Chapter 23: Caring for Clients with Infectious and Inflammatory Disorders of the Heart and Blood Vessels

An asymptomatic client questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which is the most appropriate response by the nurse?

"Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop."

What is the most common cause of mitral stenosis?

Rheumatic endocarditis

A 6-year-old client is receiving aggressive antibiotic therapy to minimize the long-lasting effects of a systemic inflammation. Rheumatic fever may develop following streptococcal infection within:

2 to 3 weeks.

The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder?

Aortic regurgitation

A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease?

Rheumatic fever

What should be included in the client teaching instructions for client with thrombophlebitis who is being discharged? Select all that apply.

Perform leg exercises each hour. Ambulate as tolerated. Avoid sitting for too long.

Septal involvement occurs in which type of cardiomyopathy?

Hypertrophic

The nurse is educating a patient about the care related to a new diagnosis of mitral valve prolapse. What statement made by the patient demonstrates understanding?

"I will avoid caffeine, alcohol, and smoking."

A nurse is teaching a client who is awaiting a heart transplant. Which statement indicates the client understands what is required to help minimize rejection?

"I will need to take three different types of medications for the rest of my life to help prevent rejection."

A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. Which of the following instructions would provide that information?

Alternate active periods with rest periods.

A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis?

Pericarditis

If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected?

mitral valve

A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition?

"I need to do my leg exercises five times or more every hour."

A client needs to have a cardiac valve replacement. The nurse offers client education about the procedures involved—including the benefits and risks. Which client statement indicates the need for more education?

"I'm anxious because I'll need to have cardiopulmonary bypass."

A client is being discharged home with a diagnosis of hypertrophic cardiomyopathy. Which statement by the client demonstrates that he understands the disease process?

"Since this is a heredity disorder, my family members should probably be evaluated for similar symptoms."

The nurse who is caring for a patient suspected of having pericarditis is aware that the patient's chest pain must be clearly differentiated from chest pain that may be attributable to myocardial infarction. When assessing the patient, how should the nurse make this differentiation?

"When you breathe in deeply, does your pain get more intense?"

A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider.

3.8

Based on assessment data for a patient with pericarditis, select a primary nursing diagnosis.

Acute pain related to inflammation of the pericardium

A nurse plans to have an education session with a client who has cardiomyopathy and the client's spouse about ways to decrease the sense of powerlessness. Which of the following actions by the nurse will provide this information?

Assist the client in identifying life areas over which she still has control.

A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)?

Bleeding and infection

A patient has been diagnosed with fused mitral leaflets, causing a backward flow of blood. What type of procedure does the nurse know is commonly performed for this type of problem?

Commissurotomy

A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis?

Echocardiography

The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse

Extra heart sound

A nurse reviewing a client's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy?

Hypertrophic

A patient with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this patient?

Prepare for pericardiocentesis.

Part of the continued management of a patient with infective endocarditis is assessment for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign?

Red or purple macules found on the palms of the hands

Following the assessment of a patient with suspected pericarditis, the nursing student would determine which of the following findings to be most characteristic?

Reports of constant chest pain

After a detailed diagnostic workup, a patient has been diagnosed with atrial septal defect (ASD). The nurse should recognize that this patient may exhibit many of the signs and symptoms that are typically associated with:

Right-sided heart failure

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?

Risk for infection

Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs?

Shortness of breath

What are contributing causes to pericarditis? Select all that apply

cardiac surgery tuberculosis myocarditis chest trauma

Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis?

increased use of prosthetic valve replacements

A client reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate:

infective endocarditis.

A client with mitral insufficiency is being treated with quinidine to control tachycardia. When assessing the client, the nurse should observe for signs of:

toxicity.

A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention?

Eliminate caffeine and alcohol

A 41-year-old IV heroin user has been admitted to the hospital with a diagnosis of infective endocarditis and begun on IV antibiotic therapy. The patient is eager to be discharged from the hospital and has asked the nurse when he is likely to be discharged. How should the nurse reply?

"Endocarditis involves a very resilient infection, so it's common to need several weeks of IV antibiotics."

When teaching a client with rheumatic carditis and a history of recurrent rheumatic fever, which statement by the client indicates that teaching has been successful?

"I may have to take prophylactic antibiotics for up to 10 years."

A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following?

"The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."

A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis?

A client 4 days postoperative after mitral valve replacement

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?

Cardiac tamponade

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic?

Check regularly for dependent edema

A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection?

Cyclosporine

Which signs and symptoms accompany a diagnosis of pericarditis?

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)

A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response?

Group A, beta-hemolytic streptococcus

The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?

Have you been to the dentist recently?

A client who is over 60 years and taking the anticoagulant therapy with heparin is at a greater risk for which of the following than a younger client who is on the same therapy?

Hemorrhage

A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis?

History of aortic valve replacement

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?

Hypertrophic

The nurse determines that a 49-year-old client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?

I have to call my doctor so I can get antibiotics before seeing the dentist.

A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume?

Leaning forward while sitting

Incomplete closure of the mitral valve results in backflow of blood from the:

Left ventricle to left atrium

Which nursing intervention would reduce cardiac workload in a client with myocarditis?

Maintain the client on bed rest.

Mary Seaver is admitted to the pediatrics unit where you practice nursing. She was admitted by her pediatrician due to suspected rheumatic fever. Aggressive antibiotic therapy and comfort measures have been instituted to minimize the long-lasting effects of the systemic inflammation. If Mary were to develop rheumatic carditis, which cardiac valve most likely would be affected?

Mitral valve

Marilyn Carr, a 75-year-old female, is a client who has an extensive history with thrombophlebitis. Her vascular surgeon instructed Mrs. Carr that she has Virchow's triad. Which answer gives the best indication as to the significance of her surgeon's statement?

Mrs. Carr is predisposed to thrombosis and thrombophlebitis

Which medical treatment should be administered to treat intermittent claudication?

Pentoxifylline (Trental)

Which intervention should the nurse include in the plan of care for a client with valvular heart disease who is experiencing pulmonary congestion?

Rest and sleep in a chair or sit in bed with head elevated

Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch.

Restrictive cardiomyopathy (RCM)

A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to:

assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin.

A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client's symptoms may indicate:

cardiomyopathy.

Which cardiomyopathy is not a major type of cardiomyopathy?

peripartum cardiomyopathy

While auscultating the heart of a pediatric client who is recovering from acute rheumatic fever, the nurse hears a murmur. This sound may indicate:

valve damage.