Nokea
A client is diagnosed with obstructive atherosclerotic plaque of the left carotid artery. What procedure does the nurse anticipate preparing the client for?
- A. Endarterectomy
- B. Thrombectomy
- C. Embolectomy
- D. Coronary artery bypass graft
Correct Answer: A
Rationale: Endarterectomy is the resection and removal of the lining of an artery. This type of surgery is performed to remove obstructive atherosclerotic plaques from the aorta, carotid, femoral, or popliteal arteries. A thrombectomy is used to remove a thrombus for a vessel. An embolectomy is the removal of an embolus. Coronary artery bypass grafting is not indicated for the removal of an atherosclerotic plaque.
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The nurse is measuring central venous pressure readings for a client receiving fluid resuscitation. Prior to obtaining the reading, what nursing action is required?
- A. Have the head of the bed at $90^{\circ}$.
- B. Ensure the level of the transducer is at the level of the right atrium.
- C. Ensure the transducer is above the level of the heart.
- D. Ensure the transducer is 2 inches below the level of the heart.
Correct Answer: B
Rationale: When measuring CVP, the nurse makes sure that the transducer is at the level of the client's right atrium; otherwise, an incorrect reading is obtained. The client is positioned supine or with the head slightly elevated but in exactly the same position as during previous measurements. Between CVP measurements, the head of the bed can be raised or lowered.
A client has a pulmonary artery catheter for monitoring and to ensure fluid balance. When measuring pulmonary capillary wedge pressure, the nurse forgets to deflate the balloon and leaves it inflated. What outcome can be the result of this action by the nurse?
- A. Pulmonary embolism
- B. Pulmonary edema
- C. A myocardial infarction
- D. Pulmonary infarction
Correct Answer: D
Rationale: When measuring pulmonary capillary wedge pressure, the balloon must be deflated immediately after the pressure is measured to avoid pulmonary infarction from prolonged blockage of capillary blood flow. Pulmonary embolism, pulmonary edema, and myocardial infarction would not be the result of not deflating the balloon initially.
The client presents to the Emergency Department with blunt trauma causing bruising and bleeding of the heart. The nurse knows that which of the following may help stop the bleeding?
- A. Embolectomy
- B. Pericardiocentesis
- C. Thoracentesis
- D. Inactivity and pressure from blood in the pericardium
Correct Answer: D
Rationale: The inactivity and increased pressure from blood in the pericardium may stop the bleeding. The client may need to have the blood aspirated from the pericardial sac, in which case pericardiocentesis is performed. One aspiration is sufficient in most cases, but if bleeding continues, open thoracotomy is indicated to control blood loss. Procedures to stop the bleeding caused by heart trauma do not include embolectomy or thoracentesis. Pericarditis is inflammation of the pericardium.
The nurse reinforces teaching for a client who is scheduled for coronary artery bypass surgery. The client asks, 'What vessels can be used if my saphenous vein doesn't meet the requirements?' Which vessel(s) should the nurse include in the response to the client? Select all that apply.
- A. The basilic vein
- B. The axillary vein
- C. The popliteal vein
- D. The gastroepiploic artery
- E. The internal thoracic artery
Correct Answer: A,D,E
Rationale: Alternative graft vessels include the following: the internal mammary and internal thoracic arteries in the chest; the basilic and cephalic veins in the arm, the radial artery in the arm, and the gastroepiploic artery from the stomach, in some cases. The axillary and popliteal veins are not alternative graft vessels; therefore, the nurse should not include them in the response to the client.
The nurse listens to the lung sounds of a postoperative client and determines that the client is not able to clear the secretions from the lungs. What intervention should the nurse provide prior to suctioning?
- A. Hyperoxygenate the client with $100% oxygen.
- B. Place the client in the supine position.
- C. Plan to suction for at least 20 seconds to remove secretions.
- D. Administer a sedative prior to suctioning.
Correct Answer: A
Rationale: Hyperoxygenate with $100% oxygen before suctioning; do not suction for more than 10 to 15 seconds. Suctioning removes oxygen and can cause hypoxemia, myocardial ischemia, and dysrhythmias. Hyperoxygenation saturates the blood and hemoglobin to compensate for temporary removal during suctioning. Elevate the head of the bed; don't place the client in the supine position. Administering a sedative may cause respiratory depression and should be avoided prior to suctioning so the cough reflex will not be depressed.