Nokea
A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy?
- A. Dilated cardiomyopathy (DCM)
- B. Arrhythmogenic right ventricular cardiomyopathy (ARVC)
- C. Hypertrophic cardiomyopathy (HCM)
- D. Restrictive or constrictive cardiomyopathy (RCM)
Correct Answer: C
Rationale: With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults who appear otherwise healthy.
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The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patients diagnosis?
- A. Mitral valve regurgitation
- B. Aortic stenosis
- C. Aortic regurgitation
- D. Mitral valve stenosis
Correct Answer: D
Rationale: Because no valve protects the pulmonary veins from the backward flow of blood from the atrium, the pulmonary circulation becomes congested. As a result, the right ventricle must contract against an abnormally high pulmonary arterial pressure and is subjected to excessive strain. Eventually, the right ventricle fails. None of the other listed valvular disorders has this pathophysiological effect.
A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurses interview is most suggestive of this valvular disorder?
- A. I get chest pain from time to time, but it usually resolves when I rest.
- B. Sometimes when Im resting, I can feel my heart skip a beat.
- C. Whenever I do any form of exercise I get terribly short of breath.
- D. My feet and ankles have gotten terribly puffy the last few weeks.
Correct Answer: C
Rationale: The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpitations occur in some patients, but dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.
A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physicians choice of antibiotics would be primarily based on what diagnostic test?
- A. Echocardiography
- B. Blood cultures
- C. Cardiac aspiration
- D. Complete blood count
Correct Answer: B
Rationale: To help determine the causative organisms and the most effective antibiotic treatment for the patient, blood cultures are taken. A CBC can help establish the degree and stage of infection, but not the causative microorganism. Echocardiography cannot indicate the microorganisms causing the infection. Cardiac aspiration is not a diagnostic test.
A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs?
- A. Enoxaparin (Lovenox)
- B. Metoprolol (Lopressor)
- C. Azathioprine (Imuran)
- D. Amoxicillin (Amoxil)
Correct Answer: D
Rationale: Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic.
A patient with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurses admission interview, the patient states that she takes over-the-counter water pills on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics?
- A. Encourage the patient to drink at least 2 liters of fluid daily.
- B. Increase the patients oral sodium intake.
- C. Inform the care provider because diuretics are contraindicated.
- D. Ensure that the patients fluid balance is monitored vigilantly.
Correct Answer: C
Rationale: Diuretics are contraindicated in patients with HCM, so the primary care provider should be made aware. Adjusting the patients sodium or fluid intake or fluid monitoring does not address this important contraindication.