PrepU ch. 19 practice quiz

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client? 1. "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation." 2. "The valve between your left ventricle and left atria is infected and isn't allowing enough blood through." 3."Your heart's mitral valve isn't closing properly so blood is flowing backwards in your heart and eventually into your lungs." 4. "The normal tissue that makes up the valve between the right sides of your heart has stiffened."

1 Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole with left atrial distention and impaired filling of the left ventricle. It does not exist in the right side of the heart and the problem is associated primarily with improper ventricular filling and with pulmonary backflow only secondarily. Though it is often caused by infection, it is not an infectious process of the valve per se. 460

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make? 1. Cardiac tamponade 2. Myocardial infarction 3. Thrombosis 4. Pericarditis

1 Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart. It can be life-threatening and symptoms include tachycardia, elevated central venous pressure, jugular vein distention, fall in systolic blood pressure with narrowed pulse pressure. Pericarditis is inflammation of the pericardium. A myocardial infarction does not have these symptoms nor does a thrombus. 466

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell? 1. A hypercyanotic attack brought on by periods of stress 2. A hyperoxygenated period when the infant is at rest 3. A stressful period right after birth that occurs without evidence of cyanosis 4. A hyperpneic attack in which the infant loses consciousness

1 The degree of obstruction may be dynamic and can increase during periods of stress causing hypercyanotic attacks ("tet spells"). None of the other answers occur in association with tetralogy of Fallot or tet spells. 479

A client is seen in the emergency room with complaints of sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have? 1. Pericarditis 2. Abdominal aortic aneurysm 3. Pneumonia 4. Myocardial infarction

1 This patient is demonstrating signs and symptoms of pericarditis, which includes a triad of chest pain, pericardial friction rub, and EKG changes. Other signs are that the pain is usually abrupt in onset, occurs in the pericardial area, and may radiate to the neck, back, abdomen or side. It is usually worse with deep breathing and swallowing, and the person often finds relief when sitting up and leaning forward. 454

A client with known pericardial effusions has developed tachycardia and a sudden drop in blood pressure. What actions should the nurse take? Select all that apply. 1. Assess heart sounds. 2. Administer prescribed NSAID medication. 3. Palpate carotid or femoral artery. 4. Arrange for STAT echocardiogram. 5. Elevate head of bed and lower the legs.

1, 3, 4 The nurse should assess the client for possible tamponade, which can present with tachycardia, and a drop in blood pressure due to pressure on the ventricles interfering with cardiac output. The nurse examines the client for pulsus paradoxus, which can be done by palpating the carotid or femoral artery and noting a weak or absent pulse during inspiration and a stronger pulse during expiration. Echocardiogram is a rapid, accurate, and widely used method of evaluating pericardial effusion, and should be anticipated. Muffled heart sounds can also help support that the client has progressed to tamponade. NSAIDs are reserved for mild effusions and are not appropriate during what could be a medical emergency. The nurse should not elevate the head of the bed and lower the legs since the client has a low blood pressure and tamponade interferes with venous return; the head of bed should instead be lowered. 383

A client who was diagnosed with myocarditis asks the nurse what caused his disease. Which response by the nurse is most accurate? 1. There is no research yet on what causes this disease. 2. It is usually caused by a viral infection. 3. It is caused by some type of bacteria. 4. You need to ask your physician.

2 Myocarditis is inflammation of the myocardium. Although there are different causes it is usually caused by a viral infection. Telling the patient there is no research would not be true and telling him to ask the physician would not be therapeutic. 470

On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds: 1. "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or lightheaded." 2. "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems." 3. "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." 4. "This could be caused by an infection. Have you been feeling well the past few weeks?"

2 Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. Blood flow through a normal valve can increase by 5-7 times the resting volume. Valvular disease is not caused by stress. The murmur can be caused by infection but also stenosis or regurgitation of a valve leaflet. The valve problem is very severe if it is causing signs of decrease cardiac output. 475

An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication? 1. Petechial hemorrhages under the skin and nail beds. 2. Systemic emboli, especially to brain. 3. GI upset from the massive amount of antibiotics required to kill the bacteria. 4. Pancreas enlargement due to increased need for insulin secretion.

2 Systemic emboli and develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. B—petechial hemorrhages are s/s of IE. GI upset is common following antibiotic therapy but is not usually life-threatening. Stress can increase insulin needs but not associated with pancreas enlargement. 465

The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications? 1. Lasix, a diuretic. 2. Propranolol, a β-Adrenergic blocker. 3. Lisinipril, an ACE-inhibitor. 4. Lanoxin, an inotropic.

2 β-adrenergic blockers are generally the initial choice for persons with symptomatic HCM. Calcium channel blockers can also be used. ACE-inhibitors, diuretics, or positive inotropics are not the initial first-line medications. 469

Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris? 1. Sedentary lifestyle 2. Abrupt change in position 3. Emotional stress 4. Exposure to heat

3 Angina pectoris usually is precipitated by situations that increase the work demands of the heart, such as physical exertion, exposure to cold, and emotional stress. The pain typically is described as a constricting, squeezing, or suffocating sensation. It usually is steady, increasing in intensity only at the onset and end of the attack. Changing positions abruptly does not cause an attack of angina pectoris. 455

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be: 1. "Aspirin will prevent a heart attack." 2. "It will give you a steady relief of your chest pain." 3. "Aspirin will help prevent blood clotting." 4. "Aspirin prevents blood clotting by halting platelet production."

3 Aspirin (i.e., acetylsalicylic acid) is the preferred antiplatelet agent for preventing platelet aggregation in persons with ACS. Aspirin, which acts by inhibiting synthesis of the prostaglandin thromboxane A2, is thought to promote reperfusion and reduce the likelihood of rethrombosis. This dose of aspirin is not appropriate for pain relief, and the final option does not demonstrate therapeutic communication. 463

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI? 1. Overproduction of energy capable of sustaining normal myocardial function 2. Inadequate production of glycogen with mitochondrial shrinkage 3. Conversion from aerobic to anaerobic metabolism 4. Conversion from anaerobic to aerobic metabolism

3 The principal biochemical consequence of MI is the conversion from aerobic to anaerobic metabolism with inadequate production of energy to sustain normal myocardial function. As a result, a striking loss of contractile function occurs within 60 seconds of onset. None of the other answers occur. 450

The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them is the most important factor in myocardial oxygen demand? 1. Left ventricular contractility 2. Systolic pressure 3. Heart rate 4. All equally important

3 There are 3 major determinants of myocardial oxygen demand, with the heart rate being the most important factor. The other two are systolic pressure and left ventricular contractility. 446

Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis? 1. Have the client change positions to unaffected side. 2. Have the client swallow slowly and frequently. 3. Have the client sit up and lean forward. 4. Have the client breathe deeply.

3 With acute periocarditis, the pain typically is pleuritic (aggravated by inspiration and swallowing) and positional (decreases with sitting and leaning forward; increases with moving to the side) because of changes in venous return and cardiac filling. 466

Which client should most benefit from treatment with antithrombin agents? 1. Client who was thought to have had an MI but who was later diagnosed with pericarditis 2. Young client diagnosed with hypertrophic cardiomyopathy (HCM) 3. 29-year-old client who developed endocarditis by injecting with a dirty needle 4. 57-year-old client who has recently been diagnosed with unstable angina

4 Anticoagulation therapy prevents myocardial infarction in clients with acute coronary syndrome. Pericarditis, HCM, and endocarditis do not normally warrant anticoagulation. 452

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium? 1. Acute pericarditis 2. Mediastinal radiation 3. Pleural effusion 4. Constrictive pericarditis

4 In constrictive pericarditis, fibrous, calcified scar tissue develops between the visceral and parietal layers of the serous pericardium. Acute pericarditis is due to inflammation of the pericardium. Pleural effusion is caused by accumulation of fluid and can lead to cardiac tamponade. 467

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications? 1. Calcium channel blocking drugs 2. Broad-spectrum antibiotic drugs 3. Antianxiety drugs 4. β-Adrenergic-blocking drugs

4 Persons with palpitations and mild tachyarrhythmias or increased adrenergic symptoms and those with chest discomfort, anxiety, and fatigue often respond to therapy with the Β-adrenergic-blocking drugs. None of the other types of drugs are used in the treatment of mitral valve prolapse to relieve symptoms or prevent complications. 463

The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason? 1. The fact that it affects young and old 2. The cost associated with treating the disease 3. That there is no definitive test used for diagnoses 4. The disabling effects that result from involvement of heart valves

4 Rheumatic fever is a very important cause of heart disease and its most serious and disabling effects result from involvement of the heart valves. 458

A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client? 1. Meningitis 2. Mononucleosis 3. Flu 4. Rheumatic fever

4 Rheumatic fever is an immune-mediated inflammatory disease that occurs a few weeks after a group A strep (sore throat). It can manifest as an acute, recurrent or chronic disorder. 458