Nokea
The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following?
- A. Use of patient-controlled analgesia
- B. Long-term anticoagulant therapy
- C. Steroid therapy
- D. Use of IV diuretics
Correct Answer: B
Rationale: Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and patient-controlled analgesia may or may be not be used in the immediate postoperative period.
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The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?
- A. To eat a small meal before taking nitroglycerin
- B. To drink a glass of milk before taking nitroglycerin
- C. To engage in 15 minutes of light exercise before taking nitroglycerin
- D. To rest and relax before taking nitroglycerin
Correct Answer: D
Rationale: The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the patient about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects. Exercising, eating, and drinking are not recommended prior to using nitroglycerin.
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.
The nurse is creating a plan of care for a patient with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this patient?
- A. Absence of complications
- B. Adherence to the self-care program
- C. Improved cardiac output
- D. Increased activity tolerance
Correct Answer: C
Rationale: The priority nursing diagnosis of a patient with cardiomyopathy would include improved or maintained cardiac output. Regardless of the category and cause, cardiomyopathy may lead to severe heart failure, lethal dysrhythmias, and death. The pathophysiology of all cardiomyopathies is a series of progressive events that culminate in impaired cardiac output. Absence of complications, adherence to the self-care program, and increased activity tolerance should be included in the care plan, but they do not have the priority of improved cardiac output.
The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what?
- A. A decrease in gamma globulins
- B. An insect bite
- C. Rheumatic heart disease and its sequelae
- D. Sepsis and its sequelae
Correct Answer: C
Rationale: The most common cause of mitral valve regurgitation in developing countries is rheumatic heart disease and its sequelae.
The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding?
- A. Decreased ejection fraction
- B. Decreased heart rate
- C. Ventricular hypertrophy
- D. Mitral valve regurgitation
Correct Answer: A
Rationale: DCM is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. The ventricles have elevated systolic and diastolic volumes, but a decreased ejection fraction. Bradycardia and mitral valve regurgitation do not typically occur in patients with DCM.