While working on the cardiac step-down unit, you are precepting a new graduate RN who has been in a 6-week orientation program. Which of these patients will be best to assign to the new graduate?

Correct Answer: A

Rationale: In this scenario, the best patient to assign to the new graduate RN is option A, the 19-year-old with rheumatic fever who needs discharge teaching. This patient is stable, requiring education on self-care and transitioning home, which aligns with the new graduate's skill set and the focus of their orientation program. By providing discharge instructions, the new nurse can reinforce their learning and develop their patient teaching skills. Option B, the 33-year-old with endocarditis receiving IV ceftizoxime, is not ideal for the new graduate as it involves administering a high-risk medication that requires advanced knowledge and experience. Option C, the 50-year-old with stable angina, although stable, has complex medication and care needs that may overwhelm a new graduate. Option D, the 75-year-old post-coronary artery bypass grafting, is also not suitable due to the recent surgery and potential for post-operative complications that require a higher level of expertise. Educationally, assigning appropriate patient assignments is crucial for new graduates to build confidence, competence, and critical thinking skills. By matching patient acuity and complexity with the nurse's level of experience, we support their professional growth and ensure safe and effective care delivery.

Correct Answer: D

Rationale: In the case of mitral valve stenosis, an early indication is dyspnea, which is difficulty or discomfort in breathing. This occurs because the narrowing of the valve impedes blood flow from the left atrium to the left ventricle, leading to increased pressure in the lungs and ultimately causing shortness of breath. A) Changes in heart sounds are more commonly associated with conditions like murmurs or valve regurgitation rather than stenosis of the mitral valve. While auscultation is important in diagnosing heart conditions, it is not typically an early sign of mitral valve stenosis. B) Crackles in the bases of the lungs are typically associated with conditions like heart failure or pneumonia, which can be consequences of untreated mitral valve stenosis but are not early indicators of the valve stenosis itself. C) Heart palpitations, or rapid, irregular heartbeats, are more commonly associated with conditions like atrial fibrillation or palpitations related to anxiety or stress. While palpitations can occur in patients with mitral valve stenosis due to associated arrhythmias, they are not specific early indicators of the valve stenosis itself. Educational Context: Understanding the early signs of mitral valve stenosis is crucial for healthcare providers to prompt early intervention and prevent complications. Dyspnea in this context serves as a red flag for further investigation and diagnostic testing to confirm the presence of mitral valve stenosis. Healthcare professionals need to be able to differentiate between various symptoms to provide accurate and timely care for patients with cardiovascular conditions.

Correct Answer: C

Rationale: The correct answer is C) Percutaneous transluminal coronary angioplasty (PTCA). In PTCA, a balloon-tipped catheter is used to compress the atherosclerotic plaque against the arterial wall, widening the diameter of the artery. This procedure helps to improve blood flow through the diseased coronary artery, relieving symptoms of angina and reducing the risk of a heart attack. Option A) Coronary stent is incorrect because a stent is a mesh-like tube inserted into the artery after angioplasty to help keep it open. It is not the initial procedure described in the question. Option B) Atherectomy involves removing plaque from the artery using a cutting device. This is different from the balloon angioplasty described in the question. Option D) Coronary artery bypass grafting (CABG) is a surgical procedure where blood flow is rerouted around blocked arteries using grafts. It is not the same as the minimally invasive PTCA procedure described. Understanding these distinctions is crucial for healthcare professionals working in cardiology to determine the most appropriate intervention for patients with coronary artery disease. PTCA is a common and effective procedure used to treat coronary artery blockages and is often performed in a cardiac catheterization lab by interventional cardiologists.

Correct Answer: B

Rationale: The correct answer is B) A sudden drop in BP may occur during the first 1 to 3 hours after the initial dosage. ACE inhibitors are commonly used in the management of hypertension and heart failure by blocking the conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased blood pressure. In clients with renal or hepatic impairment and older adults, these physiological changes can be more pronounced due to decreased drug clearance and altered metabolism. Monitoring ACE inhibitors cautiously in these populations is crucial to prevent a sudden drop in blood pressure, which can lead to adverse effects like dizziness, syncope, and falls. Option A is incorrect because ACE inhibitors typically lower blood pressure rather than raise it. Option C is incorrect as ACE inhibitors do not affect body temperature. Option D is incorrect as ACE inhibitors do not typically raise pulse rate significantly. Educationally, understanding the pharmacokinetics and potential side effects of ACE inhibitors in specific populations is essential for safe medication administration and monitoring in clinical practice. Nurses must be vigilant in assessing for signs of hypotension and adverse effects when administering ACE inhibitors to clients with renal or hepatic impairment and older adults to provide safe and effective care.

Correct Answer: A

Rationale: Heart biopsies are performed throughout a client's lifetime after heart transplantation primarily to detect rejection, which is the correct answer (A). Rejection is a significant concern post-transplant as the body's immune system may identify the new heart as a foreign entity and attack it. Detecting rejection early is crucial for prompt intervention to prevent potential organ failure. Option B, checking the rate of the heartbeat, is not the primary reason for heart biopsies post-transplant. While monitoring heart rate is important, it is more commonly done using non-invasive methods like ECG monitoring. Option C, checking heart functionality, is related to the purpose of heart biopsies but is not as specific as detecting rejection. Biopsies provide direct information on the presence of rejection, which can't always be accurately assessed through other means. Option D, checking for heart tumors, is not the main reason for heart biopsies post-transplant. While heart tumors are a consideration, the primary focus of biopsies is on detecting rejection due to its immediate threat to the transplanted organ. In an educational context, understanding the rationale behind post-transplant monitoring, such as heart biopsies, is crucial for healthcare professionals involved in the care of transplant patients. It highlights the importance of vigilance in detecting rejection early to optimize patient outcomes and ensure the long-term success of the transplant.