Chapter 36: Inflammatory & Structural Heart Disorders
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
A. Pulsus paradoxus (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. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.)
The patient had myocarditis and is now experiencing 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 collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life? (Select all that apply.) A. Decrease preload and afterload. B. Relieve left ventricular outflow obstruction. C. Control heart failure by enhancing myocardial contractility. D. Improve diastolic filling and the underlying disease process. E. Improve ventricular filling by reducing ventricular contractility
A. Decrease preload and afterload. C. Control heart failure by enhancing myocardial contractility. (The patient is experiencing 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 and improving cardiac output, which will improve the quality of life. 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 (SATA)? A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages D. Subcutaneous nodules E. Erythema marginatum lesions
A. Osler's nodes B. Janeway's lesions C. Splinter hemorrhages (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.)
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. Completion of 4 to 6 days of antibiotic therapy for infective endocarditis of respiratory infections in children born with heart defects C. Avoidance of respiratory infections in children who have rheumatoid arthritis D. Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis
A. Prompt recognition and treatment of streptococcal pharyngitis (The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.)
When teaching the patient with acute rheumatic fever, identify the rationale for the use of NSAIDs in the patient's treatment plan.
Antiinflammatory effect to control fever & joint manifestations
When teaching the patient with acute rheumatic fever, identify the rationale for the use of Aspirin in the patient's treatment plan.
Antiinflammatory effect to control fever and arthritic and joint manifestations
When teaching the patient with acute rheumatic fever, identify the rationale for the use of corticosteroids in the patient's treatment plan.
Antiinflammatory effect to control fever and inflammation of severe carditis
The nurse provides discharge instructions for a 40-year-old woman who is newly diagnosed with cardiomyopathy. Which statement, if made by the patient, 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."
B. "I can drink alcohol in moderation." (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.)
The patient had a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement? A. Long-term anticoagulation therapy B. Antibiotic prophylaxis for dental care C. Exercise plan to increase cardiac tolerance D. Take β-adrenergic blockers to control palpitations.
B. Antibiotic prophylaxis for dental care (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)
The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? A. Respiratory rate of 18 and heart rate of 90 B. Regurgitant murmur at the mitral valve area C. Heart rate of 94 and capillary refill time of 2 seconds D. Point of maximal impulse palpable in fourth intercostal space
B. Regurgitant murmur at the mitral valve area (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.)
A 25-year-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. What should the nurse tell the patient to encourage the patient to take the medications and avoid complications of the infection? A. "The complications of this infection will affect the skin, hair, and balance." B. "You will not feel well if you do not take the medicine and get over this infection." 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."
C. "Without treatment, you could get rheumatic fever, which can lead to rheumatic heart disease." (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. The complications do not include hair or balance. 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.)
A 72-year-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
C. Nitroglycerin (Nitroglycerin Aspirin, oxygen, nitroglycerin, and morphine sulfate are all commonly 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 drop in blood pressure.)
A 55-year-old female patient develops acute pericarditis after a myocardial infarction. It is most important for the nurse to assess for which clinical manifestation of 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
D. Decreased blood pressure with tachycardia (Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms indicating cardiac tamponade include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.)
The patient with pericarditis is complaining of 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
D. Nonsteroidal antiinflammatory drugs (Nonsteroidal antiinflammatory drugs (NSAIDs) will control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions or 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 GI bleeding from the NSAIDs.)
An 80-year-old patient with uncontrolled type 1 diabetes mellitus 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. Take nitroglycerin for chest pain. C. Open commissurotomy (valvulotomy) procedure D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure
D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure (The PTBV procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes mellitus. 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. Nitroglycerin is used cautiously for chest pain because it can reduce blood pressure and worsen chest pain in patients with aortic stenosis. Open commissurotomy procedure is used for mitral stenosis.)
When teaching the patient with acute rheumatic fever, identify the rationale for the use of antibiotics in the patient's treatment plan.
To eliminate any residual group A β-hemolytic streptococci; prevent spread of infection; prevent recurrent infection
What accurately describes mitral valve prolapse? a. Rapid onset prevents left chamber dilation b. May be caused by pulmonary hypertension c. Buckling of valve into left atrium during ventricular systole d. Rapid development of pulmonary edema and cardiogenic shock
c. Buckling of valve into left atrium during ventricular systole (Mitral valve prolapse is the buckling of the valve leaflets into the left atrium during ventricular systole. The rapid onset that prevents left chamber dilation and the rapid development of pulmonary edema and cardiogenic shock occur with acute mitral regurgitation. Pulmonary hypertension may contribute to tricuspid valve disease.)
Which patients are most at risk for developing infective endocarditis (select all that apply.)? a. Older woman with disseminated coccidioidomycosis b. Homeless man with history of intravenous drug abuse c. Patient with end-stage renal disease on peritoneal dialysis d. Man with complaints of chest pain and shortness of breath e. Adolescent with exertional palpitations and clubbing of fingers f. Female with peripheral intravenous site for medication administration
a,b,c (Patients with systemic coccidioidomycosis (valley fever) are at risk of fungal endocarditis. Peritoneal dialysis requires strict sterile technique to prevent peritonitis. Intravenous drug abuse, 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. 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.)
Which manifestation of infective endocarditis is a result of fragmentation and microembolization of vegetative lesions? a. Petechiae b. Roth's spots c. Osler's nodes d. Splinter hemorrhages
a. Petechiae (Petechiae are seen as small hemorrhages in the conjunctiva, lips, and buccal mucosa and over the ankles, feet, and antecubital and popliteal areas. Roth's spots are hemorrhagic retinal lesions seen with funduscopic examination. Osler's nodes are lesions on the fingertips or toes. The cause of Roth's spots and Osler's nodes is not clear. Splinter hemorrhages are black longitudinal streaks that occur on nail beds. They may be caused by vessel damage from vasculitis or microemboli.)
Assessment of an IV cocaine user with infective endocarditis should focus on which signs and symptoms (select all that apply) a. Retinal hemorrhages b. splinter hemorrhages c. presence of Osler's nodes d. Painless nodules over bony prominences e. painless erythematous macules on the palms & soles
a. Retinal hemorrhages b. splinter hemorrhages c. presence of Osler's nodes e. painless erythematous macules on the palms & soles
Which is a priority nursing intervention for a patient during the acute phase of rheumatic fever? a. administration of antibiotics as ordered b. management of pain with opioid analgesics c. encouragement of fluid intake for hydration d. performance of frequent, active range-of motion exercises
a. administration of antibiotics as ordered (The primary goal of managing a patient with acute rheumatic fever is to control and eradicate the infecting organism. The nurse should administer antibiotics as ordered to treat the streptococcal infection and teach the patient that completion of the full course of antibiotic therapy is essential for successful treatment.)
A patient is admitted with myocarditis. While performing the initial assessment, which clinical signs and symptoms might the nurse find (SATA)? a. angina b. pleuritic chest pain c. splinter hemorrhages d. pericardial friction rub e. presence of Osler's nodes
a. angina b. pleuritic chest pain d. pericardial friction rub (Clinical manifestations of myocarditis may include early systemic manifestations (i.e., fever, fatigue, malaise, myalgias, pharyngitis, dyspnea, lymphadenopathy, and nausea and vomiting), early cardiac manifestations (i.e., pleuritic chest pain with a pericardial friction rub and effusion), and late cardiac signs (i.e., S3 heart sound, crackles, jugular venous distention [JVD], syncope, peripheral edema, and angina).)
The diagnosis of acute rheumatic fever is most strongly supported in the patient with a. carditis, polyarthritis, and erythema marginatum b. polyarthritis, chorea, and increased antistreptolysin O titer c. positive C-reactive protein, elevated WBC, subcutaneous nodules d. organic heart murmurs, fever, and elevated erythrocyte sedimentation rate (ESR)
a. carditis, polyarthritis, and erythema marginatum (Major criteria for the diagnosis of rheumatic fever include evidence of carditis, polyarthritis, chorea (often very late), erythema marginatum, and subcutaneous nodules. Minor criteria include all laboratory findings as well as fever, arthralgia, and a history of previous rheumatic fever.)
When performing discharge teaching for the patient with any type of cardiomyopathy, the nurse instructs the patient to (select all that apply) a. eat a low-sodium diet b. Go to the gym every day c. engage in stress reduction activities d. abstain from alcohol and caffeine intake e. avoid strenuous activity and allow for periods of rest f. suggest that caregivers learn CPR
a. eat a low-sodium diet c. engage in stress reduction activities d. abstain from alcohol and caffeine intake e. avoid strenuous activity and allow for periods of rest f. suggest that caregivers learn CPR
Which of the following diagnostic studies best differentiates the types of cardiomyopathy? a. echocardiography b. arterial blood gases c. cardiac catheterization d. endomyocardial biopsy
a. echocardiography (The echocardiogram is the primary diagnostic tool used to differentiate between the different types of cardiomyopathies and other structural cardiac abnormalities.)
A patient is diagnosed with mitral stenosis and new-onset atrial fibrillation. Which interventions could the nurse delegate to nursing assistant personnel (NAP) (select all that apply)? a. obtain and record daily weight b. determine apical-radial pulse rate c. observe for overt signs of bleeding d. obtain and record vital signs, including pulse oximetry e. teach the patient how to purchase a Medic Alert bracelet
a. obtain and record daily weight c. observe for overt signs of bleeding d. obtain and record vital signs, including pulse oximetry (The nurse may delegate routine procedures such as obtaining weights and vital signs. The nurse may give specific directions to the nursing assistive personnel (NAP) to observe and report obvious signs of bleeding. The nurse cannot delegate teaching, assessment, or activities that require clinical judgment. Obtaining an apical-radial pulse rate is an assessment.)
A 20-year old patient has acute infective endocarditis. While obtaining a nursing history, the nurse should ask the patient about which of the following (select all that apply) a. renal dialysis b. IV drug abuse c. recent dental work d. cardiac catheterization e. recent urinary tract infection
a. renal dialysis b. IV drug abuse c. recent dental work d. cardiac catheterization e. recent urinary tract infection (recent dental, urologic, surgical, or gynecologic procedures and history of IV drug abuse, heart disease, cardiac catheterization or surgery, renal dialysis, and infections all increase the risk of IE.)
A patient has an admitting diagnosis of acute left-sided infective endocarditis. The nurse explains to the patient that this diagnosis is best confirmed with a. two blood cultures b. a complete blood count c. a cardiac catheterization d. a transesophageal echocardiogram
a. two blood cultures (Although a complete blood cell count (CBC) will reveal a mild leukocytosis and erythrocyte sedimentation rates (ESRs) will be elevated in patients with infective endocarditis, these are nonspecific findings, and blood cultures are the primary diagnostic tool for infective endocarditis. Transesophageal echocardiograms can identify vegetations on valves but are used when blood cultures are negative, and cardiac catheterizations are used when surgical intervention is being considered.)
When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of a. valvular heart disease b. pulmonary hypertension c. superior vena cava syndrome d. hypertrophy of the right ventricle
a. valvular heart disease (Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves.)
What explains the measurement of pulsus paradoxus with cardiac tamponade (SATA)? a. A difference of less than 10 mm Hg occurs. b. A difference of greater than 10 mm Hg occurs. c. It is measured with an automatic sphygmomanometer. d. Rapidly inflate the cuff until you hear sounds throughout the respiratory cycle. e. Subtract the number when sounds are heard in the respiratory cycle from the number when the first Korotkoff sound during expiration is heard.
b. A difference of greater than 10 mm Hg occurs. e. Subtract the number when sounds are heard in the respiratory cycle from the number when the first Korotkoff sound during expiration is heard (Pulsus paradoxus is measured with a manually operated sphygmomanometer. The cuff is deflated slowly until the first Korotkoff sound during expiration is heard and the number is noted. The slow deflation of the cuff is continued until sounds are heard throughout the respiratory cycle and that number is subtracted from the first number. When the difference is >10 mm Hg, cardiac tamponade may be present. The difference is normally <10 mm Hg.)
The patient is admitted with angina, syncope, and dyspnea on exertion. In the assessment, the nurse notes a systolic murmur with a prominent S4. What will the nurse suspect is occurring with this patient? a. Mitral valve stenosis b. Aortic valve stenosis c. Acute mitral valve regurgitation d. Chronic mitral valve regurgitation
b. Aortic valve stenosis (Aortic valve stenosis is identified with the triad of angina, syncope, and dyspnea on exertion, as well as the systolic murmur and prominent S4 heart sound. Mitral valve stenosis manifests as exertional dyspnea, hemoptysis, fatigue, atrial fibrillation, and a diastolic murmur. Acute mitral valve regurgitation has a new systolic murmur with pulmonary edema and cardiogenic shock rapidly developing. Chronic mitral valve regurgitation is identified with weakness, fatigue, exertional dyspnea, palpitations, an S3 gallop, and holosystolic murmur.)
Priority Decision: A patient with symptomatic mitral valve prolapse has atrial and ventricular dysrhythmias. In addition to monitoring for decreased cardiac output related to the dysrhythmias, what is an important nursing intervention related to the dysrhythmias identified by the nurse? a. Monitor breathing pattern related to hypervolemia. b. Encourage calling for assistance when getting out of bed. c. Give sleeping pills to decrease paroxysmal nocturnal dyspnea. d. Teach the patient exercises to prevent recurrence of dysrhythmias.
b. Encourage calling for assistance when getting out of bed. (Dysrhythmias frequently cause palpitations, lightheadedness, and dizziness and the patient should be carefully attended to to prevent falls. Hypervolemia and paroxysmal nocturnal dyspnea (PND) would be apparent in the patient with heart failure. Exercises will not prevent dysrhythmias.)
The patient with acute pericarditis is having a pericardiocentesis. Postoperatively what complication should the nurse monitor the patient for? a. Pneumonia b. Pneumothorax c. Myocardial infarction (MI) d. Cerebrovascular accident (CVA)
b. Pneumothorax (Pneumothorax may occur as a needle is inserted into the pericardial space to remove fluid for analysis and relieve cardiac pressure with pericardiocentesis. Other complications could include dysrhythmias, further cardiac tamponade, myocardial laceration, and coronary artery laceration.)
The patient is admitted post-radiation therapy with symptoms of cardiomyopathy (CMP). Which type of CMP should the nurse suspect that the patient is experiencing? a. Dilated b. Restrictive c. Takotsubo d. Hypertrophic
b. Restrictive (A secondary cause of restrictive cardiomyopathy (CMP) is radiation treatment to the thorax with stiffness of the ventricular wall occurring. Dilated CMP may have a genetic link, follow infectious myocarditis, or be related to an autoimmune process or excess alcohol ingestion. Takotsubo CMP is an acute stress-related syndrome that mimics acute coronary syndrome. It is most common in postmenopausal women. Hypertrophic CMP has a genetic link in about 1/2 of all cases & is frequently seen in young athletic individuals.)
Drugs that the nurse would expect to be prescribed for patients with a mechanical valve replacement include a. oral nitrates b. anticoagulants c. atrial antidysrhythmics d. beta adrenergic blocking agents
b. anticoagulants (Patients with mechanical valves have an increased risk for thrombus formation. Therefore prophylactic anticoagulation therapy is used to prevent thrombus formation and systemic or pulmonary embolization. Nitrates are contraindicated for the patient with aortic stenosis because an adequate preload is necessary to open the stiffened aortic valve. Antidysrhythmics are used only if dysrhythmias occur, and alpha or beta adrenergic blocking agents may be used to control the HR as needed.)
A patient with acute pericarditis has markedly distended jugular veins, decreased BP, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes that these symptoms occur when a. the pericardial space is obliterated with scar tissue and thickened pericardium b. excess pericardial fluid compresses the heart and prevents adequate diastolic filling c. the parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction d. fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.
b. excess pericardial fluid compresses the heart and prevents adequate diastolic filling (The patient is experiencing a cardiac tamponade that consists of excess fluid in the pericardial sac, which compresses the heart and the adjoining structures, preventing normal filling and cardiac output. Fibrin accumulation, a scarred and thickened pericardium, and adherent pericardial membranes occur in chronic constrictive pericarditis.)
A patient with infective endocarditis of a prosthetic mitral valve develops a left hemiparesis and visual changes. The nurse expects that collaborative management of the patient will include a. an embolectomy b. surgical valve replacement c. administration of anticoagulants d. higher than usual antibiotic dosages
b. surgical valve replacement (Drug therapy for patients who develop endocarditis of prosthetic valves is often unsuccessful in eliminating the infection and preventing embolization, and early valve replacement followed by prolonged drug therapy is recommended for these patients.)
A patient with rheumatic heart disease with carditis asks the nurse how long his activity will be restricted. The best answer by the nurse is that he a. can perform non- strenuous activities as soon as antibiotics are started b. will be confined to bed until symptoms of heart failure are controlled c. will be able to have full activity as soon as cute symptoms have subsided d. must be on bed rest until anti-inflammatory therapy has been discontinued
b. will be confined to bed until symptoms of heart failure are controlled (When carditis is present in the patient with rheumatic fever, ambulation is postponed until any symptoms of heart failure are controlled with treatment, and full activity cannot be resumed until anti-inflammatory therapy has been discontinued. In the patient without cardiac involvement, ambulation may be permitted as soon as acute symptoms have subsided, and normal activity can be resumed when anti-inflammatory therapy is discontinued.)
When planning care for the patient with hypertrophic CMP, what should the nurse include? a. Ventricular pacing b. Administration of vasodilators c. Teach the patient to avoid strenuous activity and dehydration d. Surgery for cardiac transplantation will need to be done soon
c. Teach the patient to avoid strenuous activity and dehydration (Nursing interventions for the patient with hypertrophic CMP are to improve ventricular filling by reducing ventricular contractility and relieving left ventricular outflow obstruction to relieve symptoms and prevent complications. Strenuous activity and dehydration will increase systemic vascular resistance and should be avoided. Atrioventricular pacing will allow the septum to move away from the left ventricular wall and reduce the degree of outflow obstruction. Vasodilators may decrease venous return and further increase obstruction of blood flow from the heart. The surgery that could be done involves cutting into the thickened septal wall and removing some of the ventricular muscle.)
A mechanical prosthetic valve is most likely to be preferred over a biologic valve for valve replacement in a a. 41-year-old man with peptic ulcer disease b. a 22-year-old woman who desires to have children c. a 35-year-old man with a history of seasonal asthma d. 62-year-old woman with early Alzheimer's disease
c. a 35-year-old man with a history of seasonal asthma (Mechanical prosthetic valves require long-term anticoagulation, and this is a factor in making a decision about the type of valve to use for replacement. Patients who cannot take anticoagulant therapy, such as women of childbearing age, patients at risk for hemorrhage, or patient who may not be compliant with anticoagulation therapy, may be candidates for the less durable biologic valves.)
The nurse is caring for a patient with chronic constrictive pericarditis. Which assessment finding reflects a more serious complication of this condition? a. fatigue b. peripheral edema c. jugular venous distention d. thickened pericardium on echocardiography
c. jugular venous distention (Cardiac tamponade is a serious complication of pericarditis. As the compression of the heart increases, decreased left atrial filling decreases cardiac output. Neck veins usually are markedly distended because of jugular venous pressure elevation.)
An RN is working with an LPN in caring for a group of patients on a cardiac telemetry unit. A patient with aortic stenosis has the nursing diagnosis of activity intolerance related to fatigue and exertional dyspnea. Which of these nursing activities could be delegated to the LPN? a. explain the reason for planning frequent periods of rest b. evaluate the patient's understanding of his disease process c. monitor BP, HR, RR, and SpO2 before, during, and after ambulation d. teach the patient which activities to choose that will gradually increase endurance
c. monitor BP, HR, RR, and SpO2 before, during, and after ambulation (Monitoring VS before and after ambulation is the collection of data. Instructions should be provided to the LPN regarding what changes in these should be reported to the RN. Other actions listed are RN responsibilities.)
The nurse is caring for a patient newly admitted with heart failure secondary to dilated cardiomyopathy. Which of the following interventions would be a priority? a. encourage caregivers to learn CPR b. consider a consultation with hospice for palliative care c. monitor the patient's response to prescribed medications d. arrange for the patient to enter a cardiac rehabilitation program
c. monitor the patient's response to prescribed medications (Observing for signs and symptoms of worsening heart failure, dysrhythmias, and embolic formation in patients with dilated cardiomyopathy is essential, as is monitoring drug responsiveness. The goal of therapy is to keep the patient at an optimal level of functioning and out of the hospital. The priority intervention is to manage the acute symptoms with medications. The caregivers should learn cardiopulmonary resuscitation (CPR) before hospital discharge, and the patient may be referred to cardiac rehabilitation. Patients with dilated cardiomyopathy with progression to class IV stage D heart failure are candidates for palliative care.)
A patient is scheduled for a percutaneous transluminal valvuloplasty. The nurse understands that this procedure is indicated for a. any patient with aortic regurgitation b. older patients with aortic regurgitation c. older patients with stenosis of any valve d. young adult patients with mild mitral valve stenosis
c. older patients with stenosis of any valve (This procedure has been used for repair of pulmonic, tricuspid, and mitral stenosis, but usually for those patients that are poor surgical risks.)
When obtaining a nursing history for a patient with myocarditis, the nurse specifically questions the patient about a. a history of CAD with or without an MI b. prior use of digoxin for treatment of cardiac problems c. recent symptoms of a viral illness, such as fever or malaise d. a recent streptococcal infection requiring treatment with penicillin
c. recent symptoms of a viral illness, such as fever or malaise (Viruses are the most common cause of myocarditis in the US, & early manifestations of myocarditis are often those of systemic viral infections. Myocarditis may also be associated with systemic inflammatory & metabolic disorders as well as with other microorganisms, drugs, or toxins. The heart has increased sensitivity to digoxin in myocarditis, and it is used very cautiously, if at all, in treatment of the condition.)
A patient is scheduled for an open surgical valvuloplasty of the mitral valve. In preparing the patient for surgery, the nurse recognizes that a. cardiopulmonary bypass is not required with this procedure b. valve repair is a palliative measure, whereas valve replacement is curative c. the operative mortality rate is lower in valve repair than in valve replacement d. patients with valve repair do not require postoperative anticoagulation as they do with valve replacement
c. the operative mortality rate is lower in valve repair than in valve replacement (Repair of mitral or tricuspid valves has a lower operative mortality rate than does replacement and is becoming the surgical procedure of choice for these valvular diseases. Open repair is more precise than closed repair and requires cardiopulmonary bypass during surgery. All types of valve surgery are palliative, not curative, and patients require lifelong health care. Anticoagulation therapy is used for all valve surgery for at least some time postoperatively.)
What accurately describes dilated CMP (SATA)? a. Characterized by ventricular stiffness b. The least common type of cardiomyopathy c. The hyperdynamic systolic function creates a diastolic failure d. Echocardiogram reveals cardiomegaly with thin ventricular walls e. Often follows an infective myocarditis or exposure to toxins or drugs f. Differs from chronic heart failure in that there is no ventricular hypertrophy
d, e, f (Dilated CMP, the most common type of CMP, reveals cardiomegaly with thin ventricular walls on echocardiogram, as there is no ventricular hypertrophy, and may follow an infective myocarditis. As well, stasis of blood in the ventricles may contribute to systemic embolization. Restrictive CMP is the least common type and is characterized by ventricular stiffness. Hypertrophic CMP has hyperdynamic systolic function creating a diastolic failure, is characterized by massive thickening of intraventricular septum and ventricular wall, & may result in syncope during increased activity resulting from an obstructed aortic valve outflow.)
What causes a sudden onset of cardiovascular collapse? a. Mitral stenosis b. Tricuspid valve disease c. Pulmonic valve stenosis d. Acute aortic regurgitation
d. Acute aortic regurgitation (Acute aortic regurgitation causes a sudden cardiovascular collapse. With mitral valve stenosis dyspnea is a prominent symptom and embolization may result from chronic atrial fibrillation. With tricuspid and pulmonic valve diseases, stenosis occurs more often than regurgitation. Tricuspid valve stenosis results in right atrial enlargement and elevated systemic venous pressures. Pulmonic valve stenosis results in right ventricular hypertension and hypertrophy.)
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
d. Decreased level of consciousness (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.)
What describes Janeway's lesions that are manifestations of infective endocarditis? a. Hemorrhagic retinal lesions b. Black longitudinal streaks in nail beds c. Painful red or purple lesions on fingers or toes d. Flat, red, painless spots on the palms of hands and soles of feet
d. Flat, red, painless spots on the palms of hands and soles of feet (Janeway's lesions are flat, painless, small red spots found on the palms of the hands & the soles of the feet. Black streaks on the nails are splinter hemorrhages. Hemorrhagic retinal lesions are Roth's spots. Painful lesions on fingers & toes are Osler's nodes.)
The nurse is caring for a patient who received a mechanical aortic valve replacement two 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. Report laboratory values to the health care provider.
d. Report laboratory values to the health care provider. (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 healthcare 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.)
What is an effect of valvular regurgitation? a. It causes a pressure gradient difference across an open valve. b. A pericardial friction rub is heard on the right sternal border of the chest. c. It leads to decreased flow of blood and hypertrophy of the preceding chamber. d. There is a backward flow of blood and volume overload in the preceding chamber.
d. There is a backward flow of blood and volume overload in the preceding chamber. (Valvular regurgitation causes a backward flow of blood and volume overload in the preceding chamber. Without treatment, eventually hypertrophy of that chamber occurs. Stenosis causes a pressure gradient difference and decreased blood flow and hypertrophy of the preceding chamber. A pericardial friction rub is not related to valvular regurgitation but would be heard at the lower left sternal border of the chest.)
A patient hospitalized for 1 week with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy is planned. During discharge planning with the patient, it is most important for the nurse to a. plan how his needs will be met while he continues on bed rest b. teach the patient to avoid crowds and exposure to upper respiratory infections c. encourage the use of diversional activities to relieve boredom and restlessness d. assess the patient's home environment in terms of family assistance and hospital access
d. assess the patient's home environment in terms of family assistance and hospital access (The patient with outpatient antibiotic therapy requires vigilant home nursing care, and it is most important to determine the adequacy of the home environment for successful management of the patient. The patient is at risk for life-threatening complications, such as embolization and pulmonary edema, and must be able to access a hospital if needed. Bed rest will not be necessary for the patient without heart damage. Avoiding infections & planning diversional activities are indicated for the patient but are not the most important step while he is on outpatient antibiotic therapy.)
When teaching a patient with endocarditis how to prevent recurrence of the infection, the nurse instructs the patient to a. start on antibiotic therapy when exposed to persons with infections b. take one aspirin a day to prevent vegetative lesions from forming around the valves c. always maintain continuous antibiotic therapy to prevent the development of any systemic infection d. obtain prophylactic antibiotic therapy before certain invasive medical or dental procedures (e.g. dental cleaning)
d. obtain prophylactic antibiotic therapy before certain invasive medical or dental procedures (e.g. dental cleaning) (Prophylactic antibiotic therapy should be initiated before invasive dental, medical, or surgical procedures to prevent recurrence of endocarditis. Continuous antibiotic therapy is indicated only in patients with implanted devices or ongoing invasive procedures. Symptoms of infection should be treated promptly, but antibiotics are not used for exposure to infection.)
Priority nursing management for a patient with myocarditis includes interventions related to a. meticulous skin care b. antibiotic prophylaxis c. tight glycemic control d. oxygenation and ventilation
d. oxygenation and ventilation (General supportive measures for management of myocarditis include interventions to improve ventilation and oxygenation (i.e., oxygen therapy, bed rest, and restricted activity).)
A patient with acute pericarditis has a nursing diagnosis of pain related to pericardial inflammation. An appropriate nursing intervention for the patient is a. administering opioids as prescribed on an around the clock schedule b. promoting progressive relaxation exercises with the use of deep, slow breathing c. positioning the patient on the right side with the head of the bed elevated 15 degrees d. positioning the patient in Fowler's position with a padded over the bed table for the patient to lean on
d. positioning the patient in Fowler's position with a padded over the bed table for the patient to lean on Rationale: (by sitting up and leaning forward. Pain is increased by lying flat. The pain has a sharp, pleuritic quality that changes with respiration, and patients take shallow breaths. Anti-inflammatory medications may also be used to help control pain, but opioids are not usually indicated.)
The most important role of the nurse in preventing rheumatic fever is to a. teach patients with infective endocarditis to adhere to antibiotic prophylaxis b. identify patients with valvular heart disease who are at risk for rheumatic fever c. encourage the use of antibiotics for treatment of all infections involving a sore throat d. promote the early diagnosis and immediate treatment of group A streptococcal pharyngitis
d. promote the early diagnosis and immediate treatment of group A streptococcal pharyngitis (Initial attacks of rheumatic fever and the development of rheumatic heart disease can be prevented by adequate treatment of group A streptococcal pharyngitis. Because streptococcal infection accounts for only about 20% of acute pharyngitis, cultures should be done to identify the organism and direct antibiotic therapy. Viral infections should not be treated with antibiotics. Prophylactic therapy is indicated in those who have valvular heart disease or have has rheumatic heart disease.)
Which clinical finding would most likely indicate decreased cardiac output in a patient with aortic valve regurgitation? a. reduction in peripheral edema and weights b. carotid venous distention and new-onset atrial fibrillation c. significant pulses paradoxus and diminished peripheral pulses d. shortness of breath on minimal exertion and a diastolic murmur
d. shortness of breath on minimal exertion and a diastolic murmur (Clinical manifestations of aortic regurgitation (AR) that indicate decreased cardiac output include severe dyspnea, chest pain, and hypotension. Other manifestations of chronic AR include water-hammer pulse (i.e., a strong, quick beat that collapses immediately), soft or absent S1, presence of S3 or S4, and soft, high-pitched diastolic murmur. A low-pitched diastolic murmur may be heard in severe AR. Early manifestations may include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.)
When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patient says, a. I may begin an exercise program to gradually increase my cardiac tolerance b. I will always need to have my blood checked once a month for its clotting function c. I should wear a medic alert bracelet to identify my valve and anticoagulant therapy d. the biggest risk I have during invasive health procedures is bleeding because of my anticoagulants
d. the biggest risk I have during invasive health procedures is bleeding because of my anticoagulants (The greatest risk to a patient who has an artificial valve is the development of endocarditis with invasive medical or dental procedures; before any of these procedures, antibiotic prophylaxis is necessary to prevent infection. Health care providers must be informed of the presence of the valve and the anticoagulation therapy, but the most important factor is using antibiotic prophylaxis before invasive procedures.)
A patient with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The nurse suspects that the patient is experiencing a. vegetative embolization to the coronary arteries b. pulmonary embolization from valve vegetations c. nonspecific manifestations that accompany infectious diseases d. valvular incompetence with possible infectious invasion of the myocardium
d. valvular incompetence with possible infectious invasion of the myocardium (The dyspnea, crackles, and restlessness the patient is manifesting are symptoms of heart failure and decreased cardiac output (CO) that occurs in up to 80% of patients with aortic valve endocarditis as a result of aortic valve incompetence. Vegetative embolization from the aortic valve occurs throughout the arterial system and may affect any body organ. Pulmonary emboli occur in right-sided endocarditis.)
A patient is admitted to the hospital with a suspected acute pericarditis. To establish the presence of a pericardial friction rub, the nurse listens to the patient's chest a. while timing the sound with the respiratory pattern b. with the bell of the stethoscope at the apex of the heart c. with the diaphragm of the stethoscope at the lower left sternal bored of the chest d. with the diaphragm of the stethoscope to auscultate a high-pitched continuous rumbling sound
d. with the diaphragm of the stethoscope to auscultate a high-pitched continuous rumbling sound (The stethoscope diaphragm at the left sternal border is the best method to use to hear the high-pitched, grating sound of a pericardial friction rub. The sound does not radiate widely and occurs with the heartbeat.)
