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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).
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The nurse is taking a health history from a 24-year-old patient with hypertrophic cardiomyopathy (HC). Which of the following information obtained by the nurse is most relevant?
- A. The patient reports using cocaine once at age 16.
- B. The patient has a history of a recent upper respiratory infection.
- C. The patient's 29-year-old brother had a sudden cardiac arrest.
- D. The patient has a family history of coronary artery disease.
Correct Answer: C
Rationale: About half of all cases of HC have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people, the information about the patient's brother will be helpful in planning care (such as an automatic implantable cardioverter-defibrillator [AICD]) for the patient and in counseling other family members. The patient should be counseled against use of stimulant drugs, but the one-time use indicates that the patient is not at current risk for cocaine use. Viral infections and CAD are risk factors for dilated cardiomyopathy, but not for HC.
The nurse is caring for a patient with infective endocarditis of the tricuspid valve. Which of the following findings should the nurse plan to monitor for the presence of endocarditis in the patient?
- A. Dyspnea
- B. Flank pain
- C. Hemiparesis
- D. Splenomegaly
Correct Answer: A
Rationale: Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain, hemiparesis, and splenomegaly would be associated with embolization from the left-sided valves.
The nurse is conducting discharge teaching about the need for prophylactic antibiotics when having dental procedures. This teaching would be provided to a patient with which of the following diagnoses?
- A. Acute myocardial infarction
- B. Exacerbation of heart failure
- C. Mechanical mitral valve replacement
- D. Rheumatic fever after a streptococcal infection
Correct Answer: C
Rationale: Current guidelines recommend the use of prophylactic antibiotics before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at risk for IE.
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.
The nurse is caring for a patient with rheumatic fever who has subcutaneous nodules, erythema marginatum, and polyarthritis. Which of the following nursing diagnoses best reflects these findings?
- A. Activity intolerance related to physical deconditioning (arthralgia)
- B. Risk for infection as evidenced by immunosuppression
- C. Chronic pain related to injury agent (permanent joint fixation)
- D. Risk for impaired skin integrity evidenced by pressure over bony prominence
Correct Answer: A
Rationale: The patient's joint pain will lead to difficulty with activity. The skin lesions seen in rheumatic fever are not open or pruritic and thus do not pose a high risk for infection. Although acute joint pain will be a problem for this patient, joint inflammation is a temporary clinical manifestation of rheumatic fever and is not associated with permanent joint changes.