Chapter 28: Managements of Patients With Structural, Infectious and Inflammatory Cardiac Disorders

A nurse is teaching a client about valve replacement surgery. Which statement by the client indicates an understanding of the benefit of an autograft replacement valve?

"The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged."

A nurse is teaching a client who is having a valuloplasty tomorrow. The client asks what the advantage is for having a tissue valve replacement instead of a mechanical valve. The correct answer by the nurse is which of the following?

"A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required."

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."

A patient with endocarditis is being discharged home. In evaluating the effectiveness of patient teaching about how to prevent recurrence of the infection, the student nurse would expect the patient to state

"I will ask for antibiotics whenever I have dental work done."

An asymptomatic client questions the nurse about the diagnosis of mitral regurgitation and inquires about continuing an exercise routine. Which is the most appropriate response by the nurse?

"Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop."

The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?

"Have you been to the dentist recently?"

The nurse determines that a 49-year-old client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?

"I have to call my doctor so I can get antibiotics before seeing the dentist."

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."

After a new graduate nurse completes an assessment of a patient with mitral regurgitation, she approaches her preceptor to report her findings. Which of the following statements represents the appropriate physical findings for a patient with mitral regurgitation?

"The high-pitched blowing sound at the apex is indicative of a systolic murmur."

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."

Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply.

- Elevated c-reactive protein - Elevated white blood cell (WBC) count - Elevated erythrocyte sedimentation rate (ESR)

A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider.

3.8

A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. Which of the following instructions would provide that information?

Alternate active periods with rest periods.

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

While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement?

Ask the patient to lean forward and listen again.

A patient hospitalized for 10 days with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy for 2 to 6 weeks is anticipated. During discharge planning with the patient, it is MOST important for the nurse to

Assess the patient's home environment in terms of family assistance and adequacy.

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

Autograft

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

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?

Cardiac tamponade

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic?

Check regularly for dependent edema

When evaluating a patient suspected of having pericarditis, the nurse documents the description of which indicator that is considered the most characteristic symptom?

Chest pain

A nurse is teaching a client about an upcoming surgery to separate fused cardiac leaflets. Which term is used to describe this surgery?

Commissurotomy

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis?

Constant chest pain

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has hypertrophic cardiomyopathy (HCM). Which nursing diagnosis may be appropriate?

Decreased cardiac output

Clients with myocarditis are sensitive to which medication?

Digoxin

A client is admitted to the hospital with aortic stenosis. Which of the following assessment findings would indicate the development of left ventricular failure?

Dyspnea, orthopnea, pulmonary edema

Which signs and symptoms accompany a diagnosis of pericarditis?

Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)

A patient with a prosthetic heart valve is diagnosed with subacute infective endocarditis. The nurse knows that the majority of these infections are caused by

Group A, beta-hemolytic Streptococcus

A patient 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

A white male, age 43, with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. His medical history reveals diabetes mellitus, hypertension, and pernicious anemia; he underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. Which history finding is a major risk factor for infective endocarditis?

History of aortic valve replacement

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 scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy?

Hypertrophic

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

Hypertrophic

A client who suffered blunt chest trauma in a motor vehicle accident complains of chest pain, which is exacerbated by deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. The physician confirms acute pericarditis and begins appropriate medical intervention. To relieve chest pain associated with pericarditis, which position should the nurse encourage the client to assume?

Leaning forward while sitting

The nurse working in the medical intensive care unit has a patient admitted with mitral stenosis. The nurse knows that the pathophysiology of mitral stenosis is consistent with some of the following.

Left atrial hypertrophy

A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the nurse to clarify one of the last treatment options available that the physician mentioned earlier. After checking with the primary nurse, the nursing student would most likely discuss which of the following?

Left ventricular assist device

For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations?

Left ventricular dysfunction

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 caring for a patient diagnosed with a mitral valve prolapse who is asymptomatic. The nurse would expect which of the following to be ordered for this patient?

No treatment required

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 is caring for a client with aortic regurgitation. The nurse knows to expect which of the following symptoms on physical examination?

Orthopnea and dyspnea

A patient has been admitted with acute pericarditis. The nurse has created a care plan with a nursing diagnosis of acute pain related to pericardial inflammation. An appropriate nursing intervention for this patient is

Placing the patient in the high-Fowler's position with an over-the-bed table for the patient to lean on

Which mitral valve condition generally produces no symptoms?

Prolapse

Following the assessment of a patient with suspected pericarditis, the nursing student would determine which of the following findings to be most characteristic?

Reports of constant chest pain

What is the most common cause of mitral stenosis?

Rheumatic endocarditis

A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease?

Rheumatic fever

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?

Rheumatic fever

Which of the following is the most significant risk factor for mitral stenosis?

Rheumatic fever

The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching?

Risk for infection

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

Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs?

Shortness of breath

A nurse is caring for a 30-year-old client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin (Comaudin). She mentions to you that she relies on the rhythm method for birth control. What education would be a priority for the nurse to provide to this client?

The high risk for complications if she becomes pregnant while taking warfarin

A nurse caring for a patient with mitral stenosis understands that the initial cause of disruption to the normal flow of blood through the heart is due to

The increased resistance of a narrowed orifice between the left atrium and the left ventricle.

A patient is being seen in a clinic to rule out mitral valve stenosis. Which assessment data would be most significant?

The patient reports shortness of breath when walking.

The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery?

Warfarin

A nurse is caring for a client receiving warfarin (Coumadin) therapy following a mechanical valve replacement. The nurse completed the client's prothrombin time and International Normalized Ratio (INR) at 7 a.m., before the morning meal. The client had an INR reading of 4. The nurse's first priority should be to

assess the client for bleeding around the gums or in the stool and notify the physician of the laboratory results and most recent administration of warfarin.

A nurse caring for a client with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which behavior would indicate to the nurse recognizes that the client's level of anxiety has decreased when the client

is able to discuss the prognosis freely.

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

mitral valve