Chapter 16: PrepU

Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? 1- Maintain the client on bed rest. 2- Administer a prescribed antipyretic. 3- Elevate the client's head. 4- Administer supplemental oxygen.

1

Which of the following is the most common complication of prosthetic valves? 1- Thromboembolism 2- Hemolysis 3- Infection 4- Arrhythmias

1

Which intervention should the nurse include in the plan of care for a client with valvular heart disease who is experiencing pulmonary congestion? 1- Report a weight gain of 3 pounds in 1 week 2- Rest and sleep in a chair or sit in bed with head elevated 3- Take nitroglycerin if shortness of breath develops 4- Drink at least 2 L of fluid daily and monitor urine output

2

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? 1- Administer oxygen 2- Check regularly for dependent edema 3- Maintain bed rest 4- Allow unrestricted physical activity

2

Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. 1- Hypertrophic cardiomyopathy (HCM) 2- Restrictive cardiomyopathy (RCM) 3- Dilated cardiomyopathy (DCM) 4- Arrhythmogenic right ventricular cardiomyopathy (ARVC)

2

While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? 1- Notify the health care provider. 2- Document that the pericarditis has resolved. 3- Ask the patient to lean forward and listen again. 4- Prepare to insert a unilateral chest tube.

3

A nurse is conducting a heath history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis? 1- Rheumatic endocarditis 2- Congestive heart failure 3- Atrial fibrillation 4- Myocardial infarction

1

Which action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community? 1- Encourage susceptible groups in the community to receive immunizations with streptococcal vaccine. 2- Teach individuals in the community to seek medical treatment for streptococcal pharyngitis. 3- Educate individuals in the community about the importance of monitoring temperature when infections occur. 4- Provide prophylactic antibiotics to individuals with a family history of rheumatic fever.

1

Which nursing intervention would reduce cardiac workload in a client with myocarditis? 1- Maintain the client on bed rest. 2- Administer a prescribed antipyretic. 3-Lower the client's head. 4- Eliminate all phone calls and visitors.

1

Which would the nurse stress as a lifelong necessity for a client managing infective endocarditis? 1- Antibiotic therapy 2- Antihypertensive medication 3- Exercise regimen 4- Potassium replacement

1

The nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis? 1- Complete blood count 2- Positive blood culture 3- Serum cardiac antigens 4- Immunosuppressant assay

2

A client is diagnosed with infective endocarditis. What laboratory values will the nurse assess? Select all that apply. 1- elevated white blood cell (WBC) count 2- elevated C-reactive protein 3- elevated erythrocyte sedimentation rate (ESR) 4- decreased erthrocyte sedimentation rate 5- decreased C-reactive protein

1,2,3

A 41-year-old IV heroin user has been admitted to the hospital with a diagnosis of infective endocarditis and begun on IV antibiotic therapy. The patient is eager to be discharged from the hospital and has asked the nurse when he is likely to be discharged. How should the nurse reply? 1- "You'll have to talk it over with your health care provider, but it's likely that you can change to oral antibiotics in a few days." 2- "Endocarditis involves a very resilient infection, so it's common to need several weeks of IV antibiotics." 3- "You'll probably be discharged if your blood cultures are clear in 7 days." 4- "Endocarditis takes a long time to treat, but you can probably come for IV antibiotics to the ambulatory clinic once or twice a week."

2

A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis? 1- Orthopnea 2- Chest pain 3- Dyspnea 4- Fatigue

2

The nurse who is caring for a patient suspected of having pericarditis is aware that the patient's chest pain must be clearly differentiated from chest pain that may be attributable to myocardial infarction. When assessing the patient, how should the nurse make this differentiation? 1- "Would you describe your pain as a stabbing pain or is it more of a dull ache?" 2- "When you breathe in deeply, does your pain get more intense?" 3- "When exactly did you first sense that you were having chest pain?" 4- "Is your pain worse when you're lying down, or is it worse when you're sitting up?"

2

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? 1- "I will avoid milk, yogurt, and other dairy products." 2- "I may have to take prophylactic antibiotics for up to 10 years." 3- "I will take a nonsteroidal anti-inflammatory medication every day." 4- "I will avoid any kind of activity."

2

Which term describes the splitting or separating of fused cardiac valve leaflets? 1- Annuloplasty 2- Chordoplasty 3- Commissurotomy 4- Valvuloplasty

3

Which valve lies between the right ventricle and the pulmonary artery? 1- Tricuspid valve 2- Mitral valve 3- Pulmonic valve 4- Chordae tendineae

3

A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis? 1- Cardiac cauterization 2- Computed tomography 3- Echocardiography 4- Chest x-ray

3

A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention? 1- Eliminate dairy products and carbonated beverages 2- Decrease the amount of sodium and saturated fat 3- Eliminate caffeine and alcohol 4- Decrease the amount of acidic beverages and fruits

3

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? 1- "I should increase my fluid intake." 2- "I'll enroll in an aerobic exercise program." 3- "I can still drink coffee and tea." 4- "I should eat foods rich in protein."

3

A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? 1- A loud, blowing murmur 2- Hypertension 3- Shortness of breath 4- Tachycardia

3

A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)? 1- Thrombosis and infection 2- Bleeding and wound dehiscence 3- Bleeding and infection 4- Evisceration

3

A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease? 1- serial enzyme studies 2- cardiac catheterization 3- echocardiogram 4- phonocardiogram

3

A patient with mitral stenosis exhibits symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm? 1- Normal sinus rhythm 2- Supraventricular tachycardia 3- Atrial fibrillation 4- Electromechanical dissociation

3

On auscultation, the nurse suspects a diagnosis of mitral valve stenosis when which of the following is heard? 1- Mitral valve click 2- High-pitched blowing sound at the apex 3- Low-pitched, rumbling diastolic murmur at the apex of the heart 4- Diastolic murmur at the left sternal border of the heart

3

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)? 1- First-degree atrioventricular block 2- Ventricular tachycardia 3- Atrial fibrillation 4- Sinus dysrhythmia

3

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? 1- Plan how needs will be met while the client continues on bed rest. 2- Teach the client to avoid crowds and exposure to upper respiratory infections. 3- Encourage use of diversional activities to relieve boredom and restlessness. 4- Assess the client's home environment in terms of family assistance and adequacy.

4

A client who had a prosthetic valve replacement was taking warfarin to reduce the risk of postoperative thrombosis. The client visited the nurse at a clinic once a week. What INR level would alert the nurse to notify the health care provider? 1- 2.6 2- 3.0 3- 3.4 4- 3.8

4

A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement? 1- The patient must take lifelong anticoagulant therapy. 2- The patient's infections are easier to treat. 3- There is a low incidence of thromboembolism. 4- The valve has to be replaced frequently.

4

It is important for a nurse to be aware of the normal hemodynamics of blood flow to recognize and understand pathology when it occurs. The nurse should know that incomplete closure of the tricuspid valve results in a backward flow of blood from the: 1- Aorta to the left ventricle. 2- Left atrium to the left ventricle. 3- Right atrium to the right ventricle. 4- Right ventricle to the right atrium.

4

Recent exacerbation of a patient's mitral valve regurgitation prompted her cardiologist to perform a mitral valve replacement in which the patient received a mechanical valve. In the weeks following the patient's surgery, which of the following blood tests will be most relevant to the patient's potential complications? 1- Blood urea nitrogen (BUN) and creatinine 2- Serum potassium level 3- White blood cell (WBC) differential 4- International normalized ratio (INR)

4

The nurse has created a care plan for a client admitted with acute pericarditis and a nursing diagnosis of acute pain related to pericardial inflammation. What is an appropriate nursing intervention for this client? 1- Administering around-the-clock opioids as prescribed 2- Promoting progressive relaxation techniques with the use of slow, deep breathing 3- Positioning the patient on the right side with the head of the bed elevated 15 degrees 4- Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on

4

The 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? 1- Mitral insufficiency 2- Tricuspid insufficiency 3- Tricuspid stenosis 4- Aortic regurgitation

4

The nurse is assessing a client admitted with acute left-sided infective endocarditis. What is the best diagnostic test to confirm the diagnosis? 1- blood cultures 2- complete blood count 3- urinalysis 4- transesophageal echocardiogram

1

A client with aortic regurgitation is admitted to the hospital. Which assessment findings would indicate left ventricular failure? 1- Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND) 2- Distended jugular veins, pedal edema, nausea 3- Dyspnea, distended jugular veins, orthopnea 4- Orthopnea, nausea, pedal edema

1

A client needs to have a cardiac valve replacement. The nurse offers client education about the procedures involved—including the benefits and risks. Which client statement indicates the need for more education? 1- "I'm anxious because I'll need to have cardiopulmonary bypass." 2- "Since the procedure is minimally invasive, there is less surgical trauma." 3- "Since the procedure is minimally invasive, there is less postoperative pain than with other techniques." 4- "I might lose some blood, but not likely a large quantity of it."

1

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: 1- infective endocarditis. 2- rheumatic fever. 3- myocarditis. 4- dilated cardiomyopathy.

1

A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease? 1- Rheumatic fever 2- Mitral stenosis 3- Cardiomyopathy 4- Pericarditis

1

A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure? 1- Dyspnea, orthopnea, pulmonary edema 2- Distended jugular veins, pedal edema, nausea 3- Dyspnea, distended jugular veins, orthopnea 4- Orthopnea, nausea, pedal edema

1

A client with infective endocarditis (IE) and a fever is admitted to the intensive care unit. Which of these physician orders should the nurse implement first? 1- Order blood cultures drawn from two sites 2- Give acetaminophen pro re nata for fever higher than 100.3 F 3- Administer ceftriaxone 1 g IVPB q 12 hours 4- Obtain a transesophageal echocardiogram

1

A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client's symptoms may indicate: 1- cardiomyopathy. 2- pericarditis. 3- thrombophlebitis. 4- Buerger's disease.

1

A nurse caring for a client with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which behavior would indicate to the nurse recognizes that the client's level of anxiety has decreased when the client 1- is able to discuss the prognosis freely. 2- is resting in bed watching TV. 3- answers questions about physical status with no problem. 4- eagerly awaits visits from family.

1

A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valular disease? 1- "The client with mitral valve prolapse probably had no health symptoms." 2- "The client needs premium insurance to cover the cost of medications." 3- "The client's religion may prohibit the client from seeking medical attention." 4- "The client may have to wear antiembolism stocking to help with venous return."

1

A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned. What is considered to be one of the last treatments for end-stage cardiomyopathy? 1- heart transplantation 2- xenograft tissue valve 3- annuloplasty 4- valvuloplasty

1

A nurse is teaching a client about valve replacement surgery. Which statement by the client indicates an understanding of the benefit of an autograft replacement valve? 1- "The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged." 2- "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." 3- "The valve is from a tissue donor, and I will not need to take any blood-thinning drugs when I am discharged." 4- "The valve is mechanical, and it will not deteriorate or need replacing."

1

A nurse is told in report that a patient has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur? 1- Second intercostal space, right sternal notch 2- Erb's point 3- Second intercostal space, left sternal notch 4- Fourth intercostal space, left sternal border

1

A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide? 1- Alternate active periods with rest periods. 2- Gradually work up to strenuous activity. 3- Include isometric exercises in the daily routine. 4- Avoid all physical and emotional stress.

1

A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant? 1- The patient reports shortness of breath when walking. 2- The patient has jugular vein distention and 3+ pedal edema. 3- The patient reports chest pain after eating a large meal. 4- The patient's has an enlarged liver and oedematous abdomen.

1

A patient with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this patient? 1- Prepare for pericardiocentesis. 2- Request STAT cardiac enzymes. 3- Perform a 12-lead ECG. 4- Assess the patient's heart and lung sounds.

1

Clients with myocarditis are sensitive to which medication? 1- Digoxin 2- Furosemide 3- Penicillin 4- Corticosteroids

1

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? 1- Decreased cardiac output 2- Autonomic dysreflexia 3- Disturbed sensory perception 4- Ineffective airway clearance

1

Following several months of increasing dyspnea on exertion, a 71-year-old woman has been diagnosed with mitral stenosis (MS). The woman is relieved to receive a diagnosis that explains her symptoms but does not completely understand the root of her problem. How can the nurse best explain the woman's health problem? 1- "The valve in the left side of your heart has become stiff and narrowed, so your heart can't fill with all the blood that your body needs." 2- "The left side of your heart is having trouble overcoming the resistance in your blood vessels because a valve is not sealing." 3- "When your heart beats, some of the blood that should go to your body is backing up into your heart because the valve leaks." 4- "The valve between your lungs and your heart has become inelastic, so your heart can't fill up with enough blood."

1

If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected? 1- mitral valve 2- coronary arteries 3- inferior vena cava 4- septum

1

Incomplete closure of the mitral valve results in backflow of blood from the: 1- Left ventricle to left atrium 2- Right ventricle to the right atrium 3- Right atrium to right ventricle 4- Left atrium to left ventricle

1

Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis? 1- increased use of prosthetic valve replacements 2- greater incidence of a history of repaired 3- congenital heart defects 3- increase in IV drug use 4- higher rate of tuberculosis

1

The diagnosis of aortic regurgitation (AR) is confirmed by which of the following? 1- Echocardiography 2- Cardiac catheterization 3- Exercise stress testing 4- Myocardial biopsy

1

The instructor is talking with a nursing student who is caring for a client with pericarditis. The instructor asks the student to name the main characteristic of pericarditis. What should be the student's answer? 1- Precordial pain 2- Dyspnea 3- Fever 4- Respiratory symptoms

1

The nurse is caring for a client with aortic regurgitation. The nurse knows to expect what symptoms during the physical examination? 1- Orthopnea and dyspnea 2- Increased urine output 3- Headache and vomiting 4- Nausea and low urine output

1

The nurse is caring for a client with manifestations of dilated cardiomyopathy. When planning care, which consideration would the nurse make? 1- Place bed in a high or semi-high Fowler's position as needed. 2- Assist client to bathroom every 2 hours. 3- Instruct client to avoid strenuous activity. 4- Assess abdominal girth daily.

1

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? 1- Cardiac tamponade 2- Decreased venous pressure 3- Hypertension 4- Left ventricular hypertrophy

1

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? 1- Risk for infection 2- Chronic pain 3- Impaired gas exchange 4- Impaired memory

1

The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask? 1- "Have you been to the dentist recently?" 2- "Do you have a family history of endocarditis?" 3- "Have you recently vacationed outside of the United States?" 4- "Do you live with any domesticated animals in your home?"

1

The nurse understands that which of the following medications will be administered to the client for 6 to 12 weeks following prosthetic porcine valve surgery? 1- Warfarin 2- Aspirin 3- Furosemide 4- Digoxin

1

A nurse is admitting a client diagnosed with infective pericarditis. What is the initial order for the nurse to implement? 1- Administer intravenous antibiotic. 2- Obtain blood cultures times two. 3- Schedule an echocardiogram. 4-Provide bedrest with bathroom privileges.

2

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? 1- Croup 2- Rheumatic fever 3- Severe staphylococcal infection 4- Medullary sponge kidney

2

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? 1- Nifedipine 2- Cyclosporine 3- Verapamil 4- Vancomycin

2

A patient with dilated cardiomyopathy has been placed on the transplant list due to the severity of her symptoms and her poor prognosis. While waiting for a donor heart, which of the following interventions carries the greatest potential for reducing the workload on the patient's heart? 1- Bioprosthetic valve replacement 2- A ventricular assist device (VAD) 3- Percutaneous aortic balloon valvuloplasty 4- Angioplasty

2

After a detailed diagnostic workup, a patient has been diagnosed with atrial septal defect (ASD). The nurse should recognize that this patient may exhibit many of the signs and symptoms that are typically associated with: 1- Unstable angina 2- Right-sided heart failure 3- Myocardial infarction 4- Endocarditis

2

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. What answer from the nurse is correct? 1- "A mechanical valve is less likely to generate blood clots, so long-term anticoagulation therapy is not required." 2- "A mechanical valve is thought to be more durable and so requires replacement less often." 3- "Mechanical valves are used for women of childbearing age." 4- "Mechanical valves are not always available and are very expensive."

2

During auscultation of a client, the nurse suspects a diagnosis of mitral valve regurgitation when hearing which of the following? 1- Mitral click 2- High-pitched blowing sound at the apex 3- Low-pitched diastolic murmur at the apex 4- Diastolic murmur at the left sternal border

2

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? 1- Dyspnea 2- Constant chest pain 3- Fatigue lasting more than 1 month 4- Uncontrolled restlessness

2

The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)? 1- Accumulation of blood in the lungs 2- Congestion in the peripheral tissues 3- Reduction in forward flow 4- Reduction in cardiac output

2

The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse? 1- Fatigue 2- An extra heart sound 3- Dizziness 4- Syncope

2

The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse? 1- Fatigue 2- Extra heart sound 3- Dizziness 4- Syncope

2

The nurse is caring for a client with cardiac compromise related to mitral valve impairment. Which outcome of the eroding of the mitral valve is most significant? 1- Presence of a heart murmur 2- Heart failure 3- Activity intolerance 4- Pulmonary congestion

2

The nurse is instructing a new graduate nurse. Together, they are caring for a client with infective endocarditis. What is a sign of infective endocarditis? 1- Polyarthritis 2- Splinter hemorrhage 3- Precordial pain 4- Heart murmur

2

The school nurse is providing care to a child with a sore throat. With any sign of throat infection, the nurse stresses which of the following? 1- Warm, salt water gargling 2-Fluid increase to 2500cc 3-Obtaining a throat culture 4-Administering antiseptic lozenges

3

Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? 1- A loud, blowing murmur 2- Hypertension 3- Shortness of breath 4- Tachycardia

3

The nurse has created a care plan for a client admitted with acute pericarditis and a nursing diagnosis of acute pain related to pericardial inflammation. What is an appropriate nursing intervention for this client? 1- Administering around-the-clock opioids as prescribed 2- Promoting progressive relaxation techniques with the use of slow, deep breathing 3- Positioning the patient on the right side with the head of the bed elevated 15 degrees 4- Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on

4

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? 1- From droplets from a cough 2- From the fecal-oral route 3- From ingestion of a food 4- From a break in the skin

4

Infective Endocarditis (IE)

an infection of the endocardial surface of the heart.

intra-aortic balloon pump

device that acts as a temporary, secondary pump to supplement ineffectual contraction of the heart's left ventricle