Which of the following interventions can help prevent venous thromboembolism (VTE) in patients post-CABG surgery?
Deep breathing.
Coughing.
Sequential compression devices (SCDs).
Incentive spirometer.
The Correct Answer is C
Choice A rationale
Deep breathing exercises help prevent atelectasis and promote full lung expansion by increasing alveolar ventilation. While important for pulmonary function post-surgery, they do not directly prevent the formation of venous thrombi in the lower extremities, which cause VTE.
Choice B rationale
Coughing is a deep, forced exhalation that assists in clearing secretions from the lower respiratory tract, preventing pneumonia and atelectasis. It is a pulmonary hygiene measure and, like deep breathing, has no direct mechanism for preventing the stasis of blood in the deep veins, which is the primary cause of VTE.
Choice C rationale
Sequential compression devices (SCDs) apply intermittent pressure to the legs, mimicking the muscle pump action. This external pressure promotes venous return and prevents venous stasis, which is a key component of Virchow's Triad and the primary physiological mechanism for preventing the formation of deep vein thrombi (DVT) and subsequent VTE.
Choice D rationale
An incentive spirometer is a device that encourages slow, deep inhalation to maximize lung inflation, thus preventing atelectasis and improving pulmonary function. Its action is entirely focused on the respiratory system and does not physiologically address the risk factors for blood clot formation and VTE in the lower limbs. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Atrial fibrillation is a common supraventricular tachyarrhythmia characterized by disorganized atrial electrical activity, leading to an irregular and often rapid ventricular response, which usually does not precipitate sudden cardiac death directly. While it increases the risk of stroke due to clot formation, its primary mechanism involves atrial, not ventricular, electrical instability, which less frequently progresses to a lethal ventricular rhythm.
Choice B rationale
Second-degree heart block (Mobitz Type I or II) involves an intermittent failure of atrioventricular conduction, resulting in dropped QRS complexes. Although severe bradycardia can occur and cause syncope, this rhythm generally does not abruptly degenerate into a fatal ventricular fibrillation, distinguishing it from the typical electrical etiology of sudden cardiac death.
Choice C rationale
Ventricular dysrhythmias, primarily ventricular fibrillation (VF) and sometimes pulseless ventricular tachycardia (VT), are the underlying electrical cause in the vast majority of sudden cardiac death cases. These rhythms involve chaotic or rapid, ineffective electrical activity in the ventricles, preventing adequate cardiac output and resulting in immediate circulatory collapse.
Choice D rationale
Heart failure represents a chronic structural impairment of ventricular filling or ejection, leading to decreased cardiac output and symptomatic fluid congestion. While it is a major risk factor for sudden cardiac death, the terminal event itself is most often an electrical instability, specifically ventricular dysrhythmia, not the mechanical failure itself. —.
Correct Answer is B
Explanation
Choice A rationale
Dyspnea (shortness of breath) is a common symptom of heart failure or pulmonary congestion, which can be related to poor cardiac function, but it is not a direct, specific sign of diaphragmatic pacing. This symptom is generally too non-specific to pinpoint lead misplacement to the diaphragm.
Choice B rationale
The diaphragm is innervated by the phrenic nerve, which passes close to the heart. When a pacemaker lead is positioned incorrectly and stimulates the phrenic nerve, it causes rhythmic, involuntary contractions of the diaphragm, which clinically manifest as persistent hiccups. This is a classic and specific sign of lead migration or perforation causing extracardiac stimulation.
Choice C rationale
Coughing up blood (hemoptysis) suggests damage to the pulmonary or tracheobronchial system, which is a serious but rare complication, and not the primary clinical manifestation associated with stimulation of the diaphragm or the phrenic nerve by an incorrectly positioned pacemaker lead.
Choice D rationale
Chest pain can occur after a pacemaker insertion due to irritation of the surrounding tissues or a complication like pneumothorax, but it is a general symptom. It is not a direct consequence of phrenic nerve stimulation and diaphragmatic contraction, which specifically causes hiccups.
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