Which information should the registered nurse include when teaching the client about the prescribed transdermal nitroglycerin patch? Select all that apply.

Rationale for Correct Condition

Endocarditis is characterized by persistent fever, chills, night sweats, fatigue, and embolic manifestations. The presence of mitral valve vegetation on echocardiogram, elevated inflammatory markers, and history of a recent dental infection suggest infective endocarditis rather than pulmonary embolism, tuberculosis, or pneumonia.

Rationale for Correct Actions

Blood cultures confirm bacterial presence and identify the causative organism, guiding antibiotic therapy. Antibiotics are the cornerstone of treatment, targeting the infecting microorganism to prevent systemic complications and cardiac damage.

Rationale for Correct Parameters

Temperature is a key indicator of infection severity and response to antibiotics. Persistent fever may indicate treatment failure or complications. Heart murmur reflects valvular dysfunction from vegetations and must be monitored for progression to heart failure or embolic events.

Rationale for Incorrect Conditions

Pulmonary embolism presents with acute dyspnea and pleuritic chest pain but lacks fever or cardiac involvement. Tuberculosis is associated with chronic cough, night sweats, and lung involvement, which are absent here. Pneumonia causes localized lung infiltrates and productive cough, not cardiac vegetations.

Rationale for Incorrect Actions

Anticoagulant medication is used for thromboembolic conditions but does not treat infective endocarditis. Isolation precautions are needed for airborne pathogens like tuberculosis, not bacterial endocarditis. Bronchodilators are used for airway constriction in COPD or asthma, not cardiac infections.

Rationale for Incorrect Parameters

Sputum specimens are relevant for pulmonary infections but not endocarditis. Pain level is not a direct indicator of endocarditis progression. Partial thromboplastin time monitors coagulation but is unnecessary in the absence of anticoagulation therapy.

Choice A rationale

Limiting exercise to 10 minutes, 2 days per week is insufficient for cardiovascular health. Current recommendations generally advise at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities at least two days a week, to reduce the risk of heart disease.

Choice B rationale

Monitoring blood pressure is a crucial preventative measure for heart disease. Hypertension is a major risk factor for cardiovascular diseases, including coronary artery disease, stroke, and heart failure. Regular blood pressure monitoring allows for early detection and management of elevated blood pressure, reducing the risk of these complications. A normal blood pressure is typically considered to be less than 120/80 mmHg.

Choice C rationale

Losing weight if necessary is an important recommendation for preventing heart disease. Obesity and being overweight are significant risk factors for hypertension, dyslipidemia, type 2 diabetes, and sleep apnea, all of which increase the risk of heart disease. Achieving and maintaining a healthy weight through diet and exercise can significantly reduce cardiovascular risk.

Choice D rationale

Eating a diet high in saturated fats increases the risk of heart disease. Saturated fats can raise low-density lipoprotein (LDL) cholesterol levels, which contribute to the formation of atherosclerotic plaques in the arteries, increasing the risk of coronary artery disease and stroke. Dietary guidelines recommend limiting saturated fat intake.

Choice E rationale

Maintaining the current cholesterol level may not be a preventative measure if the current cholesterol level is elevated. High levels of LDL cholesterol are a major risk factor for heart disease. Preventative measures often include lifestyle modifications and, if necessary, medication to lower elevated cholesterol levels to reduce cardiovascular risk. Normal total cholesterol is generally less than 200 mg/dL, LDL cholesterol less than 100 mg/dL, and HDL cholesterol greater than 60 mg/dL.