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The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?

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

The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching?

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

A client who recently had a myocardial infarction develops pericarditis and complains of chest pain rated 6 (on a scale of 0-10) with deep breathing. Which ordered pro re nata medications is most appropriate for the nurse to administer? You Selected: Ibuprofen 800 mg PO every 8 hours Correct response: Ibuprofen 800 mg PO every 8 hours Explanation: Pain associated with pericarditis is caused by inflammation; thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.

A client who recently had a myocardial infarction develops pericarditis and complains of chest pain rated 6 (on a scale of 0-10) with deep breathing. Which ordered pro re nata medications is most appropriate for the nurse to administer? You Selected: Ibuprofen 800 mg PO every 8 hours Correct response: Ibuprofen 800 mg PO every 8 hours Explanation: Pain associated with pericarditis is caused by inflammation; thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.

Administer the medication as ordered. Explanation: 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.

Administer the medication as ordered. Explanation: 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 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 ? You Selected: Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results. Correct response: Assess the client for bleeding and notify the health care provider of the results. Explanation: 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.

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

What is the total dose range of digoxin for rapid digitalization?

Correct response: 0.75 to 1.5 mg Explanation: Digitalization may be accomplished rapidly by giving a total dose of 0.75 to 1.5 mg of digoxin in divided doses. A digoxin dose range of 2.0 to 4.0 mg is too large. A digoxin dose range of 0.125 to 0.5 mg is too small.

The nurse suspects a diagnosis of mitral valve regurgitation when what type of murmur is heard on auscultation? You Selected: Mitral click Correct response: High-pitched blowing sound at the apex Explanation: Mitral valve regurgitation is assoc

Correct response: High-pitched blowing sound at the apex Explanation: Mitral valve regurgitation is associated with a systolic murmur, which is a high-pitched, blowing sound at the apex.

The nurse is discussing the cardiac system with a client admitted with heart failure. The client asks "What determines the heart rate?" What is the nurse's best response?

Correct response: The autonomic nervous system controls the heart rate. Explanation: The autonomic nervous system primarily controls the heart rate. When the sympathetic branch is stimulated, heart rate increases. When the parasympathetic branch is stimulated, heart rate decreases. Stroke volume is the amount of blood pumped out of the ventricle with each contraction and depends on three factors: preload, afterload, and contractility.

The nurse caring for a client with cardiomyopathy plans to have an education session with the client and the client's spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload?

Correct response: When resting, sit up with the legs down to pool blood in the legs. Explanation: Many clients find that sitting up with their legs down is more comfortable than lying in bed. This position is helpful in pooling venous blood in the periphery and reducing preload. Laying flat in bed impairs respiratory efforts due to abdominal contents pushing against the lungs. This client must be on a low sodium cardiac diet to avoid fluid retention. It is impossible to avoid all physical and emotional stress.

The nurse is performing a medication review of a client diagnosed with myocarditis. What medication may have precipitated the client to have myocarditis? You Selected: ciprofloxacin Correct response: azathioprine Explanation: Azathioprine is an immunosuppressive medication that can cause myocarditis. Furosemide is a diuretic and acetaminophen is an anti-inflammatory; they are not known to cause myocarditis. Ciprofloxacin is a antibiotic not known to precipitate myocarditis.

Correct response: azathioprine Explanation: Azathioprine is an immunosuppressive medication that can cause myocarditis. Furosemide is a diuretic and acetaminophen is an anti-inflammatory; they are not known to cause myocarditis. Ciprofloxacin is a antibiotic not known to precipitate myocarditis.

Which common assessment question does the nurse use when admitting all clients that helps to screen for cardiomyopathy?

Have you ever had a close family member die unexpectedly? Explanation: Having a client's close family member die unexpectedly can indicate cardiomyopathy. Many individuals with cardiomyopathy are asymptomatic with the disorder not discovered until the affected person becomes acutely ill or dies.

ST DEPRESSION

ISCHEMIA

Incomplete closure of the mitral valve results in backflow of blood from the:

Left ventricle to left atrium Explanation: 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.

ST ELVATION

MI

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?

You Selected: "I will avoid milk, yogurt, and other dairy products." Correct response: "I may have to take prophylactic antibiotics for up to 10 years." Explanation: 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. Reference:

An asymptomatic client questions the nurse about mitral regurgitation and inquires about continuing exercises. Which is the most appropriate response by the nurse?

You Selected: "Take ample rest after exercise." Correct response: "Continue exercising until mild symptoms develop." Explanation: Exercise is not limited until mild symptoms develop. It is not important for an asymptomatic client to avoid exercise or to take ample rest after exercise.

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?

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

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

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

he nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder?

You Selected: Aortic regurgitation Correct response: Aortic regurgitation Explanation: The pulse pressure (i.e., difference between systolic and diastolic pressures) is considerably widened in patients with aortic regurgitation. One characteristic sign is the water-hammer (Corrigan's) pulse, in which the pulse strikes a palpating finger with a quick, sharp stroke and then suddenly collapses. Reference:

A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?

You Selected: Assess for reduced urine output. Correct response: Assess for elevated blood urea nitrogen levels. Explanation: Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.

What should be included in the client teaching instructions for client with thrombophlebitis who is being discharged? Select all that apply.

You Selected: Avoid sitting for too long. Take anticoagulant therapy when symptoms occur. Perform leg exercises each hour. Correct response: Perform leg exercises each hour. Ambulate as tolerated. Avoid sitting for too long. Explanation: Nurses instruct clients with thrombophlebitis to prevent recurrences by being active, avoiding knee bending or leg crossing, elevating legs periodically, and taking long-term anticoagulant therapy exactly as prescribed. Clients should also watch for and report signs that indicate impaired clotting: nosebleeds, bleeding gums, rectal bleeding, easy bruising, and prolonged oozing from minor cuts.

he nurse is assessing a client admitted with infective endocarditis. Which manifestation would the nurse expect

You Selected: Bruising on the palms of the hands and soles of the feet Correct response: Small painful lesions on the pads of the fingers and toes Explanation: Primary presenting symptoms of infective endocarditis are fever and a heart murmur. In addition small, painful nodules (Osler nodes) may be present in pads of fingers or toes. Irregular red or purple, painless flat macules (Janeway lesions) may be present on palms, fingers, hands, soles, and toes. Hemorrhages with pale centers (Roth spots) caused by emboli may be observed in fundi of the eyes. Splinter hemorrhages (i.e., reddish-brown lines and streaks) may be seen under the proximal half of fingernails and toenails. Petechiae may appear in conjunctiva and mucous membranes. Cardiomegaly, heart failure, tachycardia, or splenomegaly may occur.

A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The clients reports that these symptoms came on suddenly. The nurse knows that these are symptoms of what condition?

You Selected: Cardiogenic shock Correct response: Acute pulmonary edema Explanation: Clients with acute pulmonary edema exhibit sudden dyspnea, wheezing, orthopnea, restlessness, cough (often productive of pink, frothy sputum), cyanosis, tachycardia, and severe apprehension. These symptoms do not indicate progressive heart failure, pulmonary hypertension, or cardiogenic shock.

The nurse is caring for a client in the hospital with chronic heart failure who has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, the client becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)? .

You Selected: Class III (Moderate) Correct response: Class III (Moderate) Explanation: This client is comfortable at rest, but has "marked limitations" on physical activity. Merely walking down the hall causes fatigue and dyspnea. Therefore, this client is in Class III (moderate). With Class I (mild), ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea, and the client does not experience any limitation of activity. With Class II (mild), the client is comfortable at rest, but the ordinary physical activity of daily living results in fatigue, heart palpitations, or dyspnea; the client's activity is only slightly limited. With Class IV (severe), symptoms of cardiac insufficiency occur at rest, and discomfort increases if any physical activity is undertaken.

The nurse is caring for clients on a busy cardiac unit. Following morning assessment, the nurse would notify the physician with which of the following symptoms?

You Selected: Cyanosis with a pulse oximetry level of 92% Correct response: Pulsus paradoxus on vital sign assessment Explanation: Pulsus paradoxus is a difference of 10mm Hg or more between the first Korotkoff sound noting systolic blood pressure heard during expiration and the first that is heard during inspiration. Pulsus paradoxus can signal a deteriorating condition including diminished stroke volume, compromised cardiac output, and death. This would be of high priority to notify the physician.

A diabetic client visits a walk-in clinic and asks the nurse to take a blood pressure (BP) reading. The measurements are 150/90 mm Hg. Which of the following would the nurse expect as the treatment to normalize the client's BP?

You Selected: Daily exercise Correct response: Drug therapy Explanation: The nurse would expect drug therapy to be recommended for the client. Smoking cessation, a low-fat diet, and daily exercise may be useful in the prehypertension stage. A client with diabetes should have BP levels below 139/80 mm Hg to avoid drug therapy.

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure?

You Selected: Decreased central venous pressure Correct response: Increased pulmonary artery diastolic pressure Explanation: Increased pulmonary artery diastolic pressure suggests left-sided heart failure. Central venous pressure increases in heart failure rather than decreases. The cardiac index decreases in heart failure. The mean pulmonary artery pressure increases in heart failure.

A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema?

You Selected: Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours Correct response: Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours Explanation: Pitting edema is documented as a +1 when a depression is barely detectable on release of thumb pressure and when foot and leg contours are normal. A detectable depression of less than 5 mm accompanied by normal leg and foot contours warrants a +2 rating. A deeper depression (5 to 10 mm) accompanied by foot and leg swelling is evaluated as +3. An even deeper depression (more than 1 cm) accompanied by severe foot and leg swelling rates a +4.

Which common assessment question does the nurse use when admitting all clients that helps to screen for cardiomyopathy?

You Selected: Did you have any common childhood diseases? Correct response: Have you ever had a close family member die unexpectedly? Explanation: Having a client's close family member die unexpectedly can indicate cardiomyopathy. Many individuals with cardiomyopathy are asymptomatic with the disorder not discovered until the affected person becomes acutely ill or dies.

Clients with restrictive or constrictive cardiomyopathy have increased sensitivity to which medication?

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

The nurse is caring for a client diagnosed with infective endocarditis and awaiting blood culture results. The client asks, "Where did I pick up these bacteria?" The nurse is most safe to speculate which of the following?

You Selected: From ingestion of a food Correct response: From a break in the skin Explanation: The microorganisms that cause infective endocarditis include bacteria and fungi. Streptococci and staphylococci are the bacteria most frequently responsible for this disorder. Both bacteria are abundantly found on the skin. These organisms are not found in the other locations.

The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized?

You Selected: III Correct response: II Explanation: Classification II of heart failure is indicated by the patient being comfortable at rest, but experiencing fatigue, palpitation, or dyspnea during ordinary physical activity.

The pathophysiology of pericardial effusion is associated with all of the following except:

You Selected: Inability of the ventricles to fill adequately. Correct response: Increased venous return. Explanation: Venous return is increased because there is an increase in the pericardial fluid, which raises the pressure within the pericardial sac and compresses the heart.

The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan?

You Selected: Lie very still at intermittent times during the test. Correct response: Lie very still at intermittent times during the test. Explanation: The nurse should instruct the client, who is to undergo a MUGA scan, to lie very still at intermittent times during the 45-minute test. The client need not drink plenty of fluids, avoid activities before/after the test, or avoid dairy products during the test.

During auscultation of a client, the nurse suspects a diagnosis of mitral valve regurgitation when hearing which of the following?

You Selected: Mitral click Correct response: High-pitched blowing sound at the apex Explanation: A systolic murmur is heard as a high-pitched, blowing sound at the apex. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath on exertion, and cough from pulmonary congestion also occur. All of the others are not present with mitral regurgitation.

On auscultation, the nurse suspects a diagnosis of mitral valve stenosis when which of the following is heard?

You Selected: Mitral valve click Correct response: Low-pitched, rumbling diastolic murmur at the apex of the heart Explanation: The murmur is caused by turbulent blood flow through the abnormally tight valve opening. A low-pitched, rumbling, diastolic murmur (heard on S2) is heard best at the apex. A loud S1, due to abrupt closure of the mitral valve, and an early diastolic opening snap can be heard. The snap is the premature opening of the stenotic mitral valve.

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?

You Selected: Nifedipine Correct response: Cyclosporine Explanation: 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.

Which term describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage?

You Selected: Primary hypertension Correct response: Hypertensive urgency Explanation: Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension is high blood pressure from an identified cause, such as renal disease.

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

You Selected: Red or purple macules found on the palms of the hands Correct response: Red or purple macules found on the palms of the hands Explanation: Janeway lesions are painless, red or purple macules found on the palms and soles.

The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)?

You Selected: Sinus dysrhythmia Correct response: Atrial fibrillation Explanation: In mitral stenosis, the pulse is weak and often irregular because of atrial fibrillation (caused by strain on the atrium).

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

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

A client with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the client for which manifestations?

You Selected: Tachypnea and dyspnea Correct response: Anorexia and confusion Explanation: Clients with RCM have increased sensitivity to digoxin, and the nurse must anticipate that low doses will be prescribed and assess for digoxin toxicity. The most common manifestations of digoxin toxicity are gastrointestinal (anorexia, nausea, and vomiting), cardiac (rhythm disturbances and heart block), and central nervous system disturbances (confusion, headache, weakness, dizziness, and blurred or yellow vision).

A client hospitalized for 10 days with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy for 2 to 6 weeks is anticipated. During discharge planning with the client, what is most important for the nurse to review?

You Selected: Teach the client to avoid crowds and exposure to upper respiratory infections. Correct response: Assess the client's home environment in terms of family assistance and adequacy. Explanation: Long-term IV antimicrobial therapy is often necessary. The nurse should assess the home environment to ensure successful management of long-term antibiotic therapy. Bed rest is not necessary for the patient without heart damage. The others are not the most important steps for a client undergoing outpatient antibiotic therapy.

The nursing instructor is teaching a class on thrombophlebitis. What should the nurse tell the students about the inflammatory response in thrombophlebitis?

You Selected: The inflammatory response is caused by the irritation of blood trying to flow through the vessel. Correct response: The inflammatory response is caused by accumulated waste products in the blocked vessel. Explanation: Accumulated waste products in the blocked vessel irritate the vein wall, initiating an inflammatory response. The other options are incorrect because they do not cause the inflammatory response in thrombophlebitis.

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension?

You Selected: Wilms' tumor Correct response: Pheochromocytoma Explanation: Predisposing conditions include kidney disease, pheochromocytoma (a tumor of the adrenal medulla), hyperaldosteronism (increased secretion of mineralocorticoid by the adrenal cortex), atherosclerosis, use of cocaine or other cardiac stimulants (e.g., weight-control drugs, caffeine), and use of oral contraceptives. Wilms' tumors, astrocytomas, and lymphomas are not predisposing conditions for secondary hypertension.

A client with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. What collaborative management will the nurse expect for this client?

You Selected: administration of anticoagulants Correct response: surgical valve replacement Explanation: Aortic or mitral valve debridement, excision, or replacement is required in patients with more than one serious systemic embolic episode.

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for?

You Selected: blurred vision Correct response: dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.

A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered?

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

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position

You Selected: help reduce the work required by the heart to resupply oxygen to the brain. Correct response: provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. Explanation: It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.

A client with a history of cardiomyopathy experiences dyspnea on exertion, fatigue, leg swelling, and chest pain. This client has which type of cardiomyopathy?

You Selected: hypertrophic cardiomyopathy Correct response: dilated cardiomyopathy Explanation: Dilated cardiomyopathy, the most common type, is accompanied by dyspnea on exertion and when lying down. The client experiences fatigue and leg swelling and may also have palpitations and chest pain. Peripartum cardiomyopathy may develop in women shortly before or after giving birth. Hypertrophic cardiomyopathy is associated with syncope, fatigue, shortness of breath, and chest pain. Restrictive cardiomyopathy has symptoms of exertional dyspnea, dependent edema in the legs, ascites (fluid in the abdomen), and hepatomegaly (enlarged liver).

Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis?

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

The nurse is interviewing a client during an initial visit at a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure?

You Selected: irregular pulse Correct response: fatigue Explanation: Fatigue is commonly the earliest symptom of chronic heart failure; it is caused by decreased cardiac output and tissue oxygenation. Pedal edema and nocturia are symptoms of heart failure, but they occur later in the course of the condition. An irregular pulse can be a complication of heart failure, but it is not necessarily an early indication of the condition.

A nurse is assessing a client with aortic stenosis. What type of murmur will the nurse expect to hear?

You Selected: low-pitched, rumbling during diastole. Correct response: loud and rough during systole. Explanation: 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.

The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse titrate to improve blood flow to vital organs? You Selected:

You Selected: metoprolol Correct response: dopamine Explanation: Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.

A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of

You Selected: myocardial infarction. Correct response: pulmonary embolism. Explanation: Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction, whereby emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.

A client has been rushed to the ED with pulmonary edema and is going to need oxygen immediately. Which oxygen delivery system should be used first?

You Selected: nasal cannula Correct response: mask Explanation: Because pulmonary edema can be fatal, lung congestion needs to be relieved as quickly as possible. Supplemental oxygen is one of the first tools used to fight pulmonary edema. A mask, rather than nasal cannula, is needed to deliver the maximum percentages of oxygen. Intubation is reserved for when respiratory failure occurs. Mechanical ventilation is applied once respiratory failure occurs.

A nurse is assigned to the medical intensive care unit. The nurse auscultates a water-hammer pulse. What will the sound resemble?

You Selected: quick, sharp strokes that suddenly collapse Correct response: quick, sharp strokes that suddenly collapse Explanation: 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 is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided and left-sided heart failure?

You Selected: resting bradycardia Correct response: ascites Explanation: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, ascites, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough. Mixed heart failures can have all symptoms of right and left plus cool extremities, resting tachycardia, and weight gain.

A client reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate:

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

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has a new onset of hypertrophic cardiomyopathy (HCM). What will be included on the plan of care?

You Selected: teaching about heart transplantation surgery Correct response: an insertion of an implantable cardiac defibrillator Explanation: The hypertrophied cardiac muscle decreases the effectiveness of the heart's contraction, decreasing cardiac output. The goal is to prevent sudden death. An implantable cardiac defibrillator will prevent lethal dysrhythmias. Teaching about heart transplantation surgery is not a priority. Exercise programs and weight reduction diet are not appropriate at this time for a symptomatic client with cardiomyopathy.

The nurse is assessing a client admitted with acute left-sided infective endocarditis. What is the best diagnostic test to confirm the diagnosis?

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

The critical care nurse is caring for a client with cardiogenic shock. What is the premise for inserting an intra-aortic balloon pump?

coronary artery stenosis Correct response: inadequate tissue perfusion Explanation: The classic signs of cardiogenic shock are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage. Reduced cardiac output and stroke volume reduces arterial blood pressure and tissue perfusion. A myocardial infarction may lead to cardiogenic shock, but is not the premise for the intra-aortic balloon pump. Coronary artery stenosis is not related to shock. Right arterial flutter is not indicative of shock.

The nurse is administering medications to a client with pericarditis. What medications will be commonly prescribed to treat pericarditis? Select all that apply.

colchicine ibuprofen prednisone Explanation: Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may be prescribed for pain relief during the acute phase. Indomethacin is contraindicated because it may decrease coronary blood flow. Corticosteroids (e.g., prednisone) may be prescribed if the pericarditis is severe or the patient does not respond to NSAIDs. Colchicine may also be used as alternative therapy.

A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client's symptoms may indicate:

cardiomyopathy. Explanation: Dilated cardiomyopathy is accompanied by dyspnea on exertion and when lying down. The client experiences fatigue and leg swelling and may also have palpitations and chest pain. When a client's medical history includes disorders that are bacterial or viral in origin, a family history of early cardiac deaths, or any of several other conditions that correlate with heart involvement, the possibility of cardiomyopathy is considered. Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or MI (heart attack), or develops after cardiac surgery. Clients with thrombophlebitis often complain of discomfort in the affected extremity. With Buerger's disease, the client notes that one or both feet are always cold and may report numbness, burning, and tingling in some areas of the feet.

rx that slow av conduction

dig, bb, ccb

U WAVE

repolarization of the purkinje fibers