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After being discharged from the hospital after undergoing cardiothoracic surgery, the client asks the nurse when it will be possible to resume sexual activity. What is the best response by the nurse?
- A. I can't believe you are worried about that so soon after your surgery.
- B. You won't be able to resume sexual activity until your 6-month checkup with the surgeon.
- C. In about 2 to 4 weeks if you are able to climb stairs without difficulty breathing or chest pain.
- D. You may have a difficult time resuming sexual activities after this surgery.
Correct Answer: C
Rationale: Sexual relations usually can be resumed in 2 to 4 weeks after cardiothoracic surgery depending on one's comfort level and tolerance for activity; climbing two flights of stairs without dyspnea or chest pain is a common guideline. The other options are nontherapeutic responses to the client's concern. Six months is an excessively long time period to wait if the client has been able to resume activities without shortness of breath or chest pain.
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A client was driving a car without wearing a seat belt and slid off the road and hit a tree. The client's chest was crushed against a steering wheel. What type of lethal injury does the nurse anticipate the client may have suffered?
- A. Cardiac tamponade
- B. A pleural effusion
- C. Bladder trauma
- D. Fractured pelvis
Correct Answer: A
Rationale: A nonpenetrating injury of the chest, such as being crushed against a steering wheel, may cause bruising and bleeding of the heart. Because the pericardium encloses the heart, blood accumulates in the pericardial space, resulting in cardiac tamponade. Although a fractured pelvis and bladder trauma may be sustained, they are generally not lethal. A pleural effusion would not result from this traumatic injury.
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.
A nurse caring for a client who has had cardiac surgery must understand how pulmonary artery pressure is monitored. What is important about pulmonary artery pressure?
- A. Aids in early treatment of right-sided congestive heart failure
- B. Aids in the early treatment of fluid imbalances
- C. Assesses right-sided heart pressures
- D. Assesses left atrial heart pressures
Correct Answer: B
Rationale: Pulmonary artery pressure monitoring aids in the early treatment of fluid imbalances, prevents left-sided congestive heart failure or promotes its early correction, and helps monitor the client's response to treatment. The other options are incorrect. The measurement of pulmonary artery pressure does not assess right-sided heart pressures or left atrial pressure.
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.
A client is in the intensive care unit with a diagnosis of severe uncontrolled hypertension. What method of monitoring would best meet the needs of this client?
- A. Central venous pressure monitoring
- B. Direct blood pressure monitoring
- C. Pulmonary artery pressure monitoring
- D. Manual blood pressure readings with a sphygmomanometer
Correct Answer: B
Rationale: Direct blood pressure monitoring continuously displays the waveform and indicates the client's systolic, diastolic, and mean arterial pressures. This type of equipment eliminates the need to auscultate the BP. Direct BP monitoring may be used in clients with severe and sustained hypertension or hypotension and during and after cardiac surgery. Central venous pressure monitoring would be used to detect an excess or deficit in venous blood volume and would not be indicated for this client. Pulmonary artery pressure monitoring aids in the early treatment of fluid imbalances prevents left-sided heart failure or promotes its early correction and helps monitor the client's response to treatment and would not be indicated for this client. A manual reading is dependent on who takes the BP and can vary in its readings. It is not as accurate as the direct blood pressure monitoring.