Exam 2 EAQs: Ch. 36 - Valvular Heart Disease and Cardiomyopathy
Which questions are appropriate for the nurse to ask to assess the cognitive-perceptual patterns of a patient diagnosed with valvular heart disease? Select all that apply. "Do you experience angina?" "Do you experience fainting?" "Do you experience dizziness?" "Do you experience orthopnea?" "Do you experience atypical chest pain?"
"Do you experience angina?" "Do you experience atypical chest pain?" While assessing the effect of valvular heart disease on a patient's cognitive-perceptual pattern, it is appropriate to ask if the patient has angina and atypical chest pain. Cognitive perceptual pattern understands how a patient perceives and responds to sensory input. Angina and chest pain indicates the presence of an effect on nociceptors that send signals to the brain and spinal cord. The sensation is known by the sensation-generating mechanism defined by the modality of receptors. Asking the patient about fainting, dizziness, and orthopnea helps in assessing the activity-exercise functional health pattern.
A patient has undergone surgery for a valve replacement. Which statements indicate that the patient understands the instructions from the nurse? Select all that apply. "I should wear a Medic Alert device." "I will start a vigorous aerobic exercise program." "Valve surgery has completely cured my disease." "I will need to take antibiotics when I have my teeth extracted." "I should contact my health care provider if I have a respiratory infection."
"I should wear a Medic Alert device." "I will need to take antibiotics when I have my teeth extracted." "I should contact my health care provider if I have a respiratory infection." It is advisable for this patient to wear a Medic Alert device to provide information in case of an emergency. Antibiotic prophylaxis prior to invasive dental procedures (such as extraction) is necessary to prevent endocarditis. Respiratory infections should be treated with antibiotics because some microorganisms may damage the valves of the heart. Also, valve surgery only relieves the symptoms and does not cure the disease; therefore, regular follow-up is important to monitor the disease progression. Strenuous physical exercise should be avoided because the valve may be unable to accommodate the associated increase in cardiac output. The extent of physical exercise should be prescribed by the health care provider.
Which statement made by the nurse to a patient with cardiomyopathy regarding home care instructions needs correction? "Avoid diet pills." "Eat a low-sodium diet." "Increase your caffeine consumption." "Report increased fatigue to your primary health care provider."
"Increase your caffeine consumption." Caffeine contains stimulants that stimulate the heart, which results in irregular heart rhythms. Therefore patients with cardiomyopathy should avoid caffeine. The patient should avoid diet pills because they may contain stimulants. The patient should consume a low-sodium diet. The patient should report increased fatigue to the primary health care provider.
A patient seeks information about the advantages of minimally invasive valvuloplasty surgery. What should the nurse say to explain the procedure to the patient? Select all that apply. "It is associated with less pain." "It can lead to postoperative atrial fibrillation." "It involves a shorter length of stay in the hospital." "It is associated with a higher risk of sternal infection." "It is more likely that a postoperative blood transfusion will be needed."
"It is associated with less pain." "It can lead to postoperative atrial fibrillation." "It involves a shorter length of stay in the hospital." Minimally invasive valvuloplasty surgery involves a mini-sternotomy. Hence, there is a shorter hospital stay because a small surgical wound takes less time to heal. Postoperative atrial fibrillation is reported in this procedure due to the surgery on the valves but is less common than with open surgical valvuloplasty. Because the procedure is minimally invasive, there is less postoperative pain. The procedure carries a lesser risk of sternal infection due to the small incision. Also, fewer blood transfusions are needed compared to open valvuloplasty because the blood loss is typically minimal.
The nurse is providing discharge education to a patient with dilated cardiomyopathy (CMP). Which patient statement indicates the need for further teaching? "I may need to start taking a diuretic." "I may be given a prescription for nitroglycerin." "Most patients with this diagnosis respond well to treatment." "I should alternate periods of rest with required activities of daily living."
"Most patients with this diagnosis respond well to treatment." Dilated CMP does not respond well to therapy, and patients experience multiple episodes of heart failure (HF). Nitrates and diuretics decrease preload and may be prescribed. Alternating periods of rest with activity is needed to reduce the workload of the heart.
The nurse reviews a list of potential candidates for valve replacement surgery. When considering the two types of prosthetic valves available, the nurse identifies that which patients are more likely to receive a biologic valve? Select all that apply. A 20-year-old man A 67-year-old man A 35-year-old man A 12-year-old boy A 32-year-old woman
A 67-year-old man A 32-year-old woman The 32-year-old woman is of childbearing age and cannot take anticoagulant therapy, which is required after mechanical valve replacement. Taking long-term anticoagulant therapy may increase the risk of bleeding during future pregnancies; therefore, she would be considered for a biologic valve. Biologic valves are less durable than mechanical valves. In a 67-year-old man, durability is less important than the side effects of anticoagulant therapy, such as the risk of bleeding from anticoagulants. Hence, a biologic valve is preferred. A 20-year-old boy, 35-year-old man, and 12-year-old boy are all younger patients; hence, a mechanical valve is best for them because of its durability.
The nurse assesses a patient with valvular heart disease. The nurse recalls that the absence of what heart sound is indicative of aortic valve stenosis? Absence of S 1 Absence of S 2 Absence of S 3 Absence of S 4
Absence of S 2 Aortic stenosis occurs as the result of rheumatic fever and is characterized by a diminished or absent S 2. A diminished or absent S 1, S 3, or S 4 is associated with aortic valve regurgitation.
Which is a secondary cause of restrictive cardiomyopathy? Amyloidosis Aortic stenosis Muscular dystrophy Coronary artery disease
Amyloidosis Amyloidosis is the deposition of a protein, amyloid, that can lead to restrictive cardiomyopathy as a result of the buildup of amyloid deposits in the heart affecting its shape and function. Aortic stenosis causes hypertrophic cardiomyopathy. Muscular dystrophy and coronary heart disease cause dilated cardiomyopathy.
A patient is admitted to the hospital with a diagnosis of aortic valve stenosis. Which manifestation does the nurse expect when taking the health history? Angina Fatigue Orthopnea Weakness
Angina Angina is one of the classic triad of manifestations that occurs on exertion in aortic valve stenosis. Angina occurs when the myocardial oxygen demand of the hypertrophied left ventricle exceeds oxygen supply. Fatigue and orthopnea are associated with chronic aortic valve regurgitation. Weakness is not a clinical manifestation of aortic valve stenosis.
A patient with a history of rheumatic fever is diagnosed with mitral valve stenosis. The patient is scheduled for prosthetic valve replacement surgery. The nurse should inform the patient that what protective mechanism will be implemented after the surgery? Exercise plan to increase cardiac tolerance β-adrenergic blockers to control palpitations Immunosuppressive therapy to prevent rejection Antibiotic prophylaxis for dental manipulation involving the gums of the teeth
Antibiotic prophylaxis for dental manipulation involving the gums of the teeth The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Immunosuppressive therapy is not necessary. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.
While auscultating a patient who underwent trauma, the nurse auscultates a quick, strong heartbeat that collapses immediately. The patient has severe dyspnea and describes the chest pain as 8 out of 10 on the pain scale. Which condition does the nurse suspect? Aortic valve stenosis Mitral valve stenosis Aortic valve regurgitation Mitral valve regurgitation
Aortic valve regurgitation A quick, strong beat that collapses immediately is known as water-hammer pulse. Water-hammer pulse, dyspnea, and chest pain due to trauma indicate aortic regurgitation (AR). Aortic stenosis (AS) is characterized by angina, exertional dyspnea, syncope, and left ventricular failure. Mitral valve stenosis involves exertional dyspnea, hoarseness, hemoptysis, chest pain, and seizures. Mitral valve regurgitation is associated with weakness, fatigue, palpitations, and dyspnea.
The nurse is auscultating the heart sounds of a patient with valvular heart disease. Which assessment findings may indicate mitral valve regurgitation? Select all that apply. An Austin Flint murmur A soft S 1 heart sound A prominent S 4 heart sound A diminished S 2 heart sound Audible third heart sound (S 3) A loud holosystolic murmur at the apex radiating to the left axilla.
Audible third heart sound (S 3) A loud holosystolic murmur at the apex radiating to the left axilla. Auscultation of heart sounds in the presence of mitral valve regurgitation reveals an audible third heart sound (S 3), even with normal left ventricular function, because of increased left ventricular volume. The murmur is a loud holosystolic murmur at the apex radiating to the left axilla. A systolic murmur, a soft S 1 heart sound, a prominent S 4heart sound, and a diminished S 2 heart sound are found upon assessment of aortic valve stenosis. An Austin Flint murmur is due to aortic regurgitation, originating at the mitral valve when blood enters simultaneously from both the aorta and the left atrium.
A patient is admitted to the hospital with a diagnosis of acute mitral valve regurgitation. What is the priority nursing intervention? Auscultate the lung sounds. Observe for bloody sputum. Assess for water-hammer pulse. Palpate lower extremities for edema.
Auscultate the lung sounds. Auscultation of the lung sounds is the priority nursing intervention in acute mitral valve regurgitation. In acute mitral valve regurgitation there is a rapid increase in left atrial pressure and volume, which leads to pulmonary congestion, resulting in pulmonary edema and possible cardiogenic shock. Hemoptysis can occur with mitral valve stenosis, not acute mitral valve regurgitation. Lower extremity edema is a manifestation of tricuspid stenosis. Water-hammer pulse is a manifestation of chronic, severe aortic valve regurgitation.
Which type of murmur is observed in patients with chronic aortic valve regurgitation? Diastolic murmur Austin Flint murmur Holosystolic murmur Loud midsystolic murmur
Austin Flint murmur An Austin Flint murmur occurs in patients with chronic aortic valve regurgitation. Mitral valve stenosis involves diastolic murmur. Holosystolic murmur occurs in patients with mitral valve prolapse. Loud midsystolic murmur occurs in patients with tricuspid and pulmonic stenosis.
The nurse is planning discharge teaching for a patient with cardiomyopathy. What instructions should be included in the plan? Select all that apply. Avoid alcohol. Balance activity and rest periods. Drink 2 to 4 glasses of water a day. Avoid vigorous isometric exercises. Consume food products with high sodium content.
Avoid alcohol. Balance activity and rest periods. Avoid vigorous isometric exercises. A patient with cardiomyopathy should avoid alcohol because it may increase blood pressure and can have adverse effects on the heart. Balance between activities and rest is essential to decrease systemic valvular resistance. Dehydration can increase systemic valvular resistance, which may result in obstruction to the forward flow of blood. Therefore it is important to drink six to eight glasses of water every day to avoid dehydration. Patients should avoid heavy lifting or vigorous isometric exercises. It is important to follow a low-sodium diet because it helps prevent water retention in the body.
The nurse should include which instructions when teaching a patient with mitral valve prolapse about self-care? Select all that apply. Avoid caffeine. Avoid all exercise. Avoid heavy lifting or isometric exercises. Avoid ephedrine in over-the-counter medications. Use antibiotics prophylactically prior to a procedure. Immediately report shortness of breath, fatigue, and palpitations.
Avoid caffeine. Avoid ephedrine in over-the-counter medications. Immediately report shortness of breath, fatigue, and palpitations. The nurse will teach a patient with mitral valve prolapse to immediately report shortness of breath, fatigue, palpitations, or other symptoms such as anxiety to the healthcare provider, or if necessary, activate the emergency response system. Avoiding caffeine and ephedrine will prevent heart palpitations. The patient is encouraged to begin or maintain an exercise program to maintain optimal health. The use of antibiotics prior to a procedure is not necessary with mitral valve prolapse. Instructing a patient to avoid heavy lifting or isometric exercises is reserved for patients with a symptomatic or a pathologic cardiac condition such as cardiomyopathy.
The nurse is planning discharge teaching for a patient with valvular heart disease. What instructions should the nurse include in the plan? Select all that apply. Avoid cigarettes. Take planned rest periods. Limit activities that cause fatigue. Undergo regular cardiac assessments. Continue with 30-40 minutes/day of strenuous exercise to build stamina.
Avoid cigarettes. Take planned rest periods. Limit activities that cause fatigue. Undergo regular cardiac assessments. Consumption of tobacco should be strictly avoided because it stimulates the heart. Rest periods should be planned to avoid exertion. Activities that cause fatigue or dyspnea should be limited. Regular cardiac assessment helps to monitor the disease progress and effectiveness of the treatment provided. The patient should be advised to avoid strenuous physical activities because damaged valves may not be able to properly cope with the increased cardiac output demand.
A nurse is caring for a patient with hypertrophic cardiomyopathy. What measures should be included in planning the care for this patient? Select all that apply. Avoid dehydration. Avoid strenuous activity. Encourage elevation of the feet. Administer nitroglycerin for chest pain. Ask the patient to do vigorous leg exercises.
Avoid dehydration. Avoid strenuous activity. Encourage elevation of the feet. The nurse should instruct the patient to avoid strenuous activity and dehydration, because these may increase systemic valvular resistance, which may lead to obstruction to the forward flow of the heart. Elevation of the feet while resting helps to improve the volume of blood returning to the heart. The use of vasodilators such as nitroglycerin to relieve chest pain can actually worsen the patient's condition by decreasing venous return. It can further increase obstruction of blood flow from the heart. Vigorous leg exercises should be avoided because they can lead to an increase in systemic vascular resistance.
A patient with a transplanted heart has developed heart valve disease. What should the nurse include in the patient teaching? Select all that apply. Avoid pregnancy. Avoid strenuous physical exercise. Notify the health care provider for planned dental work. If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed. If on anticoagulation therapy, the international normalized ratio (INR) will need to be checked annually.
Avoid strenuous physical exercise. Notify the health care provider for planned dental work. If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed. Patients should avoid strenuous physical exercise because damaged valve may not handle the increased cardiac output (CO) demand. Any planned invasive or dental work requires the patient to notify the health care provider. If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed. Pregnancy is not contraindicated; however, prophylactic antibiotic therapy may be administered to prevent endocarditis. If on anticoagulation therapy, the international normalized ratio (INR) will need to be checked regularly (more frequently than just annually).
A patient has been diagnosed with mitral valve prolapse. What should be included in the treatment plan of the patient? Select all that apply. Fluid restriction Maintain bed rest Nitrates for chest pain Avoiding caffeine or ephedrine β-adrenergic blockers to control palpitations
Avoiding caffeine or ephedrine β-adrenergic blockers to control palpitations A patient with mitral valve prolapse should avoid caffeine or ephedrine because these can exacerbate the symptoms. The patient should also be kept hydrated to maintain hemodynamic stability. β-adrenergic blockers should be prescribed for palpitations and chest pain. Inactivity may cause stasis of blood; hence, bed rest is not recommended. The patient with mitral valve prolapse does not respond to antianginal treatment such as nitrates when administered for chest pain.
The nurse is caring for an older patient that is diagnosed with pulmonic stenosis. The nurse anticipates that which type of conservative therapy may be prescribed? Annuloplasty Balloon valvuloplasty Mitral commissurotomy Sapien Transcatheter Heart Valve (THV)
Balloon valvuloplasty Balloon valvuloplasty or percutaneous transluminal balloon valvuloplasty (PTBV) is generally indicated for older adults and for those who are poor surgery candidates. PTBV is used for mitral, tricuspid, and pulmonic stenosis. Annuloplasty is the reconstruction of annulus that is beneficial in patients with mitral or tricuspid regurgitation. Mitral commissurotomy or valvulotomy is used in patients with pure mitral stenosis. Sapien Transcatheter Heart Valve (THV) is beneficial in patients with atrial stenosis.
A patient with atrial fibrillation has been scheduled to undergo biologic valve replacement surgery. What should the nurse tell the patient about the benefits of a biologic valve versus a mechanical valve? Select all that apply. Biologic valves do not leak. Biologic valves are more durable. Biologic valves do not cause endocarditis. Biologic valves lower the risk of tissue rejection. Biologic valves do not require anticoagulation therapy.
Biologic valves lower the risk of tissue rejection. Biologic valves do not require anticoagulation therapy. Biologic valves are made from bovine, porcine, or human tissues. Therefore they have a low risk of eliciting an immune response and tissue rejection. Because they have low thrombogenicity, they do not require anticoagulation therapy, unlike mechanical valves. However, biologic valves may tend to leak or cause endocarditis, similarly to mechanical valves. Biologic valves are also less durable than mechanical valves.
he nurse is caring for a patient with valvular heart disease who experiences atrial dysrhythmias. The nurse anticipates a prescription for which type of medication? Nitrate Positive inotrope Calcium channel blocker Angiotensin-converting enzyme (ACE) inhibitor
Calcium channel blocker Atrial dysrhythmia is an irregular heartbeat that occurs in the atrium. Calcium channel blockers dilate arteries by reducing calcium flux into the cells, which increases myocardial oxygen supply and prevents atrial dysrhythmias. Nitrates and ACE inhibitors are vasodilators that are used in the treatment of heart failure. Positive inotropes are used to treat heart failure in patients with valvular heart disease.
The nurse assesses a patient and suspects acute mitral valve regurgitation (MR). Which symptoms support the nurse's suspicion? Select all that apply. Palpitations Cool extremities Peripheral edema Thready, peripheral pulses Audible third heart sound (S 3)
Cool extremities Thready, peripheral pulses Mitral regurgitation is a valvular heart disease that causes backward flow of blood from the left ventricle to the left atrium due to incomplete valve closure during systole. Acute mitral regurgitation is characterized by thready peripheral pulses and cool extremities. Palpitations, peripheral edema, and an audible third heart sound (S 3) are symptoms of chronic mitral regurgitation.
A patient is diagnosed with dilated cardiomyopathy. The nurse identifies that interventions should focus on controlling heart failure (HF) by enhancing what cardiac activities? Select all that apply. Improving diastolic filling Decreasing preload and afterload Improving myocardial contractility Relieving left ventricular outflow obstruction Improving ventricular filling by reducing ventricular contractility
Decreasing preload and afterload Improving myocardial contractility The patient is experiencing dilated cardiomyopathy. Interventions should be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility are the goals for hypertrophic cardiomyopathy. Interventions aimed at improving diastolic filling are associated with restrictive cardiomyopathy.
While reviewing the diagnostic reports of a patient with hypertrophic cardiomyopathy, the nurse notes an abnormal, irregular, and rapid heartbeat and left ventricular outflow obstruction. Which medications may be beneficial to the patient? Select all that apply. Digitalis Verapamil Metoprolol Amiodarone Nitroglycerin
Digitalis Verapamil Metoprolol Abnormal, irregular, and rapid heartbeat indicates atrial fibrillation. Digitalis decreases automaticity at the atrioventricular (AV) node, which prolongs the effective refractory period of the AV node tissue resulting in slowing the conduction velocity through the node. Verapamil is a calcium channel blocker that is used in the reduction of ventricular filling in patients with asymmetric septal hypertrophy (ASH). Metoprolol is a beta-adrenergic blocker that reduces ventricular filling. Amiodarone is used in the treatment of dysrhythmias. Nitroglycerin is a nitrate that is used to reduce preload in patients with heart failure.
Which type of surgical therapy utilizes cardiopulmonary bypass? Annuloplasty Closed procedure Balloon valvuloplasty Direct vision procedure
Direct vision procedure Direct vision procedure or open procedure is the surgical therapy that involves the use of cardiopulmonary bypass. Annuloplasty is the reconstruction of the annulus of a valve, and it does not require cardiopulmonary bypass. Closed procedure requires the insertion of transventricular dilator through the left ventricular apex into the mitral valve. Balloon valvuloplasty involves threading a balloon-tipped catheter from the femoral artery or vein into the stenotic valve.
A patient with valvular heart disease is hospitalized. The nurse anticipates a prescription for which diagnostic tests that monitor heart disease progression? Select all that apply. Chest x-ray Electrocardiogram (ECG) Doppler color-flow imaging Real-time 3-D echocardiography Transesophageal echocardiography
Doppler color-flow imaging Transesophageal echocardiography Transesophageal echocardiography and Doppler color-flow imaging help to diagnose and monitor progression of valvular disease. A chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Real-time 3-D echocardiography helps to assess mitral valve and congenital heart diseases. An ECG identifies heart rate, rhythm, and any ischemia or ventricular hypertrophy.
A patient with suspected hypertrophic cardiomyopathy (CMP) reports exertional dyspnea, fatigue, angina, and syncope. The nurse recognizes that which assessment finding is the most common symptom associated with hypertrophic CMP? Dyspnea Fatigue Angina Syncope
Dyspnea The most common symptom is dyspnea, caused by an elevated left ventricular diastolic pressure. Fatigue occurs because of the resistant decrease in cardiac output (CO) and in exercise-induced flow obstruction. Angina can occur and is most often caused by the increased left ventricular mass or compression of the small coronary arteries by the hypertrophic ventricular myocardium. Syncope most often is caused by an increase in obstruction to aortic outflow during increased activity.
A patient is admitted to a hospital with a possible diagnosis of hypertrophic cardiomyopathy. The nurse anticipates that which diagnostic tests will be performed? Select all that apply. Echocardiogram Complete blood count Cardiac catheterization Doppler color-flow imaging Transesophageal echocardiography
Echocardiogram Cardiac catheterization Cardiac catheterization helps to clarify how well the heart chambers are pumping and will show any leakage in the valves. It is also used in diagnosing as well as guiding the treatment of hypertrophic cardiomyopathy. The echocardiogram is the primary tool used in confirming hypertrophic cardiomyopathy because it demonstrates wall motion abnormalities and diastolic dysfunction. Transesophageal echocardiography and Doppler color-flow imaging are usually not required to confirm the diagnosis. These tests are appropriate for diagnosing valvular heart diseases. A complete blood count will not help in diagnosis.
The nurse reviews the medical record of a patient with dilated cardiomyopathy. What findings are expected in the diagnostic reports? Select all that apply. Normal chest x-ray Decreased serum levels of b-type natriuretic peptide (BNP) Electrocardiogram (ECG) that reveals conduction disturbances Multiple gated acquisition (MUGA) nuclear scan that reveals a decreased ejection fraction (EF) Elevated serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels
Electrocardiogram (ECG) that reveals conduction disturbances Multiple gated acquisition (MUGA) nuclear scan that reveals a decreased ejection fraction (EF) A MUGA scan determines EF. Dilated CMP results in ventricular dilation, impaired systolic function, atrial enlargement, and stasis of blood in the left ventricle. The result is decreased EF. ECG of patients with dilated cardiomyopathy will show tachycardia, bradycardia, and dysrhythmias with conduction disturbances. Chest x-ray shows cardiomegaly with signs of pulmonary venous hypertension and pleural effusion. The serum level of BNP is elevated in case of dilated cardiomyopathy. SGOT and SGPT are liver enzymes and are not associated with dilated cardiac myopathy.
The nurse assesses a 70-year-old patient during a follow-up visit. The patient has progressive valvular disease caused by rheumatic fever. Which interventions are appropriate for the nurse to perform? Select all that apply. Encourage planned rest periods. Ensure ongoing prophylactic therapy. Encourage persistent physical exercise. Evaluate the effectiveness of medication. Discuss the recommendation for a mechanical valve replacement.
Encourage planned rest periods. Ensure ongoing prophylactic therapy. Evaluate the effectiveness of medication. When assessing a patient with progressive valvular disease caused by rheumatic fever, the nurse should ensure ongoing prophylaxis to prevent recurrence. The nurse should encourage the patient to plan rest periods and should evaluate the effectiveness of medication. The patient should avoid persistent physical exercise to prevent fatigue and dyspnea; instead, the patient should have an appropriate exercise plan to increase cardiac tolerance. It is preferable for patients over 65 years of age to undergo biologic valve replacement rather than mechanical valve replacement because the latter involves higher risk of bleeding from anticoagulants.
The nurse is assessing a patient with mitral valve stenosis. Which findings are likely during the nursing examination? Select all that apply. Syncope Exertional dyspnea Nausea and vomiting Fatigue and palpitations Low-pitched diastolic murmur at the apex
Exertional dyspnea Fatigue and palpitations Low-pitched diastolic murmur at the apex Exertional dyspnea is caused by reduced lung compliance in mitral stenosis. Fatigue and palpitations are present because of atrial fibrillation. A low-pitched diastolic murmur is heard in mitral stenosis; however, it is best heard at the apex using the stethoscope. Syncope, nausea, and vomiting are not seen in patients with mitral stenosis.
Which medication is prescribed to decrease preload in patients with dilated cardiomyopathy? Captopril Metoprolol Furosemide Spironolactone
Furosemide Furosemide is a diuretic that decreases preload in patients with dilated cardiomyopathy. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that reduces afterload. Metoprolol is an adrenergic blocker that controls neurohormonal stimulation in patients with heart failure. Spironolactone is a diuretic that controls neurohormonal stimulation in patients with heart failure.
The nurse recognizes that interventions for a patient with dilated cardiomyopathy focus on controlling heart failure (HF). Which medications are prescribed decrease preload, to assist with this goal? Select all that apply. Captopril Metoprolol Furosemide Nitroglycerin Spironolactone
Furosemide Nitroglycerin Nitroglycerin and furosemide decrease preload. Captopril reduces afterload. Metoprolol and spironolactone control the neurohormonal stimulation that occurs with HF.
The nurse recalls that which are the main characteristics of hypertrophic cardiomyopathy (CMP)? Select all that apply. Impaired systole Impaired diastole Atrial hypertrophy Massive ventricular hypertrophy Rapid, forceful contraction of the left ventricle
Impaired diastole Massive ventricular hypertrophy Rapid, forceful contraction of the left ventricle The main characteristics of hypertrophic cardiomyopathy include massive ventricular hypertrophy, impaired diastole, and rapid, forceful contractions of the left ventricle. Atrial hypertrophy and impaired systole are not characteristic of hypertrophic cardiomyopathy; this disease process involves the left ventricle.
A patient with aortic valve stenosis is receiving nitroglycerin. What should the nurse include in the medication teaching? Select all that apply. It can worsen chest pain. It is given to treat angina. It can cause hypotension. It is given to control heart palpitations. It is a drug of choice in mitral valve prolapse.
It can worsen chest pain. It is given to treat angina. It can cause hypotension. Nitroglycerin is used with caution in patients with aortic valve stenosis to treat angina. This is because it can significantly reduce blood pressure and worsen chest pain due to a decrease in preload and a drop in blood pressure. The drug causes hypotension through dilation of blood vessels. It is not recommended in mitral valve prolapse because the chest pain in mitral valve prolapse does not respond to antianginal treatment. Also, nitroglycerin is not administered for controlling palpitations.
A patient is scheduled for a percutaneous transluminal balloon valvuloplasty. What information should the nurse provide to the patient before the procedure? Select all that apply. It has few complications. It requires a surgical incision. It is performed in an operating room. The procedure is difficult but has good results. Long-term results are similar to surgical commissurotomy.
It has few complications. Long-term results are similar to surgical commissurotomy. Percutaneous transluminal balloon valvuloplasty is an alternative treatment for patients with valvular disease. It is an easy procedure with few complications, because the approach for the procedure is transcutaneous; therefore, it is a minimally invasive procedure. The long-term results are similar to those of surgical commissurotomy with regard to the function of the repaired valve. The surgery is performed in a cardiac catheterization laboratory and not in an operating room. The procedure is not difficult and does not require a surgical incision.
Which statement is true regarding hypertrophic cardiomyopathy? It involves impaired diastole. Its only symptoms are dyspnea and fatigue. It is associated with a thin and fragile ventricular wall. It is characterized by moderate to severe cardiomegaly.
It involves impaired diastole. Hypertrophic cardiomyopathy is asymmetric left ventricular hypertrophy without ventricular dilation. Impaired filling (diastole) is a main characteristic. It is associated with a thickened intraventricular septum and ventricular wall. Hypertrophic cardiomyopathy is characterized by exertional dyspnea, fatigue, angina, syncope, and palpitations; dyspnea and fatigue only occur in restrictive cardiomyopathy. Cardiomegaly is mild to moderate in hypertrophic cardiomyopathy.
The nurse is caring for a patient with Takotsubo cardiomyopathy. What information should the nurse provide to the patient about this disease? Select all that apply. It is more common in menopausal women. It causes permanent impairment of cardiac function. The clinical findings are similar to acute coronary syndrome. It does not reflect any changes in the electrocardiogram (ECG). Cardiac angiography shows no significant coronary artery disease.
It is more common in menopausal women. The clinical findings are similar to acute coronary syndrome. Cardiac angiography shows no significant coronary artery disease. Takotsubo cardiomyopathy is an acute stress-related syndrome. The clinical findings are the same as in acute coronary syndrome. It is commonly observed in menopausal women. Cardiac angiography shows no significant coronary artery disease. It is often accompanied by chest pain; the ST segment in the ECG is elevated, along with an increase in the cardiac enzyme levels. Normal cardiac function returns after days or weeks after supportive therapy.
The nurse is preparing a discharge teaching plan for a patient admitted with restrictive cardiomyopathy. Which instruction should the nurse include in the plan? Follow a normal sodium diet. Drink three to four glasses of water daily. Maintain a reasonable weight and avoid large meals. Report signs of heart failure to the health care provider, which include weight loss.
Maintain a reasonable weight and avoid large meals. The patient should maintain a reasonable weight and avoid large meals. The patient should follow a low-sodium diet and read all product labels for sodium content. The patient should drink six to eight glasses of water a day unless fluids are restricted. Weight gain is a sign of heart failure.
The nurse performs an international normalized ratio (INR) blood study for a patient two months after the patient underwent mitral valve replacement surgery. The patient has been receiving warfarin therapy since the surgery. The INR value is 3.1. The nurse should take what action? Prepare to administer a vitamin K injection. Maintain the patient at the same warfarin dose. Request a prescription for a higher dose of warfarin. Instruct the patient to stop taking the warfarin until the INR level decreases.
Maintain the patient at the same warfarin dose. International normalized ratio (INR) values of 2.5 to 3.5 are therapeutic for patients with mechanical valves, so it is not necessary to change the dose. The patient should not stop taking the warfarin or take a higher dose. Vitamin K is the antidote for warfarin, and it is not necessary to take because the INR is in a therapeutic range.
The nurse finds diastolic murmurs in a patient who says, "I'm finding it hard to breathe, and sometimes I cough up blood." What condition does the nurse suspect? Mitral valve stenosis Aortic valve stenosis Mitral valve prolapse Aortic valve regurgitation
Mitral valve stenosis Coughing up of blood from the bronchi, larynx, or lungs is known as hemoptysis, and difficulty breathing is dyspnea. Hemoptysis, dyspnea, and diastolic murmurs indicate mitral valve stenosis. Aortic valve stenosis is characterized by angina, dyspnea, syncope, and left ventricular failure. Mitral valve prolapse is an abnormality of the mitral valve leaflets and the papillary muscles that involves dysrhythmias, ventricular tachycardia, palpitations, light-headedness, and dizziness. Aortic valve regurgitation is associated with abrupt dyspnea, chest pain, left ventricular failure, and cardiogenic shock.
What assessment findings does the nurse expect when caring for a patient with mitral valve stenosis? Select all that apply. Syncope Orthopnea Palpitations Atrial fibrillation Exertional dyspnea
Palpitations Atrial fibrillation Exertional dyspnea The overloaded left atrium places the patient at risk for atrial fibrillation. Dyspnea on exertion and palpitations may also occur. Orthopnea occurs with aortic valve regurgitation. Syncope occurs with mitral valve prolapse.
An 80-year-old patient who is a poor surgery candidate is diagnosed with aortic stenosis. The nurse anticipates that what procedure will likely be recommended? Annuloplasty Aortic valve replacement Open commissurotomy (valvulotomy) procedure Percutaneous transluminal balloon valvuloplasty (PTBV) procedure
Percutaneous transluminal balloon valvuloplasty (PTBV) procedure The PTBV procedure is generally indicated for an older patient who is a poor surgery candidate. Annuloplasty is an option for patients with mitral or tricuspid regurgitation. An open commissurotomy procedure is used for mitral stenosis. Valve replacement may be required for mitral, aortic, tricuspid, and occasionally pulmonic valve disease.
A patient with mitral valve stenosis presents with hemoptysis. The nurse suspects that the symptom is caused by what? Atrial fibrillation Pulmonary hypertension Decreased cardiac output Atrial enlargement pressing on the laryngeal nerve
Pulmonary hypertension Pulmonary hypertension causes hemoptysis or bleeding in the lungs and the coughing up of blood due to increased pressure in the pulmonary circulation. Atrial fibrillation in patients with mitral valve prolapse results in fatigue and palpitations. Decreased cardiac output results in chest pain in patients with mitral valve prolapse. Hoarseness occurs due to atrial enlargement pressing on the laryngeal nerve in patients with mitral valve prolapse.
Which diagnostic study is used to assess congenital heart disease in a patient? Chest x-ray Doppler color-flow imaging Real time 3-D echocardiography Computerized tomography scan
Real time 3-D echocardiography Real-time 3-D echocardiography is used to assess mitral valve defects and congenital heart disease. Chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Doppler color-flow imaging and transesophageal echocardiography help diagnose and monitor valvular heart disease progression. Computerized tomography scan with contrast gold helps diagnose aortic disorders.
Which diagnostic study is used to diagnose mitral valve prolapse? Electrocardiogram Cardiac catheterization Real-time 3-D echocardiography CT scan of the chest with contrast
Real-time 3-D echocardiography Echocardiogram is the diagnostic study that is used to diagnose mitral valve prolapse. All echocardiograms are done in two or three dimensions. Echocardiogram is used to monitor progression of valvular heart disease. A CT scan of the chest with contrast is the gold standard for evaluating aortic disorders. An electrocardiogram is used to identify heart rate, rhythm, ischemia, or ventricular hypertrophy. Cardiac catheterization is used to detect pressure changes in the cardiac chambers.
The nurse assessing a patient with mitral valve stenosis will likely find symptoms primarily associated with what cardiac change? Reduced lung compliance Inadequate filling of the right ventricle Increased pressure in the left ventricle Decreased pulmonary vascular pressure
Reduced lung compliance The primary symptom of mitral stenosis is exertional dyspnea caused by a reduced lung compliance. Increased pulmonary vascular pressure results due to increased left atrial pressure and volume increase. Increased left ventricular pressure may be seen with aortic stenosis. Inadequate filling of the right ventricle may be due to atrial fibrillation or atrial flutter.
Which type of cardiomyopathy impairs diastolic filling and stretch? Dilated cardiomyopathy Restrictive cardiomyopathy Takotsubo cardiomyopathy Hypertrophic cardiomyopathy
Restrictive cardiomyopathy Restrictive cardiomyopathy, the least common type of cardiomyopathy, impairs diastolic filling and stretch. Dilated cardiomyopathy involves diffuse inflammation and rapid degeneration of myocardial fibers. Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome. Hypertrophic cardiomyopathy involves asymmetric hypertrophy without ventricular dilation.
The nurse conducts a complete physical assessment on a patient admitted with suspected infective endocarditis (IE). Which diagnostic finding is indicative of the disorder? Heart rate of 50 Retinal hemorrhages Respiratory rate of 10 Feeling of impending doom
Retinal hemorrhages Retinal hemorrhages are associated with IE. A feeling of impending doom is not a clinical manifestation. Tachycardia and tachypnea are also clinical manifestations.
Which complication occurs due to obstruction to aortic outflow during increased activity? Angina Fatigue Dyspnea Syncope
Syncope Syncope occurs when blood flow is obstructed and is insufficient to meet the demands associated with activity. Increased left ventricular muscle mass by the hypertrophic ventricular myocardium will result in angina. A decrease in cardiac output and in exercise-induced flow obstruction leads to fatigue. Dyspnea occurs due to increased left ventricular diastolic pressure.
The ECG (electrocardiogram) of a postmenopausal woman reporting chest pain reveals an elevated ST segment, and the laboratory test reports indicate elevated cardiac biomarkers. Which condition does the nurse suspect? Dilated cardiomyopathy Restrictive cardiomyopathy Takotsubo cardiomyopathy Hypertrophic cardiomyopathy
Takotsubo cardiomyopathy Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome and is commonly observed in postmenopausal women. Dilated cardiomyopathy is characterized by reduced capacity to exercise, dyspnea at rest, and orthopnea. Restrictive cardiomyopathy involves orthopnea, angina, palpitations, and syncope. Hypertrophic is characterized by fatigue, exertional dyspnea, syncope, and angina.
A multiple gated acquisition (MUGA) scan has been prescribed to a patient with cardiac problems to determine what? The patient's ejection fraction (EF) The presence of conduction disturbances The effectiveness of dilated cardiomyopathy The presence of infectious organisms in the heart tissue
The patient's ejection fraction (EF) A multiple gated acquisition nuclear scan determines ejection fraction. Ejection fraction less than 20 percent is associated with a 50 percent mortality rate within a year. Conduction disorders like tachycardia, bradycardia, and dysrhythmias are diagnosed by electrocardiogram. Endomyocardial biopsy at the right side of the heart helps identify infectious organisms in heart tissue. Doppler echocardiography helps evaluate the effectiveness of dilated cardiomyopathy.
A patient that has undergone valve replacement takes warfarin. The patient asks the nurse why regular international normalized ratio (INR) tests are prescribed. What explanation should the nurse give to emphasize the importance of this test? Select all that apply. To prevent endocarditis To determine proper dosage To prolong durability of valves To determine patency of valves To determine adequacy of therapy
To determine proper dosage To determine adequacy of therapy The INR must be checked regularly if the patient is on anticoagulation therapy to determine the proper dosage. A high or low INR may require the dose to be adjusted. INR is also tested to determine the adequacy of anticoagulation. If the anticoagulant is not adequate, blood clots may form. If anticoagulation is more than adequate, there is an increased risk of bleeding. The test cannot indicate endocarditis or patency or durability of valves.
While performing right-sided heart catheterization on a patient with dilated cardiomyopathy, the primary health care provider performs an endomyocardial biopsy. What does the nurse recall as the rationale for the biopsy? To rule out cardiomegaly To determine eosinophilic fasciitis To confirm coronary artery disease To identify infectious organisms in heart tissue
To identify infectious organisms in heart tissue Endomyocardial biopsy along with right-sided heart catheterization is used to identify infectious organisms in heart tissue in patients with cardiomyopathy. Chest x-ray is used to rule out cardiomegaly. A multiple gated acquisition (MUGA) nuclear scan is used to determine eosinophilic fasciitis. Cardiac catheterization is used to confirm coronary artery disease.
Which type of valvular heart disease occurs almost exclusively in patients that abuse drugs intravenously? Tricuspid stenosis Pulmonic stenosis Aortic valve stenosis Mitral valve stenosis
Tricuspid stenosis Tricuspid stenosis is the disease of the tricuspid valve that occurs in patients who abuse drugs intravenously or who have had rheumatic fever. Pulmonic stenosis is congenital. Aortic valve stenosis occurs due to rheumatic fever. Mitral valve stenosis occurs due to rheumatic heart disease.
It is determined that a patient with advanced dilated cardiomyopathy (CMP) is not a candidate for heart transplantation. The nurse anticipates a prescription for what treatment? Atrioventricular pacemaker Ventricular assist device (VAD) Ventriculomyotomy and myectomy surgery Percutaneous transluminal septal myocardial ablation
Ventricular assist device (VAD) Patients with dilated cardiomyopathy may benefit from nondrug therapies. A VAD allows the heart to rest and recover from acute heart failure. It also may serve as a bridge to heart transplantation. Additionally, cardiac resynchronization therapy and an implantable cardioverter-defibrillator are used in appropriate patients. Atrioventricular pacemaker, ventriculomyotomy and myectomy surgery, and percutaneous transluminal septal myocardial ablation are appropriate for hypertrophy cardiomyopathy.
The nurse is assessing a patient with chronic aortic regurgitation in the emergency unit of a health care facility. The nurse expects to find which heart sound? S 3 gallop Water-hammer pulse Loud accentuated S 1 Low-pitched diastolic murmur
Water-hammer pulse The nurse assessing a patient with chronic aortic regurgitation would find a strong, quick beat that collapses immediately, known as water-hammer pulse. Heart sounds may include a soft or absent S 1, S 3, or S 4 and a soft, high-pitched diastolic murmur. Low-pitched diastolic murmur and loud accentuated S 1 are observed in mitral valve stenosis. An S 3 gallop is found in patients with chronic mitral valve regurgitation.
The nurse auscultates an irregular, rapid heart rate in a patient with mitral valve prolapse. Which type of medication does the nurse expect will be prescribed? Statin Nitrate β-blocker Anti-ischemic
β-blocker Palpitations are fast, hard, and irregular heartbeats. Propranolol is an example of a β-blocker that slows the heart rate by acting on the β-adrenergic receptors located on the heart cells. A statin, such as atorvastatin, is used primarily to treat elevated blood cholesterol levels and reduce the risk of cardiovascular disease. An anti-ischemic medication, such as trimetazidine, improves glucose control and improves cardiac function in dilated cardiomyopathy. A nitrate, such as isosorbide dinitrate, is used to prevent angina attacks by dilating blood vessels.
