Deck 11: Cardiovascular and Thoracic Interventions

Question 1

Which of the following criteria must be met for a patient to be considered for abdominal aortic aneurysmectomy?

A)The patient is diagnosed with aneurysms greater than or equal to 2 cm.
B)The patient is diagnosed with aneurysms greater than or equal to 3 cm.
C)The patient is diagnosed with aneurysms greater than or equal to 4 cm.
D)The patient is diagnosed with aneurysms greater than or equal to 5 cm.

Answer 1

D
Patients who are diagnosed with aneurysms greater than or equal to 5 cm or who have rapid aneurysm enlargement are considered for surgical repair.

Question 2

Which of the following revascularization procedures is the BEST option when all three vessels of the coronary arterial supply are severely occluded?

A)Percutaneous transluminal coronary angioplasty
B)Directional coronary arthrectomy
C)Endoluminal stent
D)Coronary artery bypass graft

Answer 2

D
The Coronary Artery Surgery Study (CASS)concluded that surgical revascularization is the optimal choice for management of coronary artery disease when all three vessels are severely obstructed.

Question 3

The findings of the Stenting and Angioplasty with Protection in Patients at High risk for Endarterectomy (SAPPHIRE)trial concluded which of the following about carotid artery stenting compared to endarterectomy on the risk for death,stroke,or MI 30 days and 1 year post procedure?

A)The carotid artery stenting was not inferior to endarterectomy.
B)The carotid artery stenting led to greater risk than endarterectomy.
C)Both the carotid artery stenting and endarterectomy were equivalent.
D)Both the carotid artery stenting and endarterectomy led to low risk.

Answer 3

A
The SAPPIRE trial randomly compared carotid artery stenting to endarterectomy.Analysis of 30-day and 1-year outcomes,including deaths,stroke,or MI,found that carotid stenting was not inferior to CEA.However,the overall results in both arms of this trial were noted to be disturbingly high,with a risk of 12.2% among stenting patients and 20.1% among endarterectomy patients.

Question 4

You are evaluating a patient who is post a posterolateral thoracotomy procedure and is complaining of ipsilateral shoulder pain.Which of the following is LEAST likely a probable cause of the shoulder pain?

A)Diaphragmatic irritation referred by the phrenic nerve
B)Chest drain placed too far into the apex of the hemithorax
C)Operative positioning of the ipsilateral upper extremity
D)Developing atelectasis postoperatively

Question 5

Which of the following therapeutic interventions would be MOST appropriate for a patient who had a thoracoabdominal incision?

A)Segmental breathing
B)Side bending stretching
C)Thoracic extension
D)Specific trunk mobility is contraindicated

Question 6

A patient who is positioned one-quarter turn from supine (operative side elevated)with the upper most arm flexed at the elbow and placed beneath the back is in preparation for which of the following surgical approaches?

A)Posterolateral thoracotomy
B)Anterolateral thoracotomy
C)Lateral thoracotomy
D)Axillary thoracotomy

Question 7

A patient who is status post-abdominal aortic aneurysm repair will be at high risk for pulmonary complications.Which of the following interventions would BEST address pulmonary risk?

A)Encourage the patient to walk in the hall.
B)Encourage the patient to rest with the head of the bed elevated to 45 degrees.
C)Encourage the patient to cough,huff,or deep breathe while splinting with a pillow.
D)Encourage the patient to perform low-intensity arm and leg resistance exercise in bed.

Question 8

To drain air from the chest cavity,chest tubes are commonly placed in which of the following anatomical sites?

A)Fourth or fifth intercostal space at the anterior axillary line
B)Eighth or ninth intercostal space at the midaxillary line
C)Second or third intercostal space at the midclavicular line
D)Fourth or fifth intercostal space at the midclavicular line

Question 9

Which of the following musculoskeletal impairments is avoided by the surgeon sparing the long thoracic nerve during a lateral thoracotomy?

A)Scapular winging
B)Shoulder adhesive capsulitis
C)Shoulder external rotator weakness
D)Rhomboid weakness

Question 10

Which of the following surgical approaches is MOST commonly used for cardiac procedures?

A)Posterolateral thoracotomy
B)Median sternotomy
C)Thoracoabdominal
D)Subxiphoid

Question 11

Which of the following reasons BEST supports the administration of vascular endothelial growth factor (VEGF)with a collagen-binding domain (CBD),an agent that is used for stimulating the growth of new blood vessels?

A)Reduced blood flow to the ischemic area of the heart.
B)Inhibition of vascular endothelial growth factor production systematically due to ischemia.
C)The heart has a reduced ability to produce vascular endothelial growth factor in response to ischemia.
D)Proliferative cell stimulation that is specific and may cause detrimental effects.

Question 12

Which of the following advantages of video-assisted thoracoscopic surgery over a thoracotomy is MOST related to recovery in the activities domain within the International Classification of Functioning (ICF)model?

A)Reduced hospital length of stay
B)Improved pulmonary functioning
C)Early patient mobilization and recovery
D)Less pain postoperatively

Question 13

The implantable cardioverter defibrillator is BEST indicated in which of the following heart conditions?

A)Permanent to respond to life-threatening arrhythmias such as tachycardia
B)Temporary to control transient arrhythmias
C)Temporary control of increased vagal control after cardiac surgery
D)Permanent to control chronic arrhythmias such as second-degree heart block

Question 14

The provision of interventions including deep breathing,incentive spirometer,and coughing to a patient who is early post-coronary artery bypass graft BEST prevents which of the following clinical complications?

A)Atelectasis
B)Chest wall soreness
C)Shoulder soreness
D)Lower extremity discomfort

Question 15

A patient presents with a left chest wall intrapleural drainage tube that is connected to a sealed collection system.Which of the following actions is MOST appropriate for the physical therapist treating the patient?

A)The physical therapist should hold therapy and activity until the intrapleural draining tube is removed by the physician.
B)The physical therapist is limited to assisting the patient with low-intensity range of motion exercise with lower extremities only.
C)The physical therapist is limited to assisting the patient with transfers only from bed to/from a chair or bedside commode.
D)The physical therapist may continue physical activities with the patient as tolerated with special attention to the collection system ensuring maintenance of seal.

Question 16

If atherosclerosis is diagnosed in the carotid arteries,which of the following arteries may also be atherosclerotic secondary to the nature of the disease process?

A)Coronary arteries
B)Peripheral arteries
C)Renal arteries
D)All of the above

Question 17

An example of an atrioventricular nodal arrhythmia of which a pacemaker is indicated is which of the following?

A)Bradyarrhythmia
B)Complete heart block
C)Supraventricular tachycardia
D)Frequent ventricular ectopy

Question 18

A patient who is positioned one-quarter turn from prone (operative side elevated)with the uppermost arm elevated forward,flexed at the elbow,and placed by the head is in preparation for which of the following surgical approaches?

A)Posterolateral thoracotomy
B)Anterolateral thoracotomy
C)Lateral thoracotomy
D)Axillary thoracotomy

Question 19

When a patient is being considered for peripheral vascular disease intervention (surgical versus percutaneous transluminal angioplasty),which of the following factors considered is a lesion characteristic?

A)Presence or absence of diabetes
B)Stenosis versus occlusion
C)Hemodynamic response
D)Multilevel versus single level

Question 20

The primary cause of perioperative morbidity and mortality in the thoracic surgical population is which of the following?

A)Cardiac complications
B)Respiratory complications
C)Renal dysfunction
D)Infection

Question 21

Patients with claudication pain after a peripheral vascular intervention have better long-term outcomes and fewer amputations?

Question 22

Which of the following vessels used in a coronary artery bypass graft is preferable due to its ability to resist atherosclerosis?

A)Saphenous vein
B)Internal mammary artery
C)External mammary artery
D)None of the above

Question 23

Which of the following patients have been determined to gain the MOST benefit from a carotid endarterectomy procedure?

A)A patient who is symptomatic with carotid artery stenosis of 70% or greater
B)A patient who is symptomatic with carotid artery stenosis of 50% to 65%
C)A symptomatic patient with carotid artery stenosis of 40% to 50%
D)An asymptomatic patient with carotid artery stenosis of 50% to 55%

Question 24

Older adults who undergo a video-assisted thoracoscopic surgery experience which of the following advantages that would be MOST beneficial with regard to age-related complications?

A)Less postoperative pain
B)Reduced shoulder dysfunction
C)Higher satisfaction
D)Reduced postoperative confusion

Question 25

According to the research evidence,a coronary arterial bypass graft has a higher 3-year mortality rate as compared to the percutaneous transluminal coronary angioplasty.

Question 26

Which of the following percutaneous revascularization procedures involves the placement of a tiny springlike device into the lesion to increase the intravascular luminal diameter?

A)Percutaneous transluminal coronary angioplasty
B)Directional coronary arthrectomy
C)Endoluminal stent
D)Coronary artery bypass graft

Question 27

Which of the following interventions is MOST appropriate for a patient who is a few days postoperative a femoral-popliteal bypass for peripheral vascular disease?

A)Bed rest with surgical limb elevated
B)Transfer to bedside chair only with surgical limb elevated
C)Ambulation in room only three times per day
D)Ambulation as tolerated,gentle leg range of motion,limb elevation at rest

Question 28

Which of the following blood glucose level ranges is associated with an increased operative morbidity and mortality in women undergoing a coronary artery bypass graft?

A)<90 mg/dL
B)90 to 100 mg/dL
C)100 to 150 mg/dL
D)>150 mg/dL

Question 29

Common risk factors for thoracic aortic aneurysms include which of the following factors?

A)Hypertension
B)Hypercholesteremia
C)Prior tobacco use
D)All of the above

Question 30

A pacemaker that can stimulate the atrium,can detect spontaneous atrial depolarizations,and can inhibit a pending stimulus when a spontaneous depolarization is detected is referred to which of the following NBG pacemaker codes?

A)AAI
B)VVT
C)DDD
D)ONO