Med/Surg Ch 28 PU

A client with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the client for which manifestations? 1. Edema and orthopnea 2. Anorexia and confusion 3. Abdominal pain and diarrhea 4. Tachypnea and dyspnea

2. Anorexia and confusion The most common manifestations of digoxin toxicity are gastrointestinal (anorexia, nausea, and vomiting), cardiac (rhythm disturbances and heart block), and central nervous system disturbances (confusion, headache, weakness, dizziness, and blurred or yellow vision).

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. Check regularly for dependent edema

A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition? 1. "I need to do my leg exercises five times or more every hour." 2. "I should lie on my side with my knees bent when sleeping." 3. "I need to ice my leg every 2 hours for about 20 minutes." 4. "I should try not to drink too much during the daytime."

1. "I need to do my leg exercises five times or more every hour." Exercise prevents venous stasis by promoting venous circulation, relieves swelling, and reduces pain. Promoting venous blood flow prevents the formation of thrombi and subsequent potential for emboli in the unaffected extremity.

A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed? 1. Balloon percutaneous valvuloplasty 2. Antibiotic therapy 3. Placement of an autograft valve 4. Placement of a xenograft valve

1. Balloon percutaneous valvuloplasty 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.

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. Cardiac tamponade The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade

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. Dyspnea, orthopnea, pulmonary edema Signs and symptoms of progressive left ventricular failure include breathing difficulties, such as orthopnea, PND, and pulmonary edema. Distended jugular veins, pedal edema, and nausea are signs and symptoms of right sided heart failure.

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 earlier. What option will the nurse most likely discuss? 1. Left ventricular assist device 2. Chordoplasty 3. Annuloplasty 4. Open commissurotomy

1. Left ventricular assist device 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.

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

A nurse is caring for a client with pericarditis and auscultates a pericardial friction rub.What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub? 1. The nurse asks the client to hold the breath during auscultation. 2. There is really no question to ask the client to tell the difference. 3. The nurse has the client stand during auscultation. 4. The nurse places the client flat for at least 4 minutes.

1. The nurse asks the client to hold the breath during auscultation. 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. Length of auscultation and standing would not assist in distinguishing one kind of rub from the other.

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. Warfarin 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.

The nurse caring for a client with cardiomyopathy plans to have an education session with the client and the client's spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload? 1. When resting, sit up with the legs down to pool blood in the legs. 2. Lay flat in bed when resting so the heart does not have to pump against gravity. 3. Adhere to a regular diet without restrictions. 4. Avoid all physical and emotional stress.

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

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 erythrocyte sedimentation rate 5. decreased C-reactive protein

1. elevated white blood cell (WBC) count 2. elevated C-reactive protein 3. elevated erythrocyte sedimentation rate (ESR) Abnormal findings include anemia, elevated WBC counts, elevated ESR, and elevated c-reactive protein.

The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis? 1. fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) 2. low urine output secondary to left ventricular dysfunction 3. lethargy, anorexia, and heart failure 4. pitting edema, chest discomfort, and nonspecific ST-segment elevation

1. fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) 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.

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. Positive blood culture A positive blood culture identifies the microorganism circulating in the blood. Slight leukocytosis is common but can be associated with other disease processes. Serum cardiac antigens and immunosuppressant assay are not typical diagnostic studies.

A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? 1. heredity 2. chronic alcohol abuse 3. scleroderma 4. previous myocardial infarction

2. chronic alcohol abuse Chronic alcohol ingestion is one of the main causes of dilated cardiomyopathy.

The nurse is caring for a client diagnosed with aortic stenosis prescribed digoxin. What clinical manifestation will be the rationale for the medication? 1. angina 2. left ventricular dysfunction 3. edema 4. dyspnea

2. left ventricular dysfunction Digoxin may be used to treat left ventricular dysfunction.

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

2. mitral valve In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium.

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. "Do you have a family history of endocarditis?" 2. "Have you recently vacationed outside of the United States?" 3. "Have you been to the dentist recently?" 4. "Do you live with any domesticated animals in your home?"

3. "Have you been to the dentist recently?" Invasive procedures, particularly those involving mucosal surfaces (e.g., those involving manipulation of gingival tissue or periapical regions of teeth), can cause a bacteremia, which rarely lasts more than 15 minutes. However, if a client has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator), bacteremia can cause bacterial endocarditis.

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. Bleeding and infection Possible complications of an aortic balloon valvuloplasty include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, infection, and bleeding from the catheter insertion sites.

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

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

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. Echocardiography Echocardiography is useful in detecting the presence of pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.

The nurse is caring for a client newly diagnosed with myocarditis. Which diagnostic test would the nurse find most helpful in confirming the diagnosis? 1. Echocardiography 2. Cardiac isoenzyme level 3. Myocardial biopsy 4. Radionuclide study

3. Myocardial biopsy When choosing a definitive diagnostic test for myocarditis, a myocardial biopsy is most helpful. All of the other diagnostic tests provide information about the heart but is not as definitive as actually testing the heart muscle.

Your client has been diagnosed with mitral valve prolapse syndrome. What is an important subject to include in the client's teaching? 1. Decrease in activity level 2. Nutrition 3. Restriction of alcohol 4. Cessation of chewing tobacco

3. Restriction of alcohol Because alcohol can suppress antidiuretic hormone, leading to loss of extracellular fluid, clients with mitral valve prolapse syndrome are advised to restrict or eliminate its use. A decreased activity level, nutrition, and stopping chewing tobacco are not important subjects to cover when teaching a client with mitral valve prolapse syndrome.

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. Shortness of breath Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms.

The nurse is performing a medication review of a client diagnosed with myocarditis. What medication may have precipitated the client to have myocarditis? 1. furosemide 2. acetaminophen 3. azathioprine 4. ciprofloxacin

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

The health care provider has scheduled a client with mitral stenosis for mitral valve replacement. What condition will the nurse expect to see as a complication of mitral stenosis? 1. left-sided heart failure 2. myocardial ischemia 3. pulmonary hypertension 4. left ventricular hypertrophy

3. pulmonary hypertension 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.

The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching? 1. "I will take antibiotics before getting my teeth cleaned." 2. "I can get a tattoo at a local parlor." 3. "I can get my tongue pierced at a store in the shopping mall." 4. "I will avoid caffeine, alcohol, and smoking."

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

A client who 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. 3.8 Warfarin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5 to maintain adequate anticoagulation. Levels below 2 to 2.5 can result in insufficient anticoagulation and levels greater than 3.5 can result in dangerous and prolonged anticoagulation.

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. Assess the client's home environment in terms of family assistance and adequacy. Long-term IV antimicrobial therapy is often necessary. The nurse should assess the home environment to ensure successful management of long-term antibiotic therapy. Bed rest is not necessary for the patient without heart damage. The others are not the most important steps for a client undergoing outpatient antibiotic therapy.

The nurse is caring for clients on a busy cardiac unit. Following morning assessment, the nurse would notify the physician with which of the following symptoms? 1. Dyspnea when ambulating from the bathroom 2. A noted irregular pulse rate prior to Lanoxin (digoxin) administration 3. Cyanosis with a pulse oximetry level of 92% 4. Pulsus paradoxus on vital sign assessment

4. Pulsus paradoxus on vital sign assessment Pulsus paradoxus is a difference of 10mm Hg or more between the first Korotkoff sound noting systolic blood pressure heard during expiration and the first that is heard during inspiration. Pulsus paradoxus can signal a deteriorating condition including diminished stroke volume, compromised cardiac output, and death. This would be of high priority to notify the physician.

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. Chronic pain 2. Impaired gas exchange 3. Impaired memory 4. Risk for infection

4. Risk for infection 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.