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)
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A decrease in systolic blood pressure greater than 10 mm Hg during inspiration: Pulsus paradoxus is an exaggerated decrease in systolic blood pressure during inspiration. Normally, there is a slight decrease in systolic blood pressure during inspiration due to increased intrathoracic pressure and decreased venous return to the heart. However, in conditions such as cardiac tamponade or severe asthma exacerbations, the decrease in systolic blood pressure during inspiration is more pronounced (>10 mm Hg), indicating impaired cardiac output and decreased left ventricular filling during inspiration.
B. A decrease in heart rate greater than 10/min when lying down: This finding is not indicative of pulsus paradoxus. Pulsus paradoxus primarily refers to changes in systolic blood pressure during inspiration rather than alterations in heart rate when lying down.
C. An increase in diastolic blood pressure greater than 10 mm Hg during inspiration: This finding is not indicative of pulsus paradoxus. Pulsus paradoxus is characterized by an exaggerated decrease in systolic blood pressure during inspiration, not changes in diastolic blood pressure.
D. An increase in heart rate greater than 20/min when standing: This finding is not indicative of pulsus paradoxus. Pulsus paradoxus primarily refers to changes in systolic blood pressure during inspiration rather than alterations in heart rate when standing.
Correct Answer is C
Explanation
A. Lisinopril: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor commonly used to treat hypertension and heart failure. It is not typically contraindicated for cataract extraction surgery, and it does not significantly increase the risk of bleeding.
B. Synthroid: Synthroid is a synthetic form of thyroid hormone used to treat hypothyroidism. It does not have any direct contraindications with cataract extraction surgery and does not significantly increase the risk of bleeding.
C. Clopidogrel: Clopidogrel is an antiplatelet medication commonly used to prevent blood clots in individuals with cardiovascular diseases such as coronary artery disease or recent myocardial infarction. However, it can increase the risk of bleeding, which may be problematic during cataract extraction surgery. Therefore, it is important to question administering clopidogrel prior to the procedure and potentially coordinate with the healthcare provider regarding its management.
D. Omeprazole: Omeprazole is a proton pump inhibitor used to reduce stomach acid production and treat conditions such as gastroesophageal reflux disease (GERD) and peptic ulcer disease. It does not have any direct contraindications with cataract extraction surgery and does not significantly increase the risk of bleeding.
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