A nurse is caring for a client who was admitted with hypertrophic cardiomyopathy (HCM). What order does the nurse anticipate providing?

Prepare for transcutaneous pacing.

Instructing the client to start an aerobic exercise plan.

Instruct the client to perform a Valsalva maneuver.

Preparing for a cardiac catheterization.

Answer and Explanation

The Correct Answer is D

A. Prepare for transcutaneous pacing: Transcutaneous pacing is used to treat symptomatic bradycardia or heart block, which are not primary concerns in hypertrophic cardiomyopathy. HCM typically involves obstruction of ventricular outflow and risk for arrhythmias, but pacing is not a first-line intervention.

B. Instructing the client to start an aerobic exercise plan: Aerobic exercise may increase the risk of sudden cardiac death in clients with HCM due to potential arrhythmias and increased myocardial oxygen demand. Exercise recommendations are usually individualized and often limited rather than broadly prescribed.

C. Instruct the client to perform a Valsalva maneuver: The Valsalva maneuver transiently decreases venous return and can exacerbate left ventricular outflow obstruction in HCM, potentially worsening symptoms. It is generally contraindicated rather than recommended.

D. Preparing for a cardiac catheterization: Cardiac catheterization may be indicated to assess the severity of left ventricular outflow obstruction, measure intracardiac pressures, and evaluate coronary anatomy in HCM. It is a diagnostic intervention that guides treatment planning, making it an anticipated order for newly admitted clients.

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Correct Answer is A

Explanation

A. Client took metformin 500 mg by mouth this morning: Metformin must be withheld before and for 48 hours after procedures involving iodinated contrast dye, such as a coronary arteriogram. Contrast can impair renal function, increasing the risk of lactic acidosis in clients taking metformin. The provider must be notified immediately.

B. Sinus bradycardia with a rate of 56 on the monitor: A heart rate of 56 bpm may be normal for some clients, especially those on beta-blockers. While it should be documented and monitored, it is not the priority concern prior to the procedure.

C. Client reports chest pain that occurred yesterday: Chest pain history is relevant but expected in clients undergoing coronary arteriography. Pain that occurred yesterday and is not current is less urgent than the metformin issue.

D. Blood glucose level 144 mg/dL: A glucose level of 144 mg/dL is mildly elevated but not critical in the context of this procedure. It does not pose the same immediate risk as contrast administration with recent metformin use.

A. Atrial flutter. B. Supraventricular Tachycardia. C. Atrial fibrillation. D. Sinus rhythm

Correct Answer is A

Explanation

A. Atrial flutter: The baseline shows a rapid, regular, and "saw-tooth" pattern of atrial activity. These are referred to as F-waves (flutter waves). Atrial flutter is characterized by rapid, regular atrial depolarizations with a consistent ventricular response. The rhythm is usually regular or regularly irregular depending on the AV conduction ratio.

B. Supraventricular Tachycardia: Supraventricular tachycardia (SVT) is a rapid, regular rhythm originating above the ventricles, often with a narrow QRS, but it does not display the characteristic sawtooth flutter waves seen in atrial flutter. SVT documentation would be incorrect if the flutter waves are clearly visible.

C. Atrial fibrillation: Atrial fibrillation presents with an irregularly irregular rhythm and absence of distinct P waves, replaced by chaotic fibrillatory waves. Unlike atrial flutter, atrial fibrillation does not show organized, repetitive atrial activity, making this label inaccurate for the described EKG.

D. Sinus rhythm: Sinus rhythm is defined by a normal P wave before each QRS complex with consistent rate and rhythm. Atrial flutter deviates from normal sinus activity due to abnormal atrial depolarizations and cannot be documented as sinus rhythm.

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A nurse is caring for a client who was admitted with hypertrophic cardiomyopathy (HCM). What order does the nurse anticipate providing?

Nursing Test Bank

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