The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia?"

Premature junctional contractions

Ventricular ectopy

Second degree heart block

Atrial fibrillation or flutter

Answer and Explanation

The Correct Answer is D

A. Premature junctional contractions are incorrect because while they can occur postoperatively, they are not the most common dysrhythmia following coronary artery bypass grafting (CABG). These are usually transient and less clinically significant.

B. Ventricular ectopy is incorrect as isolated premature ventricular contractions may appear after surgery, but they are not the most frequently encountered dysrhythmia in this patient population. Ventricular arrhythmias can be serious, but they are less common than atrial arrhythmias post-CABG.

C. Second degree heart block is incorrect because this type of conduction disturbance is less common after CABG. It may occur in patients with preexisting conduction system disease but is not the usual postoperative dysrhythmia.

D. Atrial fibrillation or flutter is correct because these are the most common dysrhythmias following CABG, occurring in up to 30–40% of patients. The atrial tissue is often irritated by surgical manipulation, inflammation, and electrolyte shifts, making the patient prone to atrial arrhythmias. Monitoring for these dysrhythmias is crucial as they can increase the risk of thromboembolism, hemodynamic instability, and prolonged hospitalization. Management may include rate control, rhythm control, anticoagulation, and addressing reversible causes such as electrolyte imbalances.

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Correct Answer is B

Explanation

A. 15: This rate would result in the unit being infused over 4 hours, which is slower than the prescribed 2-hour duration. Under-infusion can delay treatment and reduce the effectiveness of oxygen delivery from PRBCs.

B. 25: To calculate drops per minute: use the formula (Volume in mL × Drop factor in gtts/mL) ÷ Time in minutes. Here, (300 × 10) ÷ 120 = 3000 ÷ 120 = 25 gtts/min. This rate will ensure the unit is transfused over 2 hours as prescribed.

C. 20: Infusing at 20 gtts/min would extend the transfusion slightly beyond 2 hours, resulting in under-delivery of the blood unit within the intended time frame.

D. 10: This rate is far too slow; the transfusion would take 5 hours, significantly exceeding the prescribed time and delaying treatment.

A. Partial occlusion of a coronary artery with a thrombus B. Complete occlusion of a coronary artery C. Vasospasm of a coronary artery D. Fatty streak within the intima of a coronary artery

Correct Answer is A

Explanation

A. Partial occlusion of a coronary artery with a thrombus is correct because unstable angina is caused by the formation of a thrombus that partially blocks a coronary artery. This leads to reduced oxygen supply to the myocardium, resulting in ischemia without causing cell death. The pain is unpredictable and may occur at rest or with minimal exertion. Prompt recognition is essential to prevent progression to myocardial infarction.

B. Complete occlusion of a coronary artery is incorrect because this leads to a myocardial infarction (MI), where the blood supply to a portion of the myocardium is completely blocked, causing irreversible myocardial necrosis. In MI, cardiac enzymes such as troponin are elevated, whereas in unstable angina they remain normal.

C. Vasospasm of a coronary artery is incorrect because it is characteristic of variant (Prinzmetal) angina, not unstable angina. Vasospasm causes temporary, episodic reduction in blood flow, usually at rest, often associated with transient ST-segment elevation on ECG. Unlike unstable angina, it is not typically caused by thrombus formation or plaque rupture.

D. Fatty streak within the intima of a coronary artery is incorrect because fatty streaks are early atherosclerotic lesions composed of lipid-laden macrophages and do not significantly obstruct blood flow. They are generally asymptomatic and present long before the development of clinically significant angina. Unstable angina occurs later, often due to plaque rupture and thrombus formation on more advanced atherosclerotic lesions.

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The patient has undergone open chest surgery for coronary artery bypass grafting. One of the nurse's responsibilities is to monitor the patient for which common postoperative dysrhythmia?"

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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