,The nurse is caring for a client diagnosed with dilated
cardiomyopathy. which clinical manifestation does the nurse
anticipate during the physical assessment? SATA
A) Fatigue
B) Lower extremity edema
C) Syncope
D) Dyspnea
E) Angina
Answer: A, B, D
A) Fatigue
B) Lower extremity edema
D) Dyspnea
Rationale: Clinical manifestations of dilated cardiomyopathy include
dyspnea, orthopnea, weakness, fatigue, peripheral edema, and
ascites. Syncope and angina are commonly associated with
hypertrophic cardiomyopathy and other forms of cardiomyopathy,
but not with dilated cardiomyopathy.
A client states to the nurse, "I know I have high BP, but I don't
want to take medication." Based on this data, which health
problem is the client at risk for developing?
A) Gastritis
B) Diabetes
C) Cardiomyopathy
D) Metabolic Syndrome
C) Cardiomyopathy
Rationale: Hypertension places the client at risk for development of
cardiomyopathy. Hypertension has not been associated with
gastritis, diabetes, or metabolic syndrome.
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A client diagnosed with cardiomyopathy reports having to rest
between activities during the day. The client asks the nurse why
, this is occurring. Which reason should the nurse include in the
response to the client?
A) Increased stroke volume
B) Decreased cardiac output
C) An elongated and dilated aorta
D) Increased blood pressure
B) Decreased cardiac output
Rationale: Decreased cardiac output is a result of decreased
efficiency and contractibility of the myocardium. Rest could be
required after each activity that puts physiological stress on the
heart. Less blood is pumped from the heart to the rest of the body
with a decreased cardiac output, and this has a direct effect on the
activity level that can be tolerated. It is unknown if the client has
increased stroke volume, an elongated and dilated aorta, or high
blood pressure.
A client admitted with the diagnosis of cardiomyopathy becomes
short of breath with ambulation and eating and fatigued with
routine care activities. Which nursing diagnosis does the nurse
include in the client's plan of care?
A) Imbalanced Nutrition: Less than Body Requirements
B) Deficient Knowledge
C) Activity Intolerance
D) Self-Care deficit
C) Activity Intolerance
Rationale: The client is short of breath with ambulation and eating
and fatigued with routine care activities. The nursing diagnosis of
Activity Intolerance is appropriate for the client at this time.
Shortness of breath with meals does not indicate that the client has
Imbalanced Nutrition. There is not enough information to
determine if the client has a knowledge deficit. Fatigue with routine
care activities does not necessarily mean that the client has a Self-
Care Deficit.
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