N123 Chp 37 Inflammatory Disorders of the Heart

While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? 1 Pulsus paradoxus 2 Prolonged PR intervals 3 Widened pulse pressure 4 Clubbing of the fingers

1 Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every four hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree atrioventricular (AV) block. Widened pulse pressure occurs with valvular heart disease. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease. Text Reference - p. 814

What is a noninfectious cause of pericarditis? 1 Uremia 2 Lyme disease 3 Rheumatic fever 4 Ankylosing spondylitis

1 Uremia is an elevated level of urea in the blood and nitrogenous waste compounds; it is a noninfectious cause of pericarditis. Lyme disease is an infectious cause of pericarditis. Rheumatic fever and ankylosing spondylitis are hypersensitive or autoimmune causes of pericarditis. Text Reference - p. 815

The nurse is assessing a patient with a pacemaker during a follow-up visit. The patient has red, painful, tender, pea-sized lesions on the fingertips and toes. How should the nurse document this finding? 1 Splinter hemorrhages 2 Osler's nodes 3 Janeway's lesions 4 Roth's spots

2 The nurse should document this finding as Osler's nodes. Osler's nodes are red or purple, tender, pea-size lesions on the fingertips and toes that are vascular manifestations of infective endocarditis. Other vascular manifestations include splinter hemorrhages, Janeway's lesions, and Roth's spots. Splinter hemorrhages are black longitudinal streaks in the nail beds. Janeway's lesions are flat, painless, small, red spots on the palms and soles. Roth's spots are hemorrhagic retinal lesions that are revealed by funduscopic examination. Text Reference - p. 812

A patient reports severe chest pain and dyspnea five weeks after a myocardial infarction. Which condition does the nurse suspect? 1 Monoarthritis 2 Acute pericarditis 3 Dressler syndrome 4 Sydenham's chorea

Severe chest pain accompanying dyspnea indicates pericarditis. If the pericarditis occurs 4 to 6 weeks after a myocardial infarction, it is known as Dressler syndrome. Monoarthritis is a manifestation of rheumatic fever and involves joint swelling, heat, redness, tenderness, and limitation of motion. Acute pericarditis occurs within 48 to 72 hours after a myocardial infarction. Sydenham's chorea is a manifestation of rheumatic fever, characterized by involuntary movements of the face and limbs. Text Reference - p. 815

A nurse is recording the amount of pulsus paradoxus in a patient. The first Korotkoff sound during expiration is noted at 115 mm Hg, and the reading at which sounds are heard throughout the respiratory cycle is noted at 84 mm Hg. What is the amount of paradox? Record your answer using a whole number.

The difference between the pressure at which the first Korotkoff sound during expiration is noted and the pressure at which sound throughout the respiratory cycle is noted is the amount of paradox (115 mm Hg - 84 mm Hg = 31 mm Hg). Text Reference - p. 816

The nurse is assessing a patient for pericardial friction rub related to myocarditis. Arrange these actions in the order the nurse would perform them during an assessment of the patient. 1. Assist the patient to lean forward. 2. Place the stethoscope at the lower left sternal border of the chest. 3. Ask the patient to hold his or her breath. 4. Repeat several times.

The nurse helps the patient to lean forward, and the stethoscope is placed at the lower left sternal border of the chest. The patient should be asked to hold his or her breath to distinguish a pericardial friction rub from a pleural friction rub. The process may be repeated several times to identify pericardial friction rub, because pericardial friction rubs are often intermittent and short lived. Text Reference - p. 815

The nurse is assessing a patient with rheumatic fever in the outpatient unit of a health care facility. Foe which condition should the nurse assess the patient? 1 Subcutaneous nodules over all bony surfaces 2 Petechiae in the conjunctivae, lips, buccal mucosa, and palate 3 Painful, tender, red or purple, pea-size lesions on the fingertips or toes 4 Black longitudinal streaks in the nail beds

When assessing the patient with rheumatic fever, the nurse should inspect the patient's skin for subcutaneous nodules by palpating over all bony surfaces and along extensor tendons of the hands and feet. Patients with infective endocarditis are assessed for petechiae in the conjunctivae, lips, buccal mucosa, and palate; Osler's nodes are painful, red or purple, pea-size lesions found on the fingertips or toes; and splinter hemorrhages are black longitudinal streaks that may occur in the nail beds. Text Reference - p. 819

A patient with suspected infective endocarditis (IE) is scheduled for cardiac catheterization. The nurse recognizes that the purpose of the test for this patient is what? 1 To evaluate valve function 2 To check for the presence of vegetations 3 To check for the presence of infection 4 To detect the presence of murmurs

1 Valve dysfunction is a common pathologic feature associated with infective endocarditis. Cardiac catheterization is an investigation required to evaluate the functioning of the heart valves. Echocardiography is an investigation used to detect the presence of vegetations. Blood cultures are done to determine the presence of an infection that can cause endocarditis. The presence of murmurs can be detected through auscultation. Text Reference - p. 813

When performing a physical examination of a patient suffering from infective endocarditis, what signs should the nurse look for? Select all that apply. 1 Osler's nodes 2 Janeway's lesions 3 Roth's spots 4 Aschoff's bodies 5 Sydenham's chorea

1, 2, 3 Osler's nodes are painful, tender, red or purple, pea-sized lesions found on the fingertips or toes in patients with infective endocarditis. Janeway's lesions are flat, painless, small, red spots that may be seen on the palms and soles of patients with infective endocarditis. Roth's spots are also seen in patients with infective endocarditis during fundoscopic examination of retinal lesions. Aschoff's bodies are nodules that are formed in patients with rheumatic heart disease. Sydenham's chorea is a central nervous system manifestation of rheumatic fever. STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know. Text Reference - p. 812

When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations? Select all that apply. 1 Osler's nodes 2 Janeway's lesions 3 Splinter hemorrhages 4 Subcutaneous nodules 5 Erythema marginatum lesions

1, 2, 3 Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever. Text Reference - p. 811

A patient has been admitted with acute pericarditis. How should the nurse care for this patient? Select all that apply. 1 Provide an overbed table. 2 Ask the patient to avoid alcohol. 3 Keep the patient in a Trendelenberg position. 4 Allow the patient to be as active as possible. 5 Administer antiinflammatory medications.

1, 2, 5 A sitting position with an overbed table helps in reducing the pain associated with acute pericarditis. The patient should be instructed to avoid alcohol to prevent gastrointestinal bleeding. Antiinflammatory medicines should be administered for pain relief. The patient should not be placed in a Trendelenberg position; instead, the head of the bed should be elevated to 45 degrees. The physical activities of the patient should be restricted, and he or she should be on complete bed rest to decrease cardiac workload. Text Reference - p. 817

A patient with pharyngitis is suspected to have rheumatic fever. Which interventions are appropriate for this patient? Select all that apply. 1 Adequate treatment for streptococcal pharyngitis 2 Discontinuation of antibiotics if there is symptomatic relief 3 Cold fomentation for painful joints 4 Administering nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain 5 Monitoring fluid intake

1, 4, 5 Adequate treatment of streptococcal pharyngitis prevents the initial attack of rheumatic fever. NSAIDs can be given to relieve pain in the joints. It is important to monitor fluid intake to prevent dehydration. Completing the full course of antibiotics is important for successful treatment. Heat needs to be applied to painful joints, because cold fomentation may lead to stiffness. Text Reference - p. 820

Which category of medication helps reduce afterload in patients with heart failure? 1 Nitrates 2 ACE inhibitors 3 Antidysrhythmia drugs 4 β-adrenergic blockers

2 Angiotensin-converting enzyme (ACE) inhibitors block angiotensin II and dilate both arteries and veins. ACE inhibitors reduce arterial pressure and afterload in patients with heart failure by causing vasodilatation. Nitrates dilate both arteries and veins. At the normal therapeutic dose, venous dilation predominates and reduces venous pressure. The decreased venous pressure helps decrease venous preload in patients with heart failure. Antidysrythmias are used to suppress abnormal rhythms such as atrial fibrillation and atrial flutter. β-adrenergic blockers suppress the neurohumoral stimulation that occurs in patients with heart failure. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 828

A nurse is performing discharge teaching for a patient with a diagnosis of subacute infective endocarditis. Which statement by the patient indicates a need for further teaching? 1 "I will make sure to plan rest periods during any of my activities." 2 "Will you give me a prescription so I can take my antibiotics by mouth." 3 "Fatigue, malaise, or chills might indicate a recurrence of the infection." 4 "Before I schedule my dentist appointment, I will tell my health care provider."

2 Intravenous, not oral, antibiotic therapy is the prescribed treatment for subacute infective endocarditis. Rest periods during activities will decrease the cardiac workload. Fatigue, malaise, or chills are signs and symptoms that may indicate recurrent infection. Prophylactic antibiotic therapy is needed before dental procedures to reduce the risk of recurrent infective endocarditis. Text Reference - p. 814

A patient with an inflammation of the pericardial sac has a history of systemic lupus erythematosus (SLE). Which therapy does the nurse think will help the patient? 1 Salicylate therapy 2 Antibiotic therapy 3 Corticosteroid therapy 4 Nonsteroidal antiinflammatory drug (NSAIDs) therapy

3 Inflammation of the pericardial sac indicates pericarditis; corticosteroid therapy is reserved for patients with pericarditis secondary to systemic lupus erythematosus (SLE). Salicylate therapy is beneficial to patients with rheumatic fever. Antibiotic therapy is used in the treatment of bacterial pericarditis. Nonsteroidal antiinflammatory drug (NSAIDs) therapy is used to control pain and inflammation in patients with pericarditis. Test-Taking Tip: Recall the conditions occurring secondary to systemic lupus erythematosus and choose the correct answer. Text Reference - p. 816

What nursing action should the nurse prioritize during the care of a patient who recently has recovered from rheumatic fever? 1 Teach the patient how to manage his or her physical activity. 2 Teach the patient about the need for ongoing anticoagulation. 3 Teach the patient about the need for continuous antibiotic prophylaxis. 4 Teach the patient about the need to maintain standard infection control procedures.

3 Patients with a history of rheumatic fever frequently require ongoing antibiotic prophylaxis, an intervention that necessitates education. This consideration is more important than activity management in preventing recurrence. Anticoagulation is not indicated in this patient population. Standard precautions are indicated for all patients. Text Reference - p. 820

A 25-year-old patient with a group A streptococcal pharyngitis does not want to take the antibiotics prescribed. What should the nurse tell the patient to encourage the patient to take the medications and avoid complications of the infection? 1 "The complications of this infection will affect the skin, hair, and balance." 2 "You will not feel well if you do not take the medicine and get over this infection." 3 "Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease." 4 "You may not want to take the antibiotics for this infection, but you will be sorry if you do not."

3 RF is not common because of effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. The complications do not include hair or balance. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say. Text Reference - p. 819

A patient with infective endocarditis is admitted to the health care facility. The nurse is aware that primary lesions of infective endocarditis can cause emboli. Which organ may be affected by the process of embolization due to right-sided heart lesions? 1 Brain 2 Spleen 3 Lungs 4 Liver

3 Right-sided heart lesions move to the lungs, resulting in pulmonary emboli. Systemic embolization occurs from left-sided heart lesions moving to the brain, spleen, liver, and kidneys. Text Reference - p. 812

After assessing a patient with rheumatic fever, the nurse documents Sydenham's chorea in the patient's medical record. Which assessment finding led the nurse to document this condition? 1 Inflammation of the joints 2 Red or purple pea-sized lesions on the toes 3 Involuntary movements of the face and limbs 4 Bright pink, nonpruritic, map-like macular lesions on the trunk

3 Sydenham's chorea is a major manifestation of rheumatic fever; it is characterized by involuntary movements of the face and limbs, muscle weakness, and speech and gait disturbances. Inflammation of the joints indicates monoarthritis or polyarthritis. Osler's nodes are red or purple pea-sized lesions on the toes observed in patients with infective endocarditis. Bright pink, nonpruritic, map-like macular lesions on the trunk indicate subacute nodules in patients with rheumatic fever. Test-Taking Tip: Sydenham's chorea is a symptom of rheumatic fever. Recall the manifestations of rheumatic fever and choose the correct answer. Text Reference - p. 819

The nurse is reviewing the assessment data of a patient who has been admitted with a febrile illness. The patient's laboratory results and head-to-toe assessment findings suggest the patient may be diagnosed with which medical condition? 1 Myocarditis 2 Heart failure 3 Rheumatic fever (RF) 4 Infectious endocarditis

3 These assessment findings suggest the presence of RF, which may lead to rheumatic heart disease. Major criteria for RF include carditis (with a heart murmur), cardiac enlargement, monoarthritis or polyarthritis, Sydenham's chorea, erythema marginatum, and subcutaneous nodules over joint areas. Minor criteria include clinical findings of fever and polyarthalgia. Laboratory findings: erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, C-reactive protein (CRP); evidence of Group A streptococcal infection as indicated by: Antistreptolysin-O titer, positive throat culture, positive rapid antigen test for group A streptococci. ECG findings: prolonged PR interval. Text Reference - p. 17

The echocardiography report of a patient with infective endocarditis (IE) indicates the presence of a vegetative mass in the right ventricle. The nurse recalls that what complication could result from this condition? 1 Renal embolization 2 Liver embolization 3 Pulmonary embolization 4 Cerebral embolization

3 Vegetations are the primary lesions of infective endocarditis (IE) that stick to the endocardium of the heart. Vegetations occurring in the right side of the heart could dislodge and then occlude the pulmonary artery, causing pulmonary embolism. Vegetations occurring in the left side of the heart can dislodge and cause embolism in the brain, liver, kidneys, and spleen. This can lead to renal, liver, or cerebral embolization. Text Reference - p. 811

What is the therapeutic role of digoxin in treating myocarditis? 1 To decrease preload 2 To treat an enlarged heart 3 To improve cardiac output 4 To improve myocardial contractility

4 Myocarditis is the diffuse inflammation of myocardium. Digoxin improves myocardial contractility and reduces the heart rate. Diuretics reduce the fluid volume and decrease the preload. ACE inhibitors reduce afterload and treat enlarged heart associated with myocarditis. Intravenous medications like nitroprusside reduce afterload and improve cardiac output by decreasing systemic vascular resistance. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 818

The nurse assesses a patient with infective endocarditis and expects that if petechiae are observed, they will be found in what location of the body? 1 Toes 2 Nail beds 3 Fingertips 4 Conjunctivae

4 Petechiae are manifestations of infective endocarditis, which result from fragmentation and microembolization of vegetative lesions. Petechiae occur on the conjunctivae, buccal mucosa, palate, and lips. Janeway's lesions occur on toes and fingertips. Splinter hemorrhages occur in nail beds. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 812

What is a major central nervous system (CNS) manifestation of rheumatic fever (RF)? 1 Aschoff's bodies 2 Pulsus paradoxus 3 Dressler syndrome 4 Sydenham's chorea

4 Sydenham's chorea is a major central nervous system (CNS) manifestation of rheumatic fever. It is characterized by involuntary movements of the face and limbs, muscle weakness, and speech and gait disturbances. Aschoff's bodies are nodules formed by a reaction to inflammation upon swelling and destruction of collagen fibers; these are not CNS manifestations. Pulsus paradoxus is an abnormally large decrease in systolic blood pressure during inspiration and is observed in patients with pericarditis. Dressler syndrome is late pericarditis that occurs four to six weeks after a myocardial infarction. Text Reference - p. 819

Which diagnostic study helps detect the presence of vegetation on the heart valves in a patient with endocarditis? 1 Chest x-ray 2 Echocardiography 3 Cardiac catheterization 4 Transesophageal echocardiogram

4 Transesophageal echocardiogram and two- or three-dimensional transthoracic echocardiograms help detect vegetation on the heart valves of a patient with infectious endocarditis. A chest x-ray helps identify changes in the heart; it cannot detect the presence of vegetation on the heart valves. Cardiac catheterization is used to examine the blood vessels; it cannot detect the presence of vegetation on the heart valves. An electrocardiogram may be used to identify first- or second-degree atrioventricular block in the patient; it cannot detect the presence of vegetation on the heart valves. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 813

A patient with infective endocarditis is being discharged from the health care facility. What should the nurse teach the patient and caregiver about nursing care at home? Select all that apply. 1 Avoid people with upper respiratory tract infection. 2 Administer antibiotics as scheduled. 3 Ensure complete bed rest. 4 Avoid exercise. 5 Continue follow-up care.

The nurse should teach the patient to avoid people with infection, especially upper respiratory tract infection. The patient should continue to receive antibiotics as scheduled, and the caregiver should observe the patient for any adverse drug reaction. The nurse should explain to the patient the importance of good follow-up care, good nutrition, and early treatment of infections. The patient should take periods of rest between activities. The patient may ambulate and perform moderate activity without exertion. The patient should be assisted in performing range of motion (ROM) exercises to prevent problems with reduced mobility. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 814