Chapter 28 prep u med surg

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

A client with a recent history of atrial fibrillation has been prescribed warfarin. What action will the nurse take to confirm safe dosing?

Review the client's international normalized ratio (INR).

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.

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?

An extra heart sound

Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis?

Antibiotic therapy

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

A client is diagnosed with mitral regurgitation. What does the nurse consider with the mechanics of cardiac hemodynamics?

Blood flows backward from the left ventricle into the left atrium during systole.

The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?

Echo

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?

"I will avoid caffeine, alcohol, and smoking."

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 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.

The nurse is caring for a client who has been diagnosed with aortic stenosis. The client is prescribed digoxin. What is the rationale for the medication?

left ventricular dysfunction

If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected?

mitral valve

A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis?

Pericarditis

A nurse is assigned to the medical intensive care unit. The nurse auscultates a water-hammer pulse. What will the sound resemble?

quick, sharp strokes that suddenly collapse

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?

"I need to do my leg exercises five times or more every hour."

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."

When teaching a client with rheumatic carditis and a history of recurrent rheumatic fever, which statement by the client indicates that teaching has been successful?

"I may have to take prophylactic antibiotics for up to 10 years."

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 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."

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?

3.8 Warfarin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5

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

A client is diagnosed with pericarditis. What symptom will be the nurse's priority for treatment?

Acute pain

Which describes a valve used in replacement surgery that is made from the client's own heart valve?

Autograft

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

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

Chest pain

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 reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate:

infective endocarditis.

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?

Echo

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

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?

Hypertrophic

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

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.

A client who suffered blunt chest trauma in a motor vehicle accident reports chest pain during deep inspiration. 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 should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis?

Maintain the client on bed rest

A nurse is preparing home care instructions for a client with infective endocarditis. What will the nurse include in the instructions? Select all that apply.

Monitor intravenous catheter sites for signs of infection. Encourage oral hygiene at least twice daily with a soft toothbrush. Inform all health care providers of the history of endocarditis.

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 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

The instructor is talking with a nursing student who is caring for a client with pericarditis. The instructor asks the student to name the main characteristic of pericarditis. What should be the student's answer?

Precordial pain

A patient with pericarditis is experiencing cardiac tamponade. Which collaborative intervention should the nurse anticipate for this patient?

Prepare for pericardiocentesis

Which valve lies between the right ventricle and the pulmonary artery?

Pulmonic valve

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

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

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?

Shortness of breath

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?

The nurse asks the client to hold the breath during auscultation.

A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement?

The valve has to be replaced frequently.

What are contributing causes to pericarditis? Select all that apply.

cardiac surgery tuberculosis myocarditis chest trauma

A client is diagnosed with infective endocarditis. What laboratory values will the nurse assess? Select all that apply.

elevated white blood cell (WBC) count elevated C-reactive protein elevated erythrocyte sedimentation rate (ESR)

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)

A nurse reviewing a client's echocardiogram report reads the following statements: "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." The nurse knows these manifestations are indicative of which type of cardiomyopathy?

hypertrophic

The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis?

reports of constant chest pain

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

A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered?

throat culture

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