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The nurse is providing discharge teaching for a patient with mitral valve prolapse (MVP) without valvular regurgitation. Which of the following patient statements indicate that teaching has been effective?
- A. Plan to take antibiotics before any dental appointments.
- B. Limit physical activity to avoid stressing the heart valves.
- C. Take one Aspirin a day to prevent embolization from the valve.
- D. Avoid use of over-the-counter (OTC) medications that contain stimulant drugs.
Correct Answer: D
Rationale: Use of stimulant medications should be avoided by patients with MVP since these may exacerbate symptoms. Daily Aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.
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Which of the following assessment information obtained by the nurse for a patient with aortic stenosis is most important to report to the health care provider?
- A. The patient complains of chest pain associated with ambulation.
- B. A loud systolic murmur is audible along the right sternal border.
- C. A thrill is palpable at the 2nd intercostal space, right sternal border.
- D. The point of maximum impulse (PMI) is at the left midclavicular line.
Correct Answer: A
Rationale: Chest pain occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic stenosis. A PMI at the left midclavicular line is normal.
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.
The nurse is caring for a patient who had an acute myocardial infarction (MI) 3 days prior and has symptoms of stabbing chest pain that increases with deep breathing. Which of the following actions should the nurse take first?
- A. Auscultate the heart sounds.
- B. Check the patient's oral temperature.
- C. Notify the patient's health care provider.
- D. Give the ordered acetaminophen.
Correct Answer: A
Rationale: The patient's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature, giving acetaminophen, and notifying the health care provider also are appropriate actions but would not be done before listening for a rub.
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).
The nurse is caring for a patient who has had recent cardiac surgery and develops pericarditis, with symptoms of chest pain at a level 6 (0-10 scale) with deep breathing. Which of the following prescribed PRN medications should the nurse administer?
- A. Fentanyl 2 mg IV
- B. Morphine sulphate 6 mg IV
- C. Ibuprofen 800 mg PO
- D. Acetaminophen 650 mg PO
Correct Answer: C
Rationale: The pain associated with pericarditis is caused by inflammation, so nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.