- Email: [email protected]
Examination: Carotid Artery Stenosis and Endarterectomy
FEBRUARY 2002, VOL 75, NO 2
Examinahon 1.Carotid artery stenosis is charqcterized by progressive narrowing of the carotid vessels and a. plaquing, seventh nerve paralysis, and demyelination. b. ulcerations, bradykinesia, and demyelination. c. atheroscleroticchanges, seventh nerve paralysis, and bradykinesia. d. atheroscleroticchanges, plaquing, and ulceration.
&Factors that regulate cerebral blood flow are a. blood pressure, metabolic demands, and the partial pressures of carbon dioxide (COz) and oxygen. b. metabolic demands, sympathetic stimulation, and heart rate. c. partial pressure of COz, heart rate, and optic nerve stimulation. d. partial pressure of oxygen, sympathetic stimulation, and optic nerve stimulation.
?.The area where the common carotid vessel branches into the internal and external carotid arteries also is known as the a. subclavian bifurcation. b. jugular bifurcation. c. subclavian bulb. d. carotid bulb.
7.The facilitates blood pressure and heart rate changes. a. moro response b. baroreceptor reflex c. Perez reflex d. Babinski response
%The mechanisms of acute arterial occlusion and embobtion resulting fiom carotid artery stenosis are significanthealth care issues because a. cerebral aneurysm is the second most common cause of death after heart attack. b. cerebral palsy is the most debilitating neurological disease process after heart attack. c. stroke is the third most common cause of death in the United States. d. myocardial infarction leads to stroke in 38% of patients age 70 or older. 4. Cerebral blood flow is provided by a. portal circulation. b. collated csdiac vessels. c. the internal carotid and vertebral arteries. d. the internal carotid and subclavian arteries. 5.Collateral blood flow through the allows the body to compensate for reduced blood flow from any of the mior contributing blood vessels. a. Palmar Arch b. Circle of Willis c. Phrenulum Lingua d. Optic Chiasma
8.All of the following are symptoms of a transient ischemic attack (TIA) except a. lower extremity claudicating pain. b. minimal loss of sensation one hand. c. complete hemiparesis on e contralateral side of the carotid lesion. d. temporary blindness on the ipsilateral side of the carotid lesion.
b:
9.A is indicative of turbulent blood flow through a diseased artery. a. rhonchus b. bronchophony c. gallop d. bruit 1 L T h e following diagnostic tools are specific to carotid artery stenosis: a. contrast arteriography, electromyography,and echoencephalography. b. duplex ultrasound, electromyography, and computed tomography (CT) scan. c. duplex ultrasound study, contrast arteriography, and magnetic resQnancearteriography. d. magnetic resonance imaging% echoencephalography, and CT scan.
326 AORN JOURNAL
FEBRUARY 2002, VOL 75, NO 2
I 1.Potential cardiogenic causes of ischemic strokes or TIAs include a. atrial fibrillation, atrial flutter, mitral valve prolapse (MVP), and patent foramen ovale. b. atrial flutter, arterial dissection, intracranial artery stenosis, and fibromuscular dysplasia. c. fibromuscular dysplasia, sickle cell disease, MVP, and hypercoagulationstates. d. patent foramen ovale, arterial dissection,hypercoagulation states, and sickle cell disease.
b. blood pressure, diabetes, hepatic disease, renal insufficiency, neurological deficit, and pulmonary disease. c. age, coronary disease, renal insufficiency, alcohol consumption,neurological deficit, and ethnicity. d. smoking cessation, hyperlipidemia, hepatic disease, alcohol consumption, ethnicity, and pulmonary disease. 1 8 T h e recommended combined perioperative neurological morbidity and mortality rates for symptomatic patients with TIAs is a. 3%. b. 5%. c. 7%. d. 9%.
12 may be a good determinant of cavitated, gelatinous, “soft” atheroma. a. Contrast arteriography b. Carotid duplex ultrasound c. Magnetic resonance imaging d. Computed tomography l3.All of the following are complications of contrast arteriography except a. arterial dissection. b. pesudoaneurysm formation. c. infection. d. implant migration. 1AMagnetic resonance angiography may not be an option for patients who a, have implanted metallic devices, may be unable to lie still, orme claustrophobic. b. may be unable to lie still, have renal insufficiency, or have hepatic disease. c. have implanted metallic devices, are allergic to contrast media, or have hepatic disease. d. are claustrophobic,have renal insufficiency,or are allergic to contrast media. 15.Medical treatment for carotid artery stenosis includes all of the following except a. weight reduction. b. antihypertensivetherapy. c. limiting alcohol consumption. d. antiplatelet therapy 1BCarotid artery endarterectomy is beneficial for symptomatic patients with a recent nondisabling neurological event and ipsilakral stenosis of a. 10% to 30%. b. 30% to 50%. c. 50% to 70%. d. 70% to 90%. 17.Surgical risk data used to develop patient selection criteria are based on a. age, blood pressure, smoking, coronary disease, diabetes, and hyperlipidemia.
1LSome studies strongly indicate that early revascularization a. rapidly occludes in spite of postoperative medication therapy. b. increases the patient’s chance for restenosis. c. precipitates hemorrhage in the infarcted area. d. precipitates development of intracranial lesions. =Before 1953,the followingprocedures were used to treat carotid artery stenosis: a. cervical sympathectomy,carotid arteriovenous fistula, carotid vein stripping, and carotid artery resection. b. thrombectomy of occluded carotid arteries, carotid vein stripping, carotidjugulap bypass, and stellate ganglion block. c. carotid bifurcation ligation, carotid arteriovenous fistula. carotidjugular bypass, and carotid artery resection. d. stellate ganglion block, cervical sympathectomy, thrombectomy of occluded carotid arteries, and carotid bifhrcation ligation. 21.A cardiac evaluation is particularly important in this patient population (ie, people with carotid artery stenosis) because a. of the frequency of comorbid neurological disease. b. a preexisting neurological deficit precludes accurate responses to health questionnaires. c. a preexisting renal insufficiency increases the patient’s risk of complications. d. of the frequency of comorbid cardiac disease. =Postoperative includes
328 AORN JOURNAL
teaching performed preoperatively
FEBRUARY 2002, VOL 75, NO 2
a. respiratory care, progression of diet and activity, and frequency of vital signs and neurological checks. b. progression of diet and activity, preoperative bowel preparation, and the potential for speech therapy to treat aphasia, if needed. c. respiratory care, eye care for ipsilateral lid droop, and preoperative bowel preparation. d. frequency of vital signs and neurological checks, eye care for ipsilateral lid droop, and the potential for speech therapy to treat aphasia, if needed.
c. EEG and pneumoencephalography. d. continuous CT scans and echoencephalography. =.Extreme hyperextension of the neck during positioning should be avoided because it may a. stimulate arthritic symptoms postoperatively and adversely affect the recovery process. b. increase venous pressure and stimulate incisional bleeding. c. actually impede exposure by tightening the sternocleidomastoid muscle and limit mobility of the common carotid artery and the bifurcation. d. cause fragmentation of the atheromatous lesions and subsequent embolization and stroke.
=The nurse instructs the patient to take all preoperatively prescribed medications before admission except for a. aspirin and aspirin-containing products, antihypertensive medications, and antidysrhythmics. =The advantage of a vertical incision is that it b. antiplatelet medications, antihypertensive a. is more acceptable cosmetiGally. medications, and neuromuscular blocking b. produces less local nerve damage. agents. c. can be extended distally and proximally to proc. warfarin sodium, aspirin and aspirin-containvide additional exposure, if needed. ing products, antiplateletmedications, and diad. heals more rapidly and provides greater postbetic medications. operative muscular support. d. diabetic medications, all facial medicated creams and lotions, and antidysrhythmics. =The is a landmark for the carotid bikcation where it obliquely crosses the =All of the following are advantages to local or carotid to the internal jugular vein. cervical block anesthesia except that the a. common facial vein a. surgeon can evaluate the patient's mental stab. retromandibularvein tus. c. superior sagittal vein b. anesthesia care provider can use halogenated d. transverse sinus vein anesthetic agents. c. patient's motor status can be evaluated ensur- =Injury to the hypoglossal nerve, which passes ing adequate cerebral circulation. across the intemal and external carotid arteries, d. surgeon can evaluate cerebral tolerance to causes clamping of the carotid vessels. a. bradycardia and subsequent hypotension. b. lateral deviation of the tongue toward the sur=Halogenated anesthetic agents have been shown gical side during protrusion and difficulty to increase cerebral blood flow and decrease swallowing. cerebral metabolism allowing c. droopy eyelid on the contralateral side. a. anesthesia to be provided to a specific region d. difficulty swallowing and speech impairment. of the body. b. the surgeon to evaluate the patient's motor 31.When dissecting the carotid bifurcation, the surstatus. geon may inject the tissues of the carotid body c. the patient to independently maintain a patent and sinus with 1% lidocaine to airway and respond to verbal commands. a. provide vasoconstriction, which minimizes d. improved tolerance of carotid clamping. intraoperativebleeding. b. mobilize tissue layers, facilitating dissection =Cerebral perfusion may be monitored during and cross clamping. carotid endarterectomy with intraoperative c. slow the rate of absorption, providing a longer a. electroencephalography (EEG) and cerebral duration of postoperative pain relief oximetry. d. prevent a reflex vagal response, resulting in b. cerebral oximetry and continuous CT scans. bradycardia and subsequent hypotension. 329 AORN JOURNAL
FEBRUARY 2002, VOL 75, NO 2
sient ischemic attacks and stroke. 3 2 A shunt may be used intraoperatively for all of c. coagulapathies and bIood pressure abnorthe followingreasons except malities. a. EEG and cerebral oximetry changes indicating d. decreased tissue perFusion and poor wound cerebral hypoxia. healing. b. hypotension resulting in sensorium changes and facial numbness. c. low pressures in the clamped distal internal 37.The intraoperative role of the RN first assistant includes all of the following except carotid artery. a. ,positioning,prepping, and draping. d. poor back bleeding from an unclamped interb. exposing the surgical site. nal carotid artery. c. retracting and providing hemostasis. d. injecting the carotid body and sinus with 33.Complications of using a shunt include lidocaine. a. air or thrombotic emboli, decreased peripheral circulation, and intimal damage. b. intimal damage and excessively rapid blood =To ensure cardiovascularand neurological stability, patients now are spending an extended time flow resulting in overprofusion. in the postanesthesia care unit rather than an c. intimal damage, air or thrombotic emboli, and intensive care stay. decreased access to the vessel. a. true d. decreased access to the vessel and excessiveb. false ly rapid blood flow, which results in overprofusion. =Discharge instructions include all of the following except 3 A A vein or prosthetic patch may be used to a. performing wound care. a. keep the internal and external carotid in close b. resuming preoperative medications. proximity. c. continuing on a diet of soft solids for two b. increase the diameter of the vessel. weeks to minimize stress on the incision. c. control blood flow later in the procedure. d. setting up a postoperative follow-up appointd. radiologically identifl the carotid vessels postment in two weeks. operatively.
35.
may be used at the end of the procedure to reverse anticoagulation. a. Warfarin sodium b. Protamine sulfate c. Anistreplase d. Papaverine hydrochloride =Bleeding postoperatively can cause a. hematomas resulting in tracheal deviation and respiratory distress. b. decreased cerebral circulation resulting in tran-
40. Severe hypertension should be avoided postoperatively because a. residual plaque may break away and cause a stroke. b. it causes subcutaneous swelling, which delays healing. c. residual plaque may break away and cause a heart attack. d. it can cause stress on the suture line and lead to postoperative bleeding.
AORN, Assoclafion of periopeative Rqist6m-i Nurses, is accm-iited as a provider of continuing education in nursing by the American Nurses Cr6dentialingGentefs (A"s) Commission on Accredifution. AORN recognizes this activity as continuing education for iqgisteed nuises. This recognition does not imply that AORN or the A W s Commission an Accreditafion approves or endorses any pn?duct included in the activity. AORN maintains the foliowing state b a r d of nurshg provider numbers:Alabama ABNP0075, Caihmia CEP13019, and Flafida F8N 2296.Check
with your state board of nursing for acceptablity of education activity for relicensure. Professional nurses ore invited to submit manuscripts for the Home Siudy Program, Manuscripts or queries should be sent to Editor, AORN Journal, 2170 S Porker Rd, Suite 300, Denver, CO 8023 1571 1. As with all manuscripts sent to the Journal, papers submitted far Home Siudy Programs should not have been previously published or submifted simultaneously to any other publication.
330 AORN JOURNAL
FEBRUARY 2002, VOL 75, NO 2
Answer Sheet CARmD ARXKRY STENOSBS AND ENDARTERE-MY
P
lease fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711 or fax with credit card information to (303) 750-3212.
ID Number OOOOOQO0QO 0000000000 0000000000' 0000000000 0000000000
A score of 70% correct is required for credit.
Event # 02027 Session ## 6507 Contact hours: 2.5 Fee: Members $12.50; Nonmembers $25 Program offered February 2002. The deadline for this program is Feb 28,2005. 1. Record your six-digit member identification number in the appropriate section below (see your member card). 2. Completely darken the space that indicates your answer to the examination starting with question one. Use blue or black ink. 3. Record the time required to complete the program. 4. Enclose fee if information is mailed.
AORN (ID) # Name Address City State RN license # State Phone number (
Zip
Fee enclosed or bill the credit card indicated MC Visa 0Am Express Card # Expiration date Signature
Discover
(for credit card authonzatlon)
331 AORN JOURNAL
Yi!
FEBRUARY 2002, VOL 75, NO 2
Learner Evaluation CARUFID AXFERY STENOSlS AND ENDARIERECTOMV
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5. oBJEcI1vLs
To what extent were the following objectives of this Home Study Program achieved? (1) Define the physiology of cerebral circulation. (2) Discuss the pathophysiology of impaired cerebral circulation. (3) Identify the selection criteria for the treatment options available to patients with carotid artery stenosis. (4) Describe the preoperative process of patients undergoing carotid artery endarterectomy. ( 5 ) Discuss perioperative nursing care of patients undergoing carotid endarterectomy for carotid artery stenosis. (6) Describe the postoperative course of patients undergoing carotid endarterectomy.
Session Number 0000000000~ 0000000000 0000000000 0000000000
(Low) (High) (Low) (High)
PURPosE/60nL
To educate the perioperative nurse about carotid artery stenosis and treatment with carotid artery endarterectomy. C0"T
(7)Did this article increase your knowledge of the subject matter? (8)Was the content clear and organized? (9)Did this article facilitate learning? (10) Were your individual objectives met? (1 1)How well did the objectives relate to the overall purpose/goal? T
E
s
T
(
w
~
~
(1 1)Were they reflective of the content? ( 12)Were they easy to understand? (13)Did they address important points? What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
332 AORN JOURNAL
Examinahon 1.Carotid artery stenosis is charqcterized by progressive narrowing of the carotid vessels and a. plaquing, seventh nerve paralysis, and demyelination. b. ulcerations, bradykinesia, and demyelination. c. atheroscleroticchanges, seventh nerve paralysis, and bradykinesia. d. atheroscleroticchanges, plaquing, and ulceration.
&Factors that regulate cerebral blood flow are a. blood pressure, metabolic demands, and the partial pressures of carbon dioxide (COz) and oxygen. b. metabolic demands, sympathetic stimulation, and heart rate. c. partial pressure of COz, heart rate, and optic nerve stimulation. d. partial pressure of oxygen, sympathetic stimulation, and optic nerve stimulation.
?.The area where the common carotid vessel branches into the internal and external carotid arteries also is known as the a. subclavian bifurcation. b. jugular bifurcation. c. subclavian bulb. d. carotid bulb.
7.The facilitates blood pressure and heart rate changes. a. moro response b. baroreceptor reflex c. Perez reflex d. Babinski response
%The mechanisms of acute arterial occlusion and embobtion resulting fiom carotid artery stenosis are significanthealth care issues because a. cerebral aneurysm is the second most common cause of death after heart attack. b. cerebral palsy is the most debilitating neurological disease process after heart attack. c. stroke is the third most common cause of death in the United States. d. myocardial infarction leads to stroke in 38% of patients age 70 or older. 4. Cerebral blood flow is provided by a. portal circulation. b. collated csdiac vessels. c. the internal carotid and vertebral arteries. d. the internal carotid and subclavian arteries. 5.Collateral blood flow through the allows the body to compensate for reduced blood flow from any of the mior contributing blood vessels. a. Palmar Arch b. Circle of Willis c. Phrenulum Lingua d. Optic Chiasma
8.All of the following are symptoms of a transient ischemic attack (TIA) except a. lower extremity claudicating pain. b. minimal loss of sensation one hand. c. complete hemiparesis on e contralateral side of the carotid lesion. d. temporary blindness on the ipsilateral side of the carotid lesion.
b:
9.A is indicative of turbulent blood flow through a diseased artery. a. rhonchus b. bronchophony c. gallop d. bruit 1 L T h e following diagnostic tools are specific to carotid artery stenosis: a. contrast arteriography, electromyography,and echoencephalography. b. duplex ultrasound, electromyography, and computed tomography (CT) scan. c. duplex ultrasound study, contrast arteriography, and magnetic resQnancearteriography. d. magnetic resonance imaging% echoencephalography, and CT scan.
326 AORN JOURNAL
FEBRUARY 2002, VOL 75, NO 2
I 1.Potential cardiogenic causes of ischemic strokes or TIAs include a. atrial fibrillation, atrial flutter, mitral valve prolapse (MVP), and patent foramen ovale. b. atrial flutter, arterial dissection, intracranial artery stenosis, and fibromuscular dysplasia. c. fibromuscular dysplasia, sickle cell disease, MVP, and hypercoagulationstates. d. patent foramen ovale, arterial dissection,hypercoagulation states, and sickle cell disease.
b. blood pressure, diabetes, hepatic disease, renal insufficiency, neurological deficit, and pulmonary disease. c. age, coronary disease, renal insufficiency, alcohol consumption,neurological deficit, and ethnicity. d. smoking cessation, hyperlipidemia, hepatic disease, alcohol consumption, ethnicity, and pulmonary disease. 1 8 T h e recommended combined perioperative neurological morbidity and mortality rates for symptomatic patients with TIAs is a. 3%. b. 5%. c. 7%. d. 9%.
12 may be a good determinant of cavitated, gelatinous, “soft” atheroma. a. Contrast arteriography b. Carotid duplex ultrasound c. Magnetic resonance imaging d. Computed tomography l3.All of the following are complications of contrast arteriography except a. arterial dissection. b. pesudoaneurysm formation. c. infection. d. implant migration. 1AMagnetic resonance angiography may not be an option for patients who a, have implanted metallic devices, may be unable to lie still, orme claustrophobic. b. may be unable to lie still, have renal insufficiency, or have hepatic disease. c. have implanted metallic devices, are allergic to contrast media, or have hepatic disease. d. are claustrophobic,have renal insufficiency,or are allergic to contrast media. 15.Medical treatment for carotid artery stenosis includes all of the following except a. weight reduction. b. antihypertensivetherapy. c. limiting alcohol consumption. d. antiplatelet therapy 1BCarotid artery endarterectomy is beneficial for symptomatic patients with a recent nondisabling neurological event and ipsilakral stenosis of a. 10% to 30%. b. 30% to 50%. c. 50% to 70%. d. 70% to 90%. 17.Surgical risk data used to develop patient selection criteria are based on a. age, blood pressure, smoking, coronary disease, diabetes, and hyperlipidemia.
1LSome studies strongly indicate that early revascularization a. rapidly occludes in spite of postoperative medication therapy. b. increases the patient’s chance for restenosis. c. precipitates hemorrhage in the infarcted area. d. precipitates development of intracranial lesions. =Before 1953,the followingprocedures were used to treat carotid artery stenosis: a. cervical sympathectomy,carotid arteriovenous fistula, carotid vein stripping, and carotid artery resection. b. thrombectomy of occluded carotid arteries, carotid vein stripping, carotidjugulap bypass, and stellate ganglion block. c. carotid bifurcation ligation, carotid arteriovenous fistula. carotidjugular bypass, and carotid artery resection. d. stellate ganglion block, cervical sympathectomy, thrombectomy of occluded carotid arteries, and carotid bifhrcation ligation. 21.A cardiac evaluation is particularly important in this patient population (ie, people with carotid artery stenosis) because a. of the frequency of comorbid neurological disease. b. a preexisting neurological deficit precludes accurate responses to health questionnaires. c. a preexisting renal insufficiency increases the patient’s risk of complications. d. of the frequency of comorbid cardiac disease. =Postoperative includes
328 AORN JOURNAL
teaching performed preoperatively
FEBRUARY 2002, VOL 75, NO 2
a. respiratory care, progression of diet and activity, and frequency of vital signs and neurological checks. b. progression of diet and activity, preoperative bowel preparation, and the potential for speech therapy to treat aphasia, if needed. c. respiratory care, eye care for ipsilateral lid droop, and preoperative bowel preparation. d. frequency of vital signs and neurological checks, eye care for ipsilateral lid droop, and the potential for speech therapy to treat aphasia, if needed.
c. EEG and pneumoencephalography. d. continuous CT scans and echoencephalography. =.Extreme hyperextension of the neck during positioning should be avoided because it may a. stimulate arthritic symptoms postoperatively and adversely affect the recovery process. b. increase venous pressure and stimulate incisional bleeding. c. actually impede exposure by tightening the sternocleidomastoid muscle and limit mobility of the common carotid artery and the bifurcation. d. cause fragmentation of the atheromatous lesions and subsequent embolization and stroke.
=The nurse instructs the patient to take all preoperatively prescribed medications before admission except for a. aspirin and aspirin-containing products, antihypertensive medications, and antidysrhythmics. =The advantage of a vertical incision is that it b. antiplatelet medications, antihypertensive a. is more acceptable cosmetiGally. medications, and neuromuscular blocking b. produces less local nerve damage. agents. c. can be extended distally and proximally to proc. warfarin sodium, aspirin and aspirin-containvide additional exposure, if needed. ing products, antiplateletmedications, and diad. heals more rapidly and provides greater postbetic medications. operative muscular support. d. diabetic medications, all facial medicated creams and lotions, and antidysrhythmics. =The is a landmark for the carotid bikcation where it obliquely crosses the =All of the following are advantages to local or carotid to the internal jugular vein. cervical block anesthesia except that the a. common facial vein a. surgeon can evaluate the patient's mental stab. retromandibularvein tus. c. superior sagittal vein b. anesthesia care provider can use halogenated d. transverse sinus vein anesthetic agents. c. patient's motor status can be evaluated ensur- =Injury to the hypoglossal nerve, which passes ing adequate cerebral circulation. across the intemal and external carotid arteries, d. surgeon can evaluate cerebral tolerance to causes clamping of the carotid vessels. a. bradycardia and subsequent hypotension. b. lateral deviation of the tongue toward the sur=Halogenated anesthetic agents have been shown gical side during protrusion and difficulty to increase cerebral blood flow and decrease swallowing. cerebral metabolism allowing c. droopy eyelid on the contralateral side. a. anesthesia to be provided to a specific region d. difficulty swallowing and speech impairment. of the body. b. the surgeon to evaluate the patient's motor 31.When dissecting the carotid bifurcation, the surstatus. geon may inject the tissues of the carotid body c. the patient to independently maintain a patent and sinus with 1% lidocaine to airway and respond to verbal commands. a. provide vasoconstriction, which minimizes d. improved tolerance of carotid clamping. intraoperativebleeding. b. mobilize tissue layers, facilitating dissection =Cerebral perfusion may be monitored during and cross clamping. carotid endarterectomy with intraoperative c. slow the rate of absorption, providing a longer a. electroencephalography (EEG) and cerebral duration of postoperative pain relief oximetry. d. prevent a reflex vagal response, resulting in b. cerebral oximetry and continuous CT scans. bradycardia and subsequent hypotension. 329 AORN JOURNAL
FEBRUARY 2002, VOL 75, NO 2
sient ischemic attacks and stroke. 3 2 A shunt may be used intraoperatively for all of c. coagulapathies and bIood pressure abnorthe followingreasons except malities. a. EEG and cerebral oximetry changes indicating d. decreased tissue perFusion and poor wound cerebral hypoxia. healing. b. hypotension resulting in sensorium changes and facial numbness. c. low pressures in the clamped distal internal 37.The intraoperative role of the RN first assistant includes all of the following except carotid artery. a. ,positioning,prepping, and draping. d. poor back bleeding from an unclamped interb. exposing the surgical site. nal carotid artery. c. retracting and providing hemostasis. d. injecting the carotid body and sinus with 33.Complications of using a shunt include lidocaine. a. air or thrombotic emboli, decreased peripheral circulation, and intimal damage. b. intimal damage and excessively rapid blood =To ensure cardiovascularand neurological stability, patients now are spending an extended time flow resulting in overprofusion. in the postanesthesia care unit rather than an c. intimal damage, air or thrombotic emboli, and intensive care stay. decreased access to the vessel. a. true d. decreased access to the vessel and excessiveb. false ly rapid blood flow, which results in overprofusion. =Discharge instructions include all of the following except 3 A A vein or prosthetic patch may be used to a. performing wound care. a. keep the internal and external carotid in close b. resuming preoperative medications. proximity. c. continuing on a diet of soft solids for two b. increase the diameter of the vessel. weeks to minimize stress on the incision. c. control blood flow later in the procedure. d. setting up a postoperative follow-up appointd. radiologically identifl the carotid vessels postment in two weeks. operatively.
35.
may be used at the end of the procedure to reverse anticoagulation. a. Warfarin sodium b. Protamine sulfate c. Anistreplase d. Papaverine hydrochloride =Bleeding postoperatively can cause a. hematomas resulting in tracheal deviation and respiratory distress. b. decreased cerebral circulation resulting in tran-
40. Severe hypertension should be avoided postoperatively because a. residual plaque may break away and cause a stroke. b. it causes subcutaneous swelling, which delays healing. c. residual plaque may break away and cause a heart attack. d. it can cause stress on the suture line and lead to postoperative bleeding.
AORN, Assoclafion of periopeative Rqist6m-i Nurses, is accm-iited as a provider of continuing education in nursing by the American Nurses Cr6dentialingGentefs (A"s) Commission on Accredifution. AORN recognizes this activity as continuing education for iqgisteed nuises. This recognition does not imply that AORN or the A W s Commission an Accreditafion approves or endorses any pn?duct included in the activity. AORN maintains the foliowing state b a r d of nurshg provider numbers:Alabama ABNP0075, Caihmia CEP13019, and Flafida F8N 2296.Check
with your state board of nursing for acceptablity of education activity for relicensure. Professional nurses ore invited to submit manuscripts for the Home Siudy Program, Manuscripts or queries should be sent to Editor, AORN Journal, 2170 S Porker Rd, Suite 300, Denver, CO 8023 1571 1. As with all manuscripts sent to the Journal, papers submitted far Home Siudy Programs should not have been previously published or submifted simultaneously to any other publication.
330 AORN JOURNAL
FEBRUARY 2002, VOL 75, NO 2
Answer Sheet CARmD ARXKRY STENOSBS AND ENDARTERE-MY
P
lease fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711 or fax with credit card information to (303) 750-3212.
ID Number OOOOOQO0QO 0000000000 0000000000' 0000000000 0000000000
A score of 70% correct is required for credit.
Event # 02027 Session ## 6507 Contact hours: 2.5 Fee: Members $12.50; Nonmembers $25 Program offered February 2002. The deadline for this program is Feb 28,2005. 1. Record your six-digit member identification number in the appropriate section below (see your member card). 2. Completely darken the space that indicates your answer to the examination starting with question one. Use blue or black ink. 3. Record the time required to complete the program. 4. Enclose fee if information is mailed.
AORN (ID) # Name Address City State RN license # State Phone number (
Zip
Fee enclosed or bill the credit card indicated MC Visa 0Am Express Card # Expiration date Signature
Discover
(for credit card authonzatlon)
331 AORN JOURNAL
Yi!
FEBRUARY 2002, VOL 75, NO 2
Learner Evaluation CARUFID AXFERY STENOSlS AND ENDARIERECTOMV
The following evaluation is used to determine the extent to which this Home Study Program met your learning needs. Rate the following items on a scale of 1 to 5. oBJEcI1vLs
To what extent were the following objectives of this Home Study Program achieved? (1) Define the physiology of cerebral circulation. (2) Discuss the pathophysiology of impaired cerebral circulation. (3) Identify the selection criteria for the treatment options available to patients with carotid artery stenosis. (4) Describe the preoperative process of patients undergoing carotid artery endarterectomy. ( 5 ) Discuss perioperative nursing care of patients undergoing carotid endarterectomy for carotid artery stenosis. (6) Describe the postoperative course of patients undergoing carotid endarterectomy.
Session Number 0000000000~ 0000000000 0000000000 0000000000
(Low) (High) (Low) (High)
PURPosE/60nL
To educate the perioperative nurse about carotid artery stenosis and treatment with carotid artery endarterectomy. C0"T
(7)Did this article increase your knowledge of the subject matter? (8)Was the content clear and organized? (9)Did this article facilitate learning? (10) Were your individual objectives met? (1 1)How well did the objectives relate to the overall purpose/goal? T
E
s
T
(
w
~
~
(1 1)Were they reflective of the content? ( 12)Were they easy to understand? (13)Did they address important points? What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
332 AORN JOURNAL