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A cardiac surgery patients new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurses most appropriate action?
- A. Prepare to assist with pericardiocentesis.
- B. Reposition the patient into a prone position.
- C. Administer a dose of metoprolol.
- D. Administer a bolus of normal saline.
Correct Answer: A
Rationale: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart and prone positioning would likely exacerbate symptoms.
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The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterize DCM?
- A. Dilated ventricles with atrophy of the ventricles
- B. Dilated ventricles without hypertrophy of the ventricles
- C. Dilation and hypertrophy of all four heart chambers
- D. Dilation of the atria and hypertrophy of the ventricles
Correct Answer: B
Rationale: DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in patients with DCM.
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 living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment?
- A. Heart transplantation
- B. Balloon valvuloplasty
- C. Cardiac catheterization
- D. Stent placement
Correct Answer: A
Rationale: When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Valvuloplasty, stent placement, and cardiac catheterization will not address the pathophysiology of cardiomyopathy.
A nurse is planning discharge health education for a patient who will soon undergo placement of a mechanical valve prosthesis. What aspect of health education should the nurse prioritize in anticipation of discharge?
- A. The need for long-term antibiotics
- B. The need for 7 to 10 days of bed rest
- C. Strategies for preventing atherosclerosis
- D. Strategies for infection prevention
Correct Answer: D
Rationale: Patients with a mechanical valve prosthesis (including annuloplasty rings and other prosthetic materials used in valvuloplasty) require education to prevent infective endocarditis. Despite these infections risks, antibiotics are not used long term. Activity management is important, but extended bed rest is unnecessary. Valve replacement does not create a heightened risk for atherosclerosis.
A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this?
- A. To prevent bacterial endocarditis
- B. To prevent hospital-acquired pneumonia
- C. To minimize the need for antibiotic use during the procedure
- D. To decrease the need for surgical asepsis
Correct Answer: A
Rationale: Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after the following invasive procedures, such as bronchoscopy. Gentamicin would not be given to prevent pneumonia, to avoid antibiotic use during the procedure, or to decrease the need for surgical asepsis.