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A client was driving a car without wearing a seat belt and slid off the road and hit a tree. The client's chest was crushed against a steering wheel. What type of lethal injury does the nurse anticipate the client may have suffered?
- A. Cardiac tamponade
- B. A pleural effusion
- C. Bladder trauma
- D. Fractured pelvis
Correct Answer: A
Rationale: A nonpenetrating injury of the chest, such as being crushed against a steering wheel, may cause bruising and bleeding of the heart. Because the pericardium encloses the heart, blood accumulates in the pericardial space, resulting in cardiac tamponade. Although a fractured pelvis and bladder trauma may be sustained, they are generally not lethal. A pleural effusion would not result from this traumatic injury.
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The nurse is caring for a client who is having a mitral valve replacement with a mechanical valve. What instructions should the nurse be sure the client understands prior to being discharged?
- A. The valve should last for 10 to 15 years.
- B. The client will require anticoagulation.
- C. There is a low potential for thrombi formations so anticoagulation is not necessary.
- D. The valve is prone to calcification.
Correct Answer: B
Rationale: A mechanical valve should last at least 20 years. The disadvantages are the risk for thrombi and emboli, so anticoagulation is necessary. There is a risk of bleeding, and there can be a sudden malfunction in the valve. An allograft will last 10 to 15 years. A bioprosthetic valve does not require anticoagulation but is prone to deterioration and calcification.
A client had a cardiac transplant 6 weeks ago. The client calls the clinic and informs the nurse he has a fever of $101^{\circ} \mathrm{F}$, chest tenderness, and flulike symptoms. What does the nurse suspect the client is experiencing?
- A. Hyperacute rejection
- B. Acute rejection
- C. Chronic rejection
- D. Subacute rejection
Correct Answer: B
Rationale: Acute rejection occurs from 1 week to 3 months after the transplant; almost all transplant recipients experience acute rejection to some degree. Hyperacute rejection is rare and occurs within a few minutes of the transplant when the donor organ and recipient are extremely mismatched. Chronic rejection may occur at any time over the remaining lifetime of a recipient, causing varying degrees of damage to the donor heart. Subacute rejection is not a classification of rejection.
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.
The pathophysiology instructor is discussing heart disease with a class of prenursing students. One of the students asks what indications there are for coronary artery bypass surgery. What would be an acceptable answer(s) from the instructor? Select all that apply.
- A. Atheromas are calcified and noncompressible.
- B. The heart cannot be repaired without compromising oxygenation of the body.
- C. The client has multiple coronary artery occlusions.
- D. Transluminal coronary angioplasty is necessary.
- E. The Anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter.
Correct Answer: A,B,E
Rationale: A coronary artery bypass is performed when (1) the client has multiple coronary artery occlusions, (2) the atheromas are calcified and noncompressible, or (3) the anatomic location of the occlusion(s) interferes with the safe insertion of a coronary artery catheter. This makes the other options incorrect.
A client is at the clinic for follow-up after cardiothoracic surgery and tells the nurse, 'I don't know what is wrong with me. I don't want to eat, and I feel depressed.' What is the best response by the nurse to this statement?
- A. I think we need to get you in to see a psychiatrist.
- B. There should be no reason for you to be depressed. You came through the surgery fine.
- C. It may take several weeks for your appetite to return, and the depression is normal and temporary.
- D. You need to tell the physician because this could be serious.
Correct Answer: C
Rationale: Discharge instruction should be given prior to the client leaving the hospital about it taking several weeks for a normal appetite to return and that depression is normal and temporary. The client does not need psychiatric help at this point but may benefit from a support group with other clients that have had cardiothoracic surgery. Telling a client there is no reason for being depressed is nontherapeutic and demeans the client's feelings. Telling the client to inform the physician because the depression could be serious could cause alarm.