Chapter 37 study guide

A patient has an admitting diagnosis of acute left sided infective endocarditis. What is the best test to confirm this diagnosis? A. Two blood cultures B. Complete blood count C. Cardiac catherization D. Transesophageal echocardiogram

A 2. a. Blood cultures are the primary diagnostic tool for infective endocarditis. Although a complete blood count (CBC) will reveal a mild leukocytosis, this is a nonspecific finding. Transesophageal echocardiograms can identify vegetations on valves but are used when blood cultures are negative. Cardiac catheterizations are used when surgical intervention is being considered

When teaching a patient about the long term consequences of rheumatic fever, the nurse should discuss the possibility of A. valvular heart disease B. Pulmonary hypertension C. Superior Vena Cava syndrome D. hypertrophy of the right ventricle

A Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves.

Which diagnostic study best differentiates the various types of cardiomyopathy? A. Echocardiography B. Arterial blood gases C. Heart catherization D. Endomyocardial biopsy

A The echocardiogram is the primary diagnostic tool used to differentiate between the different types of cardiomyopathies and other structural cardiac abnormalities. The nurse is caring for a patient newly admitted with heart failure secondary to dilated cardiomyopathy.

Which is a priority nursing intervention for a patient during the acute phase of rheumatic fever? a. administration of antibiotics as ordered b. management of pain with opioid analgesics c. encouragement of fluid intake for hydration d. performance of frequent, active range-of motion exercises

A The primary goal of managing a patient with acute rheumatic fever is to control and eradicate the infecting organism. The nurse should administer antibiotics as ordered to treat the streptococcal infection and teach the patient that completion of the full course of antibiotic therapy is essential for successful treatment.

What manifestations most strongly support a diagnosis of acute rheumatic fever? A. Carditis, polyarthritis, and erythema marginatum B. Polyarthritis, chorea, and decreased antistreptolysin-O- titer C. Organic heart murmurs, fever, and elevated erythrocyte sedimentation rate (ESR) D. Positive C-reactive protein, elevated white blood cells (WBC's), and subcutaneous nodules

A a. Major criteria for the diagnosis of rheumatic fever include evidence of carditis, polyarthritis, chorea (often very late), erythema marginatum, and subcutaneous nodules. Minor criteria include all laboratory findings as well as fever, arthralgia, and a history of previous rheumatic fever. There also must be evidence of a previous group A streptococci infection (e.g., positive antistreptolysin O titer).

Which manifestation of infective endocarditis is a result of fragmentation and microembolization of vegetative lesions? A. Petechiae B. Roth's spots C. Osler's nodes D. Splinter hemorrhages

A a. Petechiae are seen as small hemorrhages in the conjunctiva, lips, and buccal mucosa and over the ankles, feet, and antecubital and popliteal areas. Roth's spots are hemorrhagic retinal lesions seen with funduscopic examination. Osler's nodes are lesions on the fingertips or toes. The cause of Roth's spots and Osler's nodes is not clear. Splinter hemorrhages are black longitudinal streaks that occur on nail beds. They may be caused by vessel damage from vasculitis or microemboli

1) A 20 year old patient has acute infective endocarditis. While obtaining a nursing history, the nurse asks the patient about what (select all that apply)? A. Renal dialysis B. IV drug abuse C. Recent dental work D. Cardiac catherization E. Recent urinary tract infection

A, B, C, D, E 1. a, b, c, d, e. Recent dental, urologic, surgical, or gynecologic procedures and history of IV drug abuse, heart disease, cardiac catheterization or surgery, renal dialysis, and infections all increase the risk of infective endocarditis.

Assessment of an IV cocaine user with infective endocarditis should focus on which signs and symptoms (select all that apply) a. Retinal hemorrhages b. splinter hemorrhages c. presence of Osler's nodes d. Painless nodules over bony prominences e. painless erythematous macules on the palms and soles

A, B, C, E Correct answers: a, b, c, eRationale: Clinical manifestations of infective endocarditis may include hemorrhagic retinal lesions (Roth's spots), splinter hemorrhages (black, longitudinal streaks) that may occur in the nail beds, Osler's nodes (painful, tender, red or purple, pea-size lesions) on the fingertips or toes, and Janeway's lesions (flat, painless, small, red spots) on the palms and soles.

A patient is admitted with myocarditis. While performing the initial assessment, the nurse may find which clinical signs and symptoms (select all that apply)? A. Angina B. Pleuritic chest pain C. Splinter hemorrhages D. Pericardial friction rub E. Presence of Osler's nodes

A, B, D . Correct answers: a, b, d Rationale: Clinical manifestations of myocarditis may include early systemic manifestations (i.e., fever, fatigue, malaise, myalgias, pharyngitis, dyspnea, lymphadenopathy, and nausea and vomiting), early cardiac manifestations (e.g., pleuritic chest pain with a pericardial friction rub and effusion), and late cardiac signs (e.g., S3 heart sound, crackles, jugular venous distention [JVD], syncope, peripheral edema, and angina).

A patient is diagnosed with mitral stenosis and new onset atrial fibrillation. Which interventions could the nurse delegate to unlicensed assistive personnel (UAP) (select all that apply)? A. Obtain and record daily weight B. Determine apical-radial pulse rate C. Observe for overt signs of bleeding D. Obtain and record vital signs, including pulse oximetry E. Teach the patient how to purchase a Medic Alert device

A, C, D Correct answers: a, c, dRationale: The nurse may delegate routine procedures such as measuring weights and vital signs. The nurse may give specific directions to the unlicensed assistive personnel (UAP) to observe and report obvious signs of bleeding. The nurse cannot delegate teaching, assessment, or activities that require clinical judgment. Obtaining an apical-radial pulse rate is an assessment.

When performing discharge teaching for a patient with any type of CMP, the nurse should instruct the patient to do what (select all that apply)? A. Eat a low sodium diet B. Go to the gym everyday C. Engage in stress-reduction activities D. Abstain from alcohol and caffeine intake E. Avoid strenuous activity and allow for periods of rest F. Suggest that caregivers learn cardiopulmonary resuscitation (CPR)

A, C, D, E, F

When obtaining a nursing history for a patient with myocarditis, what should the nurse specifically question the patient about? A. Prior use of digoxin for treatment of cardiac problems B. Recent symptoms of viral illness, such as fever and malaise C. A history of coronary artery disease (CAD) with or without an MI D. A recent streptococcal infection requiring treatment with penicillin

B b. Viruses are the most common cause of myocarditis in the United States and early manifestations of myocarditis are often those of systemic viral infections. Myocarditis may also be associated with systemic inflammatory and metabolic disorders as well as with other microorganisms, drugs, or toxins. The patient with myocarditis is predisposed to drug-related dysrhythmias and toxicity with digoxin, so it is used very cautiously, if at all, in treatment of the condition.

The patient is admitted with angina, syncope, and dyspnea on exertion. In the assessment, the nurse notes a systolic murmur with a prominent S4. What will the nurse suspect is occurring with this patient? A.) Mitral valve stenosis B.) Aortic valve stenosis C.) Acute mitral valve regurgitation D.) Chronic mitral valve regurgitation

B . b. Aortic valve stenosis is identified with the triad of angina, syncope, and dyspnea on exertion, as well as the systolic murmur and prominent S4 heart sound. Mitral valve stenosis manifests as exertional dyspnea, hemoptysis, fatigue, atrial fibrillation, and a diastolic murmur. Acute mitral valve regurgitation has a new systolic murmur with pulmonary edema and cardiogenic shock rapidly developing. Chronic mitral valve regurgitation is identified with weakness, fatigue, exertional dyspnea, palpitations, an S3 gallop, and holosystolic murmur

A patient with infective endocarditis of a prosthetic mitral valve develops a left hemiparesis and visual changes. What should the nurse expect to be included in interprofessional care of the patient? A.) Embolectomy B.) Surgical valve replacement C.) Administration of anticoagulants D.) Higher than usual antibiotic dosages

B . b. Early valve replacement followed by prolonged antibiotic and anticoagulant therapy is recommended for these patients. Drug therapy for patients who develop endocarditis of prosthetic valves is often unsuccessful in eliminating the infection and preventing embolization.

Which drugs would the nurse expect to be included in those prescribed for patients with a mechanical valve replacement? A. Oral nitrates B. Anticoagulants C. Atrial antidysrhythmics D. Beta adrenergic blocking agents

B . b. Patients with mechanical valves have an increased risk for thrombus formation. Therefore prophylactic anticoagulation therapy is used to prevent thrombus formation and systemic or pulmonary embolization. Nitrates are contraindicated for the patient with aortic stenosis because an adequate preload is necessary to open the stiffened aortic valve. Antidysrhythmics are used only if dysrhythmias occur and β-adrenergic blocking drugs may be used to control the heart rate if needed

The patient is admitted post-radiation therapy with symptoms of cardiomyopathy (CMP). Which type of CMP should the nurse suspect that the patient is experiencing? A. Dilated B. Restrictive C. Takotsubo D. Hypertrophic

B b. A secondary cause of restrictive cardiomyopathy (CMP) is radiation treatment to the thorax with stiffness of the ventricular wall occurring. Dilated CMP may have a genetic link, follow infectious myocarditis, or be related to an autoimmune process or excess alcohol ingestion. Takotsubo CMP is an acute stress-related syndrome that mimics acute coronary syndrome. It is most common in postmenopausal women. Hypertrophic CMP has a genetic link in about one half of all cases and is frequently seen in young athletic individuals

A patient with symptomatic mitral valve prolapse has atrial and ventricular dysrhythmias. In addition to monitoring for decreased cardiac output related to the dysrhythmias, what is an important nursing intervention related to the dysrhythmias identified by the nurse? A. Monitor breathing pattern related to the hypervolemia B. Encourage calling for assistance when getting out of bed C. Give sleeping pills to decrease paroxysmal nocturnal dyspnea D. Teach the patient exercises to prevent recurrence of dysrhythmias

B b. Dysrhythmias frequently cause palpitations, lightheadedness, and dizziness and the patient should be carefully attended to to prevent falls. Hypervolemia and paroxysmal nocturnal dyspnea (PND) would be apparent in the patient with heart failure. Exercises will not prevent dysrhythmias

The patient with acute pericarditis is having a pericardiocentesis. Postoperatively, what complication should the nurse monitor the patient for? A. Pneumonia B. Pneumothorax C. Myocardial Infarction (MI) D. Cerebrovascular accident (CVA)

B b. Pneumothorax may occur as a needle is inserted into the pericardial space to remove fluid for analysis and relieve cardiac pressure with pericardiocentesis. Other complications could include dysrhythmias, further cardiac tamponade, myocardial laceration, and coronary artery laceration

A patient with acute pericarditis has markedly distended jugular veins, decreased BP, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes that these symptoms occur when that happens? A. The pericardial space is obliterated with scar tissue and thickened pericardium B. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling C. The parietal and viscera; pericardial membranes adhere to each other, preventing normal myocardial contraction D. Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction

B b. The patient is experiencing a cardiac tamponade that consists of excess fluid in the pericardial sac, which compresses the heart and the adjoining structures, preventing normal filling and cardiac output. Fibrin accumulation, a scarred and thickened pericardium, and adherent pericardial membranes occur in chronic constrictive pericarditis.

A patient with rheumatic heart disease with carditis asks the nurse how long his activity will be restricted. What is the best answer by the nurse? A.) Full activity will be allowed as soon as acute symptoms have subsided B.) Bed rest will be continue until symptoms of heart failure are controlled C.) Nonstrenuous activities can be performed as soon as antibiotics are started D.) Bed rest must be maintained until anti-inflammatory therapy has been discontinued

B b. When carditis is present in the patient with rheumatic fever, ambulation is postponed until any symptoms of heart failure are controlled with treatment and full activity cannot be resumed until antiinflammatory therapy has been discontinued. In the patient without cardiac involvement, ambulation may be permitted as soon as acute symptoms have subsided and normal activity can be resumed when antiinflammatory therapy is discontinued

What explains the measurement of pulsus paradoxus with cardiac tamponade (select all that apply)? A. A difference of less than 10 mm Hg occurs B. A difference of greater than 10 mm Hg occurs C. It is measured with an automatic sphygmomanometer D. Rapidly inflate the cuff until you hear sounds throughout the respiratory cycle E. Subtract the number when sounds are heard

B, E . b, e. Pulsus paradoxus is measured with a manually operated sphygmomanometer. The cuff is deflated slowly until the first Korotkoff sound during expiration is heard and the number is noted. The slow deflation of the cuff is continued until sounds are heard throughout the respiratory cycle and that number is subtracted from the first number. When the difference is >10 mm Hg, cardiac tamponade may be present. The difference is normally <10

In which patient would a mechanical prosthetic valve be preferred over a biologic valve for valve replacement A.) 41 year old man with a peptic ulcer disease B.) 22 year old woman who desires to have children C.) 35 year old man with a history of seasonal asthma D.) 62 year old woman with early Alzheimer's disease

C . c. Mechanical prosthetic valves require long-term anticoagulation and this is a factor in making a decision about the type of valve to use for replacement. Patients who cannot take anticoagulant therapy, such as women of childbearing age, patients at risk for hemorrhage, patients who may not be compliant with anticoagulation therapy, and patients over age 65 may be candidates for the less durable biologic valves.

A patient is scheduled for an open surgical valvuloplasty of the mitral valve. In preparing the patient for surgery, what should the nurse know about this surgery? A. Cardiopulmonary bypass is not required with this procedure B. Valve repair is a palliative measure, whereas valve replacement is curative C. The operative mortality rate is lower in valve repair than in valve replacement D. Patients with valve repair do not require postoperative anticoagulation as do those who have valve replacement

C . c. Repair of mitral or tricuspid valves has a lower operative mortality rate than does replacement and is becoming the surgical procedure of choice for these valvular diseases. Open repair is more precise than closed repair and requires cardiopulmonary bypass during surgery. All types of valve surgery are palliative, not curative, and patients require lifelong health care. Anticoagulation therapy is used for all valve surgery for at least some time postoperatively

A patient is scheduled for a percutaneous transluminal balloon valvuplasty. The nurse understands that this procedure is indicated for which patient? A.) Any patient with aortic regurgitation B.) Older patients with aortic regurgitation C.) Older patients with stenosis of any valve D.) Young adult patients with mild mitral valve stenosis

C . c. This procedure has been used for repair of mitral, tricuspid, and pulmonic stenosis and less often for aortic stenosis. It is usually used for older patients and for those patients who are poor surgical risks because it is relatively easy and has good results and few complications

The nurse is caring for a patient with chronic constrictive pericarditis. Which assessment finding reflects a more serious complication of this condition? A. Fatigue B. Peripheral edema C. Jugular venous distention D. Thickened pericardium on echocardiography

C Correct answer: cRationale: Cardiac tamponade is a serious complication of pericarditis. As the compression of the heart increases, decreased left atrial filling results in decreases in cardiac output. Neck veins usually are markedly distended as a result of jugular venous pressure elevation related to compression of the right side of the heart.

The nurse is caring for a patient newly admitted with heart failure secondary to dilated cardiomyopathy. Which intervention would be a priority? A. Encourage caregivers to learn CPR B. Consider a consultation with hospice for palliative care C. Monitor the patient's response to prescribed medications D. Arrange for the patient to enter a cardiac rehabilitation program

C Correct answer: cRationale: Observing for signs and symptoms of worsening heart failure, dysrhythmias, and embolus formation in patients with dilated cardiomyopathy is essential, as is monitoring drug responsiveness. The goal of therapy is to keep the patient at an optimal level of functioning and out of the hospital. The priority intervention is to manage the acute symptoms with medications. The caregivers should learn cardiopulmonary resuscitation (CPR) before hospital discharge, and the patient may be referred to cardiac rehabilitation. Patients with dilated cardiomyopathy with progression to class IV stage D heart failure are candidates for palliative care.

What accurately describes mitral valve prolapse? A.) Rapid onset prevents left chamber dilation B.) May be caused by pulmonary hypertension C.) Buckling of valve into left atrium during ventricular systole D.) Rapid development of pulmonary edema and cardiogenic shock

C c. Mitral valve prolapse is the ballooning of the valve leaflets into the left atrium during ventricular systole. The rapid onset that prevents left chamber dilation and the rapid development of pulmonary edema and cardiogenic shock occur with acute mitral regurgitation. Pulmonary hypertension may contribute to tricuspid valve disease.

An RN is working with licensed practical nurse/licensed vocational nurse (LPN/LVN) in caring for a group of patients on a cardiac telemetry unit. A patient with aortic stenosis has the nursing diagnosis of activity intolerance related to fatigue and exertional dyspnea. Which nursing activity could be delegated to the LPN? A.) Explain the reason for planning frequent periods of rest B.) Evaluate the patient's understanding of his disease process C.) Monitor BP, HR, RR, and SpO2 before, during, and after ambulation D.) Teach the patient which activities to choose that will

C c. Monitoring vital signs before and after ambulation is the collection of data. Instructions should be provided to the licensed practical nurse (LPN) regarding what changes in these vital signs should be reported to the RN. The other actions listed are RN responsibilities.

A patient with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. What should the nurse suspect that the patient is experiencing? A. Pulmonary embolization from valve vegetations B. Vegetative embolization to the coronary arteries C. Valvular incompetence with resulting heart failure D. Nonspecific manifestations that accompany infectious diseases

C c. The dyspnea, crackles, and restlessness that the patient is manifesting are symptoms of heart failure and decreased cardiac output (CO) that occurs in up to 80% of patients with aortic valve endocarditis as a result of aortic valve incompetence. Vegetative embolization from the aortic valve occurs throughout the arterial system and may affect any body organ. Pulmonary emboli occur in right-sided endocarditis

When planning care for the patient with hypertrophic CMP, what should the nurse include? A. Ventricular pacing B. Administration of vasodilators C. Teach the patient to avoid strenuous activity and dehydration D. Surgery for cardiac transplantation will have to be done soon

C' . c. Nursing interventions for the patient with hypertrophic CMP are to improve ventricular filling by reducing ventricular contractility and relieving left ventricular outflow obstruction to relieve symptoms and prevent complications. Strenuous activity and dehydration will increase systemic vascular resistance and should be avoided. Atrioventricular pacing will allow the septum to move away from the left ventricular wall and reduce the degree of outflow obstruction. Vasodilators may decrease venous return and further increase obstruction of blood flow from the heart. The surgery that could be done involves cutting into the thickened septal wall and removing some of the ventricular muscle

A patient is admitted to the hospital with a suspected acute pericarditis. To establish the presence of a pericardial friction rub, what is the best method for the nurse to use to listen to the patient's chest? A. While timing the sound of the respiratory pattern B. With the bell of the stethoscope at the apex of the heart C. With the diaphragm of the stethoscope to auscultate a high-pitched continuous rumbling sounds D. With the stethoscope at the lower left sternal border of the chest, patient leaning forward and holding breath

D . The stethoscope diaphragm at the left sternal border with the patient leaning forward is the best method to use to hear the high-pitched, grating sound of a pericardial friction rub. The sound does not radiate widely and occurs with the heartbeat. To differentiate a pericardial friction rub from a pleural friction rub, have the patient hold his or her breath. The rub will still be heard if it is cardiac in nature

What is the most important role of the nurse in preventing rheumatic fever? A. Teach patients with infective endocarditis to adhere to antibiotic prophylaxis B. Identify patients with valvular heart disease who are at risk for rheumatic fever C. Encourage the use of antibiotics for treatment of all infections involving a sore throat D. Promote the early diagnosis and immediate treatment of group A streptococcal pharyngitis

D . d. Initial attacks of rheumatic fever and the development of rheumatic heart disease can be prevented by adequate treatment of group A streptococcal pharyngitis. Because streptococcal infection accounts for only about 20% of acute pharyngitis, cultures should be done to identify the organism and direct antibiotic therapy. Viral infections should not be treated with antibiotics. Prophylactic therapy is indicated in those who have valvular heart disease or have had rheumatic heart disease.. d. Initial attacks of rheumatic fever and the development of rheumatic heart disease can be prevented by adequate treatment of group A streptococcal pharyngitis. Because streptococcal infection accounts for only about 20% of acute pharyngitis, cultures should be done to identify the organism and direct antibiotic therapy. Viral infections should not be treated with antibiotics. Prophylactic therapy is indicated in those who have valvular heart disease or have had rheumatic heart disease.

What describes Janeway's lesions that are manifestations of infective endocarditis? A. Hemorrhagic retinal lesions B. Black longitudinal streaks in nail beds C. Painful red or purple lesions on fingers or toes D. Flat, red painless spots on the palm of hands and soles of feet

D . d. Janeway's lesions are flat, painless, small red spots found on the palms of the hands and the soles of the feet. Black streaks on the nails are splinter hemorrhages. Hemorrhagic retinal lesions are Roth's spots. Painful lesions on the fingers and toes are Osler's nodes

A patient with acute pericarditis has a nursing diagnosis of pain related to pericardial inflammation. What is the best nursing intervention for the patient? A. Administer opioids as prescribed on an around-the-clock schedule B. Promote progressive relaxation exercises with the use of deep, slow breathing C. Position the patient on the right side with the head of the bed elevated 15 degrees D. Position the patient in Fowler's position with a padded over-the-bed table for the patient to lean on

D . d. Relief from pericardial pain is often obtained by sitting up and leaning forward. Pain is increased by lying flat. The pain has a sharp, pleuritic quality that changes with respiration and patients take shallow breaths. Antiinflammatory medications may also be used to help control pain but opioids are not usually indicated.

A patient hospitalized for 1 week with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy is planned. During discharge planning with the patient, what is it most important for the nurse to do? A.) Plan how his needs will be met while he continues on bed rest B.) Encourage the use of diversional activities to relieve boredom and restlessness C.) Teach the patient to avoid crowds ad exposure to upper respiratory infections D.) Assess the patient's home environment in terms of family assistance and hospital access.

D . d. The patient with outpatient antibiotic therapy requires vigilant home nursing care and it is most important to determine the adequacy of the home environment for successful management of the patient. The patient is at risk for life-threatening complications, such as embolization and pulmonary edema, and must be able to access a hospital if needed. Bed rest will not be necessary for the patient without heart damage. Avoiding infections and planning diversional activities are indicated for the patient but are not the most important factors while he is on outpatient antibiotic therapy

Which clinical finding would most likely indicate decreased cardiac output in a patient with aortic valve regurgitation? A. Reduction in peripheral edema and weight B. Carotid venous distention and new onset atrial fibrillation C. Significant pulsus paradoxus and diminished peripheral pulses D. Shortness of breath on minimal exertion and a diastolic murmur

D Correct answer: dRationale: Clinical manifestations of aortic regurgitation (AR) that indicate decreased cardiac output include severe dyspnea, chest pain, and hypotension. Other manifestations of chronic AR include water-hammer pulse (i.e., a strong, quick beat that collapses immediately), soft or absent S1, presence of S3 or S4, and soft, high-pitched diastolic murmur. A low-pitched diastolic murmur may be heard in severe AR. Early manifestations may include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.

Priority nursing management for a patient with myocarditis includes interventions related to A. Meticulous skin care B. Antibiotic prophylaxis C. Tight glycemic control D. Oxygenation and ventilation

D Correct answer: dRationale: General supportive measures for management of myocarditis include interventions to improve ventilation and oxygenation (oxygen therapy, bed rest, and restricted activity).

What causes a sudden onset of cardiovascular collapse? A. Mitral valve stenosis B. Tricuspid valve disease C. Pulmonic valve stenosis D. Acute aortic regurgitation

D d. Acute aortic regurgitation causes a sudden cardiovascular collapse. With mitral valve stenosis dyspnea is a prominent symptom and embolization may result from chronic atrial fibrillation. With tricuspid and pulmonic valve diseases, stenosis occurs more often than regurgitation. Tricuspid valve stenosis results in right atrial enlargement and elevated systemic venous pressures. Pulmonic valve stenosis results in right ventricular hypertension and hypertrophy

When instructing a patient with endocarditis how to prevent recurrence of the infection, what should the nurse teach the patient? A. Start on antibiotic therapy when exposed to persons with infections B. Take one aspirin a day to prevent vegetative lesions from forming around the valves C. Always maintain continuous antibiotic therapy to prevent the development of any systemic infection D. Obtain prophylactic antibiotic therapy before certain invasive medical or dental procedures (e.g., dental cleaning)

D d. Prophylactic antibiotic therapy should be initiated before invasive dental, medical, or surgical procedures to prevent recurrence of endocarditis. Continuous antibiotic therapy is indicated only in patients with implanted devices or ongoing invasive procedures. Symptoms of infection should be treated promptly but antibiotics are not used for exposure to infection

When performing discharge teaching for the patient following a mechanical valve replacement, the nurse determines that further instruction is needed when the patient says which statement? A. I may begin an exercise program to gradually increase my cardiac tolerance B. I will always need to have my blood checked once a month for its clotting function C. I should take prophylactic antibiotics before I have dental or invasive medical procedures D. The biggest risk I have during invasive health procedures is bleeding because of my anticoagulants

D d. The greatest risk to a patient who has an artificial valve is the development of endocarditis with invasive medical or dental procedures. Before any of these procedures, antibiotic prophylaxis is necessary to prevent infection. Planning of an exercise program and monitoring anticoagulant therapy will be done

What is an effect of valvular regurgitation? A.) It causes a pressure gradient difference across an open valve B.) A pericardial friction rub is heard on the right sternal border of the chest C.) It leads to decreased flow of blood and hypertrophy of the preceding chamber D.) There is a backward flow of blood and volume overload in the preceding chamber

D d. Valvular regurgitation causes a backward flow of blood and volume overload in the preceding chamber. Without treatment, eventually hypertrophy of that chamber occurs. Stenosis causes a pressure gradient difference and decreased blood flow and hypertrophy of the preceding chamber. A pericardial friction rub is not related to valvular regurgitation but would be heard at the lower left sternal border of the chest

What accurately describes dilated CMP (select all that apply) A. Characterized by ventricular stiffness B. The least common type of cardiomyopathy C. The hyperdynamic systolic function creates a diastolic failure D. Echocardiogram reveals cardiomegaly with thin ventricular walls E. Often follows an infective myocarditis or exposures to toxins or drugs F. Differs from chronic heart failure in that there is no ventricular hypertrophy

D, E, F d, e, f. Dilated CMP, the most common type of CMP, reveals cardiomegaly with thin ventricular walls on echocardiogram, as there is no ventricular hypertrophy, and may follow an infective myocarditis. As well, stasis of blood in the ventricles may contribute to systemic embolization. Restrictive CMP is the least common type and is characterized by ventricular stiffness. Hypertrophic CMP has hyperdynamic systolic function creating a diastolic failure, is characterized by massive thickening of intraventricular septum and ventricular wall, and may result in syncope during increased activity resulting from an obstructed aortic valve outflow