Chapter 28

A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis?

Chest pain

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."

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."

A client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" What is the nurse's best response?

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

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

Autograft

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 nurse is assessing a patient who has had valvular heart disease for more than 15 years. Which signs and symptoms should the nurse expect? (Choose all that apply.)

Paroxysmal nocturnal dyspnea Orthopnea Cough

What is the most common cause of mitral stenosis?

Rheumatic endocarditis

A nurse is admitting a client with hypertrophic cardiomyopathy (HCM). What medication order will the nurse question?

isosorbide dinitrate

The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis?

reports of constant chest pain

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?"

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."

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

Cardiac tamponade

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 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 caffeine and alcohol

Which mitral valve condition generally produces no symptoms?

Prolapse

A client with a recent history of atrial fibrillation has been prescribed warfarin. What action will the nurse take to confirm safe dosing?

Review the client's international normalized ratio (INR).

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?

3.8

The medical plan of treatment for chronic mitral regurgitation would include medications to reduce afterload, such as:

Angiotensin-converting enzyme (ACE) inhibitors.

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.

A client with mitral stenosis is admitted to the hospital. What assessment findings would indicate right ventricular failure?

Distended jugular veins, pedal edema, nausea

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 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

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

Group A, beta-hemolytic streptococcus

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

Heterograft

A client who suffered blunt chest trauma in a motor vehicle accident reports chest pain during deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. To relieve this chest pain, which position should the nurse encourage the client to assume?

Leaning forward while sitting

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 earlier. What option will the nurse most likely discuss?

Left ventricular assist device

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

Prepare for pericardiocentesis.

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

Severe heart failure

A 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?

Shortness of breath

A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement?

The valve has to be replaced frequently.

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

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)

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

A nurse is teaching a client about mitral stenosis. What is the key teaching point regarding the disruption to the normal flow of blood through the heart due to mitral stenosis?

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

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.

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

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

mitral valve

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 caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client?

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

While auscultating the heart of a pediatric client who is recovering from acute rheumatic fever, the nurse hears a murmur. This sound may indicate:

valve damage.

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."

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 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."

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 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 is caring for a five-client assignment on a cardiac unit. In caring for which client would the nurse be most correct to assess for an effusion?

A client with chest trauma

A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD?

An LVAD only supports a failing left ventricle.

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?

An extra heart sound

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

Antibiotic therapy

A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed?

Balloon percutaneous valvuloplasty

The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?

Echocardiography

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

Maintain the client on bed rest

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

Precordial pain

A 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

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?

Rheumatic fever

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?

Risk for infection

The nurse is caring for a client diagnosed with bacterial myocarditis. The client's heart rate is 120-130 beats per minute and blood pressure 158/89 mm Hg. What medications will the nurse administer to treat the client with myocarditis? Select all that apply.

carvedilol amiodarone penicillin