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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.
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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.
A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm?
- A. Ventricular fibrillation (VF)
- B. Ventricular tachycardia (VT)
- C. Atrial fibrillation
- D. Sinus bradycardia
Correct Answer: C
Rationale: In patients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurses interview is most suggestive of this valvular disorder?
- A. I get chest pain from time to time, but it usually resolves when I rest.
- B. Sometimes when Im resting, I can feel my heart skip a beat.
- C. Whenever I do any form of exercise I get terribly short of breath.
- D. My feet and ankles have gotten terribly puffy the last few weeks.
Correct Answer: C
Rationale: The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpitations occur in some patients, but dyspnea is a characteristic early symptom. Peripheral edema and chest pain are atypical.
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.
A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease?
- A. Recognizing and promptly treating streptococcal infections
- B. Prophylactic use of calcium channel blockers in high-risk populations
- C. Adhering closely to the recommended child immunization schedule
- D. Smoking cessation
Correct Answer: A
Rationale: Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease.