The patient with restrictive cardiomyopathy asks the nurse what could have caused this disorder. Which response by the nurse is most accurate?

"All patients with this disorder have a genetic defect which causes it."

"There are many theories about its development but amyloidosis in your history is a probable cause."

"You probably had a silent heart attack which caused this disorder."

"Your long-standing hypertension caused this disorder."

Answer and Explanation

The Correct Answer is B

A. "All patients with this disorder have a genetic defect which causes it.": Restrictive cardiomyopathy is not primarily a genetic disorder. While there may be rare familial forms, most cases are acquired, often secondary to systemic diseases, making this statement inaccurate and misleading.

B. "There are many theories about its development but amyloidosis in your history is a probable cause.": This is the most accurate response. Restrictive cardiomyopathy is commonly associated with infiltrative diseases such as amyloidosis, hemochromatosis, and sarcoidosis, which impair ventricular filling due to stiff, non-compliant myocardium.

C. "You probably had a silent heart attack which caused this disorder.": Silent myocardial infarctions can contribute to ischemic cardiomyopathy, typically leading to dilated, not restrictive, changes in the myocardium. They are not a primary cause of restrictive cardiomyopathy.

D. "Your long-standing hypertension caused this disorder.": Chronic hypertension more commonly leads to left ventricular hypertrophy and may contribute to diastolic heart failure, but it is not a typical cause of restrictive cardiomyopathy.

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Correct Answer is C

Explanation

A. Administer amiodarone 200 mg IV push: Amiodarone is used for shockable rhythms like ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) that are refractory to defibrillation. The rhythm on the monitor is asystole, which is non-shockable, and amiodarone is not indicated here.

B. Defibrillate the client using 200 joules: Defibrillation is only appropriate for shockable rhythms such as VF or pulseless VT. Asystole is not shockable, and defibrillation in this rhythm would be ineffective and inappropriate.

C. CPR until the physician stops the code: The rhythm strip shows asystole, a flatline with no electrical activity. The priority intervention is to initiate and continue high-quality cardiopulmonary resuscitation (CPR) immediately and continue until the code is terminated by the physician. This is consistent with Advanced Cardiac Life Support (ACLS) guidelines.

D. Administer adenosine 12 mg IV push: Adenosine is used to terminate supraventricular tachycardia (SVT) and is not indicated in asystole or during cardiac arrest. It would have no effect in a rhythm with no electrical activity.

A. Increase the pacemaker sensitivity B. Document that the pacemaker is regular C. Set the pacemaker to the asynchronous mode D. Document that the atria are being paced

Correct Answer is D

Explanation

A. Increase the pacemaker sensitivity: Adjusting pacemaker sensitivity is a technical function typically managed by a cardiologist or device technician. There is no indication from the information provided that the pacemaker is under- or over-sensing, so no adjustment is warranted.

B. Document that the pacemaker is regular: While the pacemaker may be functioning regularly, this statement is vague and does not accurately describe the observed pacing activity. The key observation is the spike occurring before the P wave, which requires more specific documentation.

C. Set the pacemaker to the asynchronous mode: Asynchronous pacing means the pacemaker fires at a set rate regardless of the patient's intrinsic rhythm and is generally reserved for specific situations such as during surgery or when interference with sensing is suspected. There is no evidence of pacemaker malfunction or need to override sensing in this scenario.

D. Document that the atria are being paced: A pacemaker spike immediately before the P wave indicates atrial pacing. This means the pacemaker is stimulating the atria, leading to atrial depolarization. This is the appropriate interpretation and should be documented clearly.

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Potassium 2.8 mEq/L
Sodium 133 mEq/L
Chloride 90 mEq/L
Glucose 200 mg/dl
Magnesium 2.5 mg/dL
Calcium 8.0 mg/dL

The patient with restrictive cardiomyopathy asks the nurse what could have caused this disorder. Which response by the nurse is most accurate?

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