chapter 28- med surg
If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected? mitral valve coronary arteries inferior vena cava septum
mitral valve
A patient at the clinic describes shortness of breath, periods of feeling "lightheaded," and feeling fatigued despite a full night's sleep. The nurse obtains vital signs and auscultates a systolic click. What does the nurse suspect from the assessment findings? Mitral valve prolapse Mitral regurgitation Aortic stenosis Aortic regurgitation
mitral valve prolapse
A client with infective endocarditis (IE) and a fever is admitted to the intensive care unit. Which of these physician orders should the nurse implement first? Order blood cultures drawn from two sites Give acetaminophen pro re nata for fever higher than 100.3 F Administer ceftriaxone 1 g IVPB q 12 hours Obtain a transesophageal echocardiogram
order blood cultures drawn from two sites
A health care provider admits a client with a history of I.V. drug abuse to the medical-surgical unit for evaluation for infective endocarditis. What will an assessment by the nurse most likely reveal? retrosternal pain that worsens during supine positioning. pulsus paradoxus. a scratchy pericardial friction rub. Osler's nodes and splinter hemorrhages.
oslers nodes and splinter hemorrhages
A client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis? Rheumatic fever Pericarditis Mitral valve stenosis Cardiomyopathy
pericarditis
The nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis? Complete blood count Positive blood culture Serum cardiac antigens Immunosuppressant assay
positive blood culture
A nurse is assigned to the medical intensive care unit. The nurse auscultates a water-hammer pulse. What will the sound resemble? quick, sharp strokes that suddenly collapse low-pitched diastolic murmur at the apex high-pitched blowing sound at the apex mitral click
quick, sharp strokes that suddenly collapse
The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? dyspnea fatigue lasting more than 1 month reports of constant chest pain elevated ESR and CRP
reports of constant chest pain
The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? dyspnea fatigue lasting more than 1 month reports of constant chest pain elevated ESR and CRP TAKE ANOTHER QUIZ
reports of constant chest pain
During a teaching session, a client who is having a valvuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct?
"A mechanical valve is thought to be more durable and so requires replacement less often."
During a teaching session, a client who is having a valvuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct? "A mechanical valve is less likely to generate blood clots, so long-term anticoagulation therapy is not required." "A mechanical valve is thought to be more durable and so requires replacement less often." "Mechanical valves are used for women of childbearing age." "Mechanical valves are not always available and are very expensive."
"A mechanical valve is thought to be more durable and so requires replacement less often."
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 but take ample rest after exercising." "Avoid any type of exercise." "Avoid strenuous cardiovascular exercise." "Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop."
"Continue the exercise routine unless symptoms such as shortness of breath or fatigue develop."
A client with aortic valve endocarditis develops dyspnea, crackles in the lungs, and restlessness. The novice nurse discusses this development with the nurse manager. What statement indicates the novice nurse is applying the assessment findings? "I anticipated this complication and I will call the health care provider right now." "I instructed the patient to do coughing and deep breathing and I will reassess in 30 minutes." "I told the patient that this is a normal complication and to take deep breaths." "I placed the patient in a semi-Fowler's position and started an NPO diet."
"I anticipated this complication and I will call the health care provider right now."
When teaching a client with rheumatic carditis and a history of recurrent rheumatic fever, which statement by the client indicates that teaching has been successful? "I will avoid milk, yogurt, and other dairy products." "I may have to take prophylactic antibiotics for up to 10 years." "I will take a nonsteroidal anti-inflammatory medication every day." "I will avoid any kind of activity."
"I may have to take prophylactic antibiotics for up to 10 years."
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." "I should lie on my side with my knees bent when sleeping." "I need to ice my leg every 2 hours for about 20 minutes." "I should try not to drink too much during the daytime." TAKE ANOTHER QUIZ
"I need to do my leg exercises five times or more every hour."
A client needs to have a cardiac valve replacement. The nurse offers client education about the procedures involved—including the benefits and risks. Which client statement indicates the need for more education? "I'm anxious because I'll need to have cardiopulmonary bypass." "Since the procedure is minimally invasive, there is less surgical trauma." "Since the procedure is minimally invasive, there is less postoperative pain than with other techniques." "I might lose some blood, but not likely a large quantity of it."
"I'm anxious because I'll need to have cardiopulmonary bypass."
A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valvular disease? "The client with mitral valve prolapse probably had no health symptoms." "The client needs premium insurance to cover the cost of medications." "The client's religion may prohibit the client from seeking medical attention." "The client may have to wear antiembolism stocking to help with venous return."
"The client with mitral valve prolapse probably had no health symptoms."
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." "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is from a tissue donor, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is mechanical, and it will not deteriorate or need replacing."
"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 caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? A client 4 days postoperative after mitral valve replacement A client with hypertrophic cardiomyopathy A client with a history of repaired ventricular septal defect A client 1 day post coronary stent placement
A client 4 days postoperative after mitral valve replacement
A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? An LVAD only supports a failing left ventricle. It is specifically designed for long-term use. It never needs batteries. It is designed for extremely active patients.
An LVAD only supports a failing left ventricle.
A client with aortic regurgitation is admitted to the hospital. Which assessment findings would indicate left ventricular failure? Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND) Distended jugular veins, pedal edema, nausea Dyspnea, distended jugular veins, orthopnea Orthopnea, nausea, pedal edema
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND)
A young mother brings her 4-year-old in to the pediatric clinic with a mild fever and a red, spotty rash that is beginning to fade. The child's heart rate is rapid, and the rhythm is abnormal. The mother states the child has been healthy until about 3 weeks ago when the child had a sore throat. The nurse suspects rheumatic carditis. What organism causes rheumatic carditis? Group A beta-hemolytic strep Staphylococcus aureus Streptococcus viridians Epstein-Barr virus
Group A beta-hemolytic strep
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? "I should increase my fluid intake." "I'll enroll in an aerobic exercise program." "I can still drink coffee and tea." "I should eat foods rich in protein."
I can still drink coffee and tea
The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching? "I will avoid caffeine, alcohol, and smoking." "I will take antibiotics before getting my teeth cleaned." "I can get a tattoo at a local parlor." "I can get my tongue pierced at a store in the shopping mall."
I will avoid caffeine, alcohol and smoking
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? Warm, salt water gargling Fluid increase to 2500cc Obtaining a throat culture Administering antiseptic lozenges
Obtaining a throat culture
A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? Patterns of petechiae on the chest Erythematosus modules on the pads of the fingers Red or purple macules found on the palms of the hands
Red or purple macules found on the palms of the hands
Which action will a public health nurse include when planning ways to decrease the incidence of rheumatic fever in the community? Encourage susceptible groups in the community to receive immunizations with streptococcal vaccine. Teach individuals in the community to seek medical treatment for streptococcal pharyngitis. Educate individuals in the community about the importance of monitoring temperature when infections occur. Provide prophylactic antibiotics to individuals with a family history of rheumatic fever.
Teach individuals in the community to seek medical treatment for streptococcal pharyngitis.
The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point? The treatments include medications, medical devices, surgery, or transplantation. The disease was inherited, so there are no reversal treatments. Clients with cardiomyopathy often need to live in a skilled nursing care facility. Clients with cardiomyopathy have a goal to improve lung function.
The treatments include medications, medical devices, surgery, or transplantation
A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement? The patient must take lifelong anticoagulant therapy. The patient's infections are easier to treat. There is a low incidence of thromboembolism. The valve has to be replaced frequently.
The valve has to be replaced frequently.
The nurse is preparing to administer warfarin to a client with a mechanical valve replacement. The client's international normalized ratio is 2.7. What action will the nurse take? Administer the medication as ordered. Prepare to administer vitamin K. Hold the medication and notify the HCP. Asses the client for abnormal bleeding.
administer the medication as ordered
A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide? Alternate active periods with rest periods. Gradually work up to strenuous activity. Include isometric exercises in the daily routine. Avoid all physical and emotional stress.
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? Fatigue An extra heart sound Dizziness Syncope
an extra heart sound
Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis? Antibiotic therapy Antihypertensive medication Exercise regimen Potassium replacement
antibiotic therapy
The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder? Mitral insufficiency Tricuspid insufficiency Tricuspid stenosis Aortic regurgitation
aortic regurgitation
While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? Notify the health care provider. Document that the pericarditis has resolved. Ask the patient to lean forward and listen again. Prepare to insert a unilateral chest tube.
ask the patient to lean forward and listen again
A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ? Notify the health care provider to request an increase in the warfarin dose. Be prepared to administer an I.M. vitamin K injection and notify the healthcare provider of the results. Assess the client for bleeding and notify the health care provider of the results. Notify the next nurse on afternoon shift to hold the evening dose of warfarin.
assess the client for bleeding and notify the health care provider of the results
Which describes a valve used in replacement surgery that is made from the client's own heart valve? Autograft Allograft Homograft Xenograft
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)? Thrombosis and infection Bleeding and wound dehiscence Bleeding and infection Evisceration
bleeding and infection
A client is admitted with aortic regurgitation. Which medication classification is contraindicated because they can cause bradycardia and decrease ventricular contractility? Ace inhibitors Beta blockers Nitrates Calcium channel blockers
calcium channel blockers
A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis? Orthopnea Chest pain Dyspnea Fatigue
chest pain
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? Dyspnea Constant chest pain Fatigue lasting more than 1 month Uncontrolled restlessness
constant chest pain
A client with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which assessment data obtained by the nurse should be immediately communicated to the health care provider? 4+ peripheral edema in both legs Crackles audible throughout the lungs A palpable thrill felt over the left anterior chest A loud systolic murmur all across the precordium
crackles audible throughout the lungs
The client with which characteristic is considered at high risk for the development of infective endocarditis? Cyanotic congenital malformation Mitral valve prolapse with valvular regurgitation Hypertrophic cardiomyopathy Acquired valvular dysfunction
cyanotic congenital malformation
A patient has had a successful heart transplant for end-stage heart disease. What immunosuppressant will be necessary for this patient to take to prevent rejection? Nifedipine Cyclosporine Verapamil Vancomycin
cyclosporine
A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure? Dyspnea, orthopnea, pulmonary edema Distended jugular veins, pedal edema, nausea Dyspnea, distended jugular veins, orthopnea Orthopnea, nausea, pedal edema
dyspnea, orthopnea, pulmonary edema
A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis? Cardiac catheterization Computed tomography Echocardiography Chest x-ray
echocardiography
The nurse is working with a client who asks what diagnostic studies will be done because of a suspected diagnosis of mitral stenosis. What studies will the nurse teach the client? Select all that apply. exercise test electrophysiological studies cardiac catheterization electrocardiography complete blood count
electrocardiography exercise test cardiac catheterization
A client is diagnosed with infective endocarditis. What laboratory values will the nurse assess? Select all that apply. elevated white blood cell (WBC) count elevated C-reactive protein elevated erythrocyte sedimentation rate (ESR) decreased erythrocyte sedimentation rate decreased C-reactive protein
elevated white blood cell (WBC) count elevated C-reactive protein elevated erythrocyte sedimentation rate (ESR)
A nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms? Exertional dyspnea, orthopnea, pulmonary edema Nausea, vomiting, exertional fatigue Dizziness, nausea, diarrhea Syncope, fever, vomiting
exertional dyspnea, orthopnea, pulmonary edema
Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? Maintain the client on bed rest. Administer a prescribed antipyretic. Elevate the client's head. Administer supplemental oxygen.
maintain the client on bed rest
The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis? fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) low urine output secondary to left ventricular dysfunction lethargy, anorexia, and heart failure pitting edema, chest discomfort, and nonspecific ST-segment elevation
fever, chest discomfort, and elevated erythrocyte sedimentation rate ESR
Which changes occur to the heart as a result of heart transplant? Heart beats slower than the natural heart Heart beats faster than the natural heart No significant changes are noted in the heart The heart takes less time to increase the heart rate in response to exercise
heart beats faster than the natural heart
Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve? Autograft Allograft Homograft Heterograft
heterograft
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 scarring." The nurse knows these manifestations are indicative of which type of cardiomyopathy? hypertrophic dilated restrictive arrhythmogenic right ventricular
hypertrophic
Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis? increased use of prosthetic valve replacements greater incidence of a history of repaired congenital heart defects increase in IV drug use higher rate of tuberculosis
increased use of prosthetic valve replacements
A client reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate: infective endocarditis. rheumatic fever. myocarditis. dilated cardiomyopathy.
infective endocarditis
A patient with a history of valvular disease has just arrived in the PACU after a percutaneous balloon valvuloplasty. Which intervention should the recovery nurse implement? Assess the patient's chest tube output. Monitor the patient's chest drainage. Evaluate the patient's endotracheal lip line. Keep the patient's affected leg straight.
keep the patients affected leg straight
A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned earlier. What option will the nurse most likely discuss? Left ventricular assist device Chordoplasty Annuloplasty Open commissurotomy
left ventricular assist device
A nurse is conducting a health history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis? Rheumatic endocarditis Congestive heart failure Atrial fibrillation Myocardial infarction
rheumatic endocarditis
What is the most common cause of mitral stenosis? Rheumatic endocarditis Congestive heart failure Degenerative stenosis Myocardial infarction
rheumatic endocarditis
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? Croup Rheumatic fever Severe staphylococcal infection Medullary sponge kidney
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 Chronic pain Impaired gas exchange Impaired memory
risk for infection
Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? A loud, blowing murmur Hypertension Shortness of breath Tachycardia
shortness of breath
A client with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. What collaborative management will the nurse expect for this client? embolectomy surgical valve replacement administration of anticoagulants higher than usual antibiotic dosages
surgical valve replacement
A client has a history of rheumatic fever as a child. Which instructions should be provided before the client has any dental work done? Take prophylactic antibiotics. Take steroids. Take aspirin. Avoid any kind of activities.
take prophylactic antibiotics
A nurse is caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client? the high risk for complications if she becomes pregnant while taking warfarin instructions for using the rhythm method symptoms to report of worsening tachycardia related to atrial fibrillation foods to limit (green leafy vegetables) while taking warfarin
the high risk for complications if she becomes pregnant while taking warfarin
A client's chart indicates Virchow's triad. This client is at risk for which complication? thrombophlebitis venous stasis altered blood coagulation postphlebitic syndrome
thrombophlebitis
The nurse understands that which of the following medications will be administered to the client for 6 to 12 weeks following prosthetic porcine valve surgery? Warfarin Aspirin Furosemide Digoxin
warfarin
