Nokea
The nurse is admitting a patient with possible acute pericarditis. Which of the following diagnostic assessments should the nurse plan to teach the patient about?
- A. Electrolyte levels
- B. Echocardiography
- C. Daily blood cultures
- D. Cardiac catheterization
Correct Answer: B
Rationale: Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization is not a diagnostic procedure for pericarditis. Electrolyte levels are not helpful in making a diagnosis of pericarditis.
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The nurse is planning care for a patient hospitalized with a streptococcal infective endocarditis (IE). Which of the following interventions should the nurse anticipate?
- A. Monitor laboratories for streptococcal antibodies.
- B. Arrange for insertion of a long-term IV catheter.
- C. Encourage the patient to get regular aerobic exercise.
- D. Teach the importance of completing all oral antibiotics.
Correct Answer: B
Rationale: Treatment for IE involves 4-6 weeks of IV antibiotic therapy in order to eradicate the bacteria, which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line. Rest periods and limiting physical activity to a moderate level are recommended during the treatment for IE. Oral antibiotics are not effective in eradicating the infective bacteria that cause IE. Blood cultures, rather than antibody levels, are used to monitor the effectiveness of antibiotic therapy.
The nurse is caring for a patient with acute dyspnea and is diagnosed with dilated cardiomyopathy. Which of the following information should the nurse include when teaching the patient about management of this disorder?
- A. Elevating the legs above the heart will help relieve angina.
- B. No more than two alcoholic drinks daily are recommended.
- C. Careful adherence to diet and medication regimen will prevent heart failure.
- D. Notify the health care provider about any symptoms of heart failure.
Correct Answer: D
Rationale: The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good adherence to therapy may have recurrent episodes of heart failure. The patient is instructed to avoid alcoholic beverages. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy).
Which of the following prescriptions written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever should the nurse implement first?
- A. Order blood cultures drawn from two sites.
- B. Give acetaminophen (Tylenol) PRN for fever.
- C. Administer ceftriaxone 1 g IV
- D. Obtain a transesophageal echocardiogram.
Correct Answer: A
Rationale: Treatment of the IE with antibiotics should be started as quickly as possible, but it is essential to obtain blood cultures before initiating antibiotic therapy to obtain accurate sensitivity results. The echocardiogram and Tylenol administration also should be implemented rapidly, but the blood cultures (and then administration of the antibiotic) have the highest priority.
Which of the following techniques should the nurse use to assess the patient with pericarditis for the presence of a pericardial friction rub?
- A. Auscultate with the stethoscope diaphragm at the lower left sternal border.
- B. Listen for a rumbling, low-pitched, systolic sound over the left anterior chest.
- C. Feel the precordial area with the palm of the hand to detect vibration with cardiac contraction.
- D. Ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub.
Correct Answer: A
Rationale: Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. Because dyspnea is one clinical manifestation of pericarditis, the nurse should time the friction rub with the pulse rather than ask the patient to stop breathing during auscultation. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.
The nurse is caring for a patient with aortic stenosis and establishes a nursing diagnosis of acute pain related to decreased coronary blood flow. Which of the following interventions is best?
- A. Promote rest to decrease myocardial oxygen demand.
- B. Educate the patient about the need for anticoagulant therapy.
- C. Teach the patient to use sublingual nitroglycerin for chest pain.
- D. Elevate the head of the bed 60 degrees to decrease venous return
Correct Answer: A
Rationale: Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.