Med Surg Ch 30 Cardiac Disorders

A patient with heart failure is prescribed an angiotensin-converting enzyme inhibitor. What should the nurse explain as being the purpose of this medication? 1) Reduce afterload 2) Decrease preload 3) Increase contractility 4) Control sympathetic nervous system response to decreased cardiac output

ANS: 1 Angiotensin-converting enzyme inhibitors (ACE-Is) are usually the first line of medications used to reduce afterload.

The nurse is concerned that a patient with heart failure is decompensating. What assessment finding supports the nurse's clinical decision? 1) Dyspnea on exertion 2) Dry persistent cough 3) Weak peripheral pulses 4) Increased urine output

ANS: 1 Dyspnea on exertion indicates deceased cardiac output and worsening heart failure.

The nurse explains about the development of tissue clumps within the innermost layer of the heart to a patient with infective endocarditis. What aspect of the disease process is the nurse describing? 1) Vegetation 2) Oxidation 3) Foam cells 4) Fatty streaks

ANS: 1 Infective endocarditis begins with damage to the endocardial lining of the heart, which leads to the development of nonbacterial thrombotic endocardial lesion. If the patient is exposed to microorganisms present in the bloodstream, they can become trapped under the layers of platelet and fibrin deposits. These clumps of tissue are known as vegetation.

After completing a physical assessment the nurse anticipates the health-care provider to prescribe diagnostic testing for valvular disease. What did the nurse assess to come to this conclusion? 1) Heart murmur 2) Carotid artery bruit 3) Bounding peripheral pulses 4) Displaced point of maximum impulse

ANS: 1 Often the first clinical sign of valvular disease is the auscultation of a murmur.

The nurse notes that a newly admitted patient has an elevated sedimentation rate. For which health problem should the nurse plan care for this patient? 1) Pericarditis 2) Heart failure 3) Pericardial effusion 4) Coronary artery disease

ANS: 1 Positive inflammatory markers such as sedimentation rates may indicate the presence of pericarditis.

The nurse is concerned that a patient is at risk for developing infective endocarditis. What information in the patient's history caused the nurse to have this concern? 1) 70 years of age 2) Treatment for osteoarthritis 3) Sister being treated for chronic renal failure 4) Diagnosed with benign prostatic hyperplasia

ANS: 1 Risk factors for infective endocarditis include age greater than 60

During an assessment a patient describes experiencing chest pain with exercise that disappears with rest. For which health problem should the nurse plan care for this client? 1) Stable angina 2) Variant angina 3) Unstable angina 4) Prinzmetal's angina

ANS: 1 Stable angina is chest pain or discomfort that is associated with physical activity. Symptoms of stable angina are often alleviated with rest.

A patient is demonstrating manifestations of valvular disease. Which valve should the nurse expect to be affected with this disorder? 1) Aortic 2) Mitral 3) Pulmonic 4) Tricuspid

ANS: 1 The most commonly affected valve is the aortic valve.

A patient with pericarditis is prescribed corticosteroids. What should the nurse emphasize when teaching about this medication? 1) Take the medication as prescribed 2) Increase the dose if symptoms get worse 3) Reduce the frequency when symptoms subside 4) Consider taking a dose every other day to reduce side effects

ANS: 1 The nurse should instruct the patient to not abruptly stop taking steroids even if feeling better. Properly tapering steroid dosages avoids acute adrenal insufficiency.

The nurse is caring for a patient with pericardial effusion. Which action should the nurse use to relieve shortness of breath and pain? 1) Elevate the head of the bed 2) Encourage ambulation in the room 3) Place in the left side-lying position 4) Coach in deep breathing and coughing

ANS: 1 The nurse should keep the head of the bed elevated. Pericardial effusion exerts pressure on surrounding organs, resulting in orthopnea and dyspnea. Raising the head of bed relieves shortness of breath. Pain is also relieved by sitting in the upright position.

A patient with pericarditis is being prepared for an emergency pericardiocentesis. What did the nurse most likely assess to support this immediate procedure? Select all that apply. 1) Hypotension 2) Pulsus paradoxus 3) Muffled heart sounds 4) Jugular vein distention 5) Lower extremity edema

ANS: 1, 2, 3, 4 1. If the fluid causing a pericardial effusion is not addressed, it can increase and cause cardiac tamponade, which is manifested by hypotension, 2. If the fluid causing a pericardial effusion is not addressed, it can increase and cause cardiac tamponade. Pulsus paradoxus may occur. 3. If the fluid causing a pericardial effusion is not addressed, it can increase and cause cardiac tamponade, which is manifested by muffled heart sounds. 4. If the fluid causing a pericardial effusion is not addressed, it can increase and cause cardiac tamponade, which is manifested by jugular vein distention.

The nurse notes that a patient with heart failure has a normal ejection fraction. What should this information indicate to the nurse? Select all that apply. 1) It is a common diagnosis 2) It is associated with older patients with obesity 3) It is seen in patients with diabetes mellitus and atrial fibrillation 4) It is exacerbated with invasive procedures and dental examinations 5) There is less blood in the ventricle to eject because of the impaired filling

ANS: 1, 2, 3, 5 1. There is growing evidence that diastolic dysfunction is becoming more common among patients diagnosed with HF. 2. Diastolic dysfunction is associated with patients who tend to be older and obese. 3. Diastolic dysfunction is seen in patients with diabetes mellitus and atrial fibrillation. 5. Diastolic dysfunction typically has a normal EF also known as HF with preserve EF (HFpEF). This is due to the fact that there is less blood in the ventricle to eject because of the impaired filling.

A patient with heart failure is having a B-type natriuretic peptide (BNP) level drawn. What is the purpose of this laboratory test? 1) Predict life expectancy 2) Rule out an ischemic event 3) Differentiate right from left heart failure 4) Evaluate effectiveness of medication therapy

ANS: 4 Cardiac biomarkers such as BNP are used to track a patient's response to therapy.

While planning care the nurse identified interventions to reduce a patient's risk for developing heart failure. Which assessment findings did the nurse use to make this clinical determination? Select all that apply. 1) Body mass index 31.3 2) Smokes 1/2 pack of cigarettes 3) Employed in a textile factory 4) Blood pressure 168/90 mm Hg 5) Fasting blood glucose 146 mg/dL

ANS: 1, 2, 4, 5 1. A risk factor for heart failure is obesity. 2. Smoking is a risk factor for the development of heart failure. 4. Hypertension is a risk factor for the development of heart failure. 5. Diabetes is a risk factor for the development of heart failure.

A patient is experiencing manifestations of infective endocarditis. Which diagnostic tests should the nurse expect to be prescribed for this client? Select all that apply. 1) Blood cultures 2) Ejection fraction 3) Electrocardiogram 4) Transthoracic echocardiogram (TTE) 5) Transesophageal echocardiogram (TEE)

ANS: 1, 3, 4, 5 1. Tests used to confirm infective endocarditis include blood cultures. 3. Tests used to confirm infective endocarditis include an electrocardiogram. 4. Tests used to confirm infective endocarditis include a TTE. 5. Tests used to confirm infective endocarditis include a TEE.

The nurse is preparing a community program on the metrics to improve cardiovascular health. What should be included in this program? Select all that apply. 1) Healthy diet 2) Alcohol intake 3) Physical activity 4) Smoking cessation 5) Lower blood pressure

ANS: 1, 3, 4, 5 1. The new concept "cardiovascular health" is geared to encouraging people to maintain seven metrics in order to achieve optimal cardiovascular health. These metrics include having a healthy diet. 3. The new concept "cardiovascular health" is geared to encouraging people to maintain seven metrics in order to achieve optimal cardiovascular health. These metrics include engaging in sufficient physical activity. 4. The new concept "cardiovascular health" is geared to encouraging people to maintain seven metrics in order to achieve optimal cardiovascular health. These metrics include not smoking. 5. The new concept "cardiovascular health" is geared to encouraging people to maintain seven metrics in order to achieve optimal cardiovascular health. These metrics include lower blood pressure.

A patient is admitted for treatment of pericarditis. For which additional health problem should the nurse expect the patient to be evaluated? 1) Asthma 2) Myocardial infarction 3) Infective endocarditis 4) Chronic obstructive pulmonary disease

ANS: 2 Acute pericarditis is a common occurrence following MI. It has been reported to occur in 7% to 41% of post-MI patients.

The nurse is caring for a patient with infective endocarditis. For which reason would a referral to social services be needed? 1) Lives with parents 2) Uses intravenous drugs 3) Taking a leave of absence from work 4) Has two terms of college to complete

ANS: 2 If drug use caused the disease, a referral to addiction counseling services would be indicated.

A patient is recovering from mechanical valve replacement surgery for valvular disease. What medication teaching should medication teaching should the nurse prepare for this patient? 1) Long-term use of diuretics 2) Anticoagulant therapy for life 3) Antibiotic therapy for four to six weeks 4) Episodic use of antiarrhythmic medications

ANS: 2 Patients who undergo valve replacement with a mechanical prosthetic valve will need to be anticoagulated for life to prevent thrombotic events.

The nurse is evaluating teaching provided to a patient with coronary artery disease. Which patient statement indicates that additional teaching is required? 1) "I will adhere to my smoking cessation plan." 2) "I am to reduce my daily intake of saturated fat." 3) "I can take up to three doses of nitroglycerin 15 minutes apart." 4) "I am to follow the exercise plan for 30 minutes, five days a week."

ANS: 3 A nitroglycerin administration regimen includes not exceeding three doses five minutes apart.A nitroglycerin administration regimen includes not exceeding three doses five minutes apart.

The nurse is explaining the development of atherosclerosis to a patient. What should the nurse emphasize as beginning this process? 1) Oxidation 2) Inflammatory process 3) Injury to the vessel wall 4) Trapping of low-density lipoproteins

ANS: 3 Atherosclerosis begins with an injury to the endothelium.

During a home visit the nurse determines that teaching provided to a patient recovering from infective endocarditis has been effective. What did the nurse observe to make this clinical determination? 1) Drinking skim milk 2) Measuring radial pulse 3) Using a soft toothbrush 4) Taking anticoagulant daily

ANS: 3 For the patient with infective endocarditis food oral hygiene utilizing a soft toothbrush is essential. Bleeding gums provide a portal of entry for bacteria into the bloodstream. Poor dental hygiene exacerbates the problem.

The nurse is preparing teaching for a patient being treated for coronary artery disease. What dietary information should the nurse emphasize? 1) Restrict carbohydrate intake 2) Limit calorie intake to under 1000/day 3) Reduce saturated fat and sodium intake 4) Have the biggest meal of the day for lunch

ANS: 3 It is important for patients with CAD to follow a sensible diet that is low in saturated fat and sodium.

The nurse applies oxygen two liters via nasal cannula on a patient with coronary artery disease. What should the nurse explain as being the purpose of the oxygen? 1) Ensures vessel dilation 2) Ensures perfusion to cerebral tissues 3) Supports myocardial oxygen demand 4) Facilitates the metabolism of medications

ANS: 3 The patient with CAD is prone to experiencing increased myocardial oxygen consumption. Administering oxygen will help supplement the body's need for oxygen.

A patient with infective endocarditis is being started on intravenous antibiotics. What should the nurse include when teaching about this medication? 1) "The medication may be changed every few days." 2) "The typical course of this medication is 7 to 10 days." 3) "Expect to continue this medication for four to six weeks at home." 4) "Since this infection is resilient, you might be taking antibiotics for life."

ANS: 3 The standard duration of treatment is 4 to 6 weeks. These patients are often discharged to home on IV antimicrobial therapy.

A patient is scheduled for an exercise stress test. For which cardiac health problems is this patient being tested? Select all that apply. 1) Pericarditis 2) Heart failure 3) Valvular disease 4) Infective endocarditis 5) Coronary artery disease

ANS: 3, 5 3. Diagnostic tests used to diagnose valvular disease include stress testing to identify functional capacity. 5. A patient with suspected coronary artery disease may undergo an exercise stress test. This is done to assess the function of the heart during exercise.

After an assessment the nurse concludes that a patient is experiencing infective endocarditis. What finding caused the nurse to make this decision? 1) Friction rub 2) Chest pain at rest 3) Jugular vein distention 4) Painless spots on the palms and soles

ANS: 4 Clinical manifestations of infective endocarditis include red, painless spots on the palms and soles, called Janeway's lesions.

A patient with pericarditis asks the nurse to explain the health problem. Which phrase should the nurse use when responding to this patient? 1) Heart cell dysfunction 2) Plaque buildup in vessels 3) Infection of the innermost layer of the heart 4) Inflammation of the tissue surrounding the heart

ANS: 4 Inflammation of the tissue surrounding the heart describes pericarditis.