A nurse is planning care for a client who has hypertrophic cardiomyopathy that has not improved after pharmacologic treatment. Which of the following procedures should the nurse anticipate the health care provider ordering?

Pericardiocentesis

Septal myectomy

Pericardial window

Synchronized electrical cardioversion

Answer and Explanation

The Correct Answer is B

A. Pericardiocentesis: Pericardiocentesis is a procedure used to drain fluid from the pericardial sac, typically performed in cases of pericardial effusion or cardiac tamponade. It is not indicated for the treatment of hypertrophic cardiomyopathy (HCM), which involves structural abnormalities of the heart muscle rather than pericardial fluid accumulation.

B. Septal myectomy: Septal myectomy is a surgical procedure performed to treat hypertrophic obstructive cardiomyopathy (HOCM), a subtype of hypertrophic cardiomyopathy characterized by thickening of the interventricular septum and dynamic left ventricular outflow tract obstruction. Septal myectomy involves the surgical removal of a portion of the hypertrophied septum to relieve left ventricular outflow tract obstruction and improve symptoms.

C. Pericardial window: A pericardial window is a surgical procedure used to create a communication between the pericardial sac and the pleural space, typically performed in cases of recurrent pericardial effusion or tamponade to prevent fluid re-accumulation. It is not indicated for the treatment of hypertrophic cardiomyopathy.

D. Synchronized electrical cardioversion: Synchronized electrical cardioversion is a procedure used to restore normal sinus rhythm in patients with certain types of cardiac arrhythmias, such as atrial fibrillation or atrial flutter. It is not typically indicated for the treatment of hypertrophic cardiomyopathy, although patients with HCM may develop arrhythmias as a complication.

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

Explanation

A. Difficulty swallowing: Difficulty swallowing is not typically associated with atrial fibrillation. It may be a symptom of various other conditions such as dysphagia, esophageal disorders, or neurological disorders, but it is not a common manifestation of atrial fibrillation.

B. Shortness of breath: This is the correct answer. Shortness of breath, or dyspnea, is a common symptom of atrial fibrillation. Atrial fibrillation can lead to ineffective atrial contraction, resulting in decreased cardiac output and potential fluid accumulation in the lungs, leading to dyspnea.

C. Exertional fatigue: This is the correct answer. Exertional fatigue, or feeling excessively tired or weak with physical activity, is a common manifestation of atrial fibrillation. Reduced cardiac output and inefficient heart function due to irregular heart rhythms can lead to fatigue, especially during exertion.

D. Weight gain: Weight gain is not typically associated with atrial fibrillation. While some individuals with heart conditions may experience fluid retention and subsequent weight gain, it is not a specific manifestation of atrial fibrillation itself.

A. Pooling of blood and edema around the eyes B. Ability to recall how the injury occurred C. Bruising over the mastoid process D. Chvostek’s sign

Correct Answer is A

Explanation

A. Pooling of blood and edema around the eyes: Basilar skull fractures can lead to leakage of cerebrospinal fluid (CSF) into the surrounding tissues, resulting in periorbital ecchymosis, also known as raccoon eyes, due to pooling of blood and edema around the eyes. This finding is characteristic of basilar skull fractures and is caused by disruption of the meninges and subsequent CSF leakage into the soft tissues of the face.

B. Ability to recall how the injury occurred: Memory loss regarding the events surrounding the injury, known as post-traumatic amnesia, is common with basilar skull fractures. This amnesia occurs due to the impact of the injury on the brain and may involve retrograde amnesia (loss of memory of events leading up to the injury) and anterograde amnesia (loss of memory of events occurring after the injury).

C. Bruising over the mastoid process: Bruising over the mastoid process, known as Battle sign, is associated with basilar skull fractures. Battle sign results from blood accumulation (hematoma) in the mastoid region behind the ear due to fracture-related injury to the middle meningeal artery or other blood vessels. This finding typically develops 24-48 hours after the injury.

D. Chvostek’s sign: Chvostek's sign is a clinical manifestation of hypocalcemia, not basilar skull fractures. It is elicited by tapping the facial nerve (facial nerve spasm) and is indicative of neuromuscular irritability due to decreased calcium levels. Chvostek's sign is not directly related to basilar skull fractures.

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A nurse is planning care for a client who has hypertrophic cardiomyopathy that has not improved after pharmacologic treatment. Which of the following procedures should the nurse anticipate the health care provider ordering?

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