The nurse is reviewing the diagnostic and laboratory results for a client with heart failure who presents with dyspnea. Which result would be a priority for the nurse to report to the healthcare provider?

BNP 700pg/ml (<100pg/ml)

Chest x-ray shows cardiomegaly

Hematocrit 35% (37-47%)

Echocardiogram with ejection fraction of 60% (normal is 55-75%)

Answer and Explanation

The Correct Answer is A

a. BNP 700pg/ml (<100pg/ml)

Rationale: B-type natriuretic peptide (BNP) is a biomarker used to diagnose and assess the severity of heart failure. Elevated BNP levels indicate increased ventricular stretch and fluid overload, both of which are indicative of worsening heart failure. A BNP level of 700pg/ml is significantly elevated compared to the normal range (<100pg/ml) and suggests acute exacerbation or decompensation of heart failure, requiring prompt intervention and management adjustment.

b. Chest x-ray shows cardiomegaly: While cardiomegaly on chest x-ray is indicative of heart failure, it is a diagnostic finding rather than an acute result requiring immediate intervention. It would be important to address but may not require urgent reporting unless accompanied by acute symptoms.

c. Hematocrit 35% (37-47%): A hematocrit of 35% falls at the lower end. While changes in hematocrit can indicate fluid volume status, this value alone does not indicate an urgent need for intervention or adjustment of therapy. It may warrant monitoring over time, but it is not an immediate concern.

d. Echocardiogram with ejection fraction of 60% (normal is 55-75%): An ejection fraction of 60% falls within the normal range and is not indicative of worsening heart failure. While it's essential to monitor ejection fraction in heart failure patients, this result alone does not suggest acute decompensation requiring immediate intervention.

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Correct Answer is ["B","C","D"]

Explanation

a. Monitor blood glucose: Monitoring blood glucose levels may not be directly related to the procedure itself unless the client has a pre-existing condition such as diabetes mellitus. However, it is important to monitor for any changes in blood glucose levels post-procedure, especially if the client received medications such as intravenous dextrose during the procedure.

b. Neurovascular check of lower extremities: Assessing neurovascular status of the lower extremities is crucial after percutaneous coronary revascularization via the left groin site. This procedure involves accessing the femoral artery, which carries the risk of compromising blood flow to the lower extremity. Assessing for pulses, capillary refill, sensation, and motor function helps identify any potential complications such as bleeding, hematoma, or vascular compromise.

c. Check coagulation studies: Checking coagulation studies, such as activated partial thromboplastin time (aPTT) or prothrombin time (PT/INR), may be necessary after percutaneous coronary revascularization, especially if anticoagulant medications such as heparin were used during the procedure. Monitoring coagulation studies helps assess the client's risk of bleeding or thrombosis post-procedure.

d. Continuous ECG monitoring: Continuous electrocardiogram (ECG) monitoring is essential after percutaneous coronary revascularization to monitor for any changes in cardiac rhythm, ST-segment elevation or depression, and ischemic events. This helps identify any potential complications such as arrhythmias, myocardial infarction, or ischemia.

e. Verify contrast dye allergies: Verifying contrast dye allergies is important before performing any procedure involving the use of contrast media, such as percutaneous coronary revascularization. Allergic reactions to contrast dye can range from mild itching or rash to severe anaphylaxis. Identifying any allergies beforehand allows the healthcare team to take appropriate precautions and choose alternative imaging techniques if necessary.

A. Aortic regurgitation B. Mitral valve prolapse C. Mitral stenosis D. Aortic stenosis

Correct Answer is D

Explanation

a. Aortic regurgitation: Aortic regurgitation involves the backflow of blood from the aorta into the left ventricle during diastole due to a dysfunctional aortic valve. While aortic regurgitation can cause symptoms such as dyspnea and chest pain, they are typically associated with exertion rather than occurring at rest or unrelated to activity.

b. Mitral valve prolapse: Mitral valve prolapse is characterized by the abnormal movement of the mitral valve leaflets into the left atrium during systole. While mitral valve prolapse can lead to symptoms such as palpitations, chest discomfort, and dyspnea, these symptoms are usually not unrelated to activity. They are often precipitated or exacerbated by physical exertion or stress.

c. Mitral stenosis: Mitral stenosis involves narrowing of the mitral valve opening, which obstructs blood flow from the left atrium to the left ventricle. Symptoms of mitral stenosis, such as dyspnea and chest discomfort, typically occur with exertion or during periods of increased cardiac demand rather than being unrelated to activity.

d. Aortic stenosis: Aortic stenosis is characterized by narrowing of the aortic valve opening, which obstructs blood flow from the left ventricle to the aorta. This obstruction leads to increased pressure in the left ventricle and can cause symptoms such as dyspnea (due to pulmonary congestion) and chest pain (angina) even at rest. These symptoms are often exacerbated during physical activity but can occur spontaneously as well.

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The nurse is reviewing the diagnostic and laboratory results for a client with heart failure who presents with dyspnea. Which result would be a priority for the nurse to report to the healthcare provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client after percutaneous coronary revascularization (PCR) via left groin site. Which assessments would the nurse obtain after the procedure? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

A client reports episode of dyspnea and chest pain unrelated to activity. Which valve disorder does the nurse suspect may be causing these symptoms?

Correct Answer is D

Explanation

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