Progressive Care Nursing Certification (PCCN) Practice Exam

Which nursing intervention is not appropriate for a patient with pericarditis?

1. Administering pain medications for comfort

2. Auscultating for muffled heart sounds

3. Monitoring for jugular venous distention

4. Administering anticoagulants to prevent thrombus

The correct answer is: Administering anticoagulants to prevent thrombus

In the context of pericarditis, administering anticoagulants to prevent thrombus formation is not an appropriate intervention. Pericarditis can be caused by a variety of factors, including infection, inflammation, or post-myocardial infarction, and its management typically focuses on addressing the underlying cause and relieving symptoms. The use of anticoagulants in a patient with pericarditis could potentially exacerbate the situation by increasing the risk of bleeding, especially if there is effusion or inflammation present. This risk is particularly significant if the pericarditis is accompanied by pericardial effusion, where anticoagulation could lead to hemopericardium or worsen any existing bleeding. On the other hand, managing pain with appropriate medications is essential for patient comfort, as pain is a prominent symptom of pericarditis. Assessing for muffled heart sounds and monitoring for jugular venous distention are critical observations in managing potential complications like cardiac tamponade, which could arise from severe cases of pericarditis. Thus, inappropriate use of anticoagulants stands in contrast to the other interventions, which are pertinent to the care of a patient experiencing pericarditis.