Chap. 23 - Caring for clients with infectious and inflammatory disorders of the heart and blood vessels.

The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis? a) Friction rub b) Fine crackles c) Coarse crackles d) Wheezes

A pericardial friction rub is diagnostic of pericarditis. Crackles are associated with pulmonary edema and fluid accumulation, whereas wheezes signal airway constriction; neither of these occurs with pericarditis.

Mary Seaver is admitted to the pediatrics unit where you practice nursing. She was admitted by her pediatrician due to suspected rheumatic fever. Aggressive antibiotic therapy and comfort measures have been instituted to minimize the long-lasting effects of the systemic inflammation. How long after Mary recovered from her streptococcal infection is it most common for rheumatic fever to develop? a) 2 - 3 days b) 1 - 2 weeks c) 2 - 3 months d) 2 - 3 weeks

Acute rheumatic fever is most common in children 2 to 3 weeks after a streptococcal infection.

A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? a) Staphylococcus aureus b) Group A, beta-hemolytic streptococcus c) Serratia marcescens d) Pseudomonas aeruginosa

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). Patients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure

The nurse determines that a 49-year-old client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? a) "I have to call my doctor so I can get antibiotics before seeing the dentist." b) "If I quit smoking, it will help the endocarditis." c) "Can I take the antibiotics as a pill now?" d) "I need a referral to a dietician to understand a low-sodium diet."

Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after dental procedures.

Which of the following symptoms occurs in the patient diagnosed with mitral regurgitation when pulmonary congestion occurs? a) Tachycardia b) Shortness of breath c) Hypertension d) A loud, blowing murmur

Shortness of breath Explanation: If pulmonary congestion occurs, the patient with mitral regurgitation develops shortness of breath. A loud, blowing murmur often is heard throughout ventricular systole at the heart's apex. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? a) Dyspnea b) Fatigue lasting more than 1 month c) Uncontrolled restlessness d) Constant chest pain

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. Pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.

The nurse determines that a 49-year-old client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? a) "Can I take the antibiotics as a pill now?" b) "I need a referral to a dietician to understand a low-sodium diet." c) "If I quit smoking, it will help the endocarditis." d) "I have to call my doctor so I can get antibiotics before seeing the dentist."

"I have to call my doctor so I can get antibiotics before seeing the dentist." Explanation: Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after dental procedures

When teaching a patient with rheumatic carditis and a history of recurrent rheumatic fever, which of the following statements made by the patient indicates that teaching has been successful? a) "I will take nonsteroidal anti-inflammatory medication (NSAIDs) every day." b) "I will avoid milk, yogurt and other dairy products." c) "I may have to take prophylactic antibiotics for up to 10 years." d) "I will avoid any kind of activity."

"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 (IM) every 4 weeks, penicillin V orally twice a day (BID), sulfadiazine orally daily, or erythromycin orally BID. Patients 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.

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? a) "The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged." b) "The valve is mechanical, and it will not deteriorate or need replacing." c) "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." d) "The valve is from a tissue donor, and I will not need to take any blood thinning drugs with I am discharged."

"The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged." Explanation: Autografts (i.e., autologous valves) are obtained by excising the patient's own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the patient's own tissue and is not thrombogenic. The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, patients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.

the nurse who is caring for a patient suspected of having pericarditis is aware that the patient's chest pain must be clearly differentiated from chest pain that may be attributable to myocardial infarction. When assessing the patient, how should the nurse make this differentiation? a) "Would you describe your pain as a stabbing pain or is it more of a dull ache?" b) "Is your pain worse when you're lying down, or is it worse when you're sitting up?" c) "When exactly did you first sense that you were having chest pain?" d) "When you breathe in deeply, does your pain get more intense?"

"When you breathe in deeply, does your pain get more intense?" Explanation: Recognizing that deep inspiration or coughing intensifies pain may help to differentiate the pain of pericarditis from the pain of myocardial infarction. The onset, character, and effect of positioning are less likely to help the clinician determine the etiology of the patient's pain.

Fred Edwards, a 48-year-old male, is a biker who has been diagnosed with Buerger's disease. He has a 30-pack-year history and owns a biker bar. In your client education with Mr. Edwards, what actions would you recommend to decrease the complications connected with Buerger's disease? a) Don't bite his fingernails b) Clean his arms and legs daily c) All options are correct d) Prevent trauma to extremities

All options are correct Explanation: The nurse advises the client to inspect the fingernails, toenails, and skin on the arms and legs daily. He or she teaches the client to clean the arms and legs daily; prevent trauma to the extremities; wear properly fitting shoes and stockings (or socks); and avoid prolonged exposure to the cold.

A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs? a) Metoprolol (Lopressor) b) Enoxaparin (Lovenox) c) Amoxicillin (Amoxil) d) Azathioprine (Imuran)

Amoxicillin (Amoxil) Explanation: Although rare, bacterial endocarditis may be life-threatening. A key strategy is primary prevention in high-risk patients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic.

A patient with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the patient for which of the following manifestations? a) Anorexia and confusion b) Tachypnea and dyspnea c) Edema and orthopnea d) Abdominal pain and diarrhea

Anorexia and confusion Explanation: Patients with RCM have increased sensitivity to digoxin, and the nurse must anticipate that low doses will be prescribed and assess for digoxin toxicity. The most common manifestations of digoxin toxicity are gastrointestinal (anorexia, nausea, and vomiting), cardiac (rhythm disturbances and heart block), and central nervous system (CNS) disturbances (confusion, headache, weakness, dizziness, and blurred or yellow vision

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? a) Tricuspid stenosis b) Tricuspid insufficiency c) Mitral insufficiency d) Aortic regurgitation

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 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? a) "You must listen for at least 4 minutes to distinguish between the two." b) "There is really no way to tell the difference; they both sound exactly alike." c) "Ask the client to hold the breath while you auscultate; the pericardial friction rub will continue, while the pleural friction rub will stop." d) "Have the client stand while you auscultate; the pleural friction rub will continue, while the pericardial friction rub will stop."

Ask the client to hold the breath while you auscultate; the pericardial friction rub will continue, while the pleural friction rub will stop." Explanation: A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid as a result of inflammation. The audible rub on auscultation is synchronous with the heartbeat. To distinguish between a pleural rub and a pericardial rub, the client should hold the breath. The pericardial rub will continue. Length of auscultation and standing would not assist in distinguishing one kind of rub from the other.

Which of the following nursing interventions should a nurse perform when a patient with cardiomyopathy receives a diuretic? a) Unrestricted physical activity b) Administer oxygen c) Maintain bed rest d) Check for dependent edema regularly

Check for dependent edema regularly Explanation: The nurse should monitor for dependent edema regularly if the patient with cardiomyopathy receives a diuretic. Oxygen is administered either continuously or when dyspnea or dysrhythmias develop. Bed rest is not necessary. The nurse should ensure that the patient's activity level is reduced and should sequence any activity that is slightly exertional between periods of rest

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)? a) Ventricular tachycardia b) First-degree atrioventricular block c) Sinus dysrhythmia d) Atrial fibrillation

Atrial fibrillation Explanation: In mitral stenosis, the pulse is weak and often irregular because of atrial fibrillation (caused by strain on the atrium).

A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patient's symptoms, the nurse should teach the patient to do which of the following? a) Perform deep breathing and coughing exercises. b) Avoid activities that cause an increased heart rate. c) Avoid large crowds and public events. d) Eat a high-protein, low-carbohydrate diet.

Avoid activities that cause an increased heart rate. Explanation: Patients 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 patient who had an aortic balloon valvuloplasty. The nurse would inspect the surgical insertion site closely for which of the following complications? a) Evisceration b) Bleeding and wound dehiscence c) Thrombosis and infection d) Bleeding 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.

An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patient's echocardiogram? a) Blood to flow back from the left atrium to the left ventricle b) Blood to flow back from the aorta to the left ventricle c) Obstruction of blood from the left atrium to left ventricle d) Obstruction of blood flow from the left ventricle

Blood to flow back from the aorta to the left ventricle Explanation: Aortic regurgitation occurs when the aortic valve does not completely close, and blood flows back to the left ventricle from the aorta during diastole. Aortic regurgitation does not cause obstruction of blood flow from the left ventricle, blood to flow back from the left atrium to the left ventricle, or obstruction of blood from the left atrium to left ventricle.

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

Cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium.

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a) Left ventricular hypertrophy b) Hypertension c) Cardiac tamponade d) Decreased venous pressure

Cardiac tamponade Explanation: The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a) Hypertension b) Decreased venous pressure c) Cardiac tamponade d) Left ventricular hypertrophy

Cardiac tamponade Explanation: The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade (

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? a) Palpitations b) Chest pain c) Pounding heart rate d) Burning sensation in chest

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.

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? a) Risk for infection b) Chronic pain c) Impaired memory d) Impaired gas exchange

Clients with endocarditis have a Risk for infection. The nurse should stress to the client that he'll need to continue antibiotics for a minimum of 5 years and that he'll need to take prophylactic antibiotics before invasive procedures for life. There is no indication that the client has Chronic pain or Impaired memory. Because the client doesn't have valvular damage, Impaired gas exchange doesn't apply.

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. a) 3.0 b) 2.6 c) 3.4 d) 3.8

Coumadin 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 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? a) Vancocin - Vancomyacin - treats infections b) Calan - Verapamil Hcl - hypertension and angina c) Cyclosporine - to prevent transplant rejection - immunosuppressant - also treats rheumatoid arthritis d) Procardia - Nifedipine - treats high blood pressure, angina, Raynaud's phenomena

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 (Gengraf, Neoral, and Sandimmune) and tacrolimus (Prograf, FK506) are immunosuppressants that decrease the body's rejection of foreign proteins, such as transplanted organs.

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? a) Risk for deficient fluid volume b) Ineffective thermoregulation c) Risk for peripheral neurovascular dysfunction d) Decreased cardiac output

Decreased cardiac output Explanation: Decreased cardiac output is an appropriate nursing diagnosis for a client with HCM because the hypertrophied cardiac muscle decreases the effectiveness of the heart's contraction, decreasing cardiac output. Heart failure may complicate HCM, causing fluid volume excess; therefore, the nursing diagnosis of Risk for deficient fluid volume isn't applicable. Ineffective thermoregulation and Risk for peripheral neurovascular dysfunction are inappropriate because HCM doesn't cause these problems.

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? a) Risk for peripheral neurovascular dysfunction b) Decreased cardiac output c) Risk for deficient fluid volume d) Ineffective thermoregulation

Decreased cardiac output Explanation: Decreased cardiac output is an appropriate nursing diagnosis for a client with HCM because the hypertrophied cardiac muscle decreases the effectiveness of the heart's contraction, decreasing cardiac output. Heart failure may complicate HCM, causing fluid volume excess; therefore, the nursing diagnosis of Risk for deficient fluid volume isn't applicable. Ineffective thermoregulation and Risk for peripheral neurovascular dysfunction are inappropriate because HCM doesn't cause these problems.

A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following? a) Exposure to immunocompromised individuals b) Live vaccinations c) Dental procedures d) Future hospital admissions

Dental procedures Explanation: Following mechanical valve replacement, antibiotic prophylaxis is necessary before dental procedures involving manipulation of gingival tissue, the periapical area of the teeth or perforation of the oral mucosa (not including routine anesthetic injections, placement of orthodontic brackets, or loss of deciduous teeth). There are no current recommendations around antibiotic prophylaxis prior to vaccination, future hospital admissions, or exposure to people who are immunosuppressed.

The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterise DCM? a) Dilation of the atria and hypertrophy of the ventricles b) Dilation and hypertrophy of all four heart chambers c) Dilated ventricles with atrophy of the ventricles d) Dilated ventricles without hypertrophy of the ventricles

Dilated ventricles without hypertrophy of the ventricles Explanation: DCM is characterized by significant dilation of the ventricles without significant concomitant hypertrophy and systolic dysfunction. The ventricles do not atrophy in patients with DCM.

The nurse is admitting a patient with complaints of dyspnoea on exertion and fatigue. The patient's ECG shows arrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy? a) Exercise stress test b) Arterial blood gases c) Echocardiogram d) Cardiac catheterisation

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 catheterisation 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 patient is admitted with suspected cardiomyopathy. What diagnostic test would be most helpful with the identification of this disorder? a) Phonocardiogram b) Cardiac catheterization c) Serial enzyme studies d) Echocardiogram

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.

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? a) Cardiac cauterization b) CT scan c) Chest x-ray d) Echocardiogram

Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.

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? a) Eliminate dairy products and carbonated beverages. b) Eliminate caffeine and alcohol c) Decrease the amount of acidic beverages and fruits. d) Decrease the amount of sodium and saturated fat.

Eliminate caffeine and alcohol Explanation: To minimize symptoms of mitral valve prolapse, the nurse should instruct the patient to avoid caffeine and alcohol. The nurse encourages the patient to read product labels, particularly on over-the-counter products such as cough medicine, because these products may contain alcohol, caffeine, ephedrine and adrenaline, which may produce arrhythmias and other symptoms. The nurse also explores possible diet, activity, sleep, and other lifestyle factors that may correlate with symptoms.

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? a) Extra heart sound b) Fatigue c) Dizziness d) 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 prolapsed.

Which signs and symptoms accompany a diagnosis of pericarditis? a) Pitting edema, chest discomfort, and nonspecific ST-segment elevation b) Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) c) Lethargy, anorexia, and heart failure d) Low urine output secondary to left ventricular dysfunction

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.

Which signs and symptoms accompany a diagnosis of pericarditis? a) Lethargy, anorexia, and heart failure b) Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) c) Low urine output secondary to left ventricular dysfunction d) Pitting edema, chest discomfort, and nonspecific ST-segment elevation **Remember cardiac tamponade...

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.

The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis? a) Friction rub b) Wheezes c) Coarse crackles d) Fine crackles

Friction rub Correct Explanation: A pericardial friction rub is diagnostic of pericarditis. Crackles are associated with pulmonary edema and fluid accumulation, whereas wheezes signal airway constriction; neither of these occurs with pericarditis.

A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease? a) Recognizing and promptly treating streptococcal infections b) Prophylactic use of calcium channel blockers in high-risk populations c) Adhering closely to the recommended child immunization schedule d) Smoking cessation

Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease

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? a) History of aortic valve replacement b) Age c) History of diabetes mellitus d) Race

History of aortic valve replacement Explanation: A heart valve prosthesis such as an aortic valve replacement is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, I.V. drug abuse, and immunosuppression. Although race, age, and a history of diabetes mellitus may predispose a person to cardiovascular disease, they aren't major risk factors for infective endocarditis

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? a) Dilated b) Arrhythmogenic right ventricular cardiomyopathy c) Restrictive d) Hypertrophic

Hypertrophic Explanation: In hypertrophic cardiomyopathy (HCM), the heart muscle asymmetrically increases in size and mass, especially along the septum. It often affects nonadjacent areas of the ventricle. The increased thickness of the heart muscle reduces the size of the ventricular cavities and causes the ventricles to take a longer time to relax after systole. The coronary arteriole walls are also thickened, which decreases the internal diameter of the arterioles. The narrow arterioles restrict the blood supply to the myocardium, causing numerous small areas of ischemia and necrosis. The necrotic areas of the myocardium ultimately fibrose and scar, further impeding ventricular contraction. Because of the structural changes, HCM had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). RCM is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue

Septal involvement occurs in which type of cardiomyopathy? a) Restrictive b) Congestive c) Dilated d) Hypertrophic

Hypertrophic Explanation: In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy.

A client is being discharged home with a diagnosis of hypertrophic cardiomyopathy. Which statement by the client demonstrates that he understands the disease process? a) "Since this is a heredity disorder, my family members should probably be evaluated for similar symptoms." b) "Exercise or exertion of any kind could kill me. I should have a caretaker to perform my activities of daily living." c) "I should start a vigorous aerobic exercise program to strengthen my heart function." d) "I should keep a journal of my symptoms and take my prescribed medications only when I have symptoms."

Hypertrophic cardiomyopathy is a heredity disease in which the heart muscle is abnormally thick and asymmetrical. In young clients, especially athletes, the first symptom may be sudden death during strenuous exercise. Strenuous physical exertion is restricted because it may precipitate arrhythmias or sudden cardiac death. The client is usually encouraged to perform normal activities of daily living after discussing restrictions with his physician. Medications, such as beta-adrenergic blockers, calcium channel blockers, and antiarrhythmics, are usually prescribed and should be taken daily to help prevent complications.

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: a) "I will start an antibiotic when I am exposed to anyone with infections." b) I will ask for antibiotics whenever I have dental work done." c) "I will always be on antibiotic therapy." d) "I am going to take an aspirin a day to prevent lesions around my valve."

I will ask for antibiotics whenever I have dental work done." Explanation: The patient should take antibiotics for dental procedures that involve manipulation of gingival tissue or the periapical area of the teeth or perforation of the oral mucosa. Exceptions include routine anesthetic injections through noninfected tissue, placement of orthodontic brackets, loss of deciduous teeth, bleeding from trauma to the lips or oral mucosa, dental x-rays, adjustment of orthodontic appliances, and placement of removable prosthodontic or orthodontic appliances

A patient who has had a recent myocardial infarction develops pericarditis and complains of level 6 (on a scale of 0-10) chest pain with deep breathing. Which of these ordered pro re nata (PRN) medications will be the most appropriate for the nurse to administer? a) Ibuprofen (Motrin) 800 mg po every 8 hours b) Acetaminophen (Tylenol) 650 mg per os (po) every 4 hours c) Morphine sulfate 6 mg IVP every 2-4 hours d) Fentanyl 2 mg intravenous pyelogram (IVP) every 2-4 hours

Ibuprofen (Motrin) 800 mg po every 8 hours Explanation: Pain associated with pericarditis is caused by inflammation, thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis

A patient has undergone a successful heart transplant and has been discharged home with a medication regimen that includes cyclosporine and tacrolimus - both immunosuppresant drugs. In light of this patient's medication regimen, what nursing diagnosis should be prioritized? a) Risk for infection b) Risk for injury c) Risk for unstable blood glucose d) Risk for peripheral neurovascular dysfunction

Immunosuppressants decrease the body's ability to resist infections, and a satisfactory balance must be achieved between suppressing rejection and avoiding infection. These drugs do not create a heightened risk of injury, neurovascular dysfunction, or unstable blood glucose levels.

While receiving treatment in hospital for a DVT, your client has several interventions ordered for his condition. Complete rest, anticoagulant therapy, procedures to determine the location and size of the thrombus are all utilized to decrease the danger from the blood clot. Why are continuous warm, wet packs ordered? a) Increase inflammation b) Improve circulation c) Increase warmth d) Reduce incidents of clots

Improve circulation Explanation: Continuous warm, wet packs are ordered to improve circulation, ease pain, and decrease inflammation.

The nursing instructor is discussing cardiomyopathies with the junior nursing class. The instructor asks the students to work through a plan of care for a patient with a cardiomyopathy. What priority outcomes does the instructor tell the students should be included in the care plan for these patients? a) Absence of complications. b) Improved cardiac output. c) Adherence to the self-care programme. d) Increased activity tolerance.

Improved cardiac output.

What medication order would the nurse question for a patient being treated for pericarditis? a) Ibuprofen b) Indocin c) Prednisone d) Colchicine

Indocin Explanation: Analgesic medications and NSAIDs such as aspirin or ibuprofen (Motrin) may be prescribed for pain relief during the acute phase of pericarditis. These agents also hasten reabsorption of fluid in patients with rheumatic pericarditis. Indomethacin (Indocin) is contraindicated because it may decrease coronary blood flow. Colchicine (Colcrys) or corticosteroids (e.g., prednisone) may be prescribed if the pericarditis is severe or if the patient does not respond to NSAIDs. Colchicine also may be used instead of NSAIDs during the acute phase.

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? a) Erythematosus modules on the pads of the fingers b) Patterns of petechiae on the chest c) Red or purple macules found on the palms of the hands d) Splinter hemorrhages seen under the fingernails

Janeway lesions are painless, red or purple macules found on the palms and soles.

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? a) Patterns of petechiae on the chest b) Red or purple macules found on the palms of the hands c) Erythematosus modules on the pads of the fingers d) Splinter hemorrhages seen under the fingernails

Janeway lesions are painless, red or purple macules found on the palms and soles.

Ralph Wilson, is a 52-year-old client in the hospital unit where you practice nursing. He is being treated for myocarditis. Which of the following nursing interventions should you perform to reduce cardiac workload in a client with myocarditis? a) Administer a prescribed antipyretic b) Elevate the client's head c) Maintain the client on bed rest d) Eliminate all phone calls and visitors

Maintain the client on bed rest Explanation: The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing.

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? a) Administer supplemental oxygen. b) Administer a prescribed antipyretic. c) Maintain the patient on bed rest. d) Elevate the patient's head.

Maintain the patient on bed rest. Explanation: The nurse should maintain the patient 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 patient 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 patient's head to promote maximal breathing potential.

A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient? a) Mitral stenosis b) Aortic regurgitation c) Mitral valve prolapse d) Aortic stenosis

Mitral stenosis Explanation: The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (i.e., hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not typically caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.

What is the most common cause of mitral stenosis? a) Congestive heart failure b) Rheumatic endocarditis c) Degenerative stenosis d) Myocardial infarction

Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. In adults, aortic stenosis is often a result of degenerative calcifications. Congestive heart failure and myocardial infarction are not the most common cause of mitral stenosis.

A nurse is conducting a heath history on a patient with a primary diagnosis of mitral stenosis. Which of the following disorders reported by the patient is the most common cause of mitral stenosis? a) Atrial fibrillation b) Congestive heart failure c) Rheumatic endocarditis d) Myocardial infarction

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 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? a) Septum b) Inferior vena cava c) Coronary arteries d) Mitral valve

Mitral valve Explanation: In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium.

A 65-year-old client has been diagnosed with DVT and placed on warfarin to decrease the likelihood of developing additional thrombi. What PTT and aPTT levels are desired to achieve optimum drug effect? a) 2.0 to 3.0 b) 2.5 to 3.5 times normal c) 1.5 to 2.5 times control value d) 1.5 to 2.5 times normal

Optimum oral anticoagulant drug effect is reached when PTT and aPTT are 1.5 to 2.5 times normal.

A cardiac surgery patient'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? a) Administer a bolus of normal saline. b) Administer a dose of metoprolol. c) Prepare to assist with pericardiocentesis. d) Reposition the patient into a prone position.

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 patient with mitral valve prolapse is admitted for a scheduled cystoscopy. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this? a) Decrease need for surgical asepsis. b) Avoid antibiotic use during the procedure. c) Prevent bacterial endocarditis. d) Prevent inflammation of the urethra.

Prevent bacterial endocarditis.

A nurse is presenting an educational event to the community. The nurse is providing information on rheumatic heart disease. What would the nurse tell the audience is the most effective prevention of rheumatic heart disease? a) Lowering blood cholesterol. b) Smoking cessation. c) Recognising and promptly treating streptococcal infections. d) Adhering to anti-hypertenisve medication treatment.

Recognising and promptly treating streptococcal infections.

Which of the following types of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. a) Hypertrophic cardiomyopathy (HCM) b) Arrhythmogenic right ventricular cardiomyopathy (ARVC) c) Dilated cardiomyopathy (DCM) d) Restrictive cardiomyopathy (RCM)

Restrictive cardiomyopathy (RCM) Explanation: RCM is characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. 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 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? a) Mitral stenosis b) Cardiomyopathy c) Rheumatic fever d) Pericarditis

Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease.

A patient with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which of the following manifestations that would indicate that the patient is developing pulmonary congestion? a) Shortness of breath b) A loud, blowing murmur c) Hypertension d) Tachycardia

Shortness of breath Correct 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 on exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the heart's apex. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.

A patient with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which of the following manifestations that would indicate that the patient is developing pulmonary congestion? a) Tachycardia b) Shortness of breath c) A loud, blowing murmur d) Hypertension

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 on exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the heart's apex. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.

Robert Stockwell, a 53-year-old male, has been admitted to the cardiac unit where you practice nursing. He's been admitted to rule out endocarditis and, if the diagnosis is confirmed, receive IV antibiotic and other supportive therapies. For Robert to develop endocarditis, his body's defense mechanisms, again infection, must have failed. Which of the below mechanisms are part of the body's defenses? a) Immune system b) Inflammatory response c) All options are correct. d) Skin, mucous membranes

The body uses many defense mechanisms to combat the effects of trauma, disease, and microorganisms. The inflammatory response, skin and mucous membranes, and immune system all work together to protect the body's cardiovascular system.

The nurse is admitting a patient to the cardiac care unit with complaints of dyspnea on exertion and fatigue. The patient's electrocardiogram (ECG) shows dysrhythmias associated with left ventricular hypertrophy. What diagnostic tool would be the most helpful in diagnosing cardiomyopathy? a) Swan-Ganz analysis b) Echocardiogram c) Cardiac catheterization d) Arterial blood gases (ABGs)

The echocardiogram is one of the most helpful diagnostic tools because the structure and function of the ventricles can be observed easily. ECG demonstrated dysrhythmias and changes consistent with left ventricular hypertrophy. A cardiac catheterization, ABGs, and Swan-Ganz analysis would not be helpful in diagnosing cardiomyopathy.

The nurse is caring for a patient with acute pericarditis. What nursing management would be instituted to minimize complications? a) The nurse helps the patient with activity restrictions until the pain and fever subside. b) The nurse keeps the patient isolated to prevent nosocomial infections. c) The nurse encourages coughing and deep breathing. d) The nurse encourages increased fluid intake until dehydration is resolved.

The nurse helps the patient with activity restrictions until the pain and fever subside. Explanation: To minimize complications, the nurse helps the patient with activity restrictions until the pain and fever subside. As the patient's condition improves, the nurse encourages gradual increases of activity. Actions to minimize complications of acute pericarditis do not include keeping the patient isolated; coughing and deep breathing are not encouraged. An increase in fluid intake is not necessarily required.

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? a) Semi-Fowler's b) Prone c) Leaning forward while sitting d) Supine

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, helping relieve chest pain caused by pericarditis. The semi-Fowler's, supine, and prone positions don't cause this pulling-away action and therefore don't relieve chest pain associated with pericarditis.

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? a) Elevate the patient's head. b) Administer a prescribed antipyretic. c) Maintain the patient on bed rest. d) Administer supplemental oxygen.

The nurse should maintain the patient 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 patient 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 patient's head to promote maximal breathing potential

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? a) Elevate the patient's head b) Administer a prescribed antipyretic c) Administer supplemental oxygen d) Maintain the patient on bed rest

The nurse should maintain the patient on bed rest to reduce cardiac workload and promote healing. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the patient has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures like minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the patient's head to promote maximal breathing potential.

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? a) The patient has a palpable thrill felt over the left anterior chest. b) The patient has crackles audible throughout the lungs. c) The patient has 4+ peripheral edema in both legs. d) The patient has a loud systolic murmur all across the precordium.

The patient has crackles audible throughout the lungs. Explanation: Acute mitral regurgitation, 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 on exertion and cough from pulmonary congestion also occur. Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and need immediate interventions, such as diuretics.

A client who is over 60 years and taking the anticoagulant therapy with heparin is at a greater risk for which of the following than a younger client who is on the same therapy? a) Additional thrombus formation b) Positive Homan's sign c) Hemorrhage d) Chest pain

The risk of hemorrhage during heparin therapy is greater in clients 60 years of age or older. Clients with thrombophlebitis often complain of discomfort in the affected extremity. Calf pain that increases on dorsiflexion of the foot is referred to as a positive Homans' sign. Any client with a thrombus may develop a PE, a complication of thrombophlebitis. Chest pain and dyspnea are hallmarks of PE. Any client with an existing thrombus is at risk for the development of more in the future. The use of an anticoagulant such as heparin helps reduce this risk

Maurice Taylor, an 87-year-old male, is a client on the cardiac unit where you practice nursing. Mr. Taylor has a history of congenital cardiomyopathy and has lived a long, full life despite the diagnosis. Which of the following cardiomyopathies is not a major type of cardiomyopathy? a) Dilated cardiomyopathy b) Hypertrophic cardiomyopathy c) Peripartum cardiomyopathy d) Restrictive cardiomyopathy

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 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? a) Decrease the amount of acidic beverages and fruits. b) Decrease the amount of sodium and saturated fat. c) Eliminate dairy products and carbonated beverages. d) Eliminate caffeine and alcohol

To minimize symptoms of mitral valve prolapse, the nurse should instruct the patient to avoid caffeine and alcohol. The nurse encourages the patient to read product labels, particularly on over-the-counter products such as cough medicine, because these products may contain alcohol, caffeine, ephedrine and adrenaline, which may produce arrhythmias and other symptoms. The nurse also explores possible diet, activity, sleep, and other lifestyle factors that may correlate with symptoms.

A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this? a) To prevent hospital-acquired pneumonia b) To minimize the need for antibiotic use during the procedure c) To decrease the need for surgical asepsis d) To prevent bacterial endocarditis

To prevent bacterial endocarditis Explanation: Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after the following invasive procedures, such as bronchoscopy. Gentamicin would not be given to prevent pneumonia, to avoid antibiotic use during the procedure, or to decrease the need for surgical asepsis

Marilyn Carr, a 75-year-old female, is a client who has an extensive history with thrombophlebitis. Her vascular surgeon instructed Mrs. Carr that she has Virchow's triad. Which answer gives the best indication as to the significance of her surgeon's statement? a) Mrs. Carr is predisposed to thrombosis and thrombophlebitis b) Mrs. Carr has had trauma to a vein c) Mrs. Carr is predisposed to altered blood coagulation d) Mrs. Carr is predisposed to venous stasis

Venous stasis (slowed circulation), altered blood coagulation, and trauma to the vein, referred to as Virchow's triad, predispose clients to thrombosis and thrombophlebitis.

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? a) Venous stasis b) Altered blood coagulation c) Thrombophlebitis d) Postphlebitic syndrome

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

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? a) Annuloplasty b) Xenograft tissue valve c) Valvuloplasty d) Heart transplantation

When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. The other three choices have to do with failing valves and valve repairs.

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? a) Hypertrophic b) Restrictive c) Dilated d) Arrhythmogenic right ventricular cardiomyopathy

a. Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.

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: a) notify the next shift to hold the daily 5 p.m. dose of warfarin. b) 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. c) call the physician to request an increase in the warfarin dose. d) give the client an I.M. vitamin K injection and notify the physician of the results.

b. 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. For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the physician 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 physician's order. The nurse should notify the physician before holding a medication scheduled to be administered during another shift.

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: a) Staphylococcus aureus b) Serratia marcescens c) Group A, beta-hemolytic Streptococcus d) Pseudomonas aeruginosa

c) Group A, beta-hemolytic Streptococcus Acute IE is often caused by Staphylococcus infection, and its onset is rapid, occurring within days to weeks. Subacute IE, usually caused by Streptococcus, occurs more slowly and its course is prolonged.

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? a) Do you have a family history of endocarditis? b) Have you recently vacationed outside of the United States? c) Have you been to the dentist recently? d) Do you live with any domesticated animals in your home?

c) Have you been to the dentist recently? 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 patient has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator [ICD]), bacteremia can cause bacterial endocarditis.

The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following? a) Use of patient-controlled analgesia b) Use of IV diuretics c) Long-term anticoagulant therapy d) Steroid therapy

c.) long-term anticoagulant therapy Mechanical valves necessitate long-term use of required anticoagulants. Diuretics and steroids are not indicated and patient-controlled analgesia may or may be not be used in the immediate postoperative period.

Patients 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. There are three classes of medications that are prescribed for a transplant patient to help minimize rejection:

corticosteroids (e.g., prednisone) calcineurin inhibitors (tacrolimus, cyclosporin), and antiproliferative agents (mycophenolate mofetil [CellCept], azathioprine [Imuran], or sirolimus [Rapamune]) Calcineurin inhibitors are drugs which inhibit the action of calcineurin, a protein phosphatase involved in activating the T-cells of the immune system. Antiproliferative Agents are drugs that work to block the proliferative phase of acute cellular rejection.

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. a) Ambulate as tolerated. b) Take anticoagulant therapy when symptoms occur. c) Avoid sitting for too long. d) Avoid elevating affected extremity. e) Perform leg exercises each hour.

• Perform leg exercises each hour. • Ambulate as tolerated. • Avoid sitting for too long. Explanation: Nurses instruct clients with thrombophlebitis to prevent recurrences by being active, avoiding knee bending or leg crossing, elevating legs periodically, and taking long-term anticoagulant therapy exactly as prescribed. Clients should also watch for and report signs that indicate impaired clotting: nosebleeds, bleeding gums, rectal bleeding, easy bruising, and prolonged oozing from minor cuts