypotension and a narrowed pulse pressure. As the tamponade increases, pressure on the heart interferes with the ejection of blood from the left ventricle, resulting in increased pressure on the right side of the heart, and the systemic circulation. As the heart becomes less efficient, there is a decrease in kidney perfusion and therefore urine output. The increased venous pressure caused JVD. (again, think about what happens to a pt in shock, specifically cardiogenic for this pt presentation)

For a client who excretes excessive amounts of calcium during the postoperative period after open heart surgery, which of the following measures should the nurse institute to help prevent complications associated with excessive calcium excretion? a. Ensure a liberal fluid intake b. Provide an alkaline ash diet c. Prevent constipation d. Enrich the client's diet with dairy product

Answer: a . Ensure a liberal fluid intake In an immobilized client, calcium leaves the bone and concentrates in the ECF fluid. When a large amount of calcium passes through the kidneys, calcium can precipitate and form calculi. Nursing interventions that help prevent calculi include ensuring a liberal fluid intake (unless contraindicated). • Option B: A diet rich in acid should be provided to keep the urine acidic, which increases the solubility of calcium. • Option C: Preventing constipation is not associated with excessive calcium excretion, but it can cause nausea, which we talked about with multiple myelomas • Option D: Limiting foods rich in calcium, such as dairy products, will help in preventing renal calculi

What is the most important nursing action when measuring a pulmonary capillary wedge pressure (PCWP)? a. Have the client bear down when measuring the PCWP b. Deflate the balloon as soon as the PCWP is measured c. Place the client in a supine position before measuring the PCWP d. Flush the catheter with heparin solution after the PCWP is determined

Answer: b. Deflate the balloon as soon as the PCWP is measured While the balloon must be inflated to measure the capillary wedge pressure, leaving the balloon inflated will interfere with blood flow to the lung. Option A: Bearing down will increase intrathoracic pressure and alter the reading. Option C: While a supine position is preferred; it is not essential. Option D: Agency protocols relative to flushing of unused ports must be followed

The most important assessment for the nurse to make after a client has had a femoropopliteal bypass for peripheral vascular disease would be: a. Incisional pain b. Pedal pulse rate c. Capillary refill time d Degree of hair regrowth

Answer: c . Capillary refill time Checking capillary refill provides data about current perfusion of the extremity. Option B: While the presence and quality of the pedal pulse provide data about peripheral circulation, it is not necessary to count the rate as long as it correlates with the pt's apical rate

A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery two (2) days ago. Which of the following surgical complications should the nurse suspect? a. Left-sided heart failure b. Aortic regurgitation c. Complete heart block d. Pericardial tamponade

Answer: d . Pericardial tamponade A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Option A: Left-sided heart failure can cause Option A: Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat, with a regular rhythm). Option B: Aortic regurgitation may cause bi-phasic pulse (an increased arterial pulse with a double systolic peak). Option C: Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure)

When preparing a client for discharge after surgery for a CABG, the nurse should teach the client that there will be: a. No further drainage from the incisions after hospitalizations b A mild fever and extreme fatigue for several weeks after surgery c. Little incisional pain and tenderness after 3 to 4 weeks after surgery d. Some increase in edema in the leg used for the donor graft when activity increases

Answer: d. Some increase in edema in the leg used for the donor graft when activity increases The client is up more at home, so dependent edema usually increases. Serosanguineous drainage may persist after discharge

Myocardial oxygen consumption increases as which of the following parameters increase? A Preload, afterload, & cerebral blood flow B . Preload, afterload, & renal blood flow C . Preload, afterload, contractility, & heart rate. D . Preload, afterload, cerebral blood flow, & heart rate

C . Myocardial oxygen consumption increases as preload, afterload, renal contractility, & heart rate increase. Cerebral blood flow doesn't directly affect myocardial oxygen consumption.

Which of the following cardiac conditions does a fourth heart sound (S4) indicate? A. Dilated aorta B . Normally functioning heart c Decreased myocardial contractility d . Failure of the ventricle to eject all of the blood during systole

D An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. The increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An S4 isn't heard in a normally functioning heart