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The nurse is caring for a client postoperatively after undergoing a coronary artery bypass graft. What intervention can the nurse provide to reduce the risk of the development of wound dehiscence?
- A. Encourage oral fluids.
- B. Assess lung sounds every 8 hours.
- C. Suction the client every 2 hours.
- D. Assist the client to splint with a pillow when coughing and deep breathing.
Correct Answer: D
Rationale: Instruct the client to press a pillow against the chest when deep breathing, coughing, and performing active exercise. Splinting promotes comfort and decreases the potential for dehiscence. Encouraging oral fluids will not prevent dehiscence. Lungs should be assessed every 4 hours or more frequently according to the client's condition. Suction should only be provided as needed.
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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 preparing a client for coronary artery bypass surgery. What vessel does the nurse know is most commonly used for grafting?
- A. Saphenous vein
- B. Basilic vein
- C. Radial artery
- D. Gastroepiploic artery
Correct Answer: A
Rationale: The saphenous vein in the leg is the vessel most often used for grafting in coronary artery bypass. The basilic vein in the arm, radial artery in the arm, and gastroepiploic artery from the stomach are alternative graft vessels.
A client has experienced a myocardial infarction (MI). After the acute stage of the MI, what is the most lethal complication the nurse should be aware can occur?
- A. Thrombophlebitis
- B. Ventricular aneurysm
- C. Mitral valve prolapse
- D. Septic shock
Correct Answer: B
Rationale: A ventricular aneurysm is the most lethal complication among clients who survive the acute stage of a myocardial infarction (MI). Thrombophlebitis is a complication of immobility. Mitral valve prolapse is an acquired disorder that is not a complication from having an MI. Cardiogenic shock, not septic shock, is a complication after sustaining an MI.
The pathophysiology instructor is discussing heart disease with a class of prenursing students. One of the students asks what indications there are for coronary artery bypass surgery. What would be an acceptable answer(s) from the instructor? Select all that apply.
- A. Atheromas are calcified and noncompressible.
- B. The heart cannot be repaired without compromising oxygenation of the body.
- C. The client has multiple coronary artery occlusions.
- D. Transluminal coronary angioplasty is necessary.
- E. The Anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter.
Correct Answer: A,B,E
Rationale: A coronary artery bypass is performed when (1) the client has multiple coronary artery occlusions, (2) the atheromas are calcified and noncompressible, or (3) the anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter. This makes the other options incorrect.
The client is being prepared for cardiothoracic surgery and is very apprehensive. What medication can be administered with a physician's prescription to decrease the amount of anesthetic that the client will receive in surgery?
- A. An antipsychotic drug
- B. An anxiolytic drug
- C. An anticholinergic drug
- D. An analgesic
Correct Answer: B
Rationale: Anxiolytics may be used before surgery to lessen anxiety and sedate the client. Clients who are relaxed and sedated when anesthesia is given require a smaller dose of anesthetic. An antipsychotic would not be indicated for this client. An anticholinergic medication may be given to decrease the amount of secretions the client will have during surgery but will not decrease anxiety. An analgesic is normally given postoperatively for pain control.