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The client will be having a surgical procedure that does not use cardiopulmonary bypass, and the surgeon keeps the heart at a rate of 40 beats/minute. What surgical procedure does the nurse anticipate preparing the client for?
- A. Port access coronary artery bypass (PACAB)
- B. Heart transplant
- C. Coronary artery bypass grafting
- D. Off-pump coronary artery bypass (OPCAB)
Correct Answer: D
Rationale: OPCAB is very similar to conventional CABG except that it does not involve the use of a cardiopulmonary bypass machine. Instead, the surgeon keeps the heart beating at a slow rate (about 40 beats/minute) with drugs such as adenosine and esmolol. The other answers require cardiopulmonary bypass.
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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.
When discussing the nursing process, the instructor stresses that for clients undergoing cardiac surgery, it is important for the nurse to demonstrate competence. What is the rationale for this statement?
- A. To acknowledge the client's emotion
- B. To encourage verbal conversation
- C. To relieve the client's insecurity and anxiety
- D. To encourage the client to communicate
Correct Answer: C
Rationale: When the nurse is knowledgeable and competent, it relieves the client's insecurity and anxiety regarding the surgery.
The nurse is caring for a client who is having a mitral valve replacement with a mechanical valve. What instructions should the nurse be sure the client understands prior to being discharged?
- A. The valve should last for 10 to 15 years.
- B. The client will require anticoagulation.
- C. There is a low potential for thrombi formations so anticoagulation is not necessary.
- D. The valve is prone to calcification.
Correct Answer: B
Rationale: A mechanical valve should last at least 20 years. The disadvantages are the risk for thrombi and emboli, so anticoagulation is necessary. There is a risk of bleeding, and there can be a sudden malfunction in the valve. An allograft will last 10 to 15 years. A bioprosthetic valve does not require anticoagulation but is prone to deterioration and calcification.
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 is 2 days postoperative from mitral valve replacement and is in pain at an 8 on a 0 to 10 scale. What intervention(s) can the nurse provide to control the pain before it gets to this level? Select all that apply.
- A. Suggest the client be placed on a patient-controlled analgesia (PCA) pump.
- B. Administer a non-narcotic analgesic between prescribed doses of narcotic analgesics.
- C. Administer the pain medication prior to the pain becoming severe.
- D. Wait until the client asks for the pain medication.
- E. Administer the narcotic analgesic more frequently.
Correct Answer: A,B,C
Rationale: Small, frequent self-administration of an opioid drug controls acute pain within consistently tolerable levels. Administer non-narcotic analgesics between prescribed doses of narcotic analgesics. Non-narcotics have a different mechanism of action and are not likely to cause respiratory depression or depressed level of consciousness if given concurrently with narcotics. Pain is more easily controlled by giving analgesic medication before the pain becomes severe, so the nurse would not wait until the client to ask for the pain medication. The nurse cannot administer more of the narcotic than the physician prescriptions.