Nokea
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.
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An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patients echocardiogram?
- A. Blood to flow back from the aorta to the left ventricle
- B. Obstruction of blood flow from the left ventricle
- C. Blood to flow back from the left atrium to the left ventricle
- D. Obstruction of blood from the left atrium to left ventricle
Correct Answer: A
Rationale: Aortic regurgitation occurs when the aortic valve does not completely close, and blood flows back to the left ventricle from the aorta during diastole. Aortic regurgitation does not cause obstruction of blood flow from the left ventricle, blood to flow back from the left atrium to the left ventricle, or obstruction of blood from the left atrium to left ventricle.
A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient?
- A. Patients generally stay in the hospital for 6 to 8 days.
- B. Patients are kept in the hospital until they are independent with all aspects of their care.
- C. Patients need to stay in the hospital until they regain normal heart function for their age.
- D. Patients usually remain at the hospital for 24 to 48 hours.
Correct Answer: D
Rationale: After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the patient does not need to be wholly independent prior to discharge.
The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis?
- A. Wheezes
- B. Friction rub
- C. Fine crackles
- D. Coarse crackles
Correct Answer: B
Rationale: A pericardial friction rub is diagnostic of pericarditis. Crackles are associated with pulmonary edema and fluid accumulation, whereas wheezes signal airway constriction; neither of these occurs with pericarditis.
A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?
- A. Exposure to immunocompromised individuals
- B. Future hospital admissions
- C. Dental procedures
- D. Live vaccinations
Correct Answer: C
Rationale: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.
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.