Ch 29 Cardiac PrepU Questions

An asymptomatic patient questions the nurse about mitral regurgitation and inquires about continuing exercises. Which of the following is the most appropriate nursing response?

Continue exercising until mild symptoms develop Explanation: Exercise is not limited until mild symptoms develop. It is not important for an asymptomatic patient to avoid exercise and to take ample rest after exercise.

A patient with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this patient?

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

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?

Risk for infection Explanation: Clients with endocarditis have a Risk for infection. The nurse should stress to the client that he'll need to continue antibiotics for a minimum of 5 years and that he'll need to take prophylactic antibiotics before invasive procedures for life. There is no indication that the client has Chronic pain or Impaired memory. Because the client doesn't have valvular damage, Impaired gas exchange doesn't apply.

A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant?

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

A patient with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. The nurse expects that collaborative management of the patient will include

surgical valve replacement Explanation: Aortic or mitral valve debridement, excision, or replacement is required in patients with more than one serious systemic embolic episode.

The nurse determines that a 49-year-old 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.

A nursing student is assigned to a patient with a mechanical valve replacement. The patient asks the student, "Why do I have to take antibiotics before getting my teeth cleaned?" Which response by the nursing student is most appropriate?

"You are at risk of developing an infection in your heart." Explanation: The patient is at risk for endocarditis and should take prophylactic antibiotics before any invasive procedure. Antibiotics have nothing to do with how much the teeth bleed. Cleaning of the teeth will not cause the valve to malfunction. Using the word "vegetative" with the patient may not be understood; therefore, it is not the most appropriate answer.

While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement?

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

The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?

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

Ralph Wilson, is a 52-year-old client in the hospital unit where you practice nursing. He is being treated for myocarditis. Which of the following nursing interventions should you perform to reduce cardiac workload in a client with myocarditis?

Maintain the client on bed rest Explanation: The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing.

A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to:

assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin. Explanation: For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the physician 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 physician's order. The nurse should notify the physician before holding a medication scheduled to be administered during another shift.

During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. Which of the following answers from the nurse is correct information?

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

A nurse is teaching a client who is having a valuloplasty tomorrow. The client asks what the advantage is for having a tissue valve replacement instead of a mechanical valve. The correct answer by the nurse is which of the following?

"A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required." Explanation: Tissue valves are less likely to generate thromoemboli, so long-term anticoagulation is not required. Mechanical valves do not deteriorate or become infected as easily as tissue valves. They are thought to be more durable than tissue valves and so require replacement less often

A nurse and a nursing student are caring for a client with pericarditis and perform the physical assessment together. The client has a pericardial friction rub audible on auscultation. When the nurse and student leave the room, the student asks how to distinguish a pericardial from a pleural friction rub. The nurse's best response is which of the following?

"Ask the client to hold the breath while you auscultate; the pericardial friction rub will continue, while the pleural friction rub will stop." Explanation: A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid as a result of inflammation. The audible rub on auscultation is synchronous with the heartbeat. To distinguish between a pleural rub and a pericardial rub, the client should hold the breath. The pericardial rub will continue.

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

Autograft. Explanation: An example of autograft is found when the surgeon excises the pulmonic valve and uses it for an aortic valve replacement. Allograft refers to replacement using human tissue and is a synonym for homograft. Homograft refers to replacement using human tissue and is a synonym for allograft. Xenograft refers to replacement of tissue from animal tissue.

Which of the following is a term used to describe the splitting or separating of fused cardiac valve leaflets?

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

During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following?

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

Which signs and symptoms accompany a diagnosis of pericarditis?

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR). Explanation: The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. Low urine output secondary to left ventricular dysfunction lethargy, anorexia, heart failure and pitting edema, result from acute renal failure.

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the student to clarify one of the last treatment options available that the physician mentioned. After checking with the primary nurse, the student would most likely discuss which of the following?

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

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.

Which of the following mitral valve conditions generally produces no symptoms?

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

What is the most common cause of mitral stenosis?

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

A nurse is preparing a teaching plan regarding biological tissue valve replacement. Which of the following identifies a disadvantage of this type of valve replacement?

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

Mary Seaver is admitted to the pediatrics unit where you practice nursing for treatment of rheumatic carditis. Aggressive antibiotic therapy and comfort measures have been instituted to minimize the long-lasting effects of the systemic inflammation. What is the best treatment for Mary's rheumatic carditis?

Treatment depends upon extent of cardiac involvement. Explanation: Concurrent treatment of rheumatic carditis depends on the extent of heart involvement. If minor, no treatment may be given; if heart failure or life-threatening dysrhythmias occur, extensive treatment is necessary. Surgery may be required to treat constrictive pericarditis and damage to heart valves. Prophylactic antibiotic therapy is recommended before future procedures that are associated with the dissemination of microorganisms that can lead to bacteremia and recurrence of endocarditis.

The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery?

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

A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. Which of the following instructions would provide that information?

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

The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse?

An extra heart sound Explanation: Often, the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapsed.

A nurse plans to have an education session with a client who has cardiomyopathy and the client's spouse about ways to decrease the sense of powerlessness. Which of the following actions by the nurse will provide this information?

Assist the client in identifying life areas over which she still has control. Explanation: The client should be assisted to identify the things in life that she has lost. The nurse will then assist the client to identify the amount of control that she still has (eg, low-sodium food choices, medication schedule). The nurse should never encourage the client to forget what she has lost or change the subject if a client wants to talk about something. The nurse should encourage this discussion. It is important that the client adhere closely to a low-sodium diet. The nurse should encourage this adherence and never suggest otherwise.

The nurse is caring for a client who is diagnosed with aortic stenosis, but is reluctant to have surgery for valve replacement. The nurse is present when the physician talks to the client about a treatment that is less invasive than surgery, but that will likely relieve some of the client's symptoms. Later, the client asks the nurse to review with her spouse the treatment offered. What does the nurse talk about with the spouse?

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

Which of the following nursing interventions should a nurse perform when a patient with cardiomyopathy receives a diuretic?

Check for dependent edema regularly Explanation: The nurse should monitor for dependent edema regularly if the patient with cardiomyopathy receives a diuretic. Oxygen is administered either continuously or when dyspnea or dysrhythmias develop. Bed rest is not necessary. The nurse should ensure that the patient's activity level is reduced and should sequence any activity that is slightly exertional between periods of rest.

Patient with myocarditis are sensitive to which of the following medications?

Digitalis Explanation: The nurse must closely monitor these patients for digitalis toxicity, which is evidenced by dysrhythmia, anorexia, nausea, vomiting, headache, and malaise. If the cause of the myocarditis is hemolytic streptococci, penicillin will be given. The use of corticosteroids remains controversial.

A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?

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

The nurse is preparing to administer warfarin (Coumadin), an oral anticoagulant, to a patient with a mechanical valve replacement. The patient's INR is 2.7. Which action should the nurse take?

Explanation: Patients with mechanical valve replacements who take warfarin (Coumadin) usually have individualized target international normalized ratios (INRs) between 2.0 and 3.5. The nurse would give the medication as ordered.

A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis?

History of aortic valve replacement Explanation: A heart valve prosthesis such as an aortic valve replacement is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, I.V. drug abuse, and immunosuppression. Although race, age, and a history of diabetes mellitus may predispose a person to cardiovascular disease, they aren't major risk factors for infective endocarditis.

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?

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

A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume?

Leaning forward while sitting Explanation: The nurse should encourage the client to lean forward, because this position causes the heart to pull away from the diaphragmatic pleurae of the lungs, helping relieve chest pain caused by pericarditis. The semi-Fowler's, supine, and prone positions don't cause this pulling-away action and therefore don't relieve chest pain associated with pericarditis.

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following?

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

For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations?

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

Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis?

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

A physician admits a client with a history of I.V. drug abuse to the medical-surgical unit for evaluation for infective endocarditis. Nursing assessment is most likely to reveal that this client has:

Osler's nodes and splinter hemorrhages. Explanation: Infective endocarditis occurs when an infectious agent enters the bloodstream, such as from I.V. drug abuse or during an invasive procedure or dental work. Typical assessment findings in clients with this disease include Osler's nodes (red, painful nodules on the fingers and toes), splinter hemorrhages, fever, diaphoresis, joint pain, weakness, abdominal pain, a new or altered heart murmur, and Janeway's lesions (small, hemorrhagic areas on the fingers, toes, ears, and nose). Retrosternal pain that worsens when the client is supine, pulsus paradoxus, and pericardial friction rub are common findings in clients with pericarditis, not infective endocarditis.

A physician has scheduled a client with mitral stenosis for mitral valve replacement. Which condition may arise as a complication of mitral stenosis?

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

Which valve lies between the right ventricle and the pulmonary artery?

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

Which of the following is an action of the intra-aortic balloon pump (IABP)?

Reduction of left ventricular afterload Explanation: The IABP decreases the workload of the heart by reducing left ventricular afterload. Additionally, it improves coronary artery blood flow by increasing coronary artery perfusion pressure. It does not reduce left or right ventricular preload.

Following the assessment of a patient with suspected pericarditis, the nursing student would determine which of the following findings to be most characteristic?

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

Which of the following types of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch.

Restrictive cardiomyopathy (RCM) Explanation: RCM is characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. Hypertrophic cardiomyopathy occurs when the heart muscle asymmetrically increases in size and mass, especially along the septum. Dilated cardiomyopathy is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. Arrhythmogenic right ventricular cardiomyopathy occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?

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

Which of the following symptoms occurs in the patient diagnosed with mitral regurgitation when pulmonary congestion occurs?

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

A nurse is caring for a client with acute mitral regurgitation related to an acute myocardial infarction. The nurse knows to monitor the client carefully for symptoms of which initial complication or result?

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

The nurse assessing a patient with pericardial effusion at 0800 notes the apical pulse is 74 and the BP is 140/92. At 1000, the patient has neck vein distention, the apical pulse is 72, and the BP is 108/92. Which action would the nurse implement first?

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

Atrial fibrillation is common in patients with atrial septal defects (ASDs) and further increases the risk of which of the following?

Stroke Explanation: Atrial fibrillation is common in patients with ASDs and further increases the risk of stroke. Anticoagulation with aspirin is often prescribed. Cardiomegaly, heart failure, and splenomegaly may occur with infective endocarditis.

Which of the following medications could be used to treat pericarditis? Choose all that apply.

• Colchicine • Motrin • Prednisone Explanation: Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Motrin), may be prescribed for pain relief during the acute phase. Indomethacin (Indocin) is contraindicated, because it may decrease coronary blood flow. Corticosteroids (eg, 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.

Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply.

• Elevated erythrocyte sedimentation rate (ESR) • Elevated white blood cell (WBC) count • Elevated c-reactive protein Explanation: Abnormal findings include anemia, elevated WBC counts, elevated ESR, and elevated c-reactive protein

Which of the following are the first symptoms of cardiac tamponade? Select all that apply.

• Shortness of breath • Chest tightness • Dizziness Explanation: The first symptoms of cardiac tamponade are often shortness of breath, chest tightness, dizziness, or restlessness. The patient may have tachycardia. Neck vein distention and other signs of rising central venous pressure develop.