Chapter 28: Management of Patients with Structural, Infectious and Inflammatory Cardiac Disorders - ML8

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 less likely to generate blood clots, so long-term anticoagulation therapy is not required." "A mechanical valve is thought to be more durable and so requires replacement less often." "Mechanical valves are used for women of childbearing age." "Mechanical valves are not always available and are very expensive."

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

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

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

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

"I may have to take prophylactic antibiotics for up to 10 years." 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 nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valvular disease? "The client with mitral valve prolapse probably had no health symptoms." "The client needs premium insurance to cover the cost of medications." "The client's religion may prohibit the client from seeking medical attention." "The client may have to wear antiembolism stocking to help with venous return."

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

A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following? "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." "The layers of the heart become loose from each other and rub together with each heart beat." "The great vessels rub against the pericardium with each heart beat." "The lung surfaces lose their lubrication and rub against the myocardium with each heart beat."

"The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."

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

A client 4 days postoperative after mitral valve replacement 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.

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. Prepare to administer vitamin K. Hold the medication and notify the HCP. Asses the client for abnormal bleeding.

Administer the medication as ordered.

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. Prepare to administer vitamin K. Hold the medication and notify the HCP. Asses the client for abnormal bleeding.

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

Alternate active periods with rest periods. 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.

The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse? Fatigue An extra heart sound Dizziness Syncope

An 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.

Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis? Antibiotic therapy Antihypertensive medication Exercise regimen Potassium replacement

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.

A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ? Notify the health care provider to request an increase in the warfarin dose. Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results. Assess the client for bleeding and notify the health care provider of the results. Notify the next nurse on afternoon shift to hold the evening dose of warfarin

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

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

Blood flows backward from the left ventricle into the left atrium during systole.

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

Constant chest pain The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. Pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.

The client with which characteristic is considered at high risk for the development of infective endocarditis? Cyanotic congenital malformation Mitral valve prolapse with valvular regurgitation Hypertrophic cardiomyopathy Acquired valvular dysfunction

Cyanotic congenital malformation

A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection? Nifedipine Cyclosporine Verapamil Vancomycin

Cyclosporine 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.

The nurse is admitting a client with infective endocarditis (IE). What questions will the nurse ask to explore known risk factors associated with IE? Select all that apply. Did you have a pacemaker insertion? Do you have any tattoos? Do you smoke marijuana? Are you injecting any drugs? Did you have a recent eye examination?

Did you have a pacemaker insertion? Are you injecting any drugs? Do you have any tattoos? The known risks factors for IE are cardiac device insertions such as a pacemaker, tattoos, body piercing, and intravenous drug use. Eye examinations and smoking marijuana are not known risk factors for IE.

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

Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND)

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

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 diagnosis of aortic regurgitation (AR) is confirmed by which of the following? Echocardiography Cardiac catheterization Exercise stress testing Myocardial biopsy

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 reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention? Eliminate dairy products and carbonated beverages Decrease the amount of sodium and saturated fat Eliminate caffeine and alcohol Decrease the amount of acidic beverages and fruits

Eliminate caffeine and alcohol 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.

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 Nausea, vomiting, exertional fatigue Dizziness, nausea, diarrhea Syncope, fever, vomiting

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.

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

Group A, beta-hemolytic streptococcus

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

Heterograft

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

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 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? Assess the patient's chest tube output. Monitor the patient's chest drainage. Evaluate the patient's endotracheal lip line. Keep the patient's affected leg straight.

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 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? Semi-Fowler's Leaning forward while sitting Supine Prone

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.

Incomplete closure of the mitral valve results in backflow of blood from the: Left ventricle to left atrium Right ventricle to the right atrium Right atrium to right ventricle Left atrium to left ventricle

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.

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 Chordoplasty Annuloplasty Open commissurotomy

Left ventricular assist device

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 Chordoplasty Annuloplasty Open commissurotomy

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.

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

Maintain the client on bed rest

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

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

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

Maintain the client on bed rest.

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

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 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? Warm, salt water gargling Fluid increase to 2500cc Obtaining a throat culture Administering antiseptic lozenges

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.

A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis? Rheumatic fever Pericarditis Mitral valve stenosis Cardiomyopathy

Pericarditis The 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.

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

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.

Which mitral valve condition generally produces no symptoms? Stenosis Regurgitation Prolapse Infection

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.

Which valve lies between the right ventricle and the pulmonary artery? Tricuspid valve Mitral valve Pulmonic valve Chordae tendineae

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.

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

Restrictive cardiomyopathy (RCM)

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

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

What is the most common cause of mitral stenosis? Rheumatic endocarditis Congestive heart failure Degenerative stenosis Myocardial infarction

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

A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease? Rheumatic fever Mitral stenosis Cardiomyopathy Pericarditis

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

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: Aorta to the left ventricle. Left atrium to the left ventricle. Right atrium to the right ventricle. Right ventricle to the right atrium.

Right ventricle to the right atrium.

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 Chronic pain Impaired gas exchange Impaired memory

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.

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 Kidney failure Cerebral vascular accident (CVA) Infarcted bowel

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.

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

Shortness of breath

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

Shortness of breath 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.

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

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.

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

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.

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

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.

A nurse is caring for a client with pericarditis and auscultates a pericardial friction rub. What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub? The nurse asks the client to hold the breath during auscultation. There is really no question to ask the client to tell the difference. The nurse has the client stand during auscultation. The nurse places the client flat for at least 4 minutes.

The nurse asks the client to hold the breath during auscultation. 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 is assessing a client admitted with acute left-sided infective endocarditis. What is the best diagnostic test to confirm the diagnosis? blood cultures complete blood count urinalysis transesophageal echocardiogram

blood cultures

A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? chronic alcohol abuse heredity scleroderma previous myocardial infarction

chronic alcohol abuse Chronic alcohol ingestion is one of the main causes of dilated cardiomyopathy. Other causes include history of viral myocarditis, an autoimmune response, and exposure to other chemicals in addition to alcohol. Heredity is considered the main cause of hypertrophic cardiomyopathy. Scleroderma is a connective tissue disorder thought to cause restrictive cardiomyopathy. Scar tissue that forms after a myocardial infarction is thought to be a cause of restrictive cardiomyopathy.

A client is diagnosed with infective endocarditis. What laboratory values will the nurse assess? Select all that apply. elevated white blood cell (WBC) count elevated C-reactive protein elevated erythrocyte sedimentation rate (ESR) decreased erythrocyte sedimentation rate decreased C-reactive protein

elevated erythrocyte sedimentation rate (ESR) elevated C-reactive protein elevated white blood cell (WBC) count

The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis? fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) low urine output secondary to left ventricular dysfunction lethargy, anorexia, and heart failure pitting edema, chest discomfort, and nonspecific ST-segment elevation

fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) 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 is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned. What is considered to be one of the last treatments for end-stage cardiomyopathy? heart transplantation xenograft tissue valve annuloplasty valvuloplasty

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

A nurse reviewing a client's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scarring." The nurse knows these manifestations are indicative of which type of cardiomyopathy? hypertrophic dilated restrictive arrhythmogenic right ventricular

hypertrophic

A 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? increased resistance of a narrowed orifice between the left atrium and the left ventricle inadequate left and right ventricle filling atrial hypertrophy pulmonary circulation congestion

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

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? increased resistance of a narrowed orifice between the left atrium and the left ventricle inadequate left and right ventricle filling atrial hypertrophy pulmonary circulation congestion

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

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

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 assessing a client with aortic stenosis. What type of murmur will the nurse expect to hear? high-pitched and blowing. loud and rough during systole. low-pitched, rumbling during diastole. low-pitched and blowing.

loud and rough during systole. An aortic murmur is loud and rough and is heard over the aortic area. The murmur in aortic insufficiency is high-pitched and blowing and is heard at the third or fourth intercostal space at the left sternal border. Mitral stenosis has a low-pitched rumbling murmur heard at the apex. Mitral insufficiency has a high-pitched, blowing murmur at the apex. There is no condition that has a low-pitched, blowing murmur.

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

mitral valve

The nurse is caring for a client with aortic regurgitation. What medication will the nurse administer to reduce afterload? diltiazem nitroprusside metoprolol isosorbide

nitroprusside

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 low-pitched diastolic murmur at the apex high-pitched blowing sound at the apex mitral click

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.

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

reports of constant chest pain