Chapter 28: Management of Patients with Structural, Infectious and Inflammatory Cardiac Disorders

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? A. "I may have to take prophylactic antibiotics for up to 10 years." B. "I will avoid milk, yogurt, and other dairy products." C. "I will avoid any kind of activity." D. "I will take a nonsteroidal anti-inflammatory medication every day."

A. "I may have to take prophylactic antibiotics for up to 10 years." Antibiotic prophylaxis for recurrent rheumatic fever with rheumatic carditis may require 10 or more years of antibiotic coverage (e.g., penicillin G intramuscularly every 4 weeks, penicillin V orally twice a day [BID], sulfadiazine orally daily, or erythromycin orally BID). Clients 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 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? A. "I need to do my leg exercises five times or more every hour." B. "I should lie on my side with my knees bent when sleeping." C. "I should try not to drink too much during the daytime." D. "I need to ice my leg every 2 hours for about 20 minutes."

A. "I need to do my leg exercises five times or more every hour." Exercise prevents venous stasis by promoting venous circulation, relieves swelling, and reduces pain. Promoting venous blood flow prevents the formation of thrombi and subsequent potential for emboli in the unaffected extremity. Bending the knees is contraindicated for a client with DVT because it interferes with venous circulation and may increase the size of the existing clot or contribute to the formation of additional thrombi. Clients with DVT should apply warm, moist compresses to the area of discomfort because warmth dilates blood vessels, improves circulation, and relieves swelling, all of which relieve discomfort; moist heat is more comforting than dry heat. Adequate fluid volume dilutes blood cells in plasma and reduces the risk for platelet aggregation.

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. Aortic regurgitation B. Mitral insufficiency C. Tricuspid insufficiency D. Tricuspid stenosis

A. Aortic regurgitation 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 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? A. the high risk for complications if she becomes pregnant while taking warfarin B. instructions for using the rhythm method C. foods to limit (green leafy vegetables) while taking warfarin D. symptoms to report of worsening tachycardia related to atrial fibrillation

A. the high risk for complications if she becomes pregnant while taking warfarin Women of childbearing age should not take warfarin (pregnancy X category) if they plan to become pregnant. There is danger to the placenta and risk for the mother to bleed. The fetus may also be affected. This client should practice a more reliable method of birth control. The rhythm method for birth control is not always accurate.The symptoms of worsening tachycardia are important, but do not correspond to the warfarin therapy. Limiting green leafy vegetables is important with warfarin therapy, but risk for fetal harm is more important.

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? A. "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." B. "I will need to take three different types of medications for the rest of my life to help prevent rejection." C. "I will receive medication before and during surgery, which will eliminate the risk of rejection." D. "There is no risk of rejection if the donor heart is an exact match."

B. "I will need to take three different types of medications for the rest of my life to help prevent rejection." Clients 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. Three classes of medications are prescribed for a transplant client to help minimize rejection: corticosteroids (e.g., prednisone), calcineurin inhibitors (tacrolimus, cyclosporin), and antiproliferative agents (mycophenolate mofetil, azathioprine, or sirolimus).

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? A. "It is fine to let the child recover naturally; it will save you time and money." B. "It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment." C. "Health care providers tend to overtreat children with antibiotics so the child recovers quickly." D. "It is not a good idea to give antibiotics for every sore throat that your child has because of the overuse of antibiotics."

B. "It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment." A sore throat may be streptoccocal pharyngitis. Diagnosing and treating the sore throat can prevent rheumatic fever and, therefore, rheumatic heart disease. Letting children recover naturally can be dangerous if the sore throat is a strotococcal infection. The use of antibiotics is considered by each prescribing heath care provider. General statements about treatments are not helpful.

A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valular disease? A> "The client may have to wear antiembolism stocking to help with venous return." B. "The client with mitral valve prolapse probably had no health symptoms." C. "The client needs premium insurance to cover the cost of medications." D. "The client's religion may prohibit the client from seeking medical attention."

B. "The client with mitral valve prolapse probably had no health symptoms." Most people with mitral valve prolapse (which occurs more often in women) never have symptoms. Frequently, the first and only sign is identified during a routine physical assessment, when the examiner hears an extra heart sound on auscultation. Mitral value prolapse is treated with beta blockers or valve repair so premium insurance is not necessary. The client's religion is not a factor in teaching. The use of antiembolism stockings is not a treatment for mitral vale prolapse.

While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? A. Prepare to insert a unilateral chest tube. B. Ask the patient to lean forward and listen again. C. Notify the health care provider. D. Document that the pericarditis has resolved.

B. Ask the patient to lean forward and listen again. The most characteristic sign of pericarditis is a creaky or scratchy friction rub heard most clearly at the left lower sternal border. Having the patient lean forward and to the left uses gravity to force the heart nearer to the chest wall, which allows the friction rub to be heard. These assessment data are not life-threatening and do not require a call to the health care provider. The nurse should try multiple times to auscultate the friction rub before deciding that the rub is gone. Chest tubes are not the treatment of choice for not hearing friction rubs. Reference

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. Atrial fibrillation C. First-degree atrioventricular block D. Sinus dysrhythmia

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

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? A. Placement of an autograft valve B. Balloon percutaneous valvuloplasty C. Placement of a xenograft valve D. Antibiotic therapy

B. Balloon percutaneous valvuloplasty Definitive treatment for aortic stenosis is surgical replacement of the aortic valve. Clients who are symptomatic, but not good surgical candidates may benefit from a one or two balloon percutaneous valvuloplasty. Antibiotic therapy will not open the valve. The client does not want to have a valve replacement of any kind.

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? A. Hypertension B. Cardiac tamponade C. Decreased venous pressure D. Left ventricular hypertrophy

B. Cardiac tamponade 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 (see Chapter 29).

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? A. Allow unrestricted physical activity B. Check regularly for dependent edema C. Administer oxygen D. Maintain bed rest

B. Check regularly for dependent edema The nurse should regularly monitor for dependent edema if the client 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 client's activity level is reduced and should sequence any activity that is slightly exertional between periods of rest.

Which nursing intervention would reduce cardiac workload in a client with myocarditis? A. Administer a prescribed antipyretic. B. Maintain the client on bed rest. C. Eliminate all phone calls and visitors. D. Lower the client's head.

B. Maintain the client on bed rest. The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing. The nurse would administer a prescribed antipyretic only if the client has a fever. The nurse elevates the client's head to promote maximal breathing potential. Treatment for myocarditis does not preclude allowing the client to have visitors or use the telephone.

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? A. Mitral regurgitation B. Mitral valve prolapse C. Aortic regurgitation D. Aortic stenosis

B. Mitral valve prolapse Most people with mitral valve prolapse never have symptoms. A few have fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, chest pain, or anxiety. Fatigue may occur regardless of activity level and amount of rest or sleep. Often the first and only sign of mitral valve prolapse is an extra heart sound, referred to as a mitral click. A systolic click is an early sign that a valve leaflet is ballooning into the left atrium.

Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? A. A loud, blowing murmur B. Shortness of breath C. Tachycardia D. Hypertension

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

he diagnosis of aortic regurgitation (AR) is confirmed by which of the following? A. Myocardial biopsy B. Cardiac catheterization C. Echocardiography D. Exercise stress testing

C. Echocardiography Diagnosis is confirmed by echocardiography. Cardiac catheterization is not necessary in most patients with AR. Exercise stress testing will assess functional capacity and symptom response. A myocardial biopsy may be performed to analyze myocardial tissue cells in patients with cardiomyopathy.

A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? A. Staphylococcus aureus B. Pseudomonas aeruginosa C. Group A, beta-hemolytic streptococcus D. Serratia marcescens

C. Group A, beta-hemolytic streptococcus 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). Clients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure.

Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve? A. Allograft B. Autograft C. Heterograft D. Homograft

C. Heterograft Heterograft, also called bioprosthesis, refers to replacement of tissue from animal tissue, usually pigs but also cows or horses. An autograft is a heart valve replacement made from the client's own heart valve. Allograft refers to replacement using human tissue and is a synonym for homograft.

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? A. Chordoplasty B. Annuloplasty C. Left ventricular assist device D. Open commissurotomy

C. Left ventricular assist device When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Because of the limited number of organ donors, many clients die waiting. In some cases, a left ventricular assist device is implanted to support the failing heart until a suitable donor becomes available. The other three choices have to do with failing valves and valve repairs.

he nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis? A. Serum cardiac antigens B. Immunosuppressant assay C. Positive blood culture D. Complete blood count

C. Positive blood culture A positive blood culture identifies the microorganism circulating in the blood. Slight leukocytosis is common but can be associated with other disease processes. Serum cardiac antigens and immunosuppressant assay are not typical diagnostic studies.

It is important for a nurse to be aware of the normal hemodynamics of blood flow to recognize and understand pathology when it occurs. The nurse should know that incomplete closure of the tricuspid valve results in a backward flow of blood from the: A. Aorta to the left ventricle. B. Left atrium to the left ventricle. C. Right ventricle to the right atrium. D. Right atrium to the right ventricle.

C. Right ventricle to the right atrium. The tricuspid valve is located between the right atrium and the right ventricle. Therefore, incomplete closure results in the backward flow of blood from the right ventricle to the right atrium.

The nurse assessing a patient with pericardial effusion at 0800 notes the apical pulse is 74 and the BP is 140/92. At 1000, the patient has neck vein distention, the apical pulse is 72, and the BP is 108/92. Which action would the nurse implement first? A. Notify the health care provider immediately. B. Administer morphine by intravenous push slowly. C. Stay with the patient, use a calm voice, and ask for assistance via call light. D. Place the patient in the left lateral recumbent position.

C. Stay with the patient, use a calm voice, and ask for assistance via call light. The nurse stays with the patient and continues to assess and record signs and symptoms while intervening to decrease patient anxiety. The pulse pressure is narrowing, and the patient is experiencing neck vein distention, indicative of rising central venous pressure. After reaching assistance via the call light from the patient's beside, the nurse notifies the physician immediately and prepares to assist with diagnostic echocardiography and pericardiocentesis. A left lateral recumbent position is used when administering enemas. Morphine would be given to someone who may be experiencing a myocardial infarction, not cardiac tamponade.

A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant? A. The patient reports chest pain after eating a large meal. B. The patient's has an enlarged liver and oedematous abdomen. C. The patient reports shortness of breath when walking. D. The patient has jugular vein distention and 3+ pedal edema.

C. The patient reports shortness of breath when walking. Dyspnea on exertion is typically the earliest manifestation of mitral valve stenosis. Late signs of right-sided heart failure are jugular vein distention, edema, and enlarged liver. Chest pain rarely occurs with mitral valve stenosis.

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? A. "The layers of the heart become loose from each other and rub together with each heart beat." B. "The lung surfaces lose their lubrication and rub against the myocardium with each heart beat." C. "The great vessels rub against the pericardium with each heart beat." D. "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."

D. "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid due to inflammation. The rub is audible on auscultation and is synchronous with the heartbeat. The layers of the heart never become loose from each other. The great vessels are not in contact with the inside of the pericardium, where the inflammation is located. The lungs have nothing to do with a pericardial friction rub.

Which describes a valve used in replacement surgery that is made from the client's own heart valve? A. Homograft B. Allograft C. Xenograft D. Autograft

D. Autograft An example of an autograft is when the surgeon excises the pulmonic valve and uses it for an aortic valve replacement. An allograft, also called a homograft, refers to replacement using human tissue. Xenograft refers to animal tissue used in tissue replacement.

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 scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy? A. Arrhythmogenic right ventricular B. Dilated C. Restrictive D. Hypertrophic

D. Hypertrophic 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). Restrictive (or constrictive) cardiomyopathy (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.

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? A. Fluid increase to 2500cc B. Warm, salt water gargling C. Administering antiseptic lozenges D. Obtaining a throat culture

D. Obtaining a throat culture When a child has a sore throat and symptoms of a possible infection occur, it is essential that a culture is obtained. A culture can identify group A beta-hemolytic streptococcal infection, which needs to be eliminated with use of an antibiotic. Warm, salt gargles; increasing fluids; and administering antiseptic lozenges are helpful for symptom control. Obtaining a throat culture is a priority.

The nurse is assessing a client admitted with acute left-sided infective endocarditis. What is the best diagnostic test to confirm the diagnosis? A. transesophageal echocardiogram B. urinalysis C. complete blood count D. blood cultures

D. blood cultures A definitive diagnosis of acute left-sided infective endocarditis is made when a micro-organism is found in two separate blood cultures. A complete blood count, urinalysis, and a transesophageal echocardiogram may contribute to the diagnosis, but are not the most definitive diagnostic tests for endocarditis.

If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected? A. coronary arteries B. inferior vena cava C. septum D. mitral valve

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

A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered? A. electrophysiological studies B. complete blood count C. electrocardiogram D. throat culture

D. throat culture Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease. If signs and symptoms of streptococcal pharyngitis are present, a throat culture is necessary to make an accurate diagnosis. An electrophysiology study will confirm abnormal heart rhythms. An electrocardiogram will monitor heart ryhthm disturbances, not diagnose the endocarditis. A complete blood count will not confirm the endocarditis diagnosis, but will add information for treatment.

A nurse is preparing home care instructions for a client with infective endocarditis. What will the nurse include in the instructions? Select all that apply. A. Encourage oral hygiene at least twice daily with a soft toothbrush. B. Inform all health care providers of the history of endocarditis. C. Record urine output and report anything less than 240 mL per day to your physician. D. Monitor intravenous catheter sites for signs of infection

A. Encourage oral hygiene at least twice daily with a soft toothbrush. B. Inform all health care providers of the history of endocarditis. D. Monitor intravenous catheter sites for signs of infection Increased vigilance is required for patients with intravenous catheters and during invasive procedures. Equally important is ongoing good oral hygiene. Poor dental hygiene can lead to bacteremia, particularly in the setting of a dental procedure. Antibiotic prophylaxis is recommended for high-risk patients immediately before and sometimes after certain procedures, so making dentists and other health care professionals aware of the history is important. Recording urine output is not necessary.

Which of the following is the most common complication of prosthetic valves? A. Thromboembolism B. Infection C. Arrhythmias D. Hemolysis

A. Thromboembolism Thromboembolism is the most common complication of prosthetic valves and long-term anticoagulation with warfarin is initiated 48 hours after surgery. Overall, patients are at risk for thromboembolism, infection, arrhythmias, and hemolysis.

The nurse completes an assessment of a client with mitral regurgitation. What statement represents the appropriate physical finding for a client with this condition? A. "I knew I would hear a diastolic murmur at the left sternal border." B. "The high-pitched blowing sound at the apex is indicative of a systolic murmur." C. "I auscultated a mitral click." D. "I heard a low-pitched diastolic murmur at the apex."

B. "The high-pitched blowing sound at the apex is indicative of a systolic murmur." A systolic murmur is heard as a high-pitched, blowing sound at the apex. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath on exertion, and cough from pulmonary congestion also occur. A mitral click will be present with valve replacement. A diastolic murmur is not heard with mitral regurgitation.

A young mother brings her 4-year-old in to the pediatric clinic with a mild fever and a red, spotty rash that is beginning to fade. The child's heart rate is rapid, and the rhythm is abnormal. The mother states the child has been healthy until about 3 weeks ago when the child had a sore throat. The nurse suspects rheumatic carditis. What organism causes rheumatic carditis? A. Staphylococcus aureus B. Group A beta-hemolytic strep C. Epstein-Barr virus D. Streptococcus viridians

B. Group A beta-hemolytic strep The inflammatory symptoms of rheumatic carditis are believed to be induced by antibodies originally formed to destroy the group A beta-hemolytic streptococcal microorganisms. Staphylococcus aureus and Streptococcus viridians are associated with infectious endocarditis. The Epstein-Barr virus is associated with myocarditis.

Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis? A. higher rate of tuberculosis B. increased use of prosthetic valve replacements C. greater incidence of a history of repaired congenital heart defects D. increase in IV drug use

B. increased use of prosthetic valve replacements The prevalence of infective endocarditis among older adults has increased in part due to the increased number of prosthetic valve replacements, including replacements for older adults, and an increase in hospital-acquired bacteremia. While history of a repaired congenital heart defect does place a client at greater risk for developing infective endocarditis in the future, it has not been shown as a contributing factor in the prevalence of infective endocarditis among older adults. IV drug use and IV drug abuse places individuals at greater risk for infective endocarditis. However, this risk has not been attributed to an increase in its prevalence among older adults. Tuberculosis is known to contribute to pericarditis among the general population and is not specific to the older adult client.

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. Vancomycin B. Nifedipine C. Cyclosporine D. Verapamil

C. Cyclosporine Because of advances in surgical techniques and immunosuppressive therapies, heart transplantation is now a therapeutic option for patients with end-stage heart disease. Cyclosporine and tacrolimus are immunosuppressants that decrease the body's rejection of foreign proteins, such as transplanted organs.

he diagnosis of aortic regurgitation (AR) is confirmed by which of the following? A. Myocardial biopsy B. Exercise stress testing C. Echocardiography D. Cardiac catheterization

C. Echocardiography Diagnosis is confirmed by echocardiography. Cardiac catheterization is not necessary in most patients with AR. Exercise stress testing will assess functional capacity and symptom response. A myocardial biopsy may be performed to analyze myocardial tissue cells in patients with cardiomyopathy.

Incomplete closure of the mitral valve results in backflow of blood from the: A. Left atrium to left ventricle B. Right atrium to right ventricle C. Left ventricle to left atrium D. Right ventricle to the right atrium

C. Left ventricle to left atrium Incompetent closure of the mitral valve can result from disease processes that alter valve leaflets, mitral annulus, chordae tendineae, and the papillary muscle. When mitral valve leaflets thicken, fibrose, and contract, they cannot close completely during systole. This forces blood backward from the left ventricle into the left atrium during systole.

Which action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community? A. Educate individuals in the community about the importance of monitoring temperature when infections occur. B. Encourage susceptible groups in the community to receive immunizations with streptococcal vaccine. C. Teach individuals in the community to seek medical treatment for streptococcal pharyngitis. D. Provide prophylactic antibiotics to individuals with a family history of rheumatic fever.

C. Teach individuals in the community to seek medical treatment for streptococcal pharyngitis. Prevention of acute rheumatic fever is dependent upon effective antibiotic treatment of streptococcal pharyngitis. Family history is not a risk factor for rheumatic fever. No immunization effectively decreases the incidence of rheumatic fever. Education about monitoring temperature will not decrease the incidence of rheumatic fever.

The nurse is discharging a client recently diagnosed with aortic stenosis (AS). What are symptoms associated with aortic stenosis? A. dyspnea, angina, and diastolic murmur B. syncope, diastolic murmur, and angina C. angina, syncope, and dyspnea D. diastolic murmur, syncope, and dyspnea

C. angina, syncope, and dyspnea A triad of symptoms is associated with AS: (a) angina due to left ventricular hypertrophy and diminished coronary blood flow, (b) dyspnea due to heart failure, and (c) syncope, in particular with exertion, due to fixed cardiac output. A diastolic murmur is characteristic of aortic regurgitation, whereas a systolic ejection murmur is commonly heard with aortic stenosis.

A patient with a history of valvular disease has just arrived in the PACU after a percutaneous balloon valvuloplasty. Which intervention should the recovery nurse implement? A. Assess the patient's chest tube output. B. Evaluate the patient's endotracheal lip line. C. Monitor the patient's chest drainage. D. Keep the patient's affected leg straight.

D. Keep the patient's affected leg straight. Balloon valvuloplasty is performed in the cardiac catheterization laboratory. A catheter is inserted into the femoral artery. The patient must keep the affected leg straight to prevent hemorrhage at the insertion site. It is not an open heart surgery requiring chest tubes nor a chest dressing. ET tubes are placed when someone has general anesthesia, and this procedure is performed using light or moderate sedation.

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: A. rheumatic fever. B. dilated cardiomyopathy. C. myocarditis. D. infective endocarditis.

D. infective endocarditis. Subacute endocarditis infections progress insidiously over weeks to months with vague manifestations, such as headache, malaise, fatigue, and sleep disturbances. Small, painless, red-blue macular lesions or Janeway lesions may appear on the palms of the hands and soles of the feet. Clients with myocarditis may complain of sharp stabbing or squeezing chest discomfort that resolves upon sitting up. Clients with dilated cardiomyopathy are likely to experience fatigue and leg swelling and may also have palpitations and chest pain.

The health care provider has scheduled a client with mitral stenosis for mitral valve replacement. What condition will the nurse expect to see as a complication of mitral stenosis? A. left ventricular hypertrophy B. myocardial ischemia C. left-sided heart failure D. pulmonary hypertension

D. pulmonary hypertension Mitral stenosis, or severe narrowing of the mitral valve, impedes blood flow through the stenotic valve, increasing pressure in the left atrium and pulmonary circulation. These problems may lead to low cardiac output, pulmonary hypertension, edema, and right-sided (not left-sided) heart failure. Other potential complications of mitral stenosis include mural thrombi, pulmonary hemorrhage, and embolism to vital organs. Myocardial ischemia may occur in a client with coronary artery disease. Left ventricular hypertrophy is a potential complication of aortic stenosis.

An asymptomatic client questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which is the most appropriate response by the nurse? A. "Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop." B. "Avoid strenuous cardiovascular exercise." C. "Avoid any type of exercise." D. "Continue the exercise routine but take ample rest after exercising."

A. "Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop." Exercise is not limited until mild symptoms develop. Once symptoms of heart failure develop, the client needs to restrict his or her activity level to minimize symptoms. It is not important for an asymptomatic client to avoid exercise and to take ample rest after exercise.

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? 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 from a tissue donor, and I will not need to take any blood-thinning drugs when I am discharged." 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 mechanical, and it will not deteriorate or need replacing."

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." Autografts (i.e., autologous valves) are obtained by excising the client'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 client'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, clients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.

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? A. 3.8 B. 3.0 C. 2.6 D. 3.4

A. 3.8 Warfarin 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.

The medical plan of treatment for chronic mitral regurgitation would include medications to reduce afterload, such as: A. Angiotensin-converting enzyme (ACE) inhibitors. B. Anticoagulants. C. Vasodilators. D. Diuretics

A. Angiotensin-converting enzyme (ACE) inhibitors. Afterload reduction refers to arterial dilation, which occurs with ACE inhibitors.

A client with aortic regurgitation is admitted to the hospital. Which assessment findings would indicate left ventricular failure? A. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND) B. Distended jugular veins, pedal edema, nausea C. Orthopnea, nausea, pedal edema D. Dyspnea, distended jugular veins, orthopnea

A. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND) Signs and symptoms of progressive left ventricular failure include breathing difficulties, such as orthopnea and PND. Distended jugular veins, pedal edema, and nausea are signs and symptoms of right-sided heart failure.

A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure? A. Dyspnea, orthopnea, pulmonary edema B. Dyspnea, distended jugular veins, orthopnea C. Orthopnea, nausea, pedal edema D. Distended jugular veins, pedal edema, nausea

A. Dyspnea, orthopnea, pulmonary edema Signs and symptoms of progressive left ventricular failure include breathing difficulties, such as orthopnea, PND, and pulmonary edema. Distended jugular veins, pedal edema, and nausea are signs and symptoms of right sided heart failure.

The nurse is caring for a client with cardiac compromise related to mitral valve impairment. Which outcome of the eroding of the mitral valve is most significant? A. Heart failure B. Presence of a heart murmur C. Pulmonary congestion D. Activity intolerance

A. Heart failure The most significant outcome of the eroding of the mitral valve is heart failure. Blood leaking between the heart chambers diminishes the hearts ability to circulate blood efficiently. Eventually, the heart cannot keep up with the body's metabolic need, and heart failure occurs.

An adult client with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. The medical history reveals diabetes mellitus, hypertension, and pernicious anemia. The client underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. What history finding is a major risk factor for infective endocarditis? A. History of aortic valve replacement

A. History of aortic valve replacement 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.

During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct? A. "Mechanical valves are used for women of childbearing age." B. "A mechanical valve is thought to be more durable and so requires replacement less often." C. "Mechanical valves are not always available and are very expensive." D. "A mechanical valve is less likely to generate blood clots, so long-term anticoagulation therapy is not required."

B. "A mechanical valve is thought to be more durable and so requires replacement less often." Mechanical valves are thought to be more durable than tissue valves and so require replacement less often. Tissue valves are less likely to generate blood clots and so long-term anticoagulation therapy is not required. Homografts (human valves) are not always available and are very expensive.

The nurse is caring for a client with aortic regurgitation. The nurse knows to expect what symptoms during the physical examination? A. Increased urine output B. Orthopnea and dyspnea C. Headache and vomiting D. Nausea and low urine output

B. Orthopnea and dyspnea Aortic regurgitation usually manifests as progressive left ventricular failure, resulting from blood flowing backward from the aorta to the left ventricle, and eventually into the lungs. Urine output would be decreased from lower cardiac output. Nausea and vomiting are symptoms of increased gastrointestinal pressure, which would result from right heart failure. Kidney failure could become a problem later if cardiac output became too low, but not initially. CVA and an infarcted bowel would not be caused by mitral regurgitation.

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? A. Mitral valve stenosis B. Pericarditis C. Cardiomyopathy D. Rheumatic fever

B. Pericarditis The primary symptom of pericarditis is pain, which is assessed by evaluating the client in various positions. The nurse tries to identify whether pain is influenced by respiratory movements while holding an inhaled breath or holding an exhaled breath; by flexing, extending, or rotating the spine, including the neck; by moving the shoulders and arms; by coughing; or by swallowing. Recognizing events that precipitate or intensify pain may help establish a diagnosis and differentiate pain of pericarditis from pain of myocardial infarction.

Which mitral valve condition generally produces no symptoms? A. Regurgitation B. Prolapse C. Stenosis D. Infection

B. Prolapse Mitral valve prolapse is a deformity that usually produces no symptoms and has been diagnosed more frequently in recent years, probably as a result of improved diagnostic methods. Mitral valve stenosis usually causes progressive fatigue. Mitral valve regurgitation, in its acute stage, usually presents as severe heart failure. Mitral valve infection, when acute, produces symptoms typical of infective endocarditis.

A client with a recent history of atrial fibrillation has been prescribed warfarin. What action will the nurse take to confirm safe dosing? A. Review the client's most recent warfarin blood levels. B. Review the client's international normalized ratio (INR). C. Assess the client's apical pulse. D.Assess the client's radial pulse.

B. Review the client's international normalized ratio (INR). Warfarin doses are adjusted on the basis of the client's INR. Blood levels are not taken for the drug, and the client's heart rate is not the indicator of efficacy or safety.

A nurse is conducting a heath 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? A. Atrial fibrillation B. Rheumatic endocarditis C. Myocardial infarction D. Congestive heart failure

B. Rheumatic endocarditis 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.

During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following? A. Disturbed sensory perception B. Autonomic dysreflexia C. Ineffective airway clearance D. Decreased cardiac output

D. Decreased cardiac output A primary nursing diagnosis for cardiomyopathy is decreased cardiac output related to structural disorders caused by cardiomyopathy or to dysrhythmia from the disease process and medical treatments. Dyspnea on exertion, fatigue, and fluid retention are related to poor cardiac output. Nausea is related to poor perfusion of the gastrointestinal system. Autonomic dysreflexia is related to a spinal cord injury. Ineffective airway clearance relates to the inability to clear secretions from the airway, which is not an initial problem with cardiomyopathy. Disturbed sensory perception is related to specific senses and not to initial cardiomyopathy.

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? A. Cardiac cauterization B. Chest x-ray C. Computed tomography D. Echocardiography

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

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? A. Decrease the amount of sodium and saturated fat B. Decrease the amount of acidic beverages and fruits C. Eliminate dairy products and carbonated beverages D. Eliminate caffeine and alcohol

D. Eliminate caffeine and alcohol To minimize symptoms of mitral valve prolapse, the nurse should instruct the client to avoid caffeine and alcohol. The nurse encourages the client 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 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? A. Fever B. Dyspnea C. Respiratory symptoms D. Precordial pain

D. Precordial pain Precordial pain is the main characteristic of pericarditis. Dyspnea, fever, and respiratory symptoms are not the main characteristics of pericarditis.

A patient with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this patient? A. Perform a 12-lead ECG. B. Assess the patient's heart and lung sounds. C. Request STAT cardiac enzymes. D. Prepare for pericardiocentesis.

D. Prepare for pericardiocentesis. The nurse notifies the physician immediately and prepares to assist with pericardiocentesis, the emergency treatment for cardiac tamponade. Cardiac enzymes may be elevated but would not be ordered nor would a 12-lead ECG. The nurse's assessment of the lungs and heart is not a collaborative, but an independent action.

Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. A. Arrhythmogenic right ventricular cardiomyopathy (ARVC) B. Dilated cardiomyopathy (DCM) C. Hypertrophic cardiomyopathy (HCM) D. Restrictive cardiomyopathy (RCM)

D. Restrictive cardiomyopathy (RCM) RCM may be associated with amyloidosis (amyloid, a protein substance, is deposited within cells) and other such infiltrative diseases. However, the cause is idiopathic in most cases. 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 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? A. Cerebral vascular accident (CVA) B. Kidney failure C. Infarcted bowel D. Severe heart failure

D. Severe heart failure Acute mitral regurgitation usually manifests as severe congestive heart failure, resulting from blood flowing backward from the left ventricle to the left atria and eventually into the lungs. Kidney failure could become a problem later if cardiac output is too low, but not initially. CVA and an infarcted bowel would not be caused by mitral regurgitation.

The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point? A. Clients with cardiomyopathy have a goal to improve lung function. B. The disease was inherited, so there are no reversal treatments. C. Clients with cardiomyopathy often need to live in a skilled nursing care facility. D. The treatments include medications, medical devices, surgery, or transplantation.

D. The treatments include medications, medical devices, surgery, or transplantation. Treatments for clients with cardiomyopathy include medications, medical devices such as pacemakers, internal defibrillators, surgery or transplantation. The disease is not curable or reversible. Clients with cardiomyopathy do not need to live in a skilled facility. The main goal for clients with cardiomyopathy is to improve heart function.

The nurse determines that a 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. "Can I take the antibiotics as a pill now?" C. "I need a referral to a dietician to understand a low-sodium diet." D. "If I quit smoking, it will help the endocarditis."

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

A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment? A. acute pain B. anxiety C. fatigue D. denial

A. acute pain Pain is the primary symptom of the client with pericarditis. Pain relief and the absence of complications are two major nursing goals.The client may have anxiety, fatigue, or denial, but these symptoms are not the nurse's priority for care.

he nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? A. dyspnea B. reports of constant chest pain C. elevated ESR and CRP D. fatigue lasting more than 1 month

B. reports of constant chest pain The most characteristic symptom of pericarditis is chest pain. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Other signs may include a mild fever, increased WBC count, anemia, and an elevated ESR or C-reactive protein level. Dyspnea and other signs and symptoms of heart failure may occur.

While auscultating the heart of a pediatric client who is recovering from acute rheumatic fever, the nurse hears a murmur. This sound may indicate: A. atrial gallop. B. valve damage. C. cardiac tamponade. D. pericarditis.

B. valve damage. Acute rheumatic fever may lead to cardiac complications; a heart murmur suggests valve damage. Endocarditis may lead to cardiac complications; a pericardial friction rub indicates pericarditis. Muffled heart sounds may indicate cardiac tamponade in clients with pericarditis. Atrial gallop is an abnormal heart sound, or S4, and is often associated with hypertensive heart disease.

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? A. The nurse has the client stand during auscultation. B. There is really no question to ask the client to tell the difference. C. The nurse asks the client to hold the breath during auscultation. D. The nurse places the client flat for at least 4 minutes.

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

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? A. Digoxin B. Furosemide C. Aspirin D. Warfarin

D. Warfarin To reduce the risk of thrombosis in patients with porcine or bovine tissue valves, warfarin is required for 6 to 12 weeks, followed by aspirin therapy. Furosemide would not be given for 6 to 12 weeks following this type of surgery. Digoxin may be used for the treatment of arrhythmias, but not just for 6 to 12 weeks.

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? A. "I should eat foods rich in protein." B. "I'll enroll in an aerobic exercise program." C. "I should increase my fluid intake." D. "I can still drink coffee and tea."

D. "I can still drink coffee and tea." The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.

The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? A. dyspnea B. fatigue lasting more than 1 month C. elevated ESR and CRP D. reports of constant chest pain

D. reports of constant chest pain The most characteristic symptom of pericarditis is chest pain. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Other signs may include a mild fever, increased WBC count, anemia, and an elevated ESR or C-reactive protein level. Dyspnea and other signs and symptoms of heart failure may occur.

Which would the nurse stress as a lifelong necessity for a client managing infective endocarditis? A. Antibiotic therapy B. Exercise regimen C. Potassium replacement D. Antihypertensive medication

A. Antibiotic therapy The nurse informs the client that periodic antibiotic therapy is a lifelong necessity because the client will be vulnerable to diseases for the rest of his life. Antihypertensive therapy is not always prescribed. Limited activity is stressed. Potassium replacement is typical when combined with diuretic therapy.

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? A. "I will avoid caffeine, alcohol, and smoking." B. "I can get my tongue pierced at a store in the shopping mall." C. "I can get a tattoo at a local parlor." D. "I will take antibiotics before getting my teeth cleaned."

A. "I will avoid caffeine, alcohol, and smoking." In mitral valve prolapse, if dysrhythmias are documented and cause symptoms, the client is advised to eliminate caffeine and alcohol from the diet and to stop the use of tobacco products. Antibiotics to prevent endocarditis are no longer prescribed. Tattoos and piercings are not recommended for clients with mitral valve prolapse to prevent unneccessary exposure to bacteria.

Which term describes the splitting or separating of fused cardiac valve leaflets? A. Commissurotomy B. Chordoplasty C. Valvuloplasty D. Annuloplasty

A. Commissurotomy Commissurotomy is performed to split or separate fused cardiac valve leaflets. Annuloplasty is a repair of a cardiac valve's outer ring. Chordoplasty is repair of the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle. Valvuloplasty is a repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty.

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

A. 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.

Clients with myocarditis are sensitive to which medication? A. Digoxin B. Corticosteroids C. Penicillin D. Furosemide

A. Digoxin The nurse must closely monitor these clients for digoxin toxicity, which is evidenced by arrhythmia, anorexia, nausea, vomiting, headache, and malaise. If the cause of the myocarditis is hemolytic streptococci, penicillin will be given. The use of corticosteroids remains controversial.

A nurse is teaching a client about mitral stenosis and the effect on blood flow in the heart. What is teaching point of the disruption to the normal flow of blood through the heart from the mitral stenosis? A. increased resistance of a narrowed orifice between the left atrium and the left ventricle B. atrial hypertrophy C. pulmonary circulation congestion D. inadequate left and right ventricle filling

A. increased resistance of a narrowed orifice between the left atrium and the left ventricle Left atrial pressure increases because of the slowed blood flow into the LV through the narrowed orifice. The left atrium dilates and hypertrophies because of the increased blood volume. Pulmonary venous pressure rises, and the circulation becomes congested. As a result, the RV and right atrium become enlarged. Eventually, the ventricle fails.

A client with infective endocarditis (IE) and a fever is admitted to the intensive care unit. Which of these physician orders should the nurse implement first? A. Order blood cultures drawn from two sites B. Obtain a transesophageal echocardiogram C. Administer ceftriaxone 1 g IVPB q 12 hours D. Give acetaminophen pro re nata for fever higher than 100.3 F

A. Order blood cultures drawn from two sites Blood cultures (with each set including one aerobic and one anaerobic culture) drawn from different venipuncture sites over a 24-hour period (each set at least 12 hours apart), or every 30 minutes if the client's condition is unstable, should be obtained before any antimicrobial agents are administered. It is essential to obtain blood cultures before initiating antibiotic therapy in order to obtain accurate sensitivity results.

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? A. Rheumatic fever B. Pericarditis C. Mitral stenosis D. Cardiomyopathy

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

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. Shortness of breath B. Tachycardia C. Hypertension D. A loud, blowing murmur

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

The nursing instructor is teaching a class on thrombophlebitis. What should the nurse tell the students about the inflammatory response in thrombophlebitis? A. The inflammatory response is caused by accumulated waste products in the blocked vessel. B. The inflammatory response is caused by the irritation of blood trying to flow through the vessel. C. The inflammatory response is caused by the irritation of the clot. D. The inflammatory response is caused by an excess for fibrin in the blocked vessel.

A. The inflammatory response is caused by accumulated waste products in the blocked vessel. Accumulated waste products in the blocked vessel irritate the vein wall, initiating an inflammatory response. The other options are incorrect because they do not cause the inflammatory response in thrombophlebitis.

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? A. rheumatic fever

A. rheumatic fever Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures.

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? A. "Have you recently vacationed outside of the United States?" B. "Have you been to the dentist recently?" C. "Do you have a family history of endocarditis?" D. "Do you live with any domesticated animals in your home?"

B. "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 client has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator), bacteremia can cause bacterial endocarditis.

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? A. Asses the client for abnormal bleeding. B. Administer the medication as ordered. C. Hold the medication and notify the HCP. D. Prepare to administer vitamin K.

B. Administer the medication as ordered. Patients with mechanical valve replacements who take warfarin usually have individualized target international normalized ratios (INRs) between 2.0 and 3.5. The nurse would give the medication as ordered. There is no need to adminsiter the antidote vitamin K. The medication should not be held because the INR is normal. The client should not have bleeding with the normal INR.

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? A. Gradually work up to strenuous activity. B. Alternate active periods with rest periods. C. Avoid all physical and emotional stress. D. Include isometric exercises in the daily routine.

B. Alternate active periods with rest periods. The client should plan activities to occur in cycles, alternating rest with active periods. The client with cardiomyopathy must avoid strenuous activity and isometric exercises. It is impossible to avoid all physical and emotional stress.

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? A. Syncope, fever, vomiting B. Exertional dyspnea, orthopnea, pulmonary edema C. Nausea, vomiting, exertional fatigue D. Dizziness, nausea, diarrhea

B. Exertional dyspnea, orthopnea, pulmonary edema When symptoms develop, clients with aortic stenosis usually first have exertional dyspnea, caused by increased pulmonary venous pressure from left heart failure. Orthopnea, paroxysmal nocturnal dyspnea, dizziness, and pulmonary edema may also occur. Nausea and vomiting may be signs of gastrointestinal congestion, but would be related to right heart failure, which does not occur initially with aortic stenosis.

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? A. Dizziness B. Extra heart sound C. Fatigue D. Syncope

B. Extra heart sound 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 prolapse.

The nurse is caring for a client diagnosed with infective endocarditis and awaiting blood culture results. The client asks, "Where did I pick up these bacteria?"The nurse is most safe to speculate which of the following? A. From the fecal-oral route B. From a break in the skin C. From ingestion of a food D. From droplets from a cough

B. From a break in the skin The microorganisms that cause infective endocarditis include bacteria and fungi. Streptococci and staphylococci are the bacteria most frequently responsible for this disorder. Both bacteria are abundantly found on the skin. These organisms are not found in the other locations.

Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? A. Administer a prescribed antipyretic. B. Maintain the client on bed rest. C. Elevate the client's head. D. Administer supplemental oxygen.

B. Maintain the client on bed rest. The nurse should maintain the client 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 client 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 client's head to promote maximal breathing potential.

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? A. Administering around-the-clock opioids as prescribed B. Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on C. Positioning the patient on the right side with the head of the bed elevated 15 degrees D. Promoting progressive relaxation techniques with the use of slow, deep breathing

B. Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on Clients with acute pericarditis require pain management with analgesics, positioning, and psychological support. Relief of pain is achieved by rest. Because sitting upright and leaning forward is the posture that tends to relieve pain, chair rest may be more comfortable. The pain has a sharp, pleuritic quality that changes with respiration, and patients take shallow breaths. Anti-inflammatory medications may be used to help pain; opioids are not usually indicated.

Which valve lies between the right ventricle and the pulmonary artery? A. Tricuspid valve B. Pulmonic valve C. Chordae tendineae D. Mitral valve

B. Pulmonic valve The pulmonic valve is a semilunar valve located between the right ventricle and the pulmonary artery. The tricuspid valve is an atrioventricular valve located between the right atrium and right ventricle. The mitral valve is an atrioventricular valve located between the left atrium and left ventricle. Chordae tendineae anchor the valve leaflets to the papillary muscle and ventricular wall.

A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? 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

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

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. Impaired gas exchange B. Risk for infection C. Chronic pain D. Impaired memory

B. Risk for infection 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.

The nurse is caring for a client diagnosed with aortic stenosis prescribed digoxin. What clinical manifestation will be the rationale for the medication? A. dyspnea B. left ventricular dysfunction C. edema D. angina

B. left ventricular dysfunction Digoxin may be used to treat left ventricular dysfunction. Diuretics may be used for dyspnea. Nitrates may be prescribed for the treatment of angina, but must be used with caution due to the risk of orthostatic hypotension and syncope.

A nurse is assigned to the medical intensive care unit. The nurse ascultates a water-hammer pulse. What will the sound resemble? A. low-pitched diastolic murmur at the apex B. quick, sharp strokes that suddenly collapse C. high-pitched blowing sound at the apex D. mitral click

B. quick, sharp strokes that suddenly collapse With the water-hammer (Corrigan's) pulse, the pulse strikes the palpating finger with a quick, sharp stroke and then suddenly collapses. Water-hammer pulse is not low or high pitched. A clicking sound is heard with a valve replacement.

A nurse working in the medical intensive care unit has a client admitted with mitral stenosis. The nurse is precepting a graduate nurse and explains the pathophysiology of the condition. What statement made by the graduate nurse will reflect an appropriate understanding of the disease process? Select all that apply. A. "Mitral stenosis affects the coronary blood flow and can lead to angina." B. "Mitral stenosis is caused by an obstruction between the right atrium and ventricle." C. "There is a narrowing between the left atrium and left ventricle." D. "It is caused by a tear that leads to the lungs becoming congested." E. "Increased blood flow in the left atrium causes left atrial hypertrophy."

C. "There is a narrowing between the left atrium and left ventricle." E. "Increased blood flow in the left atrium causes left atrial hypertrophy." Poor left ventricular filling can cause decreased cardiac output. The increased blood volume in the left atrium causes it to dilate and hypertrophy. The left atrium and ventricle are affected with mitral stenosis. Mitral regurgitation causes the lungs to become congested. Mitral stenosis does not interfer with coronary blood flow.

A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? A. A client with hypertrophic cardiomyopathy B. A client 1 day post coronary stent placement C. A client 4 days postoperative after mitral valve replacement D. A client with a history of repaired ventricular septal defect

C. A client 4 days postoperative after mitral valve replacement Having prosthetic cardiac valves places the client at high risk for infective endocarditis. Hypertrophic cardiomyopathy and repaired ventricular septal defects are moderate risks for infective endocarditis. Coronary stent placement isn't a risk factor for infective endocarditis.

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 ? A. Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results. B. Notify the next nurse on afternoon shift to hold the evening dose of warfarin. C. Assess the client for bleeding and notify the health care provider of the results. D.Notify the health care provider to request an increase in the warfarin dose.

C. Assess the client for bleeding and notify the health care provider of the results. For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the health care provider 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 health care provider's order. The nurse should notify the health care provider before holding a medication scheduled to be administered during another shift.

When a patient is taking an immunosuppressant following heart transplantation, the nurse would determine which of the following as the MOST important intervention? A. Place the patient in an isolation room. B. Educate the patient regarding signs and symptoms of infection. C. Assess vital signs every 4 hours. D. Prevent exposure to potentially harmful agents such as fresh fruit.

C. Assess vital signs every 4 hours. Cyclosporine is an immunosuppressant that greatly decreases the body's rejection of foreign proteins, such as transplanted organs. Unfortunately, cyclosporine also decreases the body's ability to resist infections, and a satisfactory balance must be achieved between suppressing rejection and avoiding infection. Assessing for signs and symptoms of infection is most important and is required prior to implementing other appropriate interventions.

A client is diagnosed with mitral regurgitation. What does the nurse consider with the mechanics of cardiac hemodynamics? A. Blood flows backward from the aorta into the left ventricle. B. Blood flows backward from the right ventricle into the right atrium. C. Blood flows backward from the left ventricle into the left atrium during systole. D. Blood flows backward from the left atrium into the pulmonary system.

C. Blood flows backward from the left ventricle into the left atrium during systole. When the mitral valve leaflets thicken, fibrose, and contract, they cannot close completely. With each heartbeat, blood is forced backward into the left atrium during systole. Regurgitation of blood into the left atrium causes the left atrial pressure to rise.

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? A. Restrictive B. Dilated C. Hypertrophic D. Arrhythmogenic right ventricular

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

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? A. Prone B. Semi-Fowler's C. Leaning forward while sitting D. Supine

C. Leaning forward while sitting 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, thus helping to relieve chest pain caused by pericarditis. The semi-Fowler's, supine, and prone positions don't cause this pulling-away action, and therefore, do not relieve chest pain associated with pericarditis.

A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement? A. The patient's infections are easier to treat. B. The patient must take lifelong anticoagulant therapy. C. The valve has to be replaced frequently. D. There is a low incidence of thromboembolism.

C. The valve has to be replaced frequently. Biological valves deteriorate and need to be replaced frequently. They do not necessitate accompanying anticoagulant therapy. Infections are easier to treat and the risk of thromboembolism is lower as compared with mechanical valves.

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? A. lethargy, anorexia, and heart failure B. pitting edema, chest discomfort, and nonspecific ST-segment elevation C. fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) D. low urine output secondary to left ventricular dysfunction

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

A nurse caring for a client with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which behavior would indicate to the nurse recognizes that the client's level of anxiety has decreased when the client A. is resting in bed watching TV. B. answers questions about physical status with no problem. C. is able to discuss the prognosis freely. D. eagerly awaits visits from family.

C. is able to discuss the prognosis freely. As anxiety decreases, clients will be able to discuss prognosis freely, verbalize fears and concerns, participate in support groups, and demonstrate appropriate coping mechanisms.

The nurse is teaching a school community parent group about heart wellness. What risk factor is a common leading cause for mitral stenosis? A. Marfan's syndrome B. infective endocarditis C. rheumatic fever D. dissecting aortic aneurysm

C. rheumatic fever The most significant risk factor for mitral stenosis is rheumatic fever, which gradually causes the mitral valve leaflets to thicken and can result in leaflet fusion. Risk factors for aortic regurgitation are infective endocarditis, Marfan's syndrome, and a dissecting aortic aneurysm.

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)? A. Bleeding and wound dehiscence B. Evisceration C. Thrombosis and infection D. Bleeding and infection

D. Bleeding and infection 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.

A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis? A. Orthopnea B. Fatigue C. Dyspnea D. Chest pain

D. Chest pain The most characteristic symptom of pericarditis is chest pain. The pain is typically persistent, sharp, pleuritic, and usually felt in the mid chest, although it also may be located beneath the clavicle, in the neck, or in the left trapezius region. The discomfort is usually fairly constant, but is aggravated by deep inspiration, coughing, lying down, or turning. It may be relieved with a forward-leaning or sitting position.

A client has a history of rheumatic fever as a child. Which instructions should be provided before the client has any dental work done? A. Take steroids. B. Take aspirin. C. Avoid any kind of activities. D. Take prophylactic antibiotics.

D. Take prophylactic antibiotics. Clients 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 used to suppress the inflammatory response. Aspirin is an anticoagulant and used to control the formation of blood clots around heart valves. Many clients cannot appreciate the danger of a disease without seeing external signs of the damage. The nurse gently but firmly reminds the client to limit activity.

The nurse is caring for a client with cardiogenic shock in an critical care unit and the family is asking about the intra-aortic balloon pump (IABP). What will the nurse explain is the premise of using IABP? A. The IABP is another machine used in the intensive care unit to keep the kidneys working. B. The IABP is helping to circulate oxygen to the body tissue. C. The IABP is acting as the heart to pump blood through the body. D. The IABP is reducing the workload of the heart during the shock period.

D. The IABP is reducing the workload of the heart during the shock period. The IABP decreases the workload of the heart by reducing left ventricular afterload. Additionally, it improves coronary artery blood flow by increasing coronary artery perfusion pressure.The IABP does not perform the work of the heart. The IABP does not directly circulate oxygen or keep the kidneys working.

The nurse is performing a medication review of a client diagnosed with myocarditis. What medication may have precipated the client to have myocarditis? A. furosemide B. acetaminophen C. ciprofloxacin D. azathioprine

D. azathioprine Azathioprine is an immunosuppressive medication that can cause myocarditis. Furosemide is a diuretic and acetaminophen is an antiimflammatory; they are not known to cause myocarditis.Ciprofloxacin is a antibiotic not known to precipitate myocarditis.