NCLEX Review: Structural, Infectious, & Inflammatory Cardiac Disorders

A student studying aortic stenosis is asking about signs and symptoms of this disorder. Which of the following are symptoms of aortic stenosis? Select all that apply 1. angina 2. dyspnea 3. syncope 4. thrill/vibration 5. murmur

1, 2, 3, 4, 5 All are s/s. The patient should lean forward in order for the nurse to best auscultate the murmur.

A patient recently diagnosed with MS asks, "what are some things that may make my symptoms worse?" Which of the following will make MS symptoms worse? Select all that apply 1. Exercise 2. Stress 3. Pregnancy 4. Infection 5. Coffee 6. Strenuous activities and competitive sports

1, 2, 3, 4, 5, 6 Triggers for MS symptoms are: exercise, stress, pregnancy, infection, and other things that increase the heart rate (caffeine, tobacco, etc.) Patients are advised to avoid strenuous activities and competitive sports.

A nursing student is sorting out signs and symptoms of valve disorders. Which of the following are symptoms of mitral stenosis? Select all that apply 1. PND (paroxysmal nocturnal dyspnea) 2. A fib 3. hoarseness 4. weight loss, especially in the abdominal cavity 5. peripheral edema

1, 2, 3, 5 4: ascites, not weight loss, may occur

A nursing student is learning about chronic mitral regurgitation and wants to know about signs and symptoms commonly seen. Which of the following are common signs and symptoms? Select all that apply 1. fatigue 2. tachycardia 3. weakness 4. spontaneous bleeding 5. DOE and PND 6. sudden inability to breathe and chest pain

1, 2, 3, 5 4: incorrect 6: this is seen with ACUTE mitral regurgitation, not chronic

A nursing instructor is teaching her students about the pathophysiology of aortic stenosis. Which of the following are incorrect statements? Select all that apply 1. The LV overcomes by contracting more strongly and slowly than normal, to forcibly squeeze the blood through the smaller orifice 2. When the L ventricle has to squeeze strongly, the ventricular wall often hypertrophies and dilates. 3. Pulmonary congestion is rare 4. Right HF is also rare 5. L Arterial Pressure may increase

3, 4 Pulmonary congestion and R heart failure may be seen

The nurse is monitoring a client with acute pericarditis for signs of cardiac tamponade. Which assessment finding indicates the presence of this complication? 1.Flat neck veins 2.A pulse rate of 60 beats/min 3.Muffled or distant heart sounds 4.Wheezing on auscultation of the lungss

3. Assessment findings associated with cardiac tamponade include tachycardia, distant or muffled heart sounds, jugular vein distention with clear lung sounds, and a falling blood pressure accompanied by pulsus paradoxus (a drop in inspiratory blood pressure greater than 10 mm Hg). Bradycardia is not a sign of cardiac tamponade.

When discussing treatment of aortic stenosis with a student, which of the following is incorrect information? 1. Most patient remain asymptomatic for years without intervention 2. Nitrates may be prescribed for the treatment of syncope 3. Digoxin may be used to treat LV dysfunction 4. With critical AS, strenuous exercise may be avoided.

2. Nitrates may be prescribed for angina, not syncope. Orthostatic hypotension and syncope are SIDE EFFECTS of Nitrates.

Which of the following patients is a good candidate for a heart transplant, assuming all patients have exhausted all other means of therapy: 1) Sara, a 45 year old female with severe cerebrovascular disease 2) Tim, a 52 year old male with severe PVD. 3) Angela, a 49 year old female with HCM and pulmonary hypertension that responding well to treatment. 4) Nick, a 35 year old male with stage 2 testicular cancer.

3) Severe cerebrovascular disease, severe peripheral vascular disease, and malignancy are all contraindications for a heart transplant.

During an assessment, how can a nurse differentiate the pain of pericarditis from the pain of an MI? 1) Have the patient hold his/her breath while auscultating lung sounds. 2) Question when the pain began, then check O2 sats. 3) Identify whether or not the pain is intensified by coughing and deep breathing. 4) Obtain a thorough health history, and question family history of MI and pericarditis.

3) Recognizing that deep inspiration or coughing intensifies pain may help to differentiate the pain of pericarditis from the pain of MI. (page 458)

Which of the following is an incorrect statement about hypertrophic cardiomyopathy? 1) During diastole, ventricular filling is impaired. 2) A smaller-than-normal left ventricle cavity creates high-velocity blood flow from the LV into the aorta. 3) The ejection fraction is typically at or below 40%. 4) Cardiac output is diminished, and A-fib may happen due to an enlarged atrium.

3) The ejection fraction is normal or above normal.

Which of the following do all cardiomyopathies have in common? 1) increased EF 2) decreased EF 3) decreased CO 4) increased CO

3) p. 448

Which of the following are risk factors for developing pericarditis: Select all that apply 1) recent MI 2) female gender over male gender 3) lupus 4) rheumatoid arthritis 5) autoimmune disorders

1, 3, 4, 5 2: males more likely

Which of the following are risk factors for developing aortic regurgitation/insufficiency? Select all that apply 1. rheumatic heart disease 2. Infective endocarditis 3. Marfan's syndrome 4. Dissecting aortic aneurysms 5. Bicuspid aortic valve

1, 2, 3, 4, 5

Which of the following are often the first signs of cardiac tamponade? Select all that apply 1) shortness of breath 2) dizziness 3) chest pain 4) restlessness 5) bradycardia

1, 2, 3, 4 5) Tachycardia may be present, not bradycardia In addition, a nurse might see pulsus paradoxus- a decrease in 10 mm Hg or more in the systolic BP during inspiration. She also may see distant/imperceptible heart sounds or neck vein distention. Stay with the patient and notify HCP.

A patient is diagnosed with pericarditis and pericardial effusion. Based on the physiological mechanisms of increased pericardial fluid and its effects on the heart, which of the following effects would be expected? 1) inability of the ventricles to fill and extend adequately 2) increased venous return 3) decreased L ventricular end-diastolic pressures 4) decreased R ventricular end-diastolic pressures

1)

After undergoing a pericardiocentesis and withdrawal of pericardial fluid, which of the following indicates that cardiac tamponade has been relieved? 1) decrease in central venous pressure (CVP) 2) decrease in BP 3) absence of cough 4) increase in CVP

1)

A new nurse understands that with mitral stenosis, which of the following is happening? 1. The valve orifice is narrowed between the L atrium and the L ventricle 2. The valve orifice is widened 3. Blood flows backwards from the L. Ventricle into the L. Atrium 4. The valve is narrowed between the LV and the aorta.

1) 2: This is incorrect 3: This is mitral regurgitation 4: This is aortic stenosis

A nurse has just received morning report on a 45 year-old male patient with cardiomyopathy; however, she was not told the type of cardiomyopathy by the night nurse. The patient has just received his morning dose of Coumadin. Based on this information, the nurse suspects which type of cardiomyopathy: 1) Dilated 2) Hypertrophic 3) Stress-Induced 4) Restrictive

1) Patients with dilated cardiomyopathy have a thinned left vetricular muscle, so more blood is left in the ventricle after systole. This blood can pool and cause atrial or ventricular thrombi, which may embolize to other locations in the body.

A nursing student is talking to her nursing instructor about what she knows about heart transplants. Which of the following statements would require correction by the instructor? 1) "Heart transplants usually include the donor giving his or her aorta, pulmonary artery, and vena cavae in addition to the heart." 2) "Individuals who have had heart transplants are always balancing rejection and infection. They also might experience a form of crazy CAD, called cardiac allograft vasculopathy." 3) "A medication called Tacrolimus might be used as an immunosuppressant." 4) "The new heart is denervated, so the patient must gradually increase and decrease their exercise. Even Atropine won't affect this heart rate."

1) This is incorrect. The recipient usually uses his own aorta, vena cavae, and pulmonary artery.

Which of the following are common risk factors that can lead to mitral stenosis? Select all that apply 1. Rheumatic fever, MS occurring 20-40 years afterwards 2. Radiation therapy to the chest area 3. Radiation therapy to the abdominal area 4. A diet high in fat and low in protein 5. Poor diet and exercise combination

1, 2

A nursing student is sorting out signs and symptoms of valve disorders. Which of the following are symptoms of mitral stenosis? Select all that apply 1. DOE (dyspnea on exertion) 2. Fatigue 3. Pulmonary congestion 4. Low cardiac output 5. Excessive hunger

1, 2, 3, 4 1: pulmonary congestion 2: related to low CO 3: related to the back of of the L atrium, which backs up into the lungs 4: the mitral valve is tiny, so the blood isn't getting through well

A nursing student asks her instructor, "what will a patient with MVP appear like?" The nursing instructor is correct if she names which of the following as symptoms of MVP: Select all that apply 1. The patient is often asymptomatic, but you may see dyspnea. 2. Lightheadedness 3. Ecchymosis 4. Palpitations 5. Chest pain and shortness of breath correlated with activity

1, 2, 4 3: incorrect 5: incorrect; both chest pain and SOB can be seen, but they are NOT correlated with activity

Your neighbor tells you that her sister was recently diagnosed with aortic stenosis, and she tells you, "I don't want to have aortic stenosis. What are some risk factors?" Select all that apply 1. Hypercholesterolemia 2. History of rheumatic valve disease 3. Diabetes Mellitus Type 2 4. Congenital bicuspid aortic valve 5. Young age

1, 2, 4 3: incorrect 5: incorrect; old/advancing age is a risk factor

You are caring for a patient recently diagnosed with aortic regurgitation/aortic insufficiency. Which of the following signs and symptoms would you expect to see? Select all that apply 1. Palpitations 2. Visible neck vein pulsations 3. Randomized bursts of energy 4. Angina 5, Maybe no symptoms- the patient may be asymptomatic for years

1, 2, 4, 5 3: incorrect; fatigue may be seen

A nurse knows that which of the following are s/s of hypertrophic cardiomyopathy? Select all that apply 1) syncope 2) dyspnea 3) V-fib 4) Systolic ejection murmur 5) Mitral murmur

1, 2, 4, 5, 3: A-fib, not V-fib, may be present.

A symptomatic patient newly diagnosed with MVP is questioning how she will be treated. Which of the following may be used? Select all that apply 1. Beta blockers 2. Calcium channel blockers 3. ACE inhibitors 4. Reduction of alcohol to 8 oz. a day for women, and 12 oz. a day for men 5. Elimination of caffeine and cold medicines containing ephedrine and epinephrine

1, 2, 5 3: not listed on p. 442 4: Alcohol is eliminated completely, along with caffeine

Which of the following are nursing actions that are implemented across the board for cardiomyopathies? Select all that apply 1) Have patient maintain bed rest to reduce cardiac output and oxygen demands 2) Have patient refrain from all physical activity 3) Asking patient o report symptoms that occur during physical activity 4) Have equipment readily available to treat life-threatening arrhythmias 5) Perform cardiovascular assessment every shift

1, 3, 4 2) physical activity should be increased slowly 5) a cardiovascular assessment should be performed more often than once a shift to assess for signs of worsening HF (dyspnea, peripheral edema, and abnormal heart sounds) and arrhythmias.

A nursing student is helping a peer learn about things that can occur as a result of mitral regurgitation (mitral insufficiency). Which of the following are correct? 1. Regurgitation of blood into the L atrium causes L atrial pressure to rise 2. The L atrium rarely hypertrophies and almost never dilates 3. The L ventricle may hypertrophy to accommodate all that extra blood that is regurgitating into the L atrium 4. Pulmonary congestion may occur 5. The R ventricle may enlarge or even fail 6. Having MVP or mitral valve stenosis rarely contributes to mitral regurgitation

1, 3, 4, 5 2: The L atrium will hypertrophy and dilate 6: Incorrect; these contribute to mitral regurgitation

Which of the following are risk factors for infective endocarditis? Select all that apply 1) body piercings 2) young age 3) prosthetic cardiac valves 4) IV drug use 5) indwelling catheters

1, 3, 4, 5 Others include: MVP, mitral regurgitation

A patient asks you, "why do I have MVP?" Which of the following are risk factors? Select all that apply 1. Female gender 2. Male gender 3. Advanced age (over 50) 4. Family history 5. Young age (under 25)

1, 4 Page 443

A client is admitted to the hospital with a diagnosis of aortic regurgitation. The nurse plans care for the client, knowing that the failure of the aortic valve to close completely allows blood to flow retrograde through which structures? 1.Aorta to left ventricle 2.Left ventricle to left atrium 3.Right ventricle to right atrium 4.Pulmonary artery to right ventricle

1. The aortic valve separates the aorta from the left ventricle. Options 2, 3, and 4 describe the mitral, tricuspid, and pulmonic valves, respectively.

A patient who recently received a tissue prosthetic valve presents to you with a fever, symptoms of heart failure, and a new murmur. What do you suspect? 1: DVT that led to a PE 2: Endocarditis 3: Renal failure 4: MVP

2

Which of the following are symptoms of pericarditis? Select all that apply 1) productive cough 2) dyspnea 3) pleural friction rub 4) shortness of breath 5) ataxia

2, 4 1) cough is NONproductive 3) PERICARDIAL friction rub is present 5) not listed

Which of the following nursing interventions is inappropriate for a patient with pericarditis? 1) Have the patient sit upright and lean forward if chest pain occurs. 2) Activity should be restricted for 72 hours. 3) If chest pain and friction rub recur after activity, chair/bed rest should be re-implemented. 4) Frequent rest periods are necessary.

2) Incorrect Activity is restricted until pain resides; then, activity is resumed gradually.

A client is admitted to the hospital with a diagnosis of pericarditis. The nurse should assess the client for which manifestation that differentiates pericarditis from other cardiopulmonary problems? 1.Anterior chest pain 2.Pericardial friction rub 3.Weakness and irritability 4.Chest pain that worsens on inspiration

2. A pericardial friction rub is heard when inflammation of the pericardial sac is present during the inflammatory phase of pericarditis. Anterior chest pain may be experienced with angina pectoris and myocardial infarction. Weakness and irritability are nonspecific complaints and could accompany a wide variety of disorders. Chest pain that worsens on inspiration is characteristic of both pericarditis and pleurisy.

A client is admitted to the hospital with a diagnosis of mitral stenosis. The narrowing of this valve will impede circulation of blood through which structures? 1.Left ventricle to aorta 2.Left atrium to left ventricle 3.Right atrium to right ventricle 4.Right ventricle to pulmonary artery

2. The mitral valve separates the left atrium from the left ventricle. Options 1, 3, and 4 describe the aortic, tricuspid, and pulmonic valves, respectively.

A patient with MVP, with no symptoms, asks how she will be treated. Which of the following is correct? 1. Echo every 2-5 years is necessary 2. No treatment is necessary 3. Beta blockers 4. Calcium channel blockers

2. If patients are asymptomatic, no treatment is required

Which of the following is the most common complication of prosthetic valves? 1. hemorrhage 2. high BP 3. thromboembolism 4. confusion and dizziness

3 - Warfarin 48 hr after surgery

For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations? 1) dyspnea 2) edema 3) L ventricular dysfunction 4) angina

3)

A nursing instructor questions her students about some things that may happen due to aortic regurgitation (aortic insufficiency). Which of the following are incorrect? 1. The LV may dilate and hypertrophy to accommodate that backward blood flow from the aorta. 2. The afterload and ejection fraction may be reduced, due to the hypertrophy and dilation. 3. Systolic blood pressure may rise, but the vessels may try to dilate to compensate. 4. When L ventricular dysfunction occurs, symptoms may develop.

2: Incorrect Dilation and hypertrophy allow the LV to expel more blood with above-normal force, increasing afterload and, as a result, systolic blood pressure, while maintaining a normal ejection fraction.

A nursing student asks, "how do we diagnose mitral stenosis and mitral valve prolapse?" Which of the following is used to diagnose mitral stenosis? 1. 12 lead EKG monitoring 2. Echocardiogram 3. History and physical exam findings 4. Cardiac catheterization

2: This is the most sensitive and specific noninvasive method to diagnose MS and MVP. 1: incorrect 3: incorrect, although this is used and is important 4: Cardiac cath is not indicated unless clinical findings and echo results don't match up.

A nursing student is listening to the heart sounds of someone with mitral stenosis. The student hears a diastolic murmur, and asks why she hears this. Which answer, if made by the instructor, is correct? 1. "This is caused by the quick snapping of the mitral valve." 2. "This is caused by the very delayed snapping of the mitral valve." 3. "This is caused by turbulent blood flow through the abnormally tight valve opening." 4. "This is caused by blood pressing hardly against a valve that will not open. Feel her weak and irregular pulse in relation to her A-fib?"

3 However, a weak and irregular pulse is related to A fib (#4).

The home health nurse is visiting a client who has had a prosthetic valve replacement for severe mitral valve stenosis. Which statement by the client reflects an understanding of specific postoperative care after this surgery? 1."I need to count my pulse every day." 2."I have to do deep breathing exercises every 2 hours." 3."I threw away my straight razor and bought an electric razor." 4."I have to go to the bathroom frequently because of my medication."

3. Prosthetic valves require long-term anticoagulation to prevent clots from forming on the "foreign" tissue implanted in the client's body. Anticoagulation therapy requires clients to avoid any trauma or potential means of causing bleeding, such as the use of straight razors. Counting pulse, deep breathing exercises, and going to the bathroom frequently are not specifically related to postoperative care after prosthetic valve replacement.

Which of the following is a true statement made about aortic valve repair and replacement in relation to aortic stenosis? 1. Surgical replacement of the aortic valve is temporary treatment for aortic stenosis 2. Patients with mild to moderate symptoms should receive an aortic valve repair 3. Once the patient develops angina, HF, or syncope, there is a significant decline in survival rate. 4. Patients who have symptoms but do not qualify for for surgery rarely benefit from purcutaneous aortic balloon valvuloplasty.

3. Correct 1: This is definitive treatment for aortic stenosis 2: This is for patients with severe symptoms 4: Patients often, not rarely, benefit from a valvuloplasty if they don't qualify for valve replacement.

A nursing instructor asks you to explain what water-hammer (Corrigan's pulse) is. Which definition is correct? 1. This is when the pulse is very weak and thready, and has a rapid upstroke and then collapses. It is seen in Mitral Regurgitation (Mitral Insufficiency). 2. This is when the pulse has a rapid upstroke and then collapses. It is seen with Mitral Regurgitation (Mitral Insufficiency). 3. This is when the pulse has a rapid upstroke and then collapses. It is seen with Aortic Regurgitation (Aortic Insufficiency). 4. This is when the pulse is very weak and thready, and has a rapid upstroke and then collapses. It is seen in Aortic Regurgitation (Aortic Insufficiency).

3: Correct

Which of the following statements is correct about tissue and mechanical valve prostheses? 1. Mechanical valve replacement doesn't require anticoagulation therapy, but it isn't very durable. 2. The major advantage of tissue valve replacement is that it is very durable. 3. The major advantage of mechanical valve replacement is that it is very durable. 4. The major disadvantage of tissue valve replacement is that it requires long term anticoagulation therapy.

3: Correct 1: Mechanical valve replacement DOES require long term anticoagulation therapy, but it is very durable. 2: Tissue valve replacement is less durable, but long term anticoagulation therapy isn't required. 4: Tissue valve replacement is less durable, but long term anticoagulation therapy isn't required.

A nursing student is discussing with her teacher some of the pathophysiology of mitral valve stenosis. Which of the following is an incorrect statement? 1. Normally, the mitral valve is as wide as three fingers, but in stenosis it can shrink down to the width of a pencil. 2. The L atrium will dilate and hypertrophy, due to the increased pressure caused by slow blood flow into the LV 3. Pulmonary venous pressure often decreases, because the blood pools in the atrium and diminishes supply to the pulmonary veins. This can cause R ventricular enlargement. It can even cause R atrial enlargement. 4. It is important to watch for clots, because the blood can't flow well into the LV, so it sits in the atrium and pools.

3: Incorrect. Pulmonary venous pressure will raise. The L atrium can't pump its blood into the L ventricle, so it sits there and pools in the atrium, which can cause clots. If the blood moves so sluggish in the L atrium that it backs up into the pulmonary veins, this will INCREASE pulmonary pressure. The R ventricle then has to pump harder against an increased pulmonary pressure, and this can make the RV (and even the R atrium) enlarged. Eventually, ventricles fail.

Pam has just been diagnosed with Aortic Insufficiency and is asking about her treatment regimen. Which statement, if made by Pam, MOST indicates the need for further teaching: 1. "I may be put on a Vasodilator, and this would help to reduce the afterload in my heart. At least, I think that's what the doctor told me." 2. "I used to take Metoprolol everyday, but I guess I won't be taking that now..." 3. "My acute Aortic Insufficiency may be treated with a potent vasodilator. Can you teach me more about those medications?" 4. "I heard that I won't be taking medications called Calcium Channel Blockers. I never took those anyway, so who cares."

3: Incorrect; ACUTE aortic insufficiency is a surgical emergency, and will be treated immediately. CCBs and BBs are contraindicated in patients with aortic regurgitation, so Pam is correct with 2 and 4. Vasodilators may be used to decrease afterload, so Pam is also correct with 1.

This student now feels comfortable with the signs and symptoms of aortic stenosis, but is now questioning how this valvular disorder is diagnosed. Which of the following is incorrect? 1. Diagnosed by echocardiography 2. Patients with symptoms usually have an echo every 6-12 months 3. Patients without symptoms have echos every 18-24 months. 4. Cardiac cath may be used

3: Patients w/o symptoms have echos every 2-5 years

What is the best way to assess cardiac output and oxygenation status in a patient with an LVAD? 1) assess peripheral pulses 2) auscultate lung sounds 3) O2 saturation readings 4) assess cognition

4) Pulses will not be palpable in someone with an LVAD.

Which of the following orders would the nurse question for a patient with cardiomyopathy? 1) Carvedilol after decompensated cardiomyopathy has stabilized 2) Lisinopril 3) Eplerenone 4) Nitrate

4) Nitrates and dehydration should be avoided to maintain CO

Which of the following does NOT apply to dilated cardiomyopathy? 1) The ventricles are irreversibly dilated, so less blood is ejected during systole. 2) There is systolic dysfunction, but no hypertrophy is present. 3) The ventricles are thinned. 4)The ejection fraction is normal or slightly increased.

4) The ejection fraction is reduced

The nurse is teaching a client with cardiomyopathy about home care safety measures. The nurse should address with the client which most important measure to ensure client safety? 1.Assessing pain 2.Administering vasodilators 3.Avoiding over-the-counter medications 4.Moving slowly from a sitting to a standing position

4. Orthostatic changes can occur in the client with cardiomyopathy as a result of venous return obstruction. Sudden changes in blood pressure may lead to falls. Vasodilators normally are not prescribed for the client with cardiomyopathy. Options 1 and 3, although important, are not directly related to the issue of safety.

A client is being discharged from the hospital after being treated for infective endocarditis. The nurse should provide the client with which discharge instruction? 1.Take antibiotics until the chest pain is fully resolved. 2.Take acetaminophen (Tylenol) if the chest pain worsens. 3.Use a firm-bristle toothbrush and floss vigorously to prevent cavities. 4.Notify all health care providers (HCP) of the history of infective endocarditis before any invasive procedures.

4. The client should alert any HCP about the history of infective endocarditis before any procedure that involves instrumentation. The HCP should place the client on prophylactic antibiotics if an invasive procedure is needed. Antibiotics should be taken for the full course of therapy. The client should notify the HCP if chest pain worsens or if dyspnea or other symptoms occur. The client should use a soft toothbrush and floss carefully to avoid any trauma to the gums, which could provide a portal of entry for bacterial infection.

Which of the following patients may benefit more from a tissue valve replacement rather than a mechanical valve replacement? 1. A 35 year old female with acute AS who has 5 children at home and is a newly-divorced single mother. 2. A 54 year old male, who is a widower with 2 cats, who has renal failure and receives dialysis treatments 3 times a week. 3. A 61 year old married female with endocarditis, who has recovered from an episode of sepsis 6 months ago. 4. An 89 year old male, living at home with his wife, who has stage 4 lung cancer that has metastasized to his brain.

4: Correct; mechanical valve replacement is usually used for patients who have at least 15 years to live, and for patients with renal failure, endocarditis, and sepsis who can't risk the infection associated with tissue valve replacement. Although this patient is at increased risk for infection, he would be most likely out of the other 4 to receive a tissue valve replacement due to his end-stage cancer and age. 1: she has acute AS, and has at least 15 years to live, so I would expect her to receive a mechanical valve. 2: renal failure calls for a mechanical valve 3: sepsis and endocarditis call for a mechanical valve 4: correct

Which of the following patients may benefit more from a mechanical valve replacement rather than a tissue valve replacement? 1. A 6 year old female who will have involved parental support in medication management. 2. An 85 year old male who lives at Riverside Convalescent Center and receives weekly visits from his daughter. 3. A 23 year old recently-married female who has just begun taking prenatal vitamins. 4. A 55 year old female who runs for 2 hours each morning, with a history of a broken arm.

4: This patient is not of child-bearing age, she doesn't have an apparent bleeding disorder, she isn't over 70, she isn't a child, and we don't know that she's nonadherent with her treatment, so she is the best candidate out of the 4 to receive a mechanical, rather than a tissue, valve replacement. 1: this patient is a child, and she cannot be on long term anticoagulation therapy required after mechanical replacement 2: this patient is over 70, so she would qualify for tissue replacement 3: this woman is of child-bearing age and clearly intends to get pregnant, so a tissue valve would be better for her

The primary causes of death in patients with heart transplants in the first year include A. infection and rejection. B. rejection and arrhythmias. C. arrhythmias and infection. D. myocardial infarction and lymphoma.

A. infection and rejection.

A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of peripheral pulses. The nurse's initial action should be to A. notify the physician. B. elevate the leg to promote venous return. C. wrap the leg in a blanket to provide warmth. D. perform passive range of motion to stimulate circulation to the leg.

A. notify the physician.

A patient with a tricuspid valve disorder will have impaired blood flow between the A. vena cava and right atrium. B. left atrium and left ventricle. C. right atrium and right ventricle. D. right ventricle and pulmonary artery.

C. right atrium and right ventricle.

The nurse plans care for the patient with dilated cardiomyopathy based on the knowledge that A. family members may be at risk because of the infectious nature of the disease. B. medical management of the disorder focuses on treatment of the underlying cause. C. the prognosis of the patient is poor, and emotional support is a high priority of care. D. the condition may be successfully treated with surgical ventriculomyotomy and myectomy.

C. the prognosis of the patient is poor, and emotional support is a high priority of care.

Ralph Wilson, is a 52-year-old client in the hospital unit where you practice nursing. He is being treated for myocarditis. Which of the following nursing interventions should you perform to reduce cardiac workload in a client with myocarditis? a) Maintain the client on bed rest b) Administer a prescribed antipyretic c) Eliminate all phone calls and visitors d) Elevate the client's head

a)

The nurse is auscultating the heart of a patient diagnosed with mitral valve prolapse. Which of the following is often the first and only manifestation of mitral valve prolapse? a) Dizziness b) An extra heart sound c) Fatigue d) Syncope

b)

During the cardiac assessment, the nurse learns a client had rheumatic heart fever as a child. For which of the following cardiac conditions should this client be assessed? a. Pulmonic stenosis b. Aortic stenosis c. Mitral regurgitation d. Mitral stenosis

d. Mitral stenosis