Chapter 23. Nursing Care of Patients With Valvular, Inflammatory, and Infectious Cardiac or Venous Disorders

The nurse is preparing to administer Heparin 5,000 units SQ to a patient to prevent DVT. The available dose is Heparin 2,500 units/mL. How many mL will the nurse administer? Enter the numeral only. Page: 395

ANS: 2 Feedback: mL = 1 mL/2,500 units × 5,000 units = 2 mL

The nurse is caring for a patient receiving heparin for thrombophlebitis. The nurse observes the patient has bleeding gums and black tarry stools. Which prescribed medication should the nurse plan to administer? 1. Vitamin K 2. Naloxone (Narcan) 3. Protamine sulfate 4. Flumazenil (Romazicon) Page: 393

ANS: 3 Feedback 1 This is the antidote for Coumadin. 2 This is given for opioid overdose. 3 This is the antidote for heparin. 4 This is the antidote for benzodiazepines.

The nurse is reinforcing teaching about dilated cardiomyopathy. Which statement made by the patient indicates a need for further teaching? 1. "My condition could be genetic; I should get my kids tested." 2. "I may have heart failure since I have the dilated type of cardiomyopathy." 3. "I have the more common type of cardiomyopathy." 4. "I will not have to receive treatment, since it is not useful." Page: 391

ANS: 4 1.This statement is accurate. 2 This statement is accurate. 3 This statement is accurate. 4 Treatment is not useful for restrictive cardiomyopathy.

The nurse is collecting data from a patient. Which approach should the nurse use to determine the presence of a Homans' sign? 1. Observing the calf and thigh color bilaterally 2. Listening with a Doppler to posterior bilateral tibial pulses 3. Measuring the patient's calf and thigh circumference bilaterally 4. Dorsiflexing the patient's foot sharply and asking if calf pain occurs Page: 394

ANS: 4 Feedback 1 These approaches are not used to determine the presence of a Homans' sign. 2 These approaches are not used to determine the presence of a Homans' sign. 3 These approaches are not used to determine the presence of a Homans' sign. 4 Homans' sign is performed prior to confirmation of thrombophlebitis by dorsiflexing the patient's foot sharply and asking if calf pain occurred. Pain is positive for thrombophlebitis.

The nurse is preparing to administer Vancomycin 2 mg in 250 mL normal saline IVPB to run over 2 hours. At what rate will the nurse set the infusion pump? Enter the numeral only. Page: 395

ANS: 125 Feedback: mL = 250 mL/2 mg × 2 mg/2 hr = 125 mL/hr

A patient with aortic stenosis experiencing angina and syncope is prescribed 0.25 mg of digoxin (Lanoxin). The nurse has available digoxin, 0.125 mg tablet. How many tablets should the nurse administer to the patient? Page: 375

ANS: 2 Feedback: 0.25 mg 1 tablet = 2 tablets 0.125 mg

The nurse is caring for a patient who has aortic stenosis. During data collection, which of these manifestations should indicate to the nurse that the patient is experiencing myocardial oxygen deficiency? 1. Angina 2. Sacral edema 3. Jugular vein distention 4. Pericardial friction rub Page: 375

ANS: 1 Feedback 1 Angina results if cardiac oxygen needs are not met. 2 A lack of myocardial oxygen does not cause sacral edema, jugular vein distention, or pericardial friction rub. 3 A lack of myocardial oxygen does not cause sacral edema, jugular vein distention, or pericardial friction rub. 4 A lack of myocardial oxygen does not cause sacral edema, jugular vein distention, or pericardial friction rub.

A patient who has aortic stenosis develops severe dyspnea and chest pain. Which action should the nurse take? 1. Obtain vital signs. 2. Give nitroglycerin. 3. Raise the head of the bed. 4. Encourage the patient to sleep. Page: 378

ANS: 1 Feedback 1 Data collection is the first action the nurse should take in any situation to plan further care. 2 These actions can be done after the vital signs are assessed. 3 These actions can be done after the vital signs are assessed. 4 A patient with severe dyspnea and chest pain is not going to be able to sleep.

The nurse is reinforcing teaching for a patient who has had a mechanical valve replacement. What should be included regarding safety during warfarin (Coumadin) therapy? 1. Wear medial alert identification. 2. Use a straight razor when shaving. 3. Keep yearly blood test appointments. 4. Increase intake of green leafy vegetables. Page: 375

ANS: 1 Feedback 1 If the patient is on anticoagulants for mechanical valve replacement, medical identification should be used. 2 Avoid a straight razor to avoid cuts and bleeding. 3 Monthly blood tests are done. 4 A steady (rather than fluctuating) amount of green leafy vegetables should be eaten so that international normalized ratio (INR) values do not fluctuate due to the vitamin K found in these foods.

The nurse is collecting data on a patient recovering from a hysterectomy who is experiencing left calf tenderness. Data include the following: left calf 17.5 inches; right calf 14 inches; left thigh 32 inches; right thigh 28 inches; shiny, warm, and reddened left leg. Which actions should the nurse recommend for this patient's plan of care? 1. Maintain bedrest. 2. Encourage ambulation daily. 3. Place anti-embolism stocking on left leg. 4. Place anti-embolism stocking on both legs. Page: 394

ANS: 1 Feedback 1 Patient has developed thrombophlebitis, and bedrest should be maintained as ordered until acute phase is resolved to prevent an emboli. 2 Ambulation could lead to a pulmonary embolism and should be avoided. 3 Anti-embolism stockings are placed on the unaffected leg only during the acute phase to prevent emboli. 4 Anti-embolism stockings are placed on the unaffected leg only during the acute phase to prevent emboli.

The nurse is caring for a patient with pericarditis who develops hypotension, confusion, tachycardia, tachypnea, and jugular venous distension. For which procedure should the nurse prepare the patient? 1. Pericardiocentesis 2. Myectomy 3. Endometrial biopsy 4. Commissurotomy Page: 389

ANS: 1 Feedback 1 The patient is experiencing cardiac tamponade. A pericardiocentesis is the treatment. 2 This is not the treatment for cardiac tamponade. 3 This is not the treatment for cardiac tamponade. 4 This is not the treatment for cardiac tamponade.

The nurse is assessing a patient who underwent valve replacement surgery. Which finding should concern the nurse the most? 1. Wet lung sounds 2. Urine output 50 mL/hr 3. Temperature of 99.1°F 4. Chest tube drainage of 100 mL/hr Page: 379

ANS: 1 Feedback 1 Wet lung sounds are indicative of heart failure or pulmonary edema. 2 This is normal urine output. 3 A low-grade temperature is not concerning in the first 24 hours. 4 This is normal chest tube drainage.

A patient with obstructive hypertrophic cardiomyopathy is being released from the hospital and is to continue treatment with atenolol (Tenormin) and disopyramide (Norpace) at home. Which information should be included in the patient's teaching plan? (Select all that apply.) 1. Eat small meals. 2. Drink fluids to remain hydrated. 3. Plan activities in small amounts. 4. Have one alcoholic drink per day. 5. Participate in sports, such as tennis. 6. Check the pulse daily before taking medications. Page: 382

ANS: 1, 2, 3 Feedback 1. Scheduling activities in small amounts and providing small meals that require less energy to digest than large meals reduce strain on the heart. 2. Hydration is important to maintain cardiac output. Avoid alcohol as it decreases cardiac function. 3. Scheduling activities in small amounts and providing small meals that require less energy to digest than large meals reduce strain on the heart. 4. Avoid alcohol as it decreases cardiac function. 5. Strenuous exercise and athletic sports are restricted to prevent sudden death. 6. Pulse does not need to be taken with these two medications.

The nurse is caring for a patient with aortic regurgitation. Which clinical manifestations can the nurse expect to document? (Select all that apply.) 1. Forceful heartbeat more pronounced when laying down 2. Exertional dyspnea 3. Fatigue 4. Corrigan pulse 5. Bloody sputum 6. Petechiae Page: 376

ANS: 1, 2, 3, 4 Feedback 1. This is a clinical manifestation of aortic regurgitation. 2. This is a clinical manifestation of aortic regurgitation. 3. This is a clinical manifestation of aortic regurgitation. 4. This is a clinical manifestation of aortic regurgitation. 5. This is a clinical manifestation of mitral stenosis. 6. Petechiae is a clinical manifestation of IE.

A patient is being admitted to the intensive care unit after cardiac surgery. Which nursing actions should the nurse include in this patient's plan of care? (Select all that apply.) 1. Note any patient shivering. 2. Assess breath sounds every shift. 3. Assist in head-to-toe data collection. 4. Place the patient in a cool environment. 5. Connect the patient to a cardiac monitor. 6. Palpate chest and neck for signs of crepitus. Page: 398

ANS: 1, 2, 3, 5, 6 Feedback 1. All actions should be performed for this patient except for placing the patient in a cool environment because the patient will likely be cool from surgery and need warming. 2. All actions should be performed for this patient except for placing the patient in a cool environment because the patient will likely be cool from surgery and need warming. 3. All actions should be performed for this patient except for placing the patient in a cool environment because the patient will likely be cool from surgery and need warming. 4. All actions should be performed for this patient except for placing the patient in a cool environment because the patient will likely be cool from surgery and need warming. 5. All actions should be performed for this patient except for placing the patient in a cool environment because the patient will likely be cool from surgery and need warming. 6. All actions should be performed for this patient except for placing the patient in a cool environment because the patient will likely be cool from surgery and need warming.

The nurse is reinforcing discharge teaching to a patient with IE. Which topics will the nurse include in the teaching? (Select all that apply.) 1. Brushing teeth with a soft-bristle toothbrush 2. Avoiding biting nails 3. Avoiding applying ointment to cuts 4. Reporting fever or chills to the HCP 5. Instruction on proper handwashing Page: 395

ANS: 1, 2, 4, 5 Feedback 1. This topic should be included in the teaching. 2. This topic should be included in the teaching. 3. Ointment should be applied to cuts. 4. This topic should be included in the teaching. 5. This topic should be included in the teaching.

The nurse is caring for a patient with thrombophlebitis of the left leg. Which interventions should the nurse implement? (Select all that apply.) 1. Administer acetaminophen (Tylenol) as ordered. 2. Apply ice to the affected area. 3. Encourage the patient to wear constricting clothing. 4. Apply compression stockings per order. 5. Elevate the feet above heart level. Page: 394

ANS: 1, 4, 5 Feedback 1. This is an appropriate intervention. 2. The nurse should apply heat, not ice. 3. The nurse should encourage loose clothing. 4. This is an appropriate intervention. 5. This is an appropriate intervention.

The nurse is evaluating care provided to a patient with the nursing diagnosis of activity intolerance because of aortic regurgitation. Which outcome indicates that care has been effective? 1. Stated maintained bedrest to reduce fatigue 2. Engaged in desired daily and social activities 3. Completed activities of daily living with assistance 4. Reported no longer participates in gardening hobby Pages: 378-379

ANS: 2 1 Needing bedrest to reduce fatigue indicates that interventions to address activity intolerance have not been effective. 2 The desired outcome for activity intolerance would be for the patient to be able to engage in desired daily and social activities. 3 Needing assistance to complete activities of daily indicates that interventions to address activity intolerance have not been effective. 4 No longer participating in a gardening hobby indicates that interventions to address activity intolerance have not been effective.

The nurse is caring for a group of patients. Which patient is at highest risk for developing deep vein thrombosis (DVT)? 1. A cashier 2. A truck driver 3. A nurse 4. A mail carrier Page: 394

ANS: 2 Feedback 1 A cashier is not at high risk for developing a DVT. 2 A truck driver is at highest risk because of siting for long periods of time. 3 A nurse is not at high risk for developing a DVT. 4 A mail carrier is not at high risk for developing a DVT.

The nurse is caring for a group of patients. Which patient should the nurse see first? 1. A patient with IE who is receiving IV antibiotic therapy 2. A patient who underwent valve replacement surgery 4 hours ago and reports level 9 pain 3. A patient with aortic regurgitation awaiting an echocardiogram 4. A patient with myocarditis who has a 99.1°F fever Page: 382

ANS: 2 Feedback 1 It is typical for this patient to receive antibiotics; this patient is not the highest priority. 2 This patient should be seen first and given pain medication. 3 This patient is not the highest priority. 4 This patient should be seen after the patient with level 9 pain.

The nurse is teaching a patient about mitral valve prolapse and lifestyle modifications. Which statement made by the patient indicates a need for further teaching? 1. "I should cut coffee out of my diet." 2. "I need to avoid physical activity." 3. "I have been practicing yoga to reduce stress." 4. "I will need to follow a balanced diet." Page: 375

ANS: 2 Feedback 1 Caffeine should be avoided; this is an accurate statement. 2 Exercise should be encouraged, not avoided. 3 This is an accurate statement. 4 This is an accurate statement.

The nurse is monitoring a patient with aortic stenosis and notes crackles in the lungs and a cough. Which complication should the nurse suspect is occurring in this patient? 1. Pneumonia 2. Heart failure 3. Hypertension 4. Rheumatic fever Page: 378

ANS: 2 Feedback 1 Change in lung sounds and a cough does not necessarily indicate the development of pneumonia, hypertension, or rheumatic fever. 2 Heart failure can occur with heart valve disorders. Lung symptoms are indicative of heart failure. 3 Change in lung sounds and a cough does not necessarily indicate the development of pneumonia, hypertension, or rheumatic fever. 4 Change in lung sounds and a cough does not necessarily indicate the development of pneumonia, hypertension, or rheumatic fever.

The nurse is monitoring a patient with pericarditis. What health problem is this patient at risk for developing? 1. Emboli begin to form. 2. Pericardial sac fluid increases. 3. Cardiac workload increases by 15%. 4. Cardiac output decreases more than 10%. Page: 375

ANS: 2 Feedback 1 Emboli formation and changes in cardiac workload or output are not typically associated with pericarditis. 2 Cardiac tamponade is a life-threatening compression of the heart by fluid accumulated in the pericardial sac. 3 Emboli formation and changes in cardiac workload or output are not typically associated with pericarditis. 4 Emboli formation and changes in cardiac workload or output are not typically associated with pericarditis.

The nurse is collecting data from a patient 3 days after a motor vehicle crash in which the patient hit the steering wheel. The data reveal symptoms of pericarditis. Which finding indicates the presence of pericarditis? 1. Pain on expiration 2. Pericardial friction rub 3. Jugular vein distention 4. Crackles in lung bases Page: 388

ANS: 2 Feedback 1 In pericarditis, pain occurs with inspiration. 2 A pericardial friction rub due to inflammation of pericardium is the classic sign of pericarditis. 3 Jugular vein distention and crackles in the lung bases are manifestations of heart failure. 4 Jugular vein distention and crackles in the lung bases are manifestations of heart failure.

The nurse is caring for a patient with aortic regurgitation. Which interventions should the nurse implement? 1. Encourage the patient to perform all activities of daily living at once. 2. Schedule activities with periods of rest. 3. Elevate the head of bed (HOB) to 30 degrees. 4. Apply oxygen at 2 liters/nasal cannula. Page: 376

ANS: 2 Feedback 1 The nurse should schedule activities with periods of rest. 2 This is an appropriate intervention. 3 The HOB should be elevated to 45 degrees. 4 The nurse needs an order to apply oxygen.

The nurse is reviewing the prothrombin time (PT) value for a patient prescribed warfarin (Coumadin). The laboratory's PT range is 9 to 11 seconds. What would be the therapeutic time for the patient? 1. 12.5 seconds 2. 17 seconds 3. 26 seconds 4. 30 seconds Page: 395

ANS: 2 Feedback 1 The value of 12.5 seconds is subtherapeutic. 2 Warfarin's therapeutic range is 1.5 to 2 times the normal PT range. To monitor the patient's therapeutic PT, compare the patient's result with the therapeutic range. The therapeutic range is 13.5 to 22 seconds. 3 The value of 26 seconds is above therapeutic. 4 The value of 30 seconds is above therapeutic.

The nurse is caring for a patient with a DVT who is receiving IV heparin. The nurse should monitor which of these laboratory tests specifically for the effects of the heparin? 1. PT 2. Partial thromboplastin time (PTT) 3. Platelets 4. Bleeding time Page: 395

ANS: 2 Feedback 1 These laboratory tests are not used to monitor the effectiveness of heparin. 2 PTT monitors the effects of heparin. 3 These laboratory tests are not used to monitor the effectiveness of heparin. 4 These laboratory tests are not used to monitor the effectiveness of heparin.

The nurse is caring for a patient with infective endocarditis (IE). Which statement made by the patient leads the nurse to suspect the cause of the IE? 1. "When I was a child, I had rheumatic fever." 2. "I have not been to the dentist in 8 years." 3. "I had a myocardial infarction last year." 4. "I have to sit in one spot for a long time for my job." Page: 384

ANS: 2 Feedback 1 This does not lead to IE. 2 Poor dental hygiene is a cause of IE. 3 This does not lead to IE. 4 This does not lead to IE.

The licensed practical nurse/licensed vocational nurse (LPN/LVN) is observing the student nurse administer enoxaparin (Lovenox). Which step taken by the student requires correction by the nurse? 1. The student cleans the area with alcohol. 2. The student removes any air bubbles. 3. The student injects the medication into the subcutaneous tissue (SQ). 4. The student asks the patient to verify any allergies. Page: 388

ANS: 2 Feedback 1 This does not require correction. 2 The air bubble remains in the syringe. This requires correction. 3 This does not require correction. 4 This does not require correction.

The nurse is caring for a group of patients on the cardiac unit. Which patient is at highest risk for mitral valve prolapse? 1. A 12-year-old male 2. An 18-year-old female 3. A 25-year-old male 4. A 40-year-old female Page: 375

ANS: 2 Feedback 1 This patient is not at high risk for mitral valve prolapse. 2 This patient is both between the ages of 15 and 30 and a female, placing this patient at highest risk. 3 This patient is not at highest risk for mitral valve prolapse. 4 This patient is not at highest risk for mitral valve prolapse.

The nurse is reviewing care for a group of patients. Which patient with a heart valve disorder should the nurse identify as being susceptible to developing the complication of fluid volume excess? 1. A 27-year-old male on atenolol (Tenormin) 2. A 68-year-old female on digoxin (Lanoxin) 3. A 44-year-old male taking amoxicillin (Amoxil) 4. An 18-year-old female taking warfarin (Coumadin) Page: 375

ANS: 2Feedback 1 These patients would be less prone to developing fluid volume excess with a heart valve disorder. 2 Older adults generally would be more likely to experience the complication of fluid volume excess due to aging changes and less cardiac reserve. None of the listed medications are expected to cause fluid volume retention. 3 These patients would be less prone to developing fluid volume excess with a heart valve disorder. 4 These patients would be less prone to developing fluid volume excess with a heart valve disorder.

The nurse is caring for a patient with pericarditis. Which type of medication should the nurse expect to be prescribed for the patient? 1. Beta blocker 2. Antihypertensive 3. Anti-inflammatory 4. Calcium channel blocker Page: 388

ANS: 3 Feedback 1 Beta blockers, antihypertensives, and calcium channel blockers do not treat inflammation or pain. 2 Beta blockers, antihypertensives, and calcium channel blockers do not treat inflammation or pain. 3 Anti-inflammatory medication reduces pericardial inflammation, which decreases pain and should be included in the pain management plan. 4 Beta blockers, antihypertensives, and calcium channel blockers do not treat inflammation or pain.

The nurse is reinforcing teaching provided to a patient with thrombophlebitis. Which diagnostic test should the nurse explain is used to confirm thrombophlebitis? 1. Chest radiograph 2. IV pyelogram 3. Duplex venous scanning 4. Arterial Doppler ultrasonography Page: 393

ANS: 3 Feedback 1 Chest x-ray, IV pyelogram, or arterial Doppler ultrasound is not used to diagnose thrombophlebitis. 2 Chest x-ray, IV pyelogram, or arterial Doppler ultrasound is not used to diagnose thrombophlebitis. 3 Duplex venous scanning confirms thrombophlebitis. 4 Chest x-ray, IV pyelogram, or arterial Doppler ultrasound is not used to diagnose thrombophlebitis.

A patient with a history of mitral valve replacement surgery is instructed to take prophylactic antibiotics before a scheduled root canal. Which patient statement indicates to the nurse that teaching has been effective? 1. "I know I need to call my doctor if I notice a dry cough." 2. "If I notice any ankle edema, I should lower my salt intake." 3. "If I develop a fever in the next week or so, I need to call my doctor right away." 4. "Endocarditis causes rapid weight gain so I need to weigh myself every day for a full week." Page: 381

ANS: 3 Feedback 1 Dry cough, ankle edema, and weight gain are not manifestations of acute endocarditis. 2 Dry cough, ankle edema, and weight gain are not manifestations of acute endocarditis. 3 A fever is a manifestation of acute endocarditis 4 Dry cough, ankle edema, and weight gain are not manifestations of acute endocarditis.

A postoperative patient suddenly develops dyspnea, tachypnea, restlessness, and chest pain. Which complication should the nurse suspect is occurring in this patient? 1. Pulmonary edema 2. Respiratory arrest 3. Pulmonary embolus 4. Myocardial infarction Page: 390

ANS: 3 Feedback 1 Sudden dyspnea, tachypnea, restlessness, and chest pain are not all associated with pulmonary edema, respiratory arrest, or myocardial infarction. 2 Sudden dyspnea, tachypnea, restlessness, and chest pain are not all associated with pulmonary edema, respiratory arrest, or myocardial infarction. 3 The patient likely has a pulmonary embolus, which is a life-threatening condition and requires prompt medical intervention. 4 Sudden dyspnea, tachypnea, restlessness, and chest pain are not all associated with pulmonary edema, respiratory arrest, or myocardial infarction.

A healthy postoperative patient who has been on bedrest for 3 days suddenly develops dyspnea, tachypnea, restlessness, and chest pain. The patient says, "I feel as if something is going to happen to me." Which action should the nurse take? 1. Perform a bilateral Homans' test. 2. Give a narcotic for pain as ordered. 3. Notify the health care provider (HCP) immediately. 4. Reassure the patient that everything is fine. Page: 397

ANS: 3 Feedback 1 These actions are not appropriate for the potential life-threatening condition. The physician will prescribe orders when notified. 2 These actions are not appropriate for the potential life-threatening condition. The physician will prescribe orders when notified. 3 The patient likely has pulmonary emboli, which is a life-threatening condition and requires prompt medical intervention, so the physician must be notified immediately. 4 This would provide false reassurance, which should never be done.

A patient with mitral stenosis is prescribed a preoperative antibiotic. Which patient statement indicates an understanding for taking this medication? 1. "To prevent postoperative pneumonia." 2. "To prevent an increase in body temperature." 3. "To prevent a bacterial infection in the heart." 4. "To prevent infection of the surgical incision." Page: 377

ANS: 3 Feedback 1 This medication is not provided to prevent postoperative pneumonia, fever, or infection of the surgical incision. 2 This medication is not provided to prevent postoperative pneumonia, fever, or infection of the surgical incision. 3 Prophylactic antibiotic therapy helps prevent a bacterial infection in the heart, rheumatic fever, and subsequent rheumatic heart disease and is recommended to prevent valvular disease. 4 This medication is not provided to prevent postoperative pneumonia, fever, or infection of the surgical incision.

The nurse is reviewing the medical histories for a group of patients. Which patients should receive prophylactic antibiotics to prevent infective IE? (Select all that apply.) 1. A 68-year-old with a history of atrial fibrillation scheduled for a root canal 2. A 55-year-old with a history of angina scheduled for arthroscopic knee surgery 3. A 76-year-old with a history of cardiac valve repair scheduled for a colonoscopy 4. A 71-year-old with a history of IE scheduled for a tooth extraction 5. A 69-year-old with a history of congenital heart disease who is having an abscess drained 6. A 56-year-old with a history of mitral valve prolapse scheduled for routine dental cleaning Page: 385

ANS: 3, 4, 5 Feedback 1. Antibiotic prophylaxis guidelines (AHA/ACC, 2017) recommend prophylactic antibiotics before dental procedures for only the highest risk of individuals who have an artificial heart valve or a valve repaired with artificial material, a history of IE, a heart transplant with abnormal valve function, or specific congenital heart defects. Prophylaxis for procedures on the genitourinary or gastrointestinal tract or for most people who have orthopedic implants is no longer recommended. 2. Antibiotic prophylaxis guidelines (AHA/ACC, 2017) recommend prophylactic antibiotics before dental procedures for only the highest risk of individuals who have an artificial heart valve or a valve repaired with artificial material, a history of IE, a heart transplant with abnormal valve function, or specific congenital heart defects. Prophylaxis for procedures on the genitourinary or gastrointestinal tract or for most people who have orthopedic implants is no longer recommended. 3. Antibiotic prophylaxis guidelines (AHA/ACC, 2017) recommend prophylactic antibiotics before dental procedures for only the highest risk of individuals who have an artificial heart valve or a valve repaired with artificial material, a history of IE, a heart transplant with abnormal valve function, or specific congenital heart defects. Prophylaxis for procedures on the genitourinary or gastrointestinal tract or for most people who have orthopedic implants is no longer recommended. 4. Antibiotic prophylaxis guidelines (AHA/ACC, 2017) recommend prophylactic antibiotics before dental procedures for only the highest risk of individuals who have an artificial heart valve or a valve repaired with artificial material, a history of IE, a heart transplant with abnormal valve function, or specific congenital heart defects. Prophylaxis for procedures on the genitourinary or gastrointestinal tract or for most people who have orthopedic implants is no longer recommended. 5. Antibiotic prophylaxis guidelines (AHA/ACC, 2017) recommend prophylactic antibiotics before dental procedures for only the highest risk of individuals who have an artificial heart valve or a valve repaired with artificial material, a history of IE, a heart transplant with abnormal valve function, or specific congenital heart defects. Prophylaxis for procedures on the genitourinary or gastrointestinal tract or for most people who have orthopedic implants is no longer recommended. 6. Antibiotic prophylaxis guidelines (AHA/ACC, 2017) recommend prophylactic antibiotics before dental procedures for only the highest risk of individuals who have an artificial heart valve or a valve repaired with artificial material, a history of IE, a heart transplant with abnormal valve function, or specific congenital heart defects. Prophylaxis for procedures on the genitourinary or gastrointestinal tract or for most people who have orthopedic implants is no longer recommended.

The nurse is caring for a patient who develops a fever and reports right calf pain with a reddened and swollen calf. Which action should the nurse take? 1. Massage the affected calf. 2. Place ice on the affected calf. 3. Place elastic stocking on right leg. 4. Measure bilateral calf circumference daily. Page: 394

ANS: 4 Feedback 1 Massaging the calf is contraindicated, and anti-embolism stockings are placed on the unaffected leg only during acute phase to prevent emboli. Warm, moist heat may be used for superficial thrombophlebitis. 2 Massaging the calf is contraindicated, and anti-embolism stockings are placed on the unaffected leg only during acute phase to prevent emboli. Warm, moist heat may be used for superficial thrombophlebitis. 3 Massaging the calf is contraindicated, and anti-embolism stockings are placed on the unaffected leg only during acute phase to prevent emboli. Warm, moist heat may be used for superficial thrombophlebitis. 4 The calf should be measured bilaterally for comparison and documented daily to note changes.

The nurse is providing discharge teaching for a patient with mitral stenosis. What should the nurse include in this teaching? 1. "The medications you will be taking make your blood thicker, so you are at risk for small clots to form." 2. "It is important that you increase your fluid intake and take iron supplements so that your body can make enough blood for your heart to pump around." 3. "Your blood is rushing through your heart so fast that it may not give your heart enough oxygen and you may have something called angina, or heart pain." 4. "Because of your heart condition, the blood flow through your heart is slower and blood may tend to pool in certain areas, which might allow tiny clots to form." Pages: 376-377

ANS: 4 Feedback 1 Patients are often placed on blood thinners, so this is a false statement. 2 Iron supplementation is provided for iron deficiency anemia, not for valvular disorders. 3 Blood flow through the heart is slowed, so this is a false statement. 4 Emboli form from the stasis of blood in the heart caused by valvular disorders and decreased cardiac output.

The nurse caring for patients on the cardiac unit reviews the standards related to DVT prophylaxis. Which approach should the nurse recognize as being the most effective to prevent the development of deep vein thrombosis? 1. Using bilateral thigh-high stockings throughout hospitalization 2. Using low molecular weight heparin given subcutaneously daily 3. Using bilateral leg compression devices while the patient is in bed 4. Using a combination of pharmacological and compression interventions Page: 396

ANS: 4 Feedback 1 These approaches use single treatment for the prevention of DVT. 2 These approaches use single treatment for the prevention of DVT. 3 These approaches use single treatment for the prevention of DVT. 4 The evidence shows that use of combined treatments for those at high risk for venous thromboembolism is more effective than a single treatment.

The nurse is caring for a group of patients. Which patient is at highest risk for developing pericarditis? 1. A patient with DVT of the right leg 2. A patient with a history of rheumatic fever 3. A patient with ankylosing spondylitis 4. A patient with renal disease and systemic lupus erythematosus (SLE) Page: 389

ANS: 4 Feedback 1 This patient is not at risk for pericarditis. 2 This patient is at moderate risk for pericarditis. 3 This patient is not at risk for pericarditis. 4 This patient is at highest risk for pericarditis.