Carotid Endarterectomy (10 Questions)

1. M. Jacques Roy, 68 years old, is 4 hours post-right carotid endarterectomy. He presses the call bell repeatedly. When the nurse enters the room, M. Roy appears extremely anxious and is pointing frantically to his neck. Upon assessment, the nurse hears audible stridor (high-pitched wheezing) and notes that the patient is gasping for air. There is significant, firm swelling on the right side of the neck, and the trachea appears deviated to the left.

Medical Orders:
*Elevate Head of Bed (HOB) 30 degrees.
*Vital signs q15min.
*Notify Surgeon immediately for respiratory distress or expanding hematoma.

Question:
What is the nurse’s priority action? *
2. Mme. Ginette Tremblay, 72 years old, is in the recovery unit 1 hour post-left carotid endarterectomy. During the routine check, the nurse attempts to wake the patient. Mme. Tremblay is drowsy but rousable. However, the nurse observes that she has difficulty finding her words (aphasia) and her right hand grip is significantly weaker than her left. Her face appears slightly asymmetrical on the right side.

Medical Orders:
*Neuro checks q15min x 4, then q1h.
*Maintain SBP between 120 and 160 mmHg.
*Notify MD immediately for new neurological deficits.

Question:
What do you suspect is happening to the patient? *
3. M. Robert Bouchard, 65 years old, is 6 hours post-op. He reports a mild headache rated 2/10. The nurse checks his vital signs and finds his blood pressure is 185/98 mmHg and heart rate is 80 bpm. The incision site is dry and intact.

Medical Orders:
*Vital signs q1h.
*Labetalol 10-20 mg IV PRN if SBP > 160 mmHg.
*Acetaminophen 650 mg PO q4h PRN.

Question:
What is the nurse’s priority action? *
4. M. Jean-Paul Lemieux, 60 years old, is eating his first meal post-op. He complains to the nurse that he keeps accidentally biting his tongue while chewing. The nurse asks him to stick out his tongue and observes that it deviates to the left side. His speech also sounds slightly thick and slurred.

Medical Orders:
*Clear fluids, advance to soft diet as tolerated.
*Monitor for difficulty swallowing.

Question:
Which cranial nerve has likely been injured? *
5. Mme. Lise Fortin, 59 years old, is 1 day post-op. During the morning assessment, the nurse asks the patient to smile and puff out her cheeks. The nurse notices that the left corner of Mme. Fortin's mouth droops and she cannot hold air in her left cheek, although her forehead wrinkles symmetrically.

Medical Orders:
*Routine post-op care.
*Discharge planning.

Question:
The nurse documents potential injury to which cranial nerve? *
6. Mme. Claire Desjardins, 75 years old, is 12 hours post-op. She calls the nurse stating she feels very dizzy when the head of the bed is raised. The nurse assesses her vital signs and finds a BP of 90/52 mmHg and a heart rate of 60 bpm. Her urine output has been 35 mL/hr.

Medical Orders:
*Maintain SBP > 100 mmHg.
*Bolus 500 mL Normal Saline IV PRN for SBP < 100 mmHg.
*Ephedrine 5 mg IV PRN if fluid ineffective.

Question:
What is the nurse’s priority action? *
7. M. André Cote, 64 years old, is 36 hours post-right CEA. He calls the nurse complaining of a sudden, severe headache located specifically on the right side of his head. Upon assessment, he appears confused and slightly nauseated. His blood pressure is 170/90 mmHg.

Medical Orders:
*Discharge planned for tomorrow.
*Notify MD for severe headache or change in mental status.

Question:
What condition should the nurse suspect? *
8. M. Pierre Gagnon, 70 years old, is starting a clear liquid diet post-op. When he speaks to the nurse, his voice sounds noticeably hoarse and "breathy." When he attempts to take a sip of water, he begins coughing repeatedly and cannot clear his throat effectively.

Medical Orders:
*Diet as tolerated.
*Consult Speech Therapy PRN for swallowing difficulties.

Question:
What is the nurse’s priority action? *
9. Mme. Sophie Lapointe, 66 years old, returns to the unit immediately post-op. The transport team transfers her to the bed, and she is drowsy but stable. The nurse is ensuring the environment is safe and the patient is positioned correctly to prevent complications.

Medical Orders:
*Bed rest for 4 hours.
*Monitor wound drainage.

Question:
How should the nurse position the patient? *
10. M. Michel Turcotte, 61 years old, is being discharged home. The nurse is providing education on when to call 911. M. Turcotte asks, "How will I know if something is really wrong?"

Medical Orders:
*Discharge home.
*Resume home medications.

Question:
Which statement by the patient indicates correct understanding of the teaching? *