NCLEX-CARDIO
hypertrophic cardiomyopathy
Primary disease of the cardiac muscle characterized by disproportionate, asymmetrical thickening of the interventricular septum, particularly in the anterior-superior region. Also called idiopathic hypertrophic subaortic stenosis.
A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 164/92 mm Hg and notes a 5-lb (2.3-kg) weight gain over the past 6 months. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension? 1. Noncompliance (nonadherence to therapeutic regimen) 2. Deficient knowledge 3. Excess fluid volume 4. Imbalanced nutrition: More than body requirements
RATIONALES: Noncompliance is the most serious problem in managing a client with hypertension. One authority estimates that 40% to 60% of hypertensive clients fail to comply with prescribed treatment. Reasons for noncompliance include a lack of symptoms, which makes the problem seem less serious; the difficulty of making required lifestyle changes, such as eating a low-sodium diet, stopping smoking, and losing or managing weight; adverse reactions to antihypertensive drugs; and the inconvenience and high cost of obtaining health care. The other options may promote or result from noncompliance. Deficient knowledge contributes to noncompliance; Excessive fluid volume, caused by excessive sodium intake, and Imbalanced nutrition: More than body requirements may result from noncompliance. NURSING PROCESS STEP: Planning CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Application
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? 1. Cyanosis of the lips 2. Bilateral crackles 3. Productive cough 4. Leg edema
RATIONALES: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, neck vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough. NURSING PROCESS STEP: Data collection CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Physiological adaptation COGNITIVE LEVEL: Knowledge
A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis is appropriate? 1. Risk for injury 2. Risk for deficient fluid volume 3. Ineffective thermoregulation 4. Risk for peripheral neurovascular dysfunction
RATIONALES: Risk for injury is an appropriate nursing diagnosis for a client with HCM because physical exertion may cause syncope or sudden death. Heart failure may complicate HCM, causing fluid volume excess; therefore, the nursing diagnosis of Risk for deficient fluid volume isn't applicable. Ineffective thermoregulation and Risk for peripheral neurovascular dysfunction are inappropriate because HCM doesn't cause these problems. NURSING PROCESS STEP: Planning CLIENT NEEDS CATEGORY: Physiological integrity CLIENT NEEDS SUBCATEGORY: Reduction of risk potential COGNITIVE LEVEL: Application
