A nurse is planning care for a client who has suspected cardiac tamponade. Which of the following diagnostic tests should the nurse anticipate the provider to order first?

Computed tomography (CT) scan

Chest x-ray

Echocardiogram

Electrocardiogram (ECG)

Answer and Explanation

The Correct Answer is C

A) Computed tomography (CT) scan: A CT scan may provide detailed images of the heart and surrounding structures, but it is not typically the initial diagnostic test used to assess for cardiac tamponade. CT scans are often used in conjunction with other diagnostic tests but are not the first-line investigation for suspected tamponade.

B) Chest x-ray: While a chest x-ray may show signs of cardiac tamponade, such as an enlarged cardiac silhouette or evidence of fluid accumulation around the heart, it is not as sensitive or specific as other diagnostic tests, particularly in the acute setting. Chest x-rays may be obtained as part of the diagnostic workup, but they are not the first-line test for suspected tamponade.

C) Echocardiogram: An echocardiogram is the most appropriate initial diagnostic test for suspected cardiac tamponade. It provides real-time imaging of the heart and can detect pericardial effusion, collapse of the right atrium and ventricle during diastole (diastolic collapse), and signs of hemodynamic compromise. Echocardiography allows for rapid assessment at the bedside and can guide immediate management decisions.

D) Electrocardiogram (ECG): While an electrocardiogram may show nonspecific changes in cardiac tamponade, such as low-voltage QRS complexes or electrical alternans, it is not as sensitive or specific as an echocardiogram for diagnosing tamponade. ECG findings may support the diagnosis but are not typically the first-line test for suspected tamponade.

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Correct Answer is D

Explanation

A. A CT angiogram will reveal any edema within the brain tissue: CT angiography primarily focuses on visualizing blood vessels and blood flow within the brain. While it may incidentally detect areas of edema, its primary purpose is to assess vascular structures rather than brain tissue changes such as edema.

B. A CT angiogram will reveal any overproduction of cerebrospinal fluid (CSF): CT angiography does not assess cerebrospinal fluid (CSF) production. Its main function is to visualize blood vessels and blood flow within the brain, particularly to detect abnormalities such as aneurysms, arteriovenous malformations, or vasospasm.

C. A CT angiogram will reveal any fractures within the skull or spine: CT angiography primarily focuses on imaging blood vessels and is not the preferred modality for detecting fractures within the skull or spine. CT scans or plain radiography are typically used to assess bony structures for fractures.

D. A CT angiogram will reveal any decreased blood flow related to vasospasm: This statement is correct. CT angiography is a specialized imaging technique that combines computed tomography (CT) scanning with contrast dye to visualize blood vessels and blood flow within the brain. It is commonly used to detect and monitor vasospasm, a potentially serious complication of subarachnoid hemorrhage, where blood vessels in the brain constrict, leading to decreased blood flow. CT angiography allows for the visualization of these changes in blood vessel diameter and blood flow dynamics.

A. Elevated erythrocyte sedimentation rate (ESR) B. Increased C-reactive protein (CRP) C. Elevated thyroid-stimulating hormone (TSH) D. Increased brain natriuretic peptide (BNP) E. Increased troponin I

Correct Answer is ["A","B","D","E"]

Explanation

A. Elevated erythrocyte sedimentation rate (ESR): Elevated ESR is commonly seen in inflammatory conditions such as pericarditis. ESR measures the rate at which red blood cells settle in a tube of blood over a certain period, and elevated levels indicate inflammation or tissue damage.

B. Increased C-reactive protein (CRP): CRP is an acute-phase reactant produced by the liver in response to inflammation. Elevated CRP levels are indicative of inflammation, making it a useful marker in pericarditis.

C. Elevated thyroid-stimulating hormone (TSH): Elevated TSH levels are not typically associated with pericarditis. TSH is a hormone produced by the pituitary gland that stimulates the thyroid gland to produce thyroid hormones. Elevated TSH levels are seen in conditions such as hypothyroidism.

D. Increased brain natriuretic peptide (BNP): BNP is a hormone produced by the heart in response to increased pressure and volume overload. Pericarditis can lead to increased pressure within the heart, resulting in elevated BNP levels. Therefore, increased BNP levels are anticipated in pericarditis.

E. Increased troponin I: Troponin I is a cardiac biomarker released into the bloodstream when there is damage to cardiac muscle cells. While pericarditis primarily involves inflammation of the pericardium (the sac surrounding the heart), severe cases can lead to myocardial involvement and subsequent release of troponin I. Therefore, increased troponin I levels may be observed in pericarditis, especially if there is myocardial involvement.

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A nurse is planning care for a client who has suspected cardiac tamponade. Which of the following diagnostic tests should the nurse anticipate the provider to order first?

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Correct Answer is ["A","B","D","E"]

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