Which assessment finding would the nurse expect in a patient diagnosed with acute pericarditis?
Muffled heart sound
Narrow pulse pressure
Pulses paradoxus
Pericardial friction rub
The Correct Answer is D
A. Muffled heart sounds are more commonly associated with pericardial effusion or cardiac tamponade, where fluid accumulation in the pericardial sac muffles the heart sounds. Acute pericarditis, however, typically does not cause muffled heart sounds.
B. Narrow pulse pressure (a small difference between systolic and diastolic blood pressure) is not a typical finding in acute pericarditis. It is more commonly seen in conditions such as cardiac tamponade or severe heart failure.
C. Pulses paradoxus, a significant decrease in systolic blood pressure during inspiration, is more commonly associated with conditions like cardiac tamponade, not acute pericarditis.
D. A pericardial friction rub is a hallmark sign of acute pericarditis. It occurs due to the inflammation of the pericardial layers, which rub against each other, producing a characteristic high-pitched, scratchy sound heard on auscultation.
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Related Questions
Correct Answer is C
Explanation
A. While aspirin has analgesic properties, it is not primarily used for pain relief in the case of myocardial infarction (MI). Its main role in MI is to reduce the risk of further clot formation.
B. Aspirin has anti-inflammatory properties, but in the case of MI, its primary role is not inflammation reduction but rather preventing platelet aggregation.
C. Aspirin acts as an antiplatelet aggregate, which is its key action in preventing the formation of blood clots. This is crucial for patients with a history of MI, as it helps reduce the risk of further clot-related events, such as a recurrent MI or stroke.
D. Aspirin does have antipyretic effects, but this is not the primary reason for its use in MI.
Correct Answer is D
Explanation
A. Post-traumatic arthritis can develop after a fracture, but Buck's traction does not directly prevent or treat arthritis. Post-traumatic arthritis is a long-term complication that is managed through other interventions such as physical therapy or joint replacement if necessary.
B. Intra-articular adhesions refer to scar tissue formation inside the joint, which is not the primary focus of Buck's traction. Buck's traction is used to immobilize the limb and reduce muscle spasm, not to address intra-articular issues.
C. Extra-articular adhesions involve the formation of scar tissue outside the joint and are not specifically targeted by Buck's traction. The primary goal of the boot is to reduce muscle spasm and maintain alignment.
D. Muscle spasm is the primary condition that Buck's traction helps decrease. The boot applies a gentle, continuous pull on the limb, which helps to alleviate muscle spasms, reduce pain, and maintain proper alignment while the fracture heals.
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