Chapter 28 & 29: More Cardiac Disorders

During a teaching session, a client who is having a valuloplasty 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."

Which term describes the splitting or separating of fused cardiac valve leaflets?

Commissurotomy

The nurse is caring for a client diagnosed with infective endocarditis and awaiting blood culture results. The client asks, "Where did I pick up these bacteria?"The nurse is most safe to speculate which of the following?

From a break in the skin

Which mitral valve condition generally produces no symptoms?

Prolapse

A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention? You Selected:

Eliminate caffeine and alcohol

A client has a significant history of congestive heart failure. What should the nurse specifically assess during the client's semiannual cardiology examination? Select all that apply.

Examine the client's neck for distended veins. Monitor the client for signs of lethargy or confusion.

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-pitched blowing sound at the apex

An adult client with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. The medical history reveals diabetes mellitus, hypertension, and pernicious anemia. The client underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. What history finding is a major risk factor for infective endocarditis?

History of aortic valve replacement

The nurse has created a care plan for a client admitted with acute pericarditis and a nursing diagnosis of acute pain related to pericardial inflammation. What is an appropriate nursing intervention for this client?

Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on

The nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis?

Positive blood culture

A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client?

Pulmonary congestion

A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.)

Pulmonary crackles Dyspnea Cough

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?

Pulsus paradoxus on vital sign assessment

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?

When resting, sit up with the legs down to pool blood in the legs.

A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis?

A client 4 days postoperative after mitral valve replacement Having prosthetic cardiac valves places the client at high risk for infective endocarditis. Hypertrophic cardiomyopathy and repaired ventricular septal defects are moderate risks for infective endocarditis. Coronary stent placement isn't a risk factor for infective endocarditis.

The nurse is caring for a five-client assignment on a cardiac unit. In caring for which client would the nurse be most correct to assess for an effusion?

A client with chest trauma

The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder?

Aortic regurgitation

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 nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure?

Atrial fibrillation

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

Which is a key diagnostic indicator of heart failure?

Brain natriuretic peptide (BNP) BNP is the key diagnostic indicator of HF. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of heart failure. BUN, creatinine, and a CBC are included in the initial workup

A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved?

Decrease in central venous pressure (CVP)

A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur?

Diastolic, rumbling, low-pitched

The nurse identifies which symptom as a characteristic of right-sided heart failure?

Jugular vein distention (JVD)

Which feature is the hallmark of systolic heart failure?

Low ejection fraction (EF)

Which is a manifestation of right-sided heart failure?

Systemic venous congestion

The nurse is teaching a client scheduled for an autograft aortic valve replacement. What statements are true about autograft replacement process? Select all that apply.

The grafts are obtained by excising the client's own pulmonic valves and a portion of the pulmonary artery. The autograft is an alternative for children and women of child-bearing age. Aortic valve autografts have remained viable for more than 20 years.

The nursing instructor is teaching a class on thrombophlebitis. What should the nurse tell the students about the inflammatory response in thrombophlebitis?

The inflammatory response is caused by accumulated waste products in the blocked vessel.

A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention?

Titrate oxygen therapy. The nurse needs to titrate oxygen therapy to increase the client's oxygen levels. Assessing for jugular vein distention and examining the surgical incision area will not meet the oxygen demands. Administering pain medication will not increase oxygenation levels.

A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing

decompensated heart failure with pulmonary edema.

A client with a history of cardiomyopathy experiences dyspnea on exertion, fatigue, leg swelling, and chest pain. This client has which type of cardiomyopathy?

dilated cardiomyopathy Peripartum cardiomyopathy may develop in women shortly before or after giving birth. Hypertrophic cardiomyopathy is associated with syncope, fatigue, SOB, and chest pain. Restrictive cardiomyopathy has symptoms of exertional dyspnea, dependent edema in the legs, ascites (fluid in the abdomen), and hepatomegaly (enlarged liver).

While auscultating the heart of a pediatric client who is recovering from acute rheumatic fever, the nurse hears a murmur. This sound may indicate:

valve damage.

A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, what action should the nurse perform?

place the client in high Fowler's position

The nurse is teaching a school community parent group about heart wellness. What risk factor is a common leading cause for mitral stenosis?

rheumatic fever

The nurse is teaching a client with an atrial septal defect (ASD) about atrial fibrillation. What risk factor will the nurse include with the teaching?

stroke

A nurse is caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. 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

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement?

"I sleep on three pillows each night."

A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis?

Chest pain

The nurse is caring for a client in the hospital with chronic heart failure that has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, he becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)?

Class III (Moderate)

The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)?

Congestion in the peripheral tissues Right-sided HF, failure of the right ventricle, results in congestion in the peripheral tissues and the viscera and causes systemic venous congestion and a reduction in forward flow. Left-sided HF refers to failure of the left ventricle; it results in pulmonary congestion and causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure?

Dyspnea on exertion

The diagnosis of heart failure is usually confirmed by which of the following?

Echocardiogram

A patient at the clinic describes shortness of breath, periods of feeling "lightheaded," and feeling fatigued despite a full night's sleep. The nurse obtains vital signs and auscultates a systolic click. What does the nurse suspect from the assessment findings?

Mitral valve prolapse

The school nurse is providing care to a child with a sore throat. With any sign of throat infection, the nurse stresses which of the following?

Obtaining a throat culture

The nurse is working with a client who asks what diagnostic studies will be done because of a suspected diagnosis of mitral stenosis. What studies will the nurse teach the client? Select all that apply.

exercise test cardiac catheterization electrocardiography

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) 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.

A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care prescriber?

heart rate of 55 beats per minute

The nurse is asssessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion?

inadequate cardiac output

A nurse is teaching a client about mitral stenosis and the effect on blood flow in the heart. What is teaching point of the disruption to the normal flow of blood through the heart from the mitral stenosis?

increased resistance of a narrowed orifice between the left atrium and the left ventricle

The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival?

lisinopril

A client has been rushed to the ED with pulmonary edema and is going to need oxygen immediately. Which oxygen delivery system should be used first?

mask

The nurse is caring for a client with aortic regurgitation. What medication will the nurse administer to reduce afterload?

nitroprusside

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?

"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.

The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?

"I have to call my doctor so I can get antibiotics before seeing the dentist."

A nurse is teaching a client who is awaiting a heart transplant. Which statement indicates the client understands what is required to help minimize rejection?

"I will need to take three different types of medications for the rest of my life to help prevent rejection."

The nurse is teaching a client with heart failure about digoxin. What statements by the client indicate the teaching is effective? Select all that apply.

"I will watch my urine output to be sure that the medication is not affecting my kidneys." "If I take my digoxin I should have limited episodes of shortness of breath."

A nurse working at a pediatric clinic is teaching a group of parents. A parent asks the nurse if it is okay to let the young child recover from a sore throat naturally, rather than bringing the child to the clinic for diagnosis and treatment. What is the nurse's best response?

"It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment."

The client with which characteristic is considered at high risk for the development of infective endocarditis?

Cyanotic congenital malformation The client who has unrepaired cyanotic disease is at high risk for the development of infective endocarditis. Clients with mitral valve prolapse with valvular regurgitation, hypertrophic cardiomyopathy, or acquired valvular dysfunction are at moderate risk for the development of infective endocarditis.

A client with aortic regurgitation is admitted to the hospital. Which assessment findings would indicate left ventricular failure?

Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND)

A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure?

Dyspnea, orthopnea, pulmonary edema

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."

A patient with a history of valvular disease has just arrived in the PACU after a percutaneous balloon valvuloplasty. Which intervention should the recovery nurse implement?

Keep the patient's affected leg straight. Balloon valvuloplasty is performed in the cardiac catheterization laboratory. A catheter is inserted into the femoral artery. The patient must keep the affected leg straight to prevent hemorrhage at the insertion site. It is not an open heart surgery requiring chest tubes nor a chest dressing. ET tubes are placed when someone has general anesthesia, and this procedure is performed using light or moderate sedation.

Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis?

Maintain the client on bed rest

What are the first symptoms of cardiac tamponade? Select all that apply.

Shortness of breath Chest tightness Dizziness