When evaluating the effectiveness of preoperative teaching with a client scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the client says which of the following?

"They will circulate my blood on a machine during the surgery."

"I will need to take an aspirin every day after the surgery to keep the graft open."

"They will use an artery near my heart to go around the area that is blocked."

"I will have small incisions in my leg where they will remove the vein."

Answer and Explanation

The Correct Answer is D

A. "They will circulate my blood on a machine during the surgery.": This is correct information regarding the use of a heart-lung machine during CABG.

B. "I will need to take an aspirin every day after the surgery to keep the graft open.": Daily aspirin therapy is standard to prevent graft occlusion, indicating correct understanding.

C. "They will use an artery near my heart to go around the area that is blocked.": This accurately describes using the internal mammary artery for the bypass, showing correct knowledge.

D. "I will have small incisions in my leg where they will remove the vein.": This indicates confusion, as the internal mammary artery, not leg veins, is used in this type of CABG.

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Correct Answer is D

Explanation

A. Hypercalcemia (Calcium > 10.5 mg/dL) can lead to shortened QT intervals, not prolonged ones, and is unlikely to cause Torsades de Pointes.

B. A magnesium level of 3.1 mEq/L is slightly elevated and would not contribute to QT prolongation or Torsades de Pointes. In fact, magnesium supplementation is a treatment for this condition.

C. Hypokalemia (Potassium < 3.5 mEq/L) can prolong the QT interval and contribute to dysrhythmias, but it is less commonly a direct cause of Torsades de Pointes compared to hypomagnesemia. A potassium level of 2.6 mEq/L is low but would not typically result in Torsades without coexisting hypomagnesemia.

D. Hypomagnesemia (Magnesium < 1.5 mEq/L) disrupts the heart's electrical activity, prolonging the QT interval and increasing the risk of polymorphic ventricular tachycardia, like Torsades de Pointes. Magnesium is critical for stabilizing myocardial electrical conduction, and a value of 1.1 mEq/L indicates significant deficiency, consistent with this dysrhythmia.

A. Test the equipment by delivering a smaller shock at 50 J. B. Administer 2 mg of intravenous epinephrine. C. Make sure that the defibrillator is set to the synchronous mode. D. Ensure that everyone is clear of contact with the client and the bed.

Correct Answer is D

Explanation

A. Testing the equipment with a smaller shock is unnecessary when preparing to defibrillate in an emergency.

B. Epinephrine is used in cases of cardiac arrest with no pulse, particularly in asystole or pulseless electrical activity (PEA), not immediately before defibrillation in ventricular fibrillation.

C. Synchronous mode is used for cardioversion, not for defibrillation. Defibrillation should be delivered in unsynchronized mode.

D. Before delivering a shock, it is essential to ensure that everyone, including the nurse, is clear of the client and any conductive surfaces like the bed. This prevents injury from the electrical shock.

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When evaluating the effectiveness of preoperative teaching with a client scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery, the nurse determines that additional teaching is needed when the client says which of the following?

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Correct Answer is D

Explanation

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Explanation

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