Chapter 23: Caring for Clients with Infectious and Inflammatory Disorders of the Heart and Blood Vessels
What is the most common cause of mitral stenosis? Rheumatic endocarditis Congestive heart failure Degenerative stenosis Myocardial infarction
Rheumatic endocarditis
A client comes to the clinic reporting 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 preventable disease? Rheumatic fever Mitral stenosis Cardiomyopathy Pericarditis
Rheumatic fever
The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what? A decrease in gamma globulins An insect bite Rheumatic heart disease and its sequelae Sepsis and its sequelae
Rheumatic heart disease and its sequelae
Which mechanisms are part of the body's defenses against infection? All options are correct. immune system skin, mucous membranes inflammatory response
All options are correct
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. Gradually work up to strenuous activity. Include isometric exercises in the daily routine. Avoid all physical and emotional stress.
Alternate active periods with rest periods.
A client with a history of 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 client knows the importance of taking which of the following drugs? Enoxaparin Metoprolol Azathioprine Amoxicillin
Amoxicillin
A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention? Eliminate dairy products and carbonated beverages Decrease the amount of sodium and saturated fat Eliminate caffeine and alcohol Decrease the amount of acidic beverages and fruits
Eliminate caffeine and alcohol
The client has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should assess for indications of what potential complications? Select all that apply. Emboli Mitral valve damage Ventricular dysrhythmia Atrial-septal defect Plaque formation
Emboli Mitral valve damage Ventricular dysrhythmia
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? Fatigue Extra heart sound Dizziness Syncope
Extra heart sound
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) low urine output secondary to left ventricular dysfunction lethargy, anorexia, and heart failure pitting edema, chest discomfort, and nonspecific ST-segment elevation
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
A client who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurse's assessment findings is most consistent with myocarditis? Sudden changes in level of consciousness (LOC) Peripheral edema and pulmonary edema Pleuritic chest pain Flulike symptoms
Flulike symptoms
A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? Group A, beta-hemolytic streptococcus Pseudomonas aeruginosa Serratia marcescens Staphylococcus aureus
Group A, beta-hemolytic streptococcus
A client has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment? Heart transplantation Balloon valvuloplasty Cardiac catheterization Stent placement
Heart transplantation
A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned. What is considered to be one of the last treatments for end-stage cardiomyopathy? heart transplantation xenograft tissue valve annuloplasty valvuloplasty
Heart transplantation
The nurse is on the infection control committee of a hospital and is looking into three cases of hospital-acquired infective endocarditis. What classification of patient is at highest risk for hospital-acquired endocarditis? Hemodialysis patients Patients on immunoglobulins Patients who need in-and-out catheterization Chemotherapy patients
Hemodialysis patients
A nurse reviewing a client's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scarring." The nurse knows these manifestations are indicative of which type of cardiomyopathy? hypertrophic dilated restrictive arrhythmogenic right ventricular
Hypertrophic
A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy? Dilated cardiomyopathy (DCM). Arrhythmogenic right ventricular cardiomyopathy (ARVC) Hypertrophic cardiomyopathy (HCM) Restrictive or constrictive cardiomyopathy (RCM)
Hypertrophic cardiomyopathy (HCM)
A client is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the client? "Clients generally stay in the hospital for 6 to 8 days." "Clients are kept in the hospital until they are independent with all aspects of their care." "Clients need to stay in the hospital until they regain normal heart function for their age." "Clients usually remain at the hospital for 24 to 48 hours."
"Clients usually remain at the hospital for 24 to 48 hours."
The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? "I need a referral to a dietician to understand a low-sodium diet." "I have to call my doctor so I can get antibiotics before seeing the dentist." "Can I take the antibiotics as a pill now?" "If I quit smoking, it will help the endocarditis."
"I have to call my doctor so I can get antibiotics before seeing the dentist."
When teaching a client with rheumatic carditis and a history of recurrent rheumatic fever, which statement by the client indicates that teaching has been successful? "I will avoid milk, yogurt, and other dairy products." "I may have to take prophylactic antibiotics for up to 10 years." "I will take a nonsteroidal anti-inflammatory medication every day." "I will avoid any kind of activity."
"I may have to take prophylactic antibiotics for up to 10 years."
A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition? "I need to do my leg exercises five times or more every hour." "I should lie on my side with my knees bent when sleeping." "I need to ice my leg every 2 hours for about 20 minutes." "I should try not to drink too much during the daytime."
"I need to do my leg exercises five times or more every hour."
A client with endocarditis is being discharged home. What statement indicates effectiveness of client teaching about preventing recurrence of the infection? "I will start an antibiotic when I am exposed to anyone with infections." "I am going to take an aspirin a day to prevent lesions around my valve." "I will always be on antibiotic therapy." I will ask for antibiotics whenever I have dental work done."
"I will ask for antibiotics whenever I have dental work done."
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." "I will take antibiotics before getting my teeth cleaned." "I can get a tattoo at a local parlor." "I can get my tongue pierced at a store in the shopping mall."
"I will avoid caffeine, alcohol, and smoking."
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 medication following surgery to prevent rejection, but if my body does not reject the new heart, I will not have to take any medication at home." "I will need to take three different types of medications for the rest of my life to help prevent rejection." "There is no risk of rejection if the donor heart is an exact match." "I will receive medication before and during surgery, which will eliminate the risk of rejection."
"I will need to take three different types of medications for the rest of my life to help prevent rejection."
A nurse working at a pediatric clinic is teaching a group of parents. A parent asks the nurse if it is okay to let the young child recover from a sore throat naturally, rather than bringing the child to the clinic for diagnosis and treatment. What is the nurse's best response? "It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment." "It is fine to let the child recover naturally; it will save you time and money." "It is not a good idea to give antibiotics for every sore throat that your child has because of the overuse of antibiotics." "Health care providers tend to overtreat children with antibiotics so the child recovers quickly."
"It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment."
A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following? "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." "The layers of the heart become loose from each other and rub together with each heart beat." "The great vessels rub against the pericardium with each heart beat." "The lung surfaces lose their lubrication and rub against the myocardium with each heart beat."
"The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."
A nurse is teaching a client about valve replacement surgery. Which statement by the client 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." "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is from a tissue donor, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is mechanical, and it will not deteriorate or need replacing."
"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 client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment? acute pain anxiety fatigue denial
Acute pain
A client who had a prosthetic valve replacement was taking warfarin to reduce the risk of postoperative thrombosis. The client visited the nurse at a clinic once a week. What INR level would alert the nurse to notify the health care provider? 2.6 3.0 3.4 3.8
3.8
A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? A client 4 days postoperative after mitral valve replacement A client with hypertrophic cardiomyopathy A client with a history of repaired ventricular septal defect A client 1 day post coronary stent placement
A client 4 days postoperative after mitral valve replacement
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 ? Notify the health care provider to request an increase in the warfarin dose. Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results. Assess the client for bleeding and notify the health care provider of the results. Notify the next nurse on afternoon shift to hold the evening dose of warfarin.
Assess the client for bleeding and notify the health care provider of the results.
A client with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the client's symptoms, the nurse should teach the client to do which of the following? Eat a high-protein, low-carbohydrate diet. Avoid activities that cause an increased heart rate. Avoid large crowds and public events. Perform deep breathing and coughing exercises.
Avoid activities that cause an increased heat rate.
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)? Thrombosis and infection Bleeding and wound dehiscence Bleeding and infection Evisceration
Bleeding and infection
A client has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The health care provider's choice of antibiotics would be primarily based on what diagnostic test? Echocardiography Blood cultures Cardiac aspiration Full blood count
Blood cultures
An older adult client has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this client's echocardiogram? Blood to flow back from the aorta to the left ventricle Obstruction of blood flow from the left ventricle Blood to flow back from the left atrium to the left ventricle Obstruction of blood from the left atrium to left ventricle
Blood to flow back from the aorta to the left ventricle
Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? Administer oxygen Check regularly for dependent edema Maintain bed rest Allow unrestricted physical activity
Check regularly for dependent edema
A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis? Orthopnea Chest pain Dyspnea Fatigue
Chest pain
A patient with pericarditis has been admitted to the CCU. The nurse caring for the patient knows that the most common clinical manifestation of pericarditis is what? Palpitations Chest pain Burning sensation in chest Pounding heart rate
Chest pain
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? Dyspnea Constant chest pain Fatigue lasting more than 1 month Uncontrolled restlessness
Constant chest pain
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? Nifedipine Cyclosporine Verapamil Vancomycin
Cyclosporine
The nurse is reviewing the echocardiography results of a client who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure is this client experiencing? Dilated ventricles with atrophy of the ventricles Dilated ventricles without hypertrophy of the ventricles Dilation and hypertrophy of all four heart chambers Dilation of the atria and hypertrophy of the ventricles
Dilated ventricles without hypertrophy of the ventricles
While receiving treatment in hospital for a DVT, a client has several interventions ordered. Complete rest, anticoagulant therapy, and procedures to determine the location and size of the thrombus are all utilized to decrease the danger from the blood clot. Continuous warm, wet packs are ordered to: improve circulation. increase inflammation. increase warmth. reduce incidence of clots.
Improve circulation
The nurse is creating a plan of care for a client with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this client? Absence of complications Adherence to the self-care program Improved cardiac output Increased activity tolerance
Improved cardiac output
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation, the educator describes what consequence of this disorder ? Cardiac tamponade Left ventricular hypertrophy Right-sided heart failure Ventricular insufficiency
Left ventricular hypertrophy
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? Maintain the client on bed rest Administer a prescribed antipyretic Elevate the client's head Eliminate all phone calls and visitors
Maintain the client on bed rest
A client 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 client? Aortic regurgitation Mitral stenosis Mitral valve prolapse Aortic stenosis
Mitral stenosis
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? Mitral valve Pulmonic valve Tricuspid valve Aortic valve
Mitral valve
A patient at the clinic describes shortness of breath, periods of feeling "lightheaded," and feeling fatigued despite a full night's sleep. The nurse obtains vital signs and auscultates a systolic click. What does the nurse suspect from the assessment findings? Mitral valve prolapse Mitral regurgitation Aortic stenosis Aortic regurgitation
Mitral valve prolapse
A client has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the client tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse? Arrange for an alternative bed. Measure the degree of the curvature. Notify the surgeon immediately. Note the scoliosis on the intake assessment.
Notify the surgeon immediately
A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis? Rheumatic fever Pericarditis Mitral valve stenosis Cardiomyopathy
Pericarditis
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? Administering around-the-clock opioids as prescribed Promoting progressive relaxation techniques with the use of slow, deep breathing Positioning the patient on the right side with the head of the bed elevated 15 degrees Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on
Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on
Hattie Willoughby, a 62-year-old female, is two weeks CABG and is returning to her cardiologist due to new symptoms. She reports heaviness in her chest, and pain between her breasts. She reports that leaning forward decreases the pain. After his thorough examination, the cardiologist admits her to the hospital to rule out pericarditis. Which of the following is not a contributing cause to pericarditis? Pneumonia Tuberculosis MI Chest trauma
Pneumonia
A cardiac surgery client's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action? Prepare to assist with pericardiocentesis. Reposition the client into a prone position. Administer a dose of metoprolol as prescribed. Administer a bolus of normal saline as prescribed.
Preapre to assist with pericardiocentesis.
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? Recognizing and promptly treating streptococcal infections Prophylactic use of calcium channel blockers in high-risk populations Adhering closely to the recommended child immunization schedule Smoking cessation
Recognizing and promptly treating streptococcal infections
Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. Hypertrophic cardiomyopathy (HCM) Restrictive cardiomyopathy (RCM) Dilated cardiomyopathy (DCM) Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Restrictive cardiomyopathy (RCM)
A client with a recent history of atrial fibrillation has been prescribed warfarin. What action will the nurse take to confirm safe dosing? Assess the client's radial pulse. Assess the client's apical pulse. Review the client's international normalized ratio (INR). Review the client's most recent warfarin blood levels.
Review the client's international normalized ratio (INR)
A nurse is conducting a health history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis? Rheumatic endocarditis Congestive heart failure Atrial fibrillation Myocardial infarction
Rheumatic endocarditis
A client has undergone a successful heart transplant and has been discharged home with a medication regimen that includes cyclosporine and tacrolimus. In light of this client's medication regimen, what nursing diagnosis should be prioritized? Risk for injury Risk for infection Risk for peripheral neurovascular dysfunction Risk for unstable blood glucose
Risk for infection
A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? A loud, blowing murmur Hypertension Shortness of breath Tachycardia
Shortness of breath
What are the first symptoms of cardiac tamponade? Select all that apply. Shortness of breath Chest tightness Dizziness Tachycardia Neck vein distention
Shortness of breath chest tightness Dizziness
A client who has undergone valve replacement surgery is being prepared for discharge home. Because the client will be discharged with a prescription for warfarin, the nurse should educate the client about which of the following? The need for regularly scheduled testing of the client's International Normalized Ratio (INR) The need to learn to sleep in a semi-Fowler position for the first 6 to 8 weeks to prevent emboli The need to avoid foods that contain vitamin K The need to take enteric-coated ASA on a daily basis
The need for regularly scheduled testing of the client's International Normalized Ratio (INR)
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. There is really no question to ask the client to tell the difference. The nurse has the client stand during auscultation. The nurse places the client flat for at least 4 minutes.
The nurse asks the client to hold the breath during auscultation.
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 eat a small meal before taking nitroglycerin To drink a glass of milk before taking nitroglycerin To engage in 15 minutes of light exercise before taking nitroglycerin To rest and relax before taking nitroglycerin
To rest and relax before taking nitroglycerin
A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease? serial enzyme studies cardiac catheterization echocardiogram phonocardiogram
echocardiogram
The nurse suspects a diagnosis of mitral valve regurgitation when what type of murmur is heard on auscultation? Mitral click High-pitched blowing sound at the apex Low-pitched diastolic murmur at the apex Diastolic murmur at the left sternal border
high-pitched blowing sound at the apex
