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The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The patients ECG shows dysrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy?
- A. Cardiac catheterization
- B. Arterial blood gases
- C. Echocardiogram
- D. Exercise stress test
Correct Answer: C
Rationale: The echocardiogram is one of the most helpful diagnostic tools because the structure and function of the ventricles can be observed easily. The ECG is also important, and can demonstrate dysrhythmias and changes consistent with left ventricular hypertrophy. Cardiac catheterization specifically addresses coronary artery function and arterial blood gases evaluate gas exchange and acid balance. Stress testing is not normally used to differentiate cardiomyopathy from other cardiac pathologies.
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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.
The nurse on the hospitals infection control committee is looking into two cases of hospital-acquired infective endocarditis among a specific classification of patients. What classification of patients would be at greatest risk for hospital-acquired endocarditis?
- A. Hemodialysis patients
- B. Patients on immunoglobulins
- C. Patients who undergo intermittent urinary catheterization
- D. Children under the age of 12
Correct Answer: A
Rationale: Hospital-acquired infective endocarditis occurs most often in patients with debilitating disease or indwelling catheters and in patients who are receiving hemodialysis or prolonged IV fluid or antibiotic therapy. Patients taking immunosuppressive medications or corticosteroids are more susceptible to fungal endocarditis. Patients on immunoglobulins, those who need in and out catheterization, and children are not at increased risk for nosocomial infective endocarditis.
The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse best respond?
- A. Azathioprine decreases the risk of thrombus formation.
- B. Azathioprine ensures adequate cardiac output.
- C. Azathioprine increases the number of white blood cells.
- D. Azathioprine minimizes rejection of the transplant.
Correct Answer: D
Rationale: After heart transplant, patients are constantly balancing the risk of rejection with the risk of infection. Most commonly, patients receive cyclosporine or tacrolimus (FK506, Prograf), azathioprine (Imuran), or mycophenolate mofetil (CellCept), and corticosteroids (prednisone) to minimize rejection. Cyclosporine does not prevent thrombus formation, enhance cardiac output, or increase white cell counts.
The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite?
- A. The procedure can be performed on an outpatient basis in a physicians office.
- B. Repaired valves tend to function longer than replaced valves.
- C. The procedure is not associated with a risk for infection.
- D. Lower doses of antirejection drugs are required than with valve replacement.
Correct Answer: B
Rationale: In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and patients do not require continuous anticoagulation. Valvuloplasty carries a risk of infection, like all surgical procedures, and it is not performed in a physicians office. Antirejection drugs are unnecessary because foreign tissue is not introduced.
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.