Brunner Ch 28 Managements of Patients With Structural, Infectious and Inflammatory Cardiac Disorders

A pharmacologic intervention for slowing the disease progress of aortic regurgitation by reducing afterload is the purpose of:

Vasodilators

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

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

Have you seen the dentist lately?

A physician has scheduled a client with mitral stenosis for mitral valve replacement. Which condition may arise as a complication of mitral stenosis?

Pulmonary hypertension

Which of the following symptoms occurs in the patient diagnosed with mitral regurgitation when pulmonary congestion occurs?

SOB

A patient complaining of heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. In order to relieve the symptoms, the nurse should teach the patient which of the following dietary interventions?

Eliminate caffeine and alcohol

During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. Which of the following answers from the nurse is correct information?

"A mechanical valve is thought to be more durable and so requires replacement less often."

A nurse is teaching a client who is having a valuloplasty tomorrow. The client asks what the advantage is for having a tissue valve replacement instead of a mechanical valve. The correct answer by the nurse is which of the following?

"A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required."

A nurse and a nursing student are caring for a client with pericarditis and perform the physical assessment together. The client has a pericardial friction rub audible on auscultation. When the nurse and student leave the room, the student asks how to distinguish a pericardial from a pleural friction rub. The nurse's best response is which of the following?

"Ask the client to hold the breath while you auscultate; the pericardial friction rub will continue, while the pleural friction rub will stop."

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 nurse working in the medical intensive care unit has a patient admitted with mitral stenosis. The nurse is precepting a new graduate and explains the pathophysiology of the condition. Which of the following statements made by the new graduate would reflect an appropriate understanding of the disease process? Choose all that apply.

"Increased blood flow in the left atrium causes left atrial hypertrophy." "There is a narrowing between the left atrium and left ventricle."

A patient with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which of the following assessment data obtained by the nurse should be immediately communicated to the health care provider?

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

A nursing student is assigned to a patient with a mechanical valve replacement. The patient asks the student, "Why do I have to take antibiotics before getting my teeth cleaned?" Which response by the nursing student is most appropriate?

"You are at risk of developing an infection in your heart."

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

The nurse is preparing to administer warfarin (Coumadin), an oral anticoagulant, to a patient with a mechanical valve replacement. The patient's INR is 2.7. Which action should the nurse take?

Administer the medication as ordered. Patients with mechanical valve replacements who take warfarin (Coumadin) usually have individualized target international normalized ratios (INRs) between 2.0 and 3.5. The nurse would give the medication as ordered

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?

Alternative active periods with rest periods

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

An extra heart sound

Which would the nurse stress as a lifelong necessity for a client managing infectious endocarditis?

Antibiotic Therapy

Which of the following describes a valve used in replacement surgery that is made from the patient's own heart valve?

Autograft

The nurse is caring for a client who is diagnosed with aortic stenosis, but is reluctant to have surgery for valve replacement. The nurse is present when the physician talks to the client about a treatment that is less invasive than surgery, but that will likely relieve some of the client's symptoms. Later, the client asks the nurse to review with her spouse the treatment offered. What does the nurse talk about with the spouse?

Balloon percutaneous valvuloplasty

A nurse is caring for a patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications?

Bleeding and infection

Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply

CRP, WBC, Nonstemi

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

Cardiac tamponade

Which of the following nursing interventions should a nurse perform when a patient with cardiomyopathy receives a diuretic?

Check for dependent edema regularly

When evaluating a patient suspected of having pericarditis, the nurse documents the description of which indicator that is considered the most characteristic symptom?

Chest pain

A nurse is teaching a patient about an upcoming surgery to separate fused cardiac leaflets. Which of the following is the correct term used to describe this surgery?

Commissurotomy

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis may be appropriate?

Decreased Cardiac Output

During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following?

Decreased Cardiac output

For a client with cardiomyopathy, the most important nursing diagnosis is:

Decreased cardiac output related to reduced myocardial contractility.

The nurse is caring for a patient diagnosed with myocarditis. The nurse must be aware that patients with myocarditis are sensitive to which of the following medications?

Digoxin

A nurse is caring for a client who was admitted yesterday with myocarditis. The client takes insulin, digoxin, and metformin at home and continues these medications during his hospitalization. During the morning assessment, the client reports anorexia, nausea, vomiting, headache, and disturbed color vision. His ECG strip shows a prolonged PR interval. The nurse suspects which of the following?

Digoxin toxicity

Which of the following are the first symptoms of cardiac tamponade? Select all that apply.

Dizziness, Chest tightness, SOB

The nurse is caring for a client following cardiac valve replacement. Which nursing action is correct when obtaining a Homan's sign to screen for thrombophlebitis?

Dorsiflexion of the foot with calf pain

A client with aortic regurgitation is admitted to the hospital. Which of the following assessment findings would indicate left ventricular failure?

Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND)

A client is admitted to the hospital with aortic stenosis. Which of the following assessment findings would indicate the development of left ventricular failure?

Dyspnea, orthopnea, pulmonary edema

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

Echocardiogram

A patient is admitted with suspected cardiomyopathy. What diagnostic test would be most helpful with the identification of this disorder?

Echocardiogram

Which signs and symptoms accompany a diagnosis of pericarditis?

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

A patient with a prosthetic heart valve is diagnosed with subacute infective endocarditis. The nurse knows that the majority of these infections are caused by:

Group A, beta-hemolytic Streptococcus

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

Group A, beta-hemolytic streptococcus

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the student to clarify one of the last treatment options available that the physician mentioned. After checking with the primary nurse, the student would most likely discuss which of the following?

Heart Transplantation

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

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

Hypertrophic

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

Hypertrophic

A 45-year-old male client with a confirmed DVT is being discharged from the ED. Which of the following client statements indicates that the client has received proper nursing instruction and understands how to manage his condition?

I need to do my leg exercises....

A patient with endocarditis is being discharged home. In evaluating the effectiveness of patient teaching about how to prevent recurrence of the infection, the student nurse would expect the patient to state:

I will ask for antibiotics whenever I have dental work done

One of the most common causes of mitral valve regurgitation in people living in developed countries is

Ischemia of the left ventricle

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

A patient was diagnosed with mitral regurgitation. The nurse is aware that the patient should be observed for indicators of left- and right-sided heart failure. This understanding is based on the mechanics of cardiac hemodynamics. With mitral regurgitation, due to thickened valve leaflets, blood flows backward from the:

Left ventricle into the left atrium during systole

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following?

Left ventricular assist device

For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations?

Left ventricular dysfunction

A 52-year-old male client in the hospital unit where you practice nursing is being treated for myocarditis. Which of the following nursing interventions should you perform to reduce cardiac workload in a client with myocarditis?

Maintain the client on bedrest

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis?

Maintain the patient on bedrest

A 6-year-old female client is admitted to the pediatrics unit 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 the client were to develop rheumatic carditis, which cardiac structure would most likely be affected?

Mitral Valve.

A patient comes into the emergency room complaining 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 of the following diagnoses?

Pericarditis

The instructor is talking with a nursing student who is caring for a client with pericarditis. The instructor asks the student to name the main characteristic of pericarditis. What should be the student's answer?

Precordial pain

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

Prepare for pericardiocentesis

Which of the following mitral valve conditions generally produces no symptoms?

Prolapse

Which valve lies between the right ventricle and the pulmonary artery?

Pulmonic

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

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

Restrictive cardiomyopathy (RCM)

A patient comes to the clinic with complaints of 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 of the following preventable diseases?

Rheumatic fever

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

A nurse is caring for a client with acute mitral regurgitation related to an acute myocardial infarction. The nurse knows to monitor the client carefully for symptoms of which initial complication or result?

Severe heart failure

A nurse is caring for a 30-year-old client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin (Comaudin). She mentions to you that she relies on the rhythm method for birth control. What education would be a priority for the nurse to provide to this client?

The high risk for complications if she becomes pregnant while taking warfarin

A nurse caring for a patient with mitral stenosis understands that the initial cause of disruption to the normal flow of blood through the heart is due to:

The increased resistance of a narrowed orifice between the left atrium and the left ventricle

A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant?

The patient reports shortness of breath when walking.

A nurse is preparing a teaching plan regarding biological tissue valve replacement. Which of the following identifies a disadvantage of this type of valve replacement?

The valve has to be replaced frequently

A nurse is teaching a patient about valve replacement surgery. Which statement by the patient indicates an understanding of the benefit of an autograft replacement valve?

The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged."

A patient admitted to the hospital is suspected to have rheumatic endocarditis. What diagnostic test does the nurse anticipate will be ordered?

Throat culture

The school nurse is providing care to a child with a sore throat. With any sign of throat infection, the nurse stresses which of the following?

Throat culture

The chart of a 75-year-old female client indicates Virchow's triad. The nurse recognizes that this client is at risk for which of the following complications?

Thrombophlebitis Virchow's triad refers to venous stasis (slowed circulation), altered blood coagulation, and trauma to the vein, and predisposes clients to thrombosis and thrombophlebitis. The diagnosis of Virchow's triad indicates the client already presents with venous stasis. The diagnosis of Virchow's triad indicates the client already presents with altered blood coagulation. Postphlebitic syndrome is a vascular complication that may occur for up to 5 years after the initial episode with thrombophlebitis. This client does not yet have thrombophlebitis, so she is not at risk for postphlebitic syndrome.

Which of the following clinical manifestations would the nurse expect to find in the patient diagnosed with aortic regurgitation?

Visible neck vein pulsations

The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery?

Warfarin

The nurse caring for a client with cardiomyopathy plans to have an education session with the client and her spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload, and therefore, reduce the workload of the heart?

When resting, sit up with the legs down to pool blood in the legs.

Which type of graft is utilized when a heart valve replacement is made of tissue from an animal heart valve?

Xenograft

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.

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis?

constant chest pain

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

left ventricle to left atrium

The nurse is caring for a client with aortic regurgitation. The nurse knows to expect which of the following symptoms on physical examination?

orthopnea and dyspnea

What is the most common cause of mitral stenosis?

rheumatic endocarditis

It is important for a nurse to be aware of the normal hemodynamics of blood flow to recognize and understand pathology when it occurs. The nurse should know that incomplete closure of the tricuspid valve results in a backward flow of blood from the:

right ventricle to right atrium

A patient with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. The nurse expects that collaborative management of the patient will include

surgical valve replacement

The client teaching instructions for a 57-year-old male client with thrombophlebitis who is being discharged should include which of the following? Select all that apply.

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