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A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease?
- A. Recognizing and promptly treating streptococcal infections
- B. Prophylactic use of calcium channel blockers in high-risk populations
- C. Adhering closely to the recommended child immunization schedule
- D. Smoking cessation
Correct Answer: A
Rationale: Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease.
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A patient with pericarditis has just been admitted to the CCU. The nurse planning the patients care should prioritize what nursing diagnosis?
- A. Anxiety related to pericarditis
- B. Acute pain related to pericarditis
- C. Ineffective tissue perfusion related to pericarditis
- D. Ineffective breathing pattern related to pericarditis
Correct Answer: B
Rationale: The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Anxiety is highly plausible and should be addressed, but chest pain is a nearly certain accompaniment to the disease. Breathing and tissue perfusion are likely to be at risk, but pain is certain, especially in the early stages of treatment.
A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty?
- A. For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.
- B. Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well.
- C. Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay.
- D. Its prudent to get a second opinion before deciding to have valvuloplasty.
Correct Answer: A
Rationale: Some valvuloplasty procedures do not require general anesthesia or cardiopulmonary bypass and can be performed in a cardiac catheterization laboratory or hybrid room. Open heart surgery is not required and the procedure does not carry exceptional risks that would designate it as being dangerous. Normally there is no need for the nurse to advocate for a second opinion.
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 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.
A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patients most recent laboratory results, the nurse should prioritize assessment of which of the following?
- A. Sodium
- B. AST, ALT, and bilirubin
- C. White blood cell differential
- D. BUN
Correct Answer: A
Rationale: Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels. Consequently, sodium levels are followed more closely than other important laboratory values, including BUN, leukocytes, and liver function tests.