Med Surg Prep U Chapter 23: Caring for Clients with Infectious and Inflammatory Disorders of the Heart and Blood Vessels - ML5
Which cardiomyopathy is not a major type of cardiomyopathy? -dilated cardiomyopathy -peripartum cardiomyopathy -hypertrophic cardiomyopathy -restrictive cardiomyopathy
peripartum cardiomyopathy Explanation: The three major types of cardiomyopathies are (1) dilated cardiomyopathy, (2) hypertrophic cardiomyopathy, and (3) restrictive cardiomyopathy. The International Society and Federation of Cardiology and the World Health Organization added two other types of cardiomyopathy to the list: arrhythmogenic right ventricular cardiomyopathy, which is inherited; and peripartum cardiomyopathy, which develops in women shortly before or after giving birth.
A client is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect the client's busy work schedule. Which guidance would the nurse provide to the client? -"Clients generally stay in the hospital for 6 to 8 days." -"Clients need to stay in the hospital until they regain normal heart function for their age." -"Clients are kept in the hospital until they are independent with all aspects of their care." -"Clients usually remain at the hospital for 24 to 48 hours."
"Clients usually remain at the hospital for 24 to 48 hours." Explanation: After undergoing percutaneous balloon valvuloplasty, the client usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the client does not need to be wholly independent prior to discharge.
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? -"Do you have a family history of endocarditis?" -"Have you recently vacationed outside of the United States?" -"Have you been to the dentist recently?" -"Do you live with any domesticated animals in your home?"
"Have you been to the dentist recently?" Explanation: Invasive procedures, particularly those involving mucosal surfaces (e.g., those involving manipulation of gingival tissue or periapical regions of teeth), can cause a bacteremia, which rarely lasts more than 15 minutes. However, if a client has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator), bacteremia can cause bacterial endocarditis.
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 will take a nonsteroidal anti-inflammatory medication every day." -"I will avoid any kind of activity." -"I will avoid milk, yogurt, and other dairy products." -"I may have to take prophylactic antibiotics for up to 10 years."
"I may have to take prophylactic antibiotics for up to 10 years." Explanation: Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require 10 or more years of antibiotic coverage (e.g., penicillin G intramuscularly every 4 weeks, penicillin V orally twice a day [BID], sulfadiazine orally daily, or erythromycin orally BID). Clients with a history of rheumatic fever are susceptible to infective endocarditis and should be asked to take prophylactic antibiotics before any invasive procedure, including dental work. Steroids are prescribed to suppress the inflammatory response and aspirin to control the formation of blood clots around heart valves. Activities that require minimal activity are recommended to reduce the work of the myocardium and counteract the boredom of weeks of bed rest.
The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching? -"I will take antibiotics before getting my teeth cleaned." -"I can get my tongue pierced at a store in the shopping mall." -"I can get a tattoo at a local parlor." -"I will avoid caffeine, alcohol, and smoking."
"I will avoid caffeine, alcohol, and smoking." Explanation: In mitral valve prolapse, if dysrhythmias are documented and cause symptoms, the client is advised to eliminate caffeine and alcohol from the diet and to stop the use of tobacco products. Antibiotics to prevent endocarditis are no longer prescribed. Tattoos and piercings are not recommended for clients with mitral valve prolapse to prevent unnecessary exposure to bacteria.
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 receive medication before and during surgery, which will eliminate the risk of rejection." -"There is no risk of rejection if the donor heart is an exact match." -"I will need to take three different types of medications for the rest of my life to help prevent rejection." -"I will need medication following surgery to prevent rejection, but if my body does not reject the new heart, I will not have to take any medication at home."
"I will need to take three different types of medications for the rest of my life to help prevent rejection." Explanation: Clients who have had heart transplants are constantly balancing the risk of rejection with the risk of infection. They must adhere to a complex regimen of diet, medications, activity, follow-up laboratory studies, biopsies of the transplanted heart (to diagnose rejection), and clinic visits. Three classes of medications are prescribed for a transplant client to help minimize rejection: corticosteroids (e.g., prednisone), calcineurin inhibitors (tacrolimus, cyclosporin), and antiproliferative agents (mycophenolate mofetil, azathioprine, or sirolimus).
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? -"Since the procedure is minimally invasive, there is less surgical trauma." -"I might lose some blood, but not likely a large quantity of it." -"Since the procedure is minimally invasive, there is less postoperative pain than with other techniques." -"I'm anxious because I'll need to have cardiopulmonary bypass."
"I'm anxious because I'll need to have cardiopulmonary bypass." Explanation: Cardiopulmonary bypass is not normally required for valve replacement, though it is kept available as an option should the need arise. Minimally invasive techniques generally involve less pain, trauma, and blood loss than alternative techniques.
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." -"The great vessels rub against the pericardium with each heart beat." -"The lung surfaces lose their lubrication and rub against the myocardium with each heart beat." -"The layers of the heart become loose from each other and rub together with each heart beat."
"The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." Explanation: A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid due to inflammation. The rub is audible on auscultation and is synchronous with the heartbeat. The layers of the heart never become loose from each other. The great vessels are not in contact with the inside of the pericardium, where the inflammation is located. The lungs have nothing to do with a pericardial friction rub.
A 46-year-old man has been diagnosed with pericarditis and has begun treatment. When assessing this patient, the nurse should prioritize assessments relevant to what complications of pericarditis? Select all that apply. -Transient ischemic attacks (TIAs) -Cardiac tamponade -ST elevation myocardial infarction (STEMI) -Cardiac arrest -Pericardial effusion
-Cardiac tamponade -Pericardial effusion Nurses caring for patients with pericarditis must be aware of the potential of serious complications. The two major complications of pericarditis are pericardial effusion, the accumulation of fluid in the pericardial sac, and cardiac tamponade, compression of the heart from excessive fluid build-up. MI, cardiac arrest, and TIAs are not frequent complications of pericarditis.
A client with a history of atrial fibrillation has experienced a TIA. What does the nurse expect will be the priority preventative medical treatment(s) to reduce the risk of a cerebrovascular accident (CVA)? Select all that apply. -Anticoagulant therapy -Carotid endarterectomy -Percutaneous transluminal angioplasty -Monthly prothrombin levels -Cholesterol-lowering drugs
-Cholesterol-lowering drugs -Anticoagulant therapy To manage atherosclerosis and the consequences of cardiac arrhythmias, especially atrial fibrillation, cholesterol-lowering drugs and prophylactic anticoagulant or antiplatelet therapy are prescribed. Prothrombin and international normalized ratio (INR) levels may be prescribed to monitor therapeutic effects of anticoagulant therapy. Carotid endarterectomy would be anticipated only when the carotids have narrowing from plaque. Similarly, a percutaneous transluminal angioplasty (also called a balloon angioplasty) accompanied by placement of a stent is performed to dilate the carotid artery and increase blood flow to the brain.
A client who had a prosthetic valve replacement was taking warfarin to reduce the risk of postoperative thrombosis. The client visited the nurse at a clinic once a week. What INR level would alert the nurse to notify the health care provider? -3.4 -3.0 -3.8 -2.6
3.8 Explanation: Warfarin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5 to maintain adequate anticoagulation. Levels below 2 to 2.5 can result in insufficient anticoagulation and levels greater than 3.5 can result in dangerous and prolonged anticoagulation.
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 -A client with a history of repaired ventricular septal defect -A client with hypertrophic cardiomyopathy -A client 1 day post coronary stent placement
A client 4 days postoperative after mitral valve replacement Explanation: Having prosthetic cardiac valves places the client at high risk for infective endocarditis. Hypertrophic cardiomyopathy and repaired ventricular septal defects are moderate risks for infective endocarditis. Coronary stent placement isn't a risk factor for infective endocarditis.
A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide? -Alternate active periods with rest periods. -Avoid all physical and emotional stress. -Include isometric exercises in the daily routine. -Gradually work up to strenuous activity.
Alternate active periods with rest periods. Explanation: The client should plan activities to occur in cycles, alternating rest with active periods. The client with cardiomyopathy must avoid strenuous activity and isometric exercises. It is impossible to avoid all physical and emotional stress.
Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis? -Potassium replacement -Exercise regimen -Antihypertensive medication -Antibiotic therapy
Antibiotic therapy Explanation: The nurse informs the client that periodic antibiotic therapy is a lifelong necessity because the client will be vulnerable to diseases for the rest of his life. Antihypertensive therapy is not always prescribed. Limited activity is stressed. Potassium replacement is typical when combined with diuretic therapy.
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? -Tricuspid insufficiency -Mitral insufficiency -Aortic regurgitation -Tricuspid stenosis
Aortic regurgitation Explanation: The pulse pressure (i.e., difference between systolic and diastolic pressures) is considerably widened in patients with aortic regurgitation. One characteristic sign is the water-hammer (Corrigan's) pulse, in which the pulse strikes a palpating finger with a quick, sharp stroke and then suddenly collapses.
A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ? -Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results. -Assess the client for bleeding and notify the health care provider of the results. -Notify the next nurse on afternoon shift to hold the evening dose of warfarin. -Notify the health care provider to request an increase in the warfarin dose.
Assess the client for bleeding and notify the health care provider of the results. Explanation: For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the health care provider of an elevated INR level and communicate assessment data regarding possible bleeding. The nurse shouldn't administer medication such as warfarin or vitamin K without a health care provider's order. The nurse should notify the health care provider before holding a medication scheduled to be administered during another shift.
A client with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the client to exhibit which heart rhythm? -Ventricular tachycardia (VT) -Ventricular fibrillation (VF) -Atrial fibrillation -Sinus bradycardia
Atrial fibrillation Explanation: In clients with mitral valve stenosis, the pulse is weak and often irregular because of atrial fibrillation caused by strain on the atrium. Bradycardia, VF, and VT are not characteristic of this valvular disorder.
The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)? -Sinus dysrhythmia -Atrial fibrillation -Ventricular tachycardia -First-degree atrioventricular block
Atrial fibrillation Explanation: In mitral stenosis, the pulse is weak and often irregular because of atrial fibrillation (caused by strain on the atrium).
The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)? -Ventricular tachycardia -First-degree atrioventricular block -Atrial fibrillation -Sinus dysrhythmia
Atrial fibrillation Explanation: In mitral stenosis, the pulse is weak and often irregular because of atrial fibrillation (caused by strain on the atrium).
A client with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the client's symptoms, the nurse would teach the client to take which action? -Eat a high-protein, low-carbohydrate diet. -Perform deep breathing and coughing exercises. -Avoid large crowds and public events. -Avoid activities that cause an increased heart rate.
Avoid activities that cause an increased heart rate. Explanation: Clients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding crowds is not usually necessary. Deep breathing and coughing are not likely to prevent exacerbations of symptoms and increased protein intake is not necessary.
A client with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the client's symptoms, the nurse would teach the client to take which action? -Perform deep breathing and coughing exercises. -Eat a high-protein, low-carbohydrate diet. -Avoid large crowds and public events. -Avoid activities that cause an increased heart rate.
Avoid activities that cause an increased heart rate. Explanation: Clients with mitral stenosis are advised to avoid strenuous activities, competitive sports, and pregnancy, all of which increase heart rate. Infection prevention is important, but avoiding crowds is not usually necessary. Deep breathing and coughing are not likely to prevent exacerbations of symptoms and increased protein intake is not necessary.
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 wound dehiscence -Evisceration -Bleeding and infection -Thrombosis and infection
Bleeding and infection Explanation: Possible complications of an aortic balloon valvuloplasty include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, infection, and bleeding from the catheter insertion sites.
A patient with pericarditis has been admitted to the CCU. The nurse caring for the patient knows that the most common clinical manifestation of pericarditis is what? -Palpitations -Pounding heart rate -Burning sensation in chest -Chest pain
Chest pain Explanation: The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.
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? -Vancomycin -Cyclosporine -Nifedipine -Verapamil
Cyclosporine Explanation: Because of advances in surgical techniques and immunosuppressive therapies, heart transplantation is now a therapeutic option for patients with end-stage heart disease. Cyclosporine and tacrolimus are immunosuppressants that decrease the body's rejection of foreign proteins, such as transplanted organs.
The nurse is admitting a client reporting dyspnea on exertion and fatigue. The client's ECG shows arrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy? -Arterial blood gases -Exercise stress test -Echocardiogram -Cardiac catheterization
Echocardiogram Explanation: The echocardiogram is one of the most helpful diagnostic tools because the structure and function of the ventricles can be observed easily. The ECG is also important, and can demonstrate arrhythmias and changes consistent with left ventricular hypertrophy. Cardiac catheterization specifically addresses coronary artery function, and arterial blood gases evaluate gas exchange and acid balance. Stress testing is not normally used to differentiate cardiomyopathy from other cardiac pathologies.
The nurse is admitting a client reporting dyspnea on exertion and fatigue. The client's ECG shows arrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy? -Echocardiogram -Exercise stress test -Arterial blood gases -Cardiac catheterization
Echocardiogram Explanation: The echocardiogram is one of the most helpful diagnostic tools because the structure and function of the ventricles can be observed easily. The ECG is also important, and can demonstrate arrhythmias and changes consistent with left ventricular hypertrophy. Cardiac catheterization specifically addresses coronary artery function, and arterial blood gases evaluate gas exchange and acid balance. Stress testing is not normally used to differentiate cardiomyopathy from other cardiac pathologies.
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? -Chest x-ray -Echocardiography -Cardiac catheterization -Computed tomography
Echocardiography Explanation: Echocardiography is useful in detecting the presence of pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.
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? -Computed tomography -Cardiac catheterization -Chest x-ray -Echocardiography
Echocardiography Explanation: Echocardiography is useful in detecting the presence of pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.
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? -Dizziness -Fatigue -Syncope -Extra heart sound
Extra heart sound Explanation: Often the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound, referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapse.
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 -Fatigue -Dizziness -Syncope
Extra heart sound Explanation: Often the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound, referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapse.
A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? -Pseudomonas aeruginosa -Group A, beta-hemolytic streptococcus -Staphylococcus aureus -Serratia marcescens
Group A, beta-hemolytic streptococcus Explanation: Acute rheumatic fever, which occurs most often in school-age children, may develop after an episode of group A beta-hemolytic streptococcal pharyngitis (Chart 28-2). Clients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure.
The nurse is creating a plan of care for a client diagnosed with cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this client? -Absence of complications -Adherence to the self-care program -Increased activity tolerance -Improved cardiac output
Improved cardiac output Explanation: The priority nursing diagnosis of a client with cardiomyopathy would include improved or maintained cardiac output. Regardless of the category and cause, cardiomyopathy may lead to severe heart failure, lethal dysrhythmias, and death. The pathophysiology of all cardiomyopathies is a series of progressive events that culminate in impaired cardiac output. Absence of complications, adherence to the self-care program, and increased activity tolerance should be included in the care plan, but they do not have the priority of improved cardiac output.
A client with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurse's admission interview, the client states that she takes over-the-counter (OTC) "water pills" on a regular basis. How should the nurse best respond to the fact that the client has been taking diuretics? -Ensure that the client's fluid balance is monitored vigilantly. -Increase the client's oral sodium intake. -Inform the care provider because diuretics are contraindicated. -Encourage the client to drink at least 2 liters of fluid daily.
Inform the care provider because diuretics are contraindicated. Explanation: Diuretics are contraindicated in clients with HCM, so the health care provider should be made aware. Adjusting the client's sodium or fluid intake or fluid monitoring does not address this important contraindication.
A client who suffered blunt chest trauma in a motor vehicle accident reports chest pain during deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. To relieve this chest pain, which position should the nurse encourage the client to assume? -Prone -Supine -Semi-Fowler's -Leaning forward while sitting
Leaning forward while sitting Explanation: The nurse should encourage the client to lean forward, because this position causes the heart to pull away from the diaphragmatic pleurae of the lungs, thus helping to relieve chest pain caused by pericarditis. The semi-Fowler's, supine, and prone positions don't cause this pulling-away action, and therefore, do not relieve chest pain associated with pericarditis.
Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? -Administer supplemental oxygen. -Administer a prescribed antipyretic. -Elevate the client's head. -Maintain the client on bed rest.
Maintain the client on bed rest. Explanation: The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing. Bed rest also helps decrease myocardial damage and the complications of myocarditis. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the client has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures such as minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the client's head to promote maximal breathing potential.
A client has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the client tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse? -Arrange for an alternative bed. -Note the scoliosis on the intake assessment. -Measure the degree of the curvature. -Notify the surgeon immediately.
Notify the surgeon immediately. Explanation: Most often used for mitral and aortic valve stenosis, balloon valvuloplasty is contraindicated for clients with left atrial or ventricular thrombus, severe aortic root dilation, significant mitral valve regurgitation, thoracolumbar scoliosis, rotation of the great vessels, and other cardiac conditions that require open heart surgery. Therefore notifying the physician would be the priority over further physical assessment. An alternative bed would be unnecessary and documentation is not a sufficient response.
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 -Mitral valve stenosis -Cardiomyopathy -Rheumatic fever
Pericarditis Explanation: The primary symptom of pericarditis is pain, which is assessed by evaluating the client in various positions. The nurse tries to identify whether pain is influenced by respiratory movements while holding an inhaled breath or holding an exhaled breath; by flexing, extending, or rotating the spine, including the neck; by moving the shoulders and arms; by coughing; or by swallowing. Recognizing events that precipitate or intensify pain may help establish a diagnosis and differentiate pain of pericarditis from pain of myocardial infarction.
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? -Rheumatic fever -Mitral valve stenosis -Cardiomyopathy -Pericarditis
Pericarditis Explanation: The primary symptom of pericarditis is pain, which is assessed by evaluating the client in various positions. The nurse tries to identify whether pain is influenced by respiratory movements while holding an inhaled breath or holding an exhaled breath; by flexing, extending, or rotating the spine, including the neck; by moving the shoulders and arms; by coughing; or by swallowing. Recognizing events that precipitate or intensify pain may help establish a diagnosis and differentiate pain of pericarditis from pain of myocardial infarction.
A cardiac surgery client's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action? -Administer a bolus of normal saline. -Reposition the client into a prone position. -Administer a dose of metoprolol. -Prepare to assist with pericardiocentesis.
Prepare to assist with pericardiocentesis. Explanation: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart, and prone positioning would likely exacerbate symptoms.
A cardiac surgery client's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action? -Reposition the client into a prone position. -Prepare to assist with pericardiocentesis. -Administer a bolus of normal saline. -Administer a dose of metoprolol.
Prepare to assist with pericardiocentesis. Explanation: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart, and prone positioning would likely exacerbate symptoms.
A client with infective endocarditis is assessed by the nurse 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 -Erythematosus modules on the pads of the fingers -Patterns of petechiae on the chest -Splinter hemorrhages seen under the fingernails
Red or purple macules found on the palms of the hands Explanation: Janeway lesions are painless, red or purple macules found on the palms and soles.
A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? -Splinter hemorrhages seen under the fingernails -Red or purple macules found on the palms of the hands -Patterns of petechiae on the chest -Erythematosus modules on the pads of the fingers
Red or purple macules found on the palms of the hands Explanation: Janeway lesions are painless, red or purple macules found on the palms and soles.
Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. -Arrhythmogenic right ventricular cardiomyopathy (ARVC) -Restrictive cardiomyopathy (RCM) -Dilated cardiomyopathy (DCM) -Hypertrophic cardiomyopathy (HCM)
Restrictive cardiomyopathy (RCM) Explanation: RCM may be associated with amyloidosis (amyloid, a protein substance, is deposited within cells) and other such infiltrative diseases. However, the cause is idiopathic in most cases. Hypertrophic cardiomyopathy occurs when the heart muscle asymmetrically increases in size and mass, especially along the septum. Dilated cardiomyopathy is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. Arrhythmogenic right ventricular cardiomyopathy occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.
A nurse is conducting a health history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis? -Atrial fibrillation -Rheumatic endocarditis -Myocardial infarction -Congestive heart failure
Rheumatic endocarditis Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. Leaflets often fuse together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle.
A nurse is conducting a health history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis? -Rheumatic endocarditis -Congestive heart failure -Myocardial infarction -Atrial fibrillation
Rheumatic endocarditis Explanation: Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. Leaflets often fuse together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle.
A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? -Medullary sponge kidney -Severe staphylococcal infection -Croup -Rheumatic fever
Rheumatic fever Explanation: Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures.
A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? -Severe staphylococcal infection -Medullary sponge kidney -Croup -Rheumatic fever
Rheumatic fever Explanation: Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures.
Which factor is the most common cause of mitral valve regurgitation in developing countries? -A decrease in gamma globulins -Sepsis and its sequelae -An insect bite -Rheumatic heart disease and its sequelae
Rheumatic heart disease and its sequelae Explanation: The most common cause of mitral valve regurgitation in developing countries is rheumatic heart disease and its sequelae, not a decrease in gamma globulins, an insect bite, or sepsis and its sequelae.
A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? -Hypertension -Shortness of breath -Tachycardia -A loud, blowing murmur
Shortness of breath Explanation: Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath upon exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the apex of the heart. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.
A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? -Shortness of breath -Hypertension -Tachycardia -A loud, blowing murmur
Shortness of breath Explanation: Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath upon exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the apex of the heart. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.
Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? -Tachycardia -Shortness of breath -Hypertension -A loud, blowing murmur
Shortness of breath Explanation: If pulmonary congestion occurs, the client with mitral regurgitation develops shortness of breath. A loud, blowing murmur often is heard throughout ventricular systole at the apex of the heart. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.
When auscultating the heart of a client with mitral regurgitation, the nurse would expect to hear: -a diminished S1. -a split S2. -a loud S1. -irregular rhythm.
a diminished S1. Explanation: The S1 heart sound is diminished in clients with mitral regurgitation because of incomplete closure of the mitral valve. A client with aortic stenosis will have a split S2 sound. In mitral valve stenosis, S1 may be extremely loud if the cusps are fused or muffled, or absent if the cusps have calcified and are immobile. Mitral regurgitation does not normally affect the rhythm.
A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment? -denial -fatigue -acute pain -anxiety
acute pain Explanation: Pain is the primary symptom of the client with pericarditis. Pain relief and the absence of complications are two major nursing goals. The client may have anxiety, fatigue, or denial, but these symptoms are not the nurse's priority for care.
A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease? -echocardiogram -serial enzyme studies -cardiac catheterization -phonocardiogram
echocardiogram Explanation: The echocardiogram is one of the most helpful diagnostic tools for cardiomyopathy because the structure and function of the ventricles can be observed easily. Cardiac catheterization will focus on coronary vessels. The serial enzymes are done to detect heart muscle damage. The phonocardiogram is helpful for valve function.
The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis? -pitting edema, chest discomfort, and nonspecific ST-segment elevation -fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) -low urine output secondary to left ventricular dysfunction -lethargy, anorexia, and heart failure
fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Explanation: The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. Low urine output secondary to left ventricular dysfunction lethargy, anorexia, heart failure, and pitting edema result from acute renal failure.
A client with a suspected DVT is scheduled for a diagnostic test to confirm its location. What is the preferred test or procedure for diagnosing thrombi in deep veins? -pericardiectomy -Doppler ultrasound -venography -impedance plethysmography
impedance plethysmography Explanation: IPG is the preferred test for diagnosing clots in deep veins. During IPG, a sensor records blood volume in the arm or leg before and after inflating a BP cuff to stop venous blood flow. If a clot is present, the blood volumes are nearly the same because the clot impairs venous return. Pericardiectomy is a surgical treatment for constrictive pericarditis that involves removing the pericardium to allow more adequate filling and contraction of the heart chambers. Venography is an invasive procedure that uses radiopaque dye instilled into the venous system to indicate a filling defect in the area of the clot. While noninvasive, Doppler ultrasounds are sometimes difficult to interpret because there are so many collateral vessels, and deep veins are especially difficult to assess.
While receiving treatment in hospital for a DVT, a client has several interventions ordered. Complete rest, anticoagulant therapy, and procedures to determine the location and size of the thrombus are all utilized to decrease the danger from the blood clot. Continuous warm, wet packs are ordered to: -increase inflammation. -increase warmth. -reduce incidence of clots. -improve circulation.
improve circulation. Explanation: Continuous warm, wet packs are ordered to improve circulation, ease pain, and decrease inflammation.
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 -higher rate of tuberculosis -increase in IV drug use -greater incidence of a history of repaired congenital heart defects
increased use of prosthetic valve replacements Explanation: The prevalence of infective endocarditis among older adults has increased in part due to the increased number of prosthetic valve replacements, including replacements for older adults, and an increase in hospital-acquired bacteremia. While history of a repaired congenital heart defect does place a client at greater risk for developing infective endocarditis in the future, it has not been shown as a contributing factor in the prevalence of infective endocarditis among older adults. IV drug use and IV drug use disorder places individuals at greater risk for infective endocarditis. However, this risk has not been attributed to an increase in its prevalence among older adults. Tuberculosis is known to contribute to pericarditis among the general population and is not specific to the older adult client.
The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? -elevated ESR and CRP -dyspnea -reports of constant chest pain -fatigue lasting more than 1 month
reports of constant chest pain Explanation: The most characteristic symptom of pericarditis is chest pain. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Other signs may include a mild fever, increased WBC count, anemia, and an elevated ESR or C-reactive protein level. Dyspnea and other signs and symptoms of heart failure may occur.
A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered? -throat culture -electrocardiogram -electrophysiological studies -complete blood count
throat culture Explanation: Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease. If signs and symptoms of streptococcal pharyngitis are present, a throat culture is necessary to make an accurate diagnosis. An electrophysiology study will confirm abnormal heart rhythms. An electrocardiogram will monitor heart rhythm disturbances, not diagnose the endocarditis. A complete blood count will not confirm the endocarditis diagnosis, but will add information for treatment.
A client with mitral insufficiency is being treated with quinidine to control tachycardia. When assessing the client, the nurse should observe for signs of: -thrombocytosis. -infection. -anemia. -toxicity.
toxicity. Explanation: Clients who are taking quinidine are at risk for quinidine toxicity. This medication does not normally increase the client's risk for infection and it does not cause anemia or increased platelet production.
While auscultating the heart of a pediatric client who is recovering from acute rheumatic fever, the nurse hears a murmur. This sound may indicate: -pericarditis. -cardiac tamponade. -atrial gallop. -valve damage.
valve damage. Explanation: Acute rheumatic fever may lead to cardiac complications; a heart murmur suggests valve damage. Endocarditis may lead to cardiac complications; a pericardial friction rub indicates pericarditis. Muffled heart sounds may indicate cardiac tamponade in clients with pericarditis. Atrial gallop is an abnormal heart sound, or S4, and is often associated with hypertensive heart disease.
