Nokea
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.
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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.
The nurse is assessing a patient who has mitral valve regurgitation. Which of the following findings should be communicated to the health care provider immediately?
- A. 4+ peripheral edema in both legs
- B. Crackles audible to the lung apices
- C. A palpable thrill felt over the left anterior chest
- D. A loud systolic murmur all across the precordium
Correct Answer: B
Rationale: Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.
The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge concerning long-term management of rheumatic fever when a patient who is recovering from rheumatic fever says which of the following statements?
- A. I will need to have monthly antibiotic injections for 10 years or longer.
- B. I will need to take Aspirin or ibuprofen to relieve my joint pain.
- C. I will call the doctor if I develop excessive fatigue or difficulty breathing.
- D. I will be immune to further episodes of rheumatic fever after this infection.
Correct Answer: D
Rationale: Patients with a history of rheumatic fever are more susceptible to a second episode. The other patient statements are correct and would not support the nursing diagnosis of ineffective health maintenance.
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.
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.