Cardiac Surgery (12 Questions)

1.1 Mr. Laurent Gagnon, a 67-year-old client, is on his second postoperative day following cardiac surgery via sternotomy. During your morning assessment, you inspect his surgical incision. You note slight puffiness along the edges, but the area is non-reddened and without drainage. Mr. Gagnon is afebrile with a temperature of 99°F (37.2°C) orally, and his white blood cell count is 7500 cells/mm³. He is alert and reports mild tenderness at the incision site.

Question:
What is the most appropriate nursing action? *
1.2 On the third postoperative day, Mr. Laurent Gagnon, recovering from cardiac surgery, presses the call bell and states, “I’m feeling chest pain again, like yesterday, but I don’t know if it’s the same.” The nurse immediately assesses him.

Mr. Gagnon describes the pain as sharp and localized near the sternum, worsened by movement and coughing, and rated 6 out of 10 on the pain scale. He reports that the pain eases slightly when resting in bed and does not radiate.

Vital signs:
-BP: 126/78 mmHg
-HR: 84 bpm
-RR: 18 breaths/min
-SpO₂: 98% on room air
-Temperature: 37.1°C

Postoperative medical orders:
-Morphine 2 mg IV every 4 hours PRN for moderate to severe pain (pain scale ≥4)
-Nitroglycerin 0.4 mg SL every 5 minutes PRN for chest pain, max 3 doses
-ECG stat for unexplained chest pain
-Notify physician if chest pain is unrelieved after interventions

Question:
What is the most appropriate nursing action? *
2. Mme. Claudine Moreau, a 61-year-old client, is being discharged home after a successful heart transplant. As part of her lifelong immunosuppressive therapy, she has been prescribed cyclosporine and azathioprine to prevent organ rejection. Before discharge, you provide teaching regarding her medications, lifestyle modifications, and infection prevention. Mme. Moreau is alert and asks, “Are there any precautions I need to take while on these medications?”

Question:
Which two precautions should the nurse include in the discharge teaching? Choose TWO (2) answers *
3. Mr. Lambert, 62, is on post-operative day 1 following a coronary artery bypass graft (CABG). He remains in the cardiac step-down unit with continuous telemetry. He reports feeling “a bit light-headed.” His BP is 88/54 mmHg, HR 112 bpm, skin cool and pale. His urine output over the last hour is 18 mL. His chest tube drainage is increasing, currently at 180 mL in one hour, dark red in color.

Question:
What is the nurse’s priority action? *
4. Ms. Richard, 48, is on post-op day 3 after a mechanical mitral valve replacement. She is beginning to ambulate with assistance. She complains of mild shortness of breath when walking but denies chest pain. Her INR today is 1.5 (2.0 to 3.0).

Question:
Which nursing action is the priority? *
5. Mr. Gagnon, 71, is recovering from an open repair of an abdominal aortic aneurysm. On your assessment, he reports new numbness in both legs. Pedal pulses are faint but present. His BP is stable. He says, “I feel like my legs are weaker than earlier.”

Question:
What should the nurse do first? *
6. Mrs. Caron, 79, is on day 1 after permanent pacemaker insertion. She is alert, walking slowly in the hallway, but you notice she frequently raises her left arm above her head to scratch her hair. Her incision looks clean with no drainage.

Question:
Which instruction is the priority? *
7. Ms. Sauvé, 52, is recovering from aortic valve replacement due to infective endocarditis. On post-op day 4, her temperature increases to 38.4°C, HR 110 bpm. She reports chills and fatigue. Her surgical wound is clean and intact.

Question:
What should the nurse do first? *
8. Mr. Nadeau, 54, had a heart transplant 6 months ago and is visiting the clinic for routine follow-up. He reports mild fatigue, low-grade fever, and a new cough over the past 48 hours. He is on lifelong immunosuppressive therapy.

Question:
What is the nurse’s priority? *
9. Ms. Chen, 57, returned 2 hours ago from a percutaneous coronary intervention (PCI) with femoral access. She reports increasing back pain. Her HR is 118 bpm, and you notice her groin dressing is slightly swollen and firm. Her BP is dropping to 94/56.

Question:
What is the nurse’s priority? *
10. Mr. Glover, 70, is 8 days post-CABG. He reports tenderness around his sternotomy but denies fever. You observe a slight separation at the lower end of the incision, and when he coughs, the wound edges visibly shift (“clicking”).

Question:
What is the priority nursing action? *
11. Ms. Poirier, 63, is post-operative day 2 after valve repair. Over the last hour she developed muffled heart sounds, jugular venous distension, and her BP has fallen to 86/50. She appears anxious and dyspneic, saying “I can’t catch my breath.”

Question:
What is the nurse’s priority? *