Nokea
A client recently had a myocardial infarction (MI) and asks the nurse if he will require a heart transplant. Based on the nurse's knowledge of indications for heart transplant, what is the best response?
- A. No. Heart transplant is indicated for cardiomyopathy, end-stage coronary artery disease, and end-stage heart failure.
- B. No. Heart transplant is only indicated for congenital heart defects.
- C. Yes. You may require a heart transplant if you have another heart attack.
- D. Yes. Your heart will not function as well as it did before the heart attack, and a new heart will give you the best chance for survival.
Correct Answer: A
Rationale: In adults, heart transplantation is indicated for cardiomyopathy, end-stage coronary artery disease, and end-stage heart failure. In newborns and infants, heart transplantation is indicated for a severe congenital cardiac defect. It is performed only when other treatment modalities fail or are unavailable. It is not used to treat clients after an MI unless they meet any of the given criteria.
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A client has experienced a myocardial infarction (MI). After the acute stage of the MI, what is the most lethal complication the nurse should be aware can occur?
- A. Thrombophlebitis
- B. Ventricular aneurysm
- C. Mitral valve prolapse
- D. Septic shock
Correct Answer: B
Rationale: A ventricular aneurysm is the most lethal complication among clients who survive the acute stage of a myocardial infarction (MI). Thrombophlebitis is a complication of immobility. Mitral valve prolapse is an acquired disorder that is not a complication from having an MI. Cardiogenic shock, not septic shock, is a complication after sustaining an MI.
The nurse is caring for a client who has had cardiothoracic surgery, and the nurse is palpating the peripheral pulses. The nurse cannot palpate the left lower extremity pulse. What is the first action by the nurse?
- A. Call the physician.
- B. Call the charge nurse.
- C. Apply a vasodilator such as nitroglycerin cream on the skin surface and then palpate.
- D. Use a Doppler ultrasound device.
Correct Answer: D
Rationale: Palpate the peripheral pulses or use a Doppler ultrasound device if the pulses are not palpable. Prior to calling the physician or notifying the charge nurse, attempt to use the Doppler, and then, if no pulse is heard, the nurse may notify either. Administration of medications without a physician's prescription is contraindicated.
A client has just had cardiothoracic surgery and tells the nurse about having a 6-month-old grandchild. The client states, 'I can't wait to hold my grandchild!' What is the best response by the nurse?
- A. I bet your grandchild is wonderful, and I know you are glad you made it through the surgery.
- B. I am sure you are excited to see your grandchild, but you must refrain from lifting, pushing, or pulling anything over 10 pounds for at least 6 to 12 weeks.
- C. You will not be able to lift that grandchild for at least 6 months, but you can sit with him and play.
- D. You have done so well after your surgery, and there are no restrictions for your activities.
Correct Answer: B
Rationale: The client must refrain from lifting, pushing, or pulling anything that weighs more than 10 lb. until the physician relieves the restriction in approximately 6 to 12 weeks. Telling the client 'I know you are glad you made it through the surgery' is not an informative or therapeutic response. Six months for lifting is an excessive time frame for activity to resume. There are several restrictions that the client should be made aware of during the postoperative time period.
After being discharged from the hospital after undergoing cardiothoracic surgery, the client asks the nurse when it will be possible to resume sexual activity. What is the best response by the nurse?
- A. I can't believe you are worried about that so soon after your surgery.
- B. You won't be able to resume sexual activity until your 6-month checkup with the surgeon.
- C. In about 2 to 4 weeks if you are able to climb stairs without difficulty breathing or chest pain.
- D. You may have a difficult time resuming sexual activities after this surgery.
Correct Answer: C
Rationale: Sexual relations usually can be resumed in 2 to 4 weeks after cardiothoracic surgery depending on one's comfort level and tolerance for activity; climbing two flights of stairs without dyspnea or chest pain is a common guideline. The other options are nontherapeutic responses to the client's concern. Six months is an excessively long time period to wait if the client has been able to resume activities without shortness of breath or chest pain.
A nurse caring for a client who has had cardiac surgery must understand how pulmonary artery pressure is monitored. What is important about pulmonary artery pressure?
- A. Aids in early treatment of right-sided congestive heart failure
- B. Aids in the early treatment of fluid imbalances
- C. Assesses right-sided heart pressures
- D. Assesses left atrial heart pressures
Correct Answer: B
Rationale: Pulmonary artery pressure monitoring aids in the early treatment of fluid imbalances, prevents left-sided congestive heart failure or promotes its early correction, and helps monitor the client's response to treatment. The other options are incorrect. The measurement of pulmonary artery pressure does not assess right-sided heart pressures or left atrial pressure.