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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.
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The nurse is obtaining a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which of the following questions by the nurse is best?
- A. Have you been to the dentist lately?
- B. Do you have a history of a heart attack?
- C. Is there a family history of endocarditis?
- D. Have you had any recent immunizations?
Correct Answer: A
Rationale: Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk factors for IE.
Which of the following findings in a patient with infective endocarditis (IE) is most important for the nurse to communicate to the health care provider?
- A. Generalized muscle aching
- B. Sudden onset left flank pain
- C. Janeway's lesions on the palms
- D. Temperature 38.1°C
Correct Answer: B
Rationale: Sudden onset of flank pain indicates possible embolization to the kidney and may require diagnostic testing such as a renal arteriogram and interventions to improve renal perfusion. The other findings are typically found in IE but do not require any new interventions.
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.
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.