Chapter 36: Cardiomyopathy & Valvular Heart Disease Evolve Practice Questions

1. What are the priority nursing care concepts for clients with vascular problems? A. Perfusion and fluid balance B. Clo

1. D The priority care concepts for clients with vascular problems are perfusion and clo

2. Which factors would the nurse note as increasing the risk for atherosclerosis with an older African-American client? Select all that apply. A. 20-year history of type 2 diabetes B. Nutrition includes three to four diet sodas per day C. Sedentary lifestyle D. 25 pounds overweight E. Father with history of colon cancer F. Grandmother died after heart a

2. A, C, D, F Risk factors for atherosclerosis include: low HDL-C, high LDL-C, increased triglycerides, genetic predisposition, diabetes mellitus, obesity, hypertension, sedentary lifestyle, smoking, stress, African American or Hispanic ethnicity, older adult, and diet high in saturated and trans fats, cholesterol, sodium, and sugar.

34. During which timeframe is it most important for the nurse to monitor a client for graft occlusion after receiving revascularization with graft placement? A. First 2 hours B. First 24 hours C. Days 1 and 2 postoperative D. During the first week

34. B Graft occlusion (blockage) is a postoperative emergency that can occur within the first 24 hours after arterial revascularization. Monitor the client for and report severe, continuous, and aching pain, which may be the first indicator of postoperative graft occlusion and ischemia.

26. Which findings would the nurse expect in a client with mitral valve stenosis? Select all that apply. A. A client with mild mitral valve stenosis will likely be asymptomatic. B. Classic signs include dyspnea, angina, and syncope. C. Rumbling apical diastolic murmur D. Syncope on exertion E. Sinus tachycardia F. Right-sided heart failure with jugular (neck) vein distention

26. A, B, C, F Key features of mitral valve stenosis include fatigue; dyspnea of exertion; orthopnea; paroxysmal nocturnal dyspnea; hemoptysis; hepatomegaly; neck vein distention; pi

27. For which finding in a client with mitral valve stenosis would the nurse immediately notify the primary health care provider because of the potential for decompensation? A. Slow, bounding peripheral pulses associated with bradycardia B. An increase and decrease in pulse rate that follows inspiration and expiration C. An irregular heart rhythm and ECG strip that indicate atrial fibrillation D. An increase in pulse rate and blood pressure after exertion

27. C Because the development of atrial fibrillation in a client with mitral valve stenosis indicates that the client may decompensate, the health care provider should be notified immediately of changes to the heart rhythm. Increase and decrease in pulse rate that varies with inspiration and expiration is characteristic of sinus arrythmia. An increase in heart rate and blood pressure is common for most clients. Bounding arterial pulses are associated with aortic regurgitation.

34. Which priority information would the nurse be sure to provide for a client who is scheduled for mitral valve replacement with a xenograft valve? A. "You will need an individualized exercise program to develop collateral circulation." B. "Your xenograft valve will need to be replaced in about 7 to 10 years." C. "You must take and record your temperature daily and watch for signs of rejection." D. "You will require frequent laboratory tests to monitor your coagulation status."

34. B Biologic valve replacements may be xenograft (from other species), such as a porcine valve (from a pig) or a bovine valve (from a cow). Because tissue valves are associated with li

28. Which are the characteristics that the nurse would expect when a client is diagnosed with mitral valve prolapse (MVP)? Select all that apply. A. Valve leaflets enlarge and bulge up into the left atrium during systole. B. Hepatomegaly is a late sign. C. Most clients are asymptomatic and this abnormality is benign. D. Many clients have normal heart rates and blood pressures. E. Older adults have increased risk for mitral valve prolapse. F. A midsystolic click and late systolic murmur is best heard at the apex of the heart.

28. A, C, D, F With MVP, the valvular leaflets enlarge and prolapse (bulge) upward into the left atrium during systole. This abnormality is usually benign. However, it may progress to pronounced mitral regurgitation in some clients. A normal heart rate and BP are usually found on physical examination. A midsystolic click and a late systolic murmur may be heard at the apex of the heart. MVP often begins in younger adults and has a familial tendency. Hepatomegaly occurs with mitral stenosis, not MVP

29. Which signs and symptoms would the nurse expect to assess when a client is diagnosed with aortic stenosis? Select all that apply. A. Dyspnea on exertion B. Atypical chest pain C. Angina D. Hemoptysis E. Harsh, systolic crescendo-decrescendo murmur F. Orthopnea

29. A, C, E, F Signs and symptoms of aortic stenosis include dyspnea on exertion; angina; syncope on exertion; fatigue, orthopnea, paroxysmal nocturnal dyspnea; and harsh, systolic crescendo- decrescendo murmur. Atypical chest pain is characteristic of mitral valve prolapse and hemoptysis occurs with mitral stenosis

30. Which urgent intervention is required when the nurse reviews the results of diagnostic testing for a client with aortic stenosis and discovers that the surface area of the valve is less than 1 cm? A. Surgical aortic heart valve replacement B. Aortic valvuloplasty in the cardiac catheterization laboratory C. Physical therapy to create an individualized exercise program D. Therapy with drugs that will increase myocardial contractility

30. A As stenosis worsens, cardiac output becomes fixed and cannot increase to meet the demands of the body during exertion and symptoms develop. Eventually the left ventricle fails, blood backs up in the left atrium, and the pulmonary system becomes congested. Right-sided HF can occur late in the disease. When a client has aortic stenosis and the surface area of the valve becomes 1 cm or less, surgery is indicated on an urgent basis!

31. Which type of heart valvular disease does the nurse suspect when a client's assessment reveals pi

31. B Pi

32. Which client with valvular heart disease would benefit from the nonsurgical invasive procedure balloon valvuloplasty? A. Older adult who needs a valve replacement B. Middle-aged adult whose open-heart surgery failed C. Young adult with a genetic valve defect D. Older adult who is not a surgical candidate

32. D Balloon valvuloplasty, an invasive nonsurgical procedure, is possible for stenotic mitral and aortic valves; however, careful selection of clients is needed. It may be the initial treatment of choice for people with noncalcified, mobile mitral valves. Clients selected for aortic valvuloplasty are usually older and are at high risk for surgical complications. The benefits of this procedure for aortic stenosis tend to be short lived, rarely lasting longer than 6 months. Aortic valvuloplasty may be beneficial as a bridge to either surgical or percutaneous aortic valve replacement.

33. Which essential medications would the nurse provide teaching about postoperatively for a client who received a prosthetic valve replacement? A. Immunosuppressants B. Antibiotics C. Anticoagulants D. Diuretics

33. C When a client has a mechanical valve, lifelong anticoagulant therapy with warfarin is required. Teach the client that the international normalized ratio (INR) will need to be monitored frequently. The therapeutic goal for clients with mechanical heart valves is 3.0 to 4.0

35. Which topics would the nurse be sure to cover when providing discharge instructions for a client with prosthetic valve surgery? Select all that apply. A. Avoid heavy lifting for 3 to 6 weeks. B. Report dyspnea, syncope, dizziness, edema, and palpitations to your health care provider. C. Use an electric razor to avoid skin cuts. D. Increase your consumption of foods that are high in vitamin K. E. Notify your health provider for any bleeding or excessive bruising. F. Watch for and report any fever or drainage and redness at the surgical site.

35. B, C, E, F A client receiving a prosthetic valve will be taking anticoagulants for the rest of his or her life. Teach nutritional considerations (if taking warfarin) and the prevention of bleeding. For example, the client is taught to avoid foods high in vitamin K, especially dark green leafy vegetables, and to use an electric razor to avoid skin cuts. Also teach him or her to report any bleeding or excessive bruising to the primary health care provider. Reinforce how to care for the sternal incision and instruct him or her to watch for and report any fever, drainage, or redness at the site. Most clients return to normal activity after 6 weeks, but should avoid heavy physical activity involving their upper extremities for 3 to 6 months to allow the incision to heal. Teach the client to report any changes in cardiovascular status, such as dyspnea, syncope, dizziness, edema, and palpitations.

35. Which method would the postanesthesia care unit (PACU) nurse use to assess the patency of the graft after a client's arterial revascularization with graft placement? A. Gently palpate the site every 15 minutes for the first hour and assess for warmth, redness, and swelling. B. Ask the client if there is any pain or loss of sensation anywhere in the extremity. C. Check the dorsalis pedis and post tibial pulses for the first hour, then every 2 hours. D. Check the affected extremity, comparing it to the unaffected, for changes in color, temperature, and pulse intensity every 15 minutes for the first hour, then hourly.

35. D To assess graft patency after arterial revascularization, monitor the patency of the graft by checking the extremity every 15 minutes for the first hour and then hourly for changes in color, temperature, and pulse intensity. Compare the operative leg with the unaffected extremity. If the operative leg feels cold; becomes pale, ashen, or cyanotic; or has a decreased or absent pulse, contact the surgeon immediately!

36. What would the nurse expect to find in the history of a client admi

36. B Acute arterial occlusion is most often caused by an embolus (piece of a clot that travels and lodges in a new area). Emboli originating from the heart are the most common cause of acute arterial occlusions. Most clients with an embolic occlusion have had an acute myocardial infarction (MI) and/or atrial fibrillation within the previous weeks.

37. What would be the priority nursing action when a client experiences increasing pain, swelling, and tenseness after thrombectomy? A. Elevate the affected extremity and apply ice packs. B. Prepare to initiate systemic thrombolytic therapy. C. Report these symptoms to the health care provider immediately. D. Administer the prescribed pain medication as soon as possible.

37. C After thrombectomy, monitor for increasing pain, swelling, and tenseness. Report any of these symptoms to the health care provider immediately. These symptoms signal compartment syndrome which occurs when tissue pressure within a confined body space becomes elevated and restricts blood flow. The resulting ischemia can lead to tissue damage and eventually tissue death.

38. Which statements are accurate about a client's true aneurysm?Select all that apply. A. The aneurysm may be described as fusiform or saccular. B. An aneurysm is formed when blood accumulates in the wall of an artery. C. The aneurysm creates a permanent dilation of an artery. D. A true aneurysm can occur as a result of trauma to the arterial walls. E. A congenitally weakened arterial wall may result in an aneurysm. F. The aneurysm section of the arterial wall is enlarged to at least twice its normal diameter.

38. A, C, E, F An aneurysm is a permanent localized dilation of an artery, which enlarges the artery to at least two times its normal diameter. It may be described as fusiform (a diffuse dilation affecting the entire circumference of the artery) or saccular (an outpouching affecting only a distinct portion of the artery). Aneurysms may also be described as true or false. In true aneurysms, the arterial wall is weakened by congenital or acquired problems. False aneurysms occur as a result of vessel injury or trauma to all three layers of the arterial wall. Dissecting aneurysms differ from true aneurysms in that they are formed when blood accumulates within the wall of an artery

39. What is the nurse's best interpretation when reviewing a client's abdominal CT scan and noting that there is an outpouched segment coming off the abdominal aorta? A. Dissecting aneurysm B. Saccular aneurysm C. Fusiform aneurysm D. False aneurysm

39. B A saccular aneurysm is an outpouching affecting only a distinct portion of the artery. A fusiform aneurysm is a diffuse dilation affecting the entire circumference of the artery (often appears egg shaped on scans). A dissecting aneurysm is a false aneurysm which occurs when blood accumulates in the wall of an artery.

42. Which diagnostic tests would the health care provider prescribe to confirm a diagnosis of abdominal aortic aneurysm (AAA) suspected in a client? Select all that apply. A. Chest x-ray B. Ultrasound C. Electrocardiogram D. Magnetic resonance imaging E. Computed tomography scan F. Cardiac catheterization

42. B, E To confirm a diagnosis of AAA, computed tomography (CT) scanning with contrast is the standard tool for assessing the size and location of an abdominal or thoracic aneurysm. Ultrasonography is also used.

40. Which location would the nurse expect to be the most common for a client to form an aneurysm? A. Femoral artery B. Radial artery C. Thoracic aorta D. Abdominal aorta

40. D Aneurysms tend to occur at specific anatomic sites, most commonly in the abdominal aorta. They often occur at a point where the artery is not supported by skeletal muscles or on the lines of curves or flexion in the arterial tree. Abdominal aortic aneurysms (AAAs) account for most true aneurysms. They are commonly asymptomatic, and frequently rupture. Most of these are located between the renal arteries and the aortic bifurcation (dividing area).

41. What would the nurse assess for when a client is suspected of having an abdominal aortic aneurysm? Select all that apply. A. Chest pain and shortness of breath B. Abdominal, flank, or back pain C. Gnawing pain unaffected by movement D. Pulsation in the upper abdomen E. Auscultation of a bruit in the upper abdomen F. Palpation of a mass in the upper abdomen

41. B, C, D, E Assessment findings for a client's AAA include: abdominal, flank, or back pain; pain that is usually described as steady with a gnawing quality, unaffected by movement, and lasting for hours or days; pulsation in the upper abdomen slightly to the left of the midline between the xiphoid process and the umbilicus (a detectable aneurysm is at least 5 cm in diameter); and auscultation of a bruit over the pulsatile mass. Avoid palpating the mass because it may be tender and there is risk for rupture of the aneurysm.

43. What is the best nonsurgical intervention for a client with a 3-cm abdominal aortic aneurysm to decrease the risk of rupture? A. Bedrest with bathroom privileges until the aneurysm shrinks B. Maintenance of normal blood pressure and avoidance of hypertension C. Heparin followed by warfarin therapy to prevent clo

43. B The desired outcome of nonsurgical management is to monitor the growth of the aneurysm and maintain the blood pressure at a normal level to decrease the risk for rupture. Clients with hypertension are treated with antihypertensive drugs to decrease the rate of enlargement and the risk for early rupture. Additionally, the client would receive frequent ultrasound or CT scans to monitor the growth of the aneurysm.

44. Which symptoms would indicate to the nurse that a client's aneurysm had ruptured? Select all that apply. A. Hypotension B. Diaphoresis C. Decreased level of consciousness D. Loss of pulses distal to rupture E. Bradypnea F. Scant urine output

44. A, B, C, D, F Clients with a rupturing AAA are critically ill and at risk for hypovolemic shock caused by hemorrhage. Signs and symptoms include hypotension, diaphoresis, decreased level of consciousness, oliguria (scant urine output), loss of pulses distal to the rupture, and dysrhythmias. Retroperitoneal hemorrhage is manifested by hematomas in the flanks (lower back). Rupture into the abdominal cavity causes abdominal distention. Tachypnea occurs, rather than bradypnea, as a compensation during hypovolemic shock.

44. Which signs or symptoms would the nurse expect when assessing a client with chronic constrictive pericarditis? Select all that apply. A. Exertional fatigue and dyspnea B. Dependent edema C. Crackles and wheezes D. Hepatic engorgement E. Pink, frothy sputum F. Decreased appetite

44. A, B, D Clients with chronic constrictive pericarditis (lasting longer than 3 months) have signs of right-sided HF, including elevated systemic venous pressure with jugular distention, hepatic engorgement, and dependent edema. Exertional fatigue and dyspnea are common.

45. Which are complications that the nurse would monitor for after a client receives an endovascular stent graft for emergent repair of an abdominal aortic aneurysm? Select all that apply. A. Bleeding B. Misplacement of stent graft C. Dissecting aneurysm D. Peripheral embolization E. Endoleak F. Aneurysm rupture

45. A, B, D, E, F The repair of AAAs with endovascular stent grafts is the procedure of choice for almost all clients on an elective or emergent basis. Complications of this procedure include: conversion to open surgical repair; bleeding; aneurysm rupture; peripheral embolization; misplacement of the stent graft; endoleak (a persistent blood flow outside the lumen of an endoluminal graft but within the aneurysm sac or adjacent vascular segment being treated by the device used for endovascular aneurysm repair); and infection.

45. What does the nurse instruct a client with pericarditis to do to make him or her will feel more comfortable? A. Lie down and bend the legs at the knees. B. Sit in a semi-Fowler position with pillows under each arm. C. Sit up and lean forward. D. Lie on the side in a fetal position.

45. C The pain is worse when a client with acute pericarditis is in the supine position and may be relieved by si

46. Which are proposed criteria for diagnosis of a client with acute pericarditis? Select all that apply. A. Chest pain that lasts longer than 3 months B. Pericardial chest pain C. Presence of a pericardial friction rub D. New ST elevation in all ECG leads or PR-segment depression E. New or worsening pericardial effusion F. Hepatic engorgement

46. B, C, D, E The proposed diagnostic criteria for acute pericarditis are presence of two of the following: pericardial chest pain; presence of pericardial rub; new ST elevation in all ECG leads or PR- segment depression; and new or worsening pericardial effusion.

46. Which activity would the nurse advise during the recovery period for a client returning home after AAA repair? A. Climbing a flight of stairs B. Driving a car C. Playing golf D. Gradually increased walking

46. D The client must follow instructions regarding activity level. Because stair climbing may be restricted initially, he or she may need a bedside commode if the bathroom is inaccessible. Clients may not perform activities that involve lifting heavy objects (usually more than 15 to 20 lb [6.8 to 9.1 kg]) for 6 to 12 weeks after surgery. Advise them to use caution for activities that involve pulling, pushing, or straining. Most clients are restricted from driving a car for several weeks after discharge. Instruct clients to try to walk each day. They should gradually increase and walk a li

47. What is the nurse's priority action when a client with AAA suddenly exhibits decreased level of consciousness, blood pressure 82/48 mm Hg, irregular apical pulse, and perfuse diaphoresis? A. Alert the Rapid Response Team. B. Establish IV access. C. Place the client on a cardiac monitor. D. Auscultate for bruit and palpate for a mass

47. A These findings indicate a ruptured AAA which means that the client is critically ill and at risk for hypovolemic shock caused by hemorrhage. Signs and symptoms include hypotension, diaphoresis, decreased level of consciousness, oliguria (scant urine output), loss of pulses distal to the rupture, and dysrhythmias. The priority action is to notify the Rapid Response Team to intervene and save the client's life.

47. What is the definitive treatment for chronic constrictive pericarditis? A. Pericardiocentesis B. Surgical removal of the pericardium C. Placement of a pericardial drain D. Creation of a pericardial window

47. B The definitive treatment for chronic constrictive pericarditis is surgical excision of the pericardium (pericardiectomy). Pericardiocentesis, placement of a drain, or creation of a pericardial window are all interventions for clients with acute pericarditis.

48. Which are potential causes of dilated cardiomyopathy? Select all that apply. A. Alcohol abuse B. Sedentary lifestyle C. Cigare

48. A, D, E, F Causes of dilated cardiomyopathy may include alcohol abuse, chemotherapy, infection, inflammation, and poor nutrition.

48. Which findings would the nurse expect to assess when a client presents with a thoracic aortic aneurysm? Select all that apply. A. Tachycardia B. Hoarseness C. Shortness of breath D. Paralytic ileus E. Difficulty swallowing F. Visible mass above the suprasternal notch

48. B, C, E, F When a thoracic aortic aneurysm (TAA) is suspected, assess for back pain and manifestations of compression of the aneurysm on adjacent structures. Signs include shortness of breath, hoarseness, and difficulty swallowing. TAAs are not often detected by physical assessment, but sometimes a mass may be visible above the suprasternal notch. Assess the client with suspected rupture of a thoracic aneurysm for sudden and excruciating back or chest pain. Hypovolemic shock also occurs with TAA.

49. Which type of cardiomyopathy may present with sudden death as the first symptom? A. Dilated B. Arrhythmogenic right ventricular C. Restrictive D. Hypertrophic

49. D Sudden death may be the first symptom of hypertrophic cardiomyopathy (HCM), although the primary symptoms of HCM are exertional dyspnea, angina, and syncope. The chest pain is atypical in that it usually occurs at rest, is prolonged, has no relation to exertion, and is not relieved by the administration of nitrates. A high incidence of ventricular dysrhythmias is also associated with HCM.

50. Which criteria are appropriate for a client with dilated cardiomyopathy to become a candidate for heart transplant surgery? Select all that apply. A. Life expectancy greater than 2 years B. Age generally less than 65 years C. New York Heart Association Class III or IV D. Normal or only slightly increased pulmonary vascular resistance E. Consumes less than five to six beers per day F. Absence of active infection

50. B, C, D, F Candidate selection criteria for heart transplantation include: life expectancy less than 1 year; age generally less than 65 years; New York Heart Association (NYHA) Class III or IV; normal or only slightly increased pulmonary vascular resistance; absence of active infection; stable psychosocial status; and no evidence of current drug or alcohol misuse

51. Which assessment findings would suggest to the nurse that a client who received a heart transplant was experiencing organ rejection? Select all that apply. A. Shortness of breath B. Hypotension C. Abdominal pain D. Decreased activity tolerance E. Fluid gain (edema, increased weight) F. Atrial fibrillation or flu

51. A, B, D, E, F Signs and symptoms of heart transplant rejection include: shortness of breath; fatigue; fluid gain (edema, increased weight); abdominal bloating; new bradycardia; hypotension; atrial fibrillation or flu

58. What is the priority action for the nurse when a client is to have unfractionated heparin (UFH) discontinued and to start receiving subcutaneous low-molecular-weight heparin (LMWH)? A. Discontinue the UFH at least 30 minutes before giving the first LMWH injection. B. Check the aPTT and INR laboratory results before giving the first LMWH injection. C. Assess the client's IV site and convert it to a saline lock before starting LMWH. D. Instruct the client about the need for frequent laboratory test to ensure the LMWH is working.

58. A When a client is prescribed a change from UFH to LMWH, the nurse's priority is to discontinue the UFH at least 30 minutes before the first LMWH injection. While the nurse should be familiar with the client's clo

62. Which essential teaching would the nurse provide for a client being discharged with chronic venous insufficiency? Select all that apply. A. Elevate your legs at least 20 minutes four to five times a day. B. Avoid crossing legs at all times. C. Wear compression stocking at night during sleep. D. Avoid standing still for any length of time. E. Keep legs and feet positioned below the heart for be

62. A, B, D, F Essential teaching for a client being discharged with chronic venous insufficiency includes: elevate your legs for at least 20 minutes four to five times a day; when in bed, elevate your legs above the level of your heart; avoid prolonged si

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? A. Regurgitant murmur at the mitral valve area B. Point of maximal impulse palpable in fourth intercostal space C. Heart rate of 94 beats/min and capillary refill time of 2 seconds D. Respiratory rate of 18 breaths/min and heart rate of 90 beats/min

ANS: A A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. All the other findings are within normal limits.

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? A. Pulsus paradoxus B. Prolonged PR intervals C. Widened pulse pressure D. Clubbing of the fingers

ANS: A Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease and increased intracranial pressure. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.

The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include? A. Prompt recognition and treatment of streptococcal pharyngitis B. Avoiding respiratory infections in children born with heart defects C. Completion of 4 to 6 weeks of antibiotic therapy for infective endocarditis D. Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis

ANS: A The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.

The nurse provides discharge instructions for a 40-yr-old woman newly diagnosed with cardiomyopathy. Which statement indicates that further teaching is necessary? A. "I will avoid lifting heavy objects." B. "I can drink alcohol in moderation." C. "My family will need to take a CPR course." D. "I will reduce stress by learning guided imagery."

ANS: B Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.

A patient who has myocarditis now has fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What should collaborative care accomplish to improve cardiac output and quality of life? A. Decrease preload and afterload. B. Relieve left ventricular outflow obstruction. C. Improve diastolic filling and the underlying disease process. D. Improve ventricular filling by reducing ventricular contractility.

ANS: A The patient has developed dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process.

When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations? (Select all that apply.) A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages D. Subcutaneous nodules E. Erythema marginatum lesions

ANS: A, B, C Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.

What should the nurse teach the patient who has had a valve replacement with a biologic valve? A. Long-term anticoagulation therapy B. Antibiotic prophylaxis for dental care C. Exercise plan to increase cardiac tolerance D. β-Adrenergic blockers to control palpitations

ANS: B The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.

A 72-yr-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question? A. Aspirin B. Oxygen C. Nitroglycerin D. Morphine sulfate

ANS: C Aspirin, oxygen, nitroglycerin, and morphine sulfate are all used to treat acute chest pain suspected to be caused by myocardial ischemia. However, nitroglycerin should be used cautiously or avoided in patients with aortic stenosis as a significant reduction in blood pressure may occur. Chest pain can worsen because of a decrease in blood pressure.

A 25-yr-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. How should the nurse respond? A. "You will not feel well if you do not take the medicine and get over this infection." B. "Once you have been treated for a group A streptococcal infection, you will not get it again." C. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." D. "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

ANS: C Rheumatic fever (RF) is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say. Patients may have reoccurring infection of group A streptococcus.

Which patients are most at risk for developing endocarditis? (Select all that apply.) A. Older woman with histoplasmosis B. Man with reports of chest pain and dyspnea C. Man who is homeless with history of IV drug use D. Patient with end-stage renal disease on peritoneal dialysis E. Adolescent with exertional palpitations and clubbing of fingers F. Female with peripheral intravenous site for medication administration

ANS: C, D Intravenous drug use, especially if reusing or sharing needles are at risk of developing sepsis. In addition, risk for infection is increased in the elderly, homeless, and those with chronic illness. Peritoneal dialysis requires strict sterile technique to prevent peritonitis. Chest pain, shortness of breath, and palpitations may be signs of endocarditis. Clubbing of the fingers indicates long-term hypoxia. Central venous catheters, not peripheral, increase risk to for infective endocarditis. Patients with fungal infections, such as histoplasmosis and candida, are at risk for pericarditis.

A 55-yr-old female patient develops acute pericarditis after a myocardial infarction. Which assessment finding indicates a possible complication? A. Presence of a pericardial friction rub B. Distant and muffled apical heart sounds C. Increased chest pain with deep breathing D. Decreased blood pressure with tachycardia

ANS: D Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.

On admission to the emergency department, a patient with cardiomyopathy has an ejection fraction of 10%. On assessment, the nurse notes bilateral crackles and shortness of breath. Which additional assessment finding would most indicate patient decline? A. Increased heart rate B. Increased blood pressure C. Decreased respiratory rate D. Decreased level of consciousness

ANS: D Decreased level of consciousness indicates a lack of perfusion, hypoxia, or both. A patient with an ejection fraction of 10% indicates very low cardiac output. Bilateral crackles and shortness of breath are consistent with decompensating heart failure. The nurse would expect an increase in heart rate, blood pressure, and respiratory rate in response to the low ejection fraction. When blood pressure drops, the nurse would be aware of potential shock.

The patient with pericarditis is reporting chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief? A. Corticosteroids B. Morphine sulfate C. Proton pump inhibitor D. Nonsteroidal antiinflammatory drugs

ANS: D Nonsteroidal antiinflammatory drugs (NSAIDs) control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions and those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of gastrointestinal bleeding from the NSAIDs.

The nurse is caring for a patient who received a mechanical aortic valve replacement 2 years ago. Current lab values include an international normalized ratio (INR) of 1.5, platelet count of 150,000/µL, and hemoglobin of 8.6g/dL. Which nursing action is most appropriate? A. Assess the vital signs. B. Start intravenous fluids. C. Monitor for signs of bleeding. D. Contact the health care provider.

ANS: D Patients with mechanical valve replacement are placed on anticoagulants and should be in a therapeutic INR range of 2.5 to 3.5. Administration of Coumadin (Warfarin) prolongs clotting time and prevents clot formation on the valve. The low INR would require a call to the health care provider for an order increase the medication dose. Vital signs would be unchanged related to the low INR. Intravenous fluids are not indicated. The patient is at risk of forming clots, not bleeding.

An 80-yr-old patient with uncontrolled type 1 diabetes is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to do or have what done? A. Aortic valve replacement B. Have a pacemaker inserted C. Open commissurotomy (valvulotomy) procedure D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

ANS: D The PTBV procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes. Aortic valve replacement would probably not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Open commissurotomy procedure is used for mitral stenosis. The patient is not a candidate for a pacemaker.