Ch. 24

Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis?

maintain the client on bedrest

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

mitral valve

A nurse is caring for a client diagnosed with a mitral valve prolapse who is asymptomatic. What will nurse expect to be ordered for this client?

no treatment

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

Which common assessment question does the nurse use when admitting all clients that helps to screen for cardiomyopathy?

"Have you ever had a close family member die unexpectedly?"

The nurse is teaching a school community parent group about heart wellness. What risk factor is a common leading cause for mitral stenosis?

rheumatic fever

During a teaching session, a client who is having a valvuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct?

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

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 with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The novice nurse discusses this development with the nurse manager. What statement indicates the novice nurse is applying the assessment findings?

"I anticipated this complication and I will call the health care provider right now."

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching?

"I can still drink coffee and tea."

The nurse determines that a 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 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."

The nurse instructs a client recovering from mechanical valve replacement surgery. Which client statement indicates that teaching has been effective?

"I will not drive until informed by my health care provider."

A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valvular disease?

"The client with mitral valve prolapse probably had no health symptoms."

The nurse is caring for a client diagnosed with infective endocarditis and awaiting blood culture results. The client asks, "Where did I pick up these bacteria?" The nurse is most safe to speculate which of the following?

From a break in the skin

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

While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement?

Ask the patient to lean forward and listen again.

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 ?

Assess the client for bleeding and notify the health care provider of the results

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)?

Atrial fibrillation

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

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

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

Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND)

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

Dyspnea, orthopnea, pulmonary edema

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

A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?

Exertional dyspnea, orthopnea, pulmonary edema

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 young parent brings a 4-year-old child to the pediatric clinic with a mild fever and a red, spotty rash that is beginning to fade. The child's heart rate is rapid, and the rhythm is abnormal. The parent states the child has been healthy until about 3 weeks ago, when the child had a sore throat. The nurse suspects rheumatic carditis. What organism causes rheumatic carditis?

Group A beta-hemolytic strep

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 avoid caffeine, alcohol, and smoking

A client who recently had a myocardial infarction develops pericarditis and complains of chest pain rated 6 (on a scale of 0-10) with deep breathing. Which ordered pro re nata medications is most appropriate for the nurse to administer?

Ibuprofen 800 mg PO every 8 hours

A patient with a history of valvular disease has just arrived in the PACU after a percutaneous balloon valvuloplasty. Which intervention should the recovery nurse implement?

Keep the patient's affected leg straight.

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

Left ventricle to left atrium

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?

Obtaining a throat culture

A client is diagnosed with cardiomyopathy. Which symptoms that are specific to cardiomyopathy will the nurse instruct the client to report to the health care provider? Select all that apply.

Persistent cough Shortness of breath at rest Weight gain of 5 lbs. (2.3 kg) in one week

The nurse has created a care plan for a client admitted with acute pericarditis and a nursing diagnosis of acute pain related to pericardial inflammation. What is an appropriate nursing intervention for this client?

Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on

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

Prepare for pericardiocentesis.

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

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

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

A client has a history of rheumatic fever as a child. Which instructions should be provided before the client has any dental work done?

Take prophylactic antibiotics.

The nurse is teaching a client scheduled for an autograft aortic valve replacement. What statements are true about autograft replacement process? Select all that apply.

The grafts are obtained by excising the client's own pulmonic valves and a portion of the pulmonary artery. The autograft is an alternative for children and women of child-bearing age. Aortic valve autografts have remained viable for more than 20 years.

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 nurse is caring for a client with pericarditis and auscultates a pericardial friction rub. What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub?

The nurse asks the client to hold the breath during auscultation.

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.

The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point?

The treatments include medications, medical devices, surgery, or transplantation.

The nurse is teaching a client diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without resorting to taking medications. What should the nurse teach the client?

To rest and relax before taking nitroglycerin

The nurse is preparing to administer warfarin to a client with a mechanical valve replacement. The client's international normalized ratio is 2.7. What action will the nurse take?

administer the medication as ordered

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 Cholesterol-lowering drugs

The nurse is working with a client who asks what diagnostic studies will be done because of a suspected diagnosis of mitral stenosis. What studies will the nurse teach the client? Select all that apply.

cardiac catheterization exercise test electrocardiography

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

cardiac tamponade

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 suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis?

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

The nurse is caring for a client with cardiac compromise related to mitral valve impairment. Which outcome of the eroding of the mitral valve is most significant?

heart failure

The nurse is caring for a client who has been diagnosed with aortic stenosis. The client is prescribed digoxin. What is the rationale for the medication?

left ventricular dysfunction

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

The nurse is administering medications to a client with pericarditis. What medications will be commonly prescribed to treat pericarditis? Select all that apply.

prednisone colchicine ibuprofen

Which mitral valve condition generally produces no symptoms?

prolapse

A nurse is assigned to the medical intensive care unit. The nurse auscultates a water-hammer pulse. What will the sound resemble?

quick, sharp strokes that suddenly collapse

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

A client with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. What collaborative management will the nurse expect for this client?

surgical valve replacement

Which of the following is the most common complication of prosthetic valves?

thromboembolism

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

warfarin