CH 24 MED SURG
he nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion?
Shortness of breath
During a teaching session, a client who is having a valvuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct?
"A mechanical valve is thought to be more durable and so requires replacement less often."
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?
"I can still drink coffee and tea"
The nurse instructs a client recovering from mechanical valve replacement surgery. Which client statement indicates that teaching has been effective?
"I will not drive until informed by my health care provider."
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?
"I'm anxious because I'll need to have cardiopulmonary bypass."
The nurse is preparing to administer warfarin to a client with a mechanical valve replacement. The client's international normalized ratio is 2.7. What action will the nurse take?
Administer the medication as ordered.
A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD?
An LVAD only supports a failing left ventricle.
While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement?
Ask the patient to lean forward and listen again.
The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ?
Assess the client for bleeding and notify the health care provider of the results.
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?
Assess the client's home environment in terms of family assistance and adequacy.
When a patient is taking an immunosuppressant following heart transplantation, the nurse would determine which of the following as the MOST important intervention?
Assess vitals every 4 hours
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?
Balloon percutaneous valvuloplasty
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)?
Bleeding and infection
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?
Cardiac tamponade
A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition?
Chronic alcohol abuse
Which procedure describes splitting or separating fused cardiac valve leaflets?
Commissurotomy
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis?
Constant chest pain
A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?
Exertional dyspnea, orthopnea, pulmonary edema
A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response?
Group A, beta-hemolytic streptococcus
Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve?
Heterograft
During auscultation of a client, the nurse suspects a diagnosis of mitral valve regurgitation when hearing which of the following?
High-pitch blowing sound at the apex
A client with endocarditis is being discharged home. What statement indicates effectiveness of client teaching about preventing recurrence of the infection?
I will ask for antibiotics whenever I have dental work done."
On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. To relieve this chest pain, which position should the nurse encourage the client to assume?
Leaning forward while sitting
Which nursing intervention would reduce cardiac workload in a client with myocarditis?
Maintain client on bedrest
If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected?
Mitral valve
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?
Order blood cultures drawn from two sites
A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign?
Red or purple macules found on the palms of the hands
Your client has been diagnosed with mitral valve prolapse syndrome. What is an important subject to include in the client's teaching?
Restriction of alcohol
Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch.
Restrictive cardiomyopathy (RCM)
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?
Rheumatic fever
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?
Risk for infection
A nurse is caring for a client with acute mitral regurgitation related to an acute myocardial infarction. The nurse knows to monitor the client carefully for symptoms of which initial complication or result?
Severe heart failure
Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs?
Shortness of breath
A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant?
The patient reports shortness of breath when walking.
A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following?
The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."
The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point?
The treatments include medications, medical devices, surgery, or transplantation.
Which statement by the client indicates an understanding of the benefit of an autograft replacement valve?
The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged."
The nurse is obtaining a history from a client diagnosed with hypertrophic cardiomyopathy. What information obtained from the client is indicative of hypertrophic cardiomyopathy?
a parent has the same disorder
A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease?
echocardiogram
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?
extra heart sound
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?
fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub?
he nurse asks the client to hold the breath during auscultation.
The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scarring."
hypertrophic
What is the key teaching point regarding the disruption to the normal flow of blood through the heart due to mitral stenosis?
increased resistance of a narrowed orifice between the left atrium and the left ventricle
. Which factor places older adults at risk for developing infective endocarditis?
increased use of prosthetic valve replacements
The nurse auscultates a water-hammer pulse. What will the sound resemble?
quick, sharp strokes that suddenly collapse
The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client?
the high risk for complications if she becomes pregnant while taking warfarin
