A nurse is teaching a client who has arrhythmogenic cardiomyopathy about the risk for sudden cardiac death. Which of the following client statements indicates to the nurse an understanding of the teaching?

"I should ask my son to drive me to the grocery store."

"l will probably become easily constipated."

"l am aware that I may develop frequent hiccups."

"I will need to avoid strenuous activity to prevent my heart from stopping."

Answer and Explanation

The Correct Answer is D

A. "I should ask my son to drive me to the grocery store." This statement does not directly address the risk for sudden cardiac death associated with arrhythmogenic cardiomyopathy. While it may be a valid safety precaution to have someone else drive, it does not specifically address the client's understanding of the condition and its implications for sudden cardiac death.

B. "I will probably become easily constipated." Constipation is not a typical manifestation or complication of arrhythmogenic cardiomyopathy. This statement does not demonstrate an understanding of the condition and its associated risk of sudden cardiac death.

C. "I am aware that I may develop frequent hiccups." Frequent hiccups are not a characteristic symptom or complication of arrhythmogenic cardiomyopathy. This statement does not indicate an understanding of the condition and its risk for sudden cardiac death.

D. "I will need to avoid strenuous activity to prevent my heart from stopping." This statement reflects an understanding of the condition and its associated risk of sudden cardiac death. Strenuous activity can exacerbate arrhythmias in individuals with arrhythmogenic cardiomyopathy, potentially leading to life-threatening arrhythmias such as ventricular fibrillation. Avoiding strenuous activity is a recommended precaution to reduce the risk of sudden cardiac death in individuals with this condition.

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Correct Answer is C

Explanation

A. Lower blood pressure: Lowering blood pressure may be indicated in certain cases of brain herniation to reduce cerebral perfusion pressure (CPP) and decrease cerebral blood volume. However, this intervention should be carefully titrated based on the individual client's condition and should not be applied universally as a treatment for brain herniation. In some cases, lowering blood pressure may exacerbate cerebral ischemia and worsen neurological outcomes.

B. Decrease sedation: Reducing sedation may be necessary to allow for neurological assessment and evaluation of the client's neurological status. However, it is not a direct treatment for brain herniation. Sedation may need to be adjusted to facilitate neurological monitoring and assessment of the client's response to treatment interventions. Excessive sedation can obscure neurological signs and symptoms, making it difficult to assess the effectiveness of interventions aimed at reducing ICP.

C. Hyperventilate the client: Hyperventilation is a potential intervention for managing brain herniation as it helps temporarily lower intracranial pressure (ICP) by inducing cerebral vasoconstriction. By increasing the rate and depth of breathing, hyperventilation reduces the partial pressure of carbon dioxide (PaCO2) in the blood, leading to vasoconstriction of cerebral blood vessels and a decrease in cerebral blood flow. This can help alleviate symptoms associated with increased ICP and reduce the risk of further brain injury.

D. Reduce the temperature in the room: Therapeutic hypothermia may be considered as a treatment option in certain cases of brain injury to reduce metabolic demand, lower ICP, and attenuate secondary brain injury. However, simply reducing the temperature in the room without implementing therapeutic hypothermia protocols is unlikely to effectively manage brain herniation. Therapeutic hypothermia requires careful monitoring and control of the client's body temperature to prevent complications. Additionally, hypothermia alone may not provide immediate relief from increased ICP associated with brain herniation.

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 teaching a client who has arrhythmogenic cardiomyopathy about the risk for sudden cardiac death. Which of the following client statements indicates to the nurse an understanding of the teaching?

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