A patient is admitted with acute pericarditis. When auscultating ...

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A patient is admitted with acute pericarditis. When auscultating heart sounds, the nurse should ask the patient to perform which action?
 
  1. sit and lean forward while the nurse auscultates at the left lower sternal border
  2. lie supine and breathe quietly while the nurse auscultates for expiratory wheezes
  3. sit upright while the nurse auscultates the outer aspects of the upper lobes for vesicular breath sounds
  4. sit and lean forward while the nurse auscultates at the second right intercostal space, near the sternal border

Question 2

A patient is being discharged from the healthcare facility following surgical replacement of a mitral valve with a mechanical valve. The patient asks the nurse how much longer he will need to take warfarin (Coumadin). What is the nurse's best response?
 
  1. You will be on it for the rest of your life because you have a mechanical valve.
  2. That will depend on your surgeon. Ask her when you go to your office visit.
  3. You will be on it for the rest of your life because you have a biologic tissue valve.
  4. You will be told when to stop, usually when your mechanical prosthetic valve is healed and there is a minimal risk of clots.

[JCABRERA33]

Answer to Question 1

Correct Answer: 1
Pericardial friction rub is the characteristic sign of pericarditis and can be heard best at the left lower sternal border when the patient is sitting and leans forward. The rub is usually heard on expiration and may be constant or intermittent. Auscultating lung sounds for expiratory wheezes and vesicular breath sounds is done but does not focus on the pericardial friction rub. Auscultating at the second right intercostal space near the sternal border will not help determine the presence of a pericardial friction rub.

Answer to Question 2

Correct Answer: 1
Long-term anticoagulation is necessary with a mechanical prosthetic valve, due to the risk of development of clots on the valve. Biologic tissue valves have a low risk of thrombus formation and long-term anticoagulation is rarely necessary. The nurse should address the patient's question.

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TYSM

[abro1885]

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