The nurse is caring for client who is diagnosed with hypertrophic cardiomyopathy. Which medical Intervention should the nurse anticipate for this client for the complications of dysrhythmias?

Insertion of a cardioverter-defibrillator

A medication regimen that includes nitrates

Immediate cardiac transplantation

Insertion of a drug eluting stent

Answer and Explanation

The Correct Answer is A

A) Insertion of a cardioverter-defibrillator:
Hypertrophic cardiomyopathy (HCM) is a condition characterized by abnormal thickening of the heart muscle, particularly the septum, which can lead to obstruction of blood flow and contribute to the development of arrhythmias. The most concerning arrhythmias in HCM include ventricular tachycardia and ventricular fibrillation, both of which can lead to sudden cardiac arrest. A cardioverter-defibrillator (ICD) is a device that monitors the heart's rhythm and can deliver a shock to restore normal rhythm in the event of a life-threatening arrhythmia.

B) A medication regimen that includes nitrates:
Nitrates are vasodilators commonly used in the treatment of conditions like angina and heart failure. However, nitrates are generally avoided in patients with hypertrophic cardiomyopathy because they can exacerbate the condition by decreasing preload and increasing the outflow tract obstruction due to the thickened heart muscle.

C) Immediate cardiac transplantation:
Cardiac transplantation is a treatment for end-stage heart failure, typically in patients who have not responded to medical or surgical treatments. While hypertrophic cardiomyopathy can lead to heart failure, it is not the first line treatment for dysrhythmias or complications from the disease.

D) Insertion of a drug-eluting stent:
Drug-eluting stents are used to prevent restenosis (narrowing) of coronary arteries after percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). However, hypertrophic cardiomyopathy is not caused by coronary artery disease.

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Correct Answer is C

Explanation

A) Take this medication as needed for pain:
Baclofen is a muscle relaxant typically prescribed for managing spasticity associated with multiple sclerosis (MS), rather than for pain. It should be taken as prescribed, typically on a scheduled basis rather than on an as-needed basis for pain. Misunderstanding this could lead to improper use of the medication and ineffective symptom management.

B) Stop the medication if I experience dry mouth:
Dry mouth is a potential side effect of baclofen, but it should not be the reason to stop the medication abruptly. Stopping baclofen suddenly can result in withdrawal symptoms and could potentially worsen spasticity. If dry mouth or other side effects are bothersome, the client should consult the healthcare provider for management options rather than discontinuing the medication abruptly.

C) Taper this medication off over 1-2 weeks:
This statement demonstrates a correct understanding of the proper way to discontinue baclofen. Baclofen should not be stopped suddenly due to the risk of withdrawal symptoms, which can include increased spasticity, hallucinations, or seizures. A gradual tapering of the dose over a period of 1 to 2 weeks is recommended to avoid withdrawal. This is the most appropriate and safe response.

D) Feel an increase in energy with this medication:
Baclofen is not a medication designed to increase energy. Its primary purpose is to reduce muscle spasticity, not to provide a stimulant effect. If the client expects an increase in energy, this could indicate a misunderstanding of the medication's effects. Baclofen's focus is on reducing spasticity and muscle tightness, not improving energy levels.

A. Urine output of 0.5-1 mL/kg/hr B. Serum sodium level 149 mEq/L. (normal 135-145) C. Blood pressure 82/54 D. Heart rate 124 beats per minute

Correct Answer is A

Explanation

A) Urine output of 0.5-1 mL/kg/hr:
This is a positive outcome during fluid resuscitation for burn patients. Adequate urine output is a key indicator of proper renal perfusion and fluid balance. A urine output of 0.5-1 mL/kg/hr is considered optimal for burn patients during the first 24-48 hours of resuscitation. It suggests that the kidneys are receiving sufficient blood flow and that the patient is responding appropriately to the fluids being administered.

B) Serum sodium level 149 mEq/L (normal 135-145):
A serum sodium level of 149 mEq/L is high and indicates hypernatremia, which is a common complication of excessive fluid resuscitation, particularly with the use of crystalloids. Hypernatremia can lead to cerebral edema, altered mental status, and other severe complications. Therefore, this finding would suggest improper fluid management and would not be considered a positive outcome.

C) Blood pressure 82/54:
A blood pressure of 82/54 is hypotensive, which is concerning in a burn patient. Hypotension indicates inadequate tissue perfusion, potentially leading to shock and organ failure. While low blood pressure may occur in the initial stages of resuscitation due to the rapid shifts in fluid, a sustained low blood pressure is not a positive outcome.

D) Heart rate 124 beats per minute:
A heart rate of 124 beats per minute is tachycardic and suggests that the patient is compensating for hypovolemia or inadequate circulatory volume, possibly due to insufficient fluid resuscitation. Although an elevated heart rate may occur as a compensatory mechanism in the initial stages of burn resuscitation, sustained tachycardia indicates ongoing volume depletion or inadequate perfusion and is not an ideal outcome.

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The nurse is caring for client who is diagnosed with hypertrophic cardiomyopathy. Which medical Intervention should the nurse anticipate for this client for the complications of dysrhythmias?

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