A post-CABG patient's cardiac output has decreased. Which of the following interventions should the nurse implement first?
Administer IV fluids.
Increase oxygen flow rate.
Assess for bleeding.
Notify the physician.
The Correct Answer is A
Choice A rationale
Decreased cardiac output (CO) post-CABG is often due to hypovolemia resulting from third-spacing, blood loss, or insufficient fluid replacement, especially given the open heart procedure's significant fluid shifts. Administering a rapid IV fluid bolus is the initial priority to promptly increase preload and thus stroke volume and cardiac output, assuming no contraindications like signs of pulmonary edema.
Choice B rationale
Increasing the oxygen flow rate addresses potential hypoxemia, but it does not correct the underlying issue of low cardiac output and impaired systemic perfusion. While oxygenation is vital, fluid resuscitation directly targets the most likely hemodynamic cause of decreased CO post-surgery.
Choice C rationale
Assessing for bleeding (e.g., chest tube output) is a necessary step to identify and correct a source of ongoing hypovolemia. However, administering a fluid challenge is the immediate, life-sustaining intervention to temporize the falling CO while the assessment and notification process proceeds.
Choice D rationale
Notifying the physician is necessary after performing initial life-saving interventions and gathering supporting data. The nurse must first implement the standing protocol intervention for low cardiac output, which is often a fluid bolus, as delaying treatment for low CO can lead to critical organ hypoperfusion. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Administering epinephrine is typically reserved for pulseless electrical activity (PEA) or asystole during cardiac arrest. It is not the initial, first action for a wide-complex tachycardia where the patient's stability is yet to be determined by a prompt clinical assessment, which guides further therapy.
Choice B rationale
The initial and most crucial action in any sudden rhythm change, especially a potentially life-threatening wide-complex tachycardia (e.g., Ventricular Tachycardia), is to quickly assess the patient's hemodynamic stability, primarily by checking their level of consciousness, pulse, and blood pressure. This assessment determines the subsequent treatment, such as immediate cardioversion/defibrillation if the patient is unstable or antiarrhythmics if stable.
Choice C rationale
While a 12-lead ECG is essential for definitive diagnosis of the rhythm, it is not the first action. The immediate priority is the patient's stability, and treatment, guided by the patient's status, should precede the time taken to obtain a comprehensive ECG tracing.
Choice D rationale
Immediate defibrillation is indicated only if the patient with wide-complex tachycardia is pulseless (Ventricular Fibrillation or pulseless Ventricular Tachycardia). The nurse must first assess the patient's hemodynamic status (e.g., level of consciousness, presence of a pulse) to determine the appropriate intervention before proceeding with defibrillation. —.
Correct Answer is D
Explanation
Choice A rationale
A chest X-ray is a standard pre-operative screen to assess lung fields, heart size, and position. While it provides useful anatomical context, it lacks the detailed 3D visualization necessary to precisely measure the aortic annulus, calculate valve size, and plan the complex delivery route for the transcatheter procedure.
Choice B rationale
Blood work provides information on organ function, coagulation status, and electrolyte balance. While essential for patient safety and risk assessment, it provides no structural or anatomical information required to physically plan the precise pathway for the catheter and the sizing of the prosthetic valve.
Choice C rationale
Pulmonary function tests assess respiratory capacity. They are important for risk stratification, especially for patients with significant lung disease, but they do not provide the detailed vascular and anatomical measurements of the aorta, femoral arteries, or the aortic annulus needed for TAVR procedural planning.
Choice D rationale
A Coronary CT angiogram (CTA) is the critical planning tool. It uses contrast to create a detailed 3D reconstruction of the aorta, the aortic annulus (to precisely size the valve), the access vessels (e.g., femoral arteries), and their calcification, ensuring the safest and most effective catheter route and valve size. —.
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