more cardiac practice

Rheumatic carditis Clinical manifestations are

tachycardia, cardiomegaly, a new murmur or a change in an existing murmur, pericardial friction rub, precordial pain, prolonged PR interval, indications of HF, streptococcal infection, and enlarged lymph nodes.

A client has been taking furosemide (Lasix) and valsartan (Diovan) for the past year. The hospital laboratory notifies the nurse that the client's serum potassium level is 6.2 mEq/L. What is the nurse's best action at this time? A. Assess the client's oxygen saturation level. B. Ask the laboratory to retest the potassium level. C. Give potassium as an IV infusion. D. Check the client's serum creatinine.

D Rationale: Clients who are hyperkalemic (those with an elevated serum potassium level) may also be in renal failure. The client's serum creatinine should be reviewed to determine if it is greater than 1.8 mg/dL, at which time the health care provider should be notified before administering any supplemental potassium.

transplanted heart _______ are not used because they do not have their usual effects on the new heart.

Atropine, digoxin, and carotid sinus pressure

Echocardiography is the best tool in diagnosing

HF, cardiac valvular changes, pericardial effusion, chamber enlargement, ventricular hypertrophy, and ejection fraction.

Typical causes of left-sided ventricular failure include

hypertensive, coronary artery, and valvular disease involving the mitral or aortic valve.

Impaired perfusion, pulmonary congestion, and edema indicate

left ventricular failure

Nitrates are administered cautiously to patients with aortic stenosis because of the

potential for syncope associated with a reduction in left ventricular volume (preload).

Interventions to improve stroke volume include

reducing afterload, reducing preload, and improving cardiac muscle contractility.

Vasodilators such as calcium channel blockers may be used to reduce the ________ for patients with mitral or aortic stenosis.

regurgitant flow

Mitral stenosis usually results from _________, which can cause valve thickening by fibrosis and calcification.

rheumatic carditis

Systemic venous congestion and peripheral edema indicate

right ventricular failure.

When cardiac output is insufficient to meet the demands of the body:

compensatory mechanisms attempt to improve cardiac output.

Rheumatic carditis Inflammation is evident in

all layers of the heart and results in impaired contractile function of the myocardium, thickening of the pericardium, and valvular damage.

A client is diagnosed with left-sided heart failure. Which assessment findings will the nurse expect the client to have? Select all that apply. A. Peripheral edema B. Crackles in both lungs C. Breathlessness D. Ascites E. Tachypnea

B, C, E Rationale: Clients with left-sided heart failure will exhibit symptoms such as fatigue, dyspnea or breathlessness, and crackles on auscultation of breath sounds. Peripheral edema and ascites are associated with right-sided heart failure.

Teach the patient with valvular dysfunction, cardiac infection, or cardiomyopathy the necessity of taking preventive

antibiotic therapy before any invasive procedure.

For patients with a myocardial infarction and resultant HF, morphine sulfate is given to reduce

anxiety, decrease preload and afterload, slow respirations, and reduce pain.

A client is admitted to the telemetry unit after a right-sided cardiac catheterization. What is the nurse's priority when caring for this client? A. Assess the intensity and quality of the client's pain. B. Position the client in a sitting position to improve breathing. C. Check the client's arterial insertion site. D. Apply oxygen at 2 L/min via nasal cannula.

C Rationale: Patients who have had cardiac catheterization should be restricted to short-term bedrest, and the insertion site extremity should be kept straight. The nurse should assess the insertion site for bloody drainage or hematoma formation because complications with vascular closure devices are not common but can be very serious.

_______, which occurs in almost half of patients with rheumatic fever, develops after upper respiratory tract infection with a group A beta-hemolytic streptococcus.

Rheumatic carditis

_______ therapy is the only definitive treatment of aortic stenosis and is recommended when angina, syncope, or dyspnea on exertion develops.

Surgical

Valve treatment Nonsurgical management focuses on drug therapy, including

diuretics, beta blockers, digoxin, and oxygen, and rest.

cardiac tamponade

excessive fluid within the pericardial cavity, restricting diastolic ventricular filling and cardiac output.

Compensatory mechanisms include

sympathetic nervous system stimulation, renin-angiotensin system activation, chemical responses, and myocardial hypertrophy.

An older adult taking digoxin and hydrochlorothiazide (HCTZ) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 48. A family member states that the client has reported blurred vision and loss of appetite for 2 weeks. What is the nurse's first action? A. Call the ED physician immediately. B. Draw a serum digoxin level. C. Assess for signs of hypokalemia. D. Establish the client's airway.

: B Rationale: The clinical manifestations of digoxin toxicity are often vague and nonspecific and include anorexia, fatigue, blurred vision, and changes in mental status, especially in older adults. Older adults are more likely than other patients to become toxic because of decreased renal excretion.

A client who had open abdominal surgery 4 hours ago reports feeling weak and dizzy. The client's current blood pressure has decreased to 98/50, and pulse rate is 108. What is the nurse's best action at this time? A. Document the vital signs, and continue to monitor the client. B. Remind the client to stay in bed if feeling weak and dizzy. C. Call the health care provider immediately. D. Increase the client's IV rate to restore fluid volume.

C Rationale: Surgery or trauma may cause ventricular fibrillation. Symptoms may include faintness, loss of consciousness, and then apnea with pulselessness. The nurse should contact the health care provider immediately.