Chpt 28 Inflamm&struct disease PrepUU
A nurse working in the medical intensive care unit has a patient admitted with mitral stenosis. The nurse is precepting a new graduate and explains the pathophysiology of the condition. Which of the following statements made by the new graduate would reflect an appropriate understanding of the disease process? Choose all that apply. a) "There is a narrowing between the left atrium and left ventricle." b) "Increased blood flow in the left atrium causes left atrial hypertrophy." c) "Mitral stenosis is caused by an obstruction between the right atrium and ventricle." d) "It is caused by a tear that leads to the lungs becoming congested."
a, b • "There is a narrowing between the left atrium and left ventricle." • "Increased blood flow in the left atrium causes left atrial hypertrophy." Explanation: Poor left ventricular filling can cause decreased cardiac output. The increased blood volume in the left atrium causes it to dilate and hypertrophy. The left atrium and ventricle are affected with mitral stenosis. Mitral regurgitation causes the lungs to become congested.
Which of the following describes a valve used in replacement surgery that is made from the patient's own heart valve? a) Autograft b) Xenograft c) Homograft d) Allograft
a. Autograft Explanation: An example of autograft is found when the surgeon excises the pulmonic valve and uses it for an aortic valve replacement. Allograft refers to replacement using human tissue and is a synonym for homograft. Homograft refers to replacement using human tissue and is a synonym for allograft. Xenograft refers to replacement of tissue from animal tissue.
When evaluating a patient suspected of having pericarditis, the nurse documents the description of which indicator that is considered the most characteristic symptom? a) Chest pain b) Fatigue c) Orthopnea d) Dyspnea
a. Chest pain Explanation: The most characteristic symptom of pericarditis is chest pain. The pain is typically persistent, sharp, pleuritic, and usually felt in the mid chest, although it also may be located beneath the clavicle, in the neck, or in the left trapezius region. The discomfort is usually fairly constant, but is aggravated by deep inspiration, coughing, lying down, or turning. It may be relieved with a forward-leaning or sitting position.
A patient is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the patient for which diagnostic test used to confirm the patient's diagnosis? a) Echocardiogram b) CT scan c) Cardiac cauterization d) Chest x-ray
a. Echocardiogram Explanation: Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.
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) Extra heart sound b) Fatigue c) Syncope d) Dizziness
a. Extra heart sound Explanation: Often, the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapsed.
Which signs and symptoms accompany a diagnosis of pericarditis? a) Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) b) Lethargy, anorexia, and heart failure c) Low urine output secondary to left ventricular dysfunction d) Pitting edema, chest discomfort, and nonspecific ST-segment elevation
a. Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Explanation: The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. Low urine output secondary to left ventricular dysfunction lethargy, anorexia, heart failure and pitting edema, result from acute renal failure.
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? a) History of aortic valve replacement b) History of diabetes mellitus c) Age d) Race
a. History of aortic valve replacement Explanation: A heart valve prosthesis such as an aortic valve replacement is a major risk factor for infective endocarditis. Other risk factors include a history of heart disease (especially mitral valve prolapse), chronic debilitating disease, I.V. drug abuse, and immunosuppression. Although race, age, and a history of diabetes mellitus may predispose a person to cardiovascular disease, they aren't major risk factors for infective endocarditis.
A patient was diagnosed with mitral regurgitation. The nurse is aware that the patient should be observed for indicators of left- and right-sided heart failure. This understanding is based on the mechanics of cardiac hemodynamics. With mitral regurgitation, due to thickened valve leaflets, blood flows backward from the: a) Left ventricle into the left atrium during systole. b) Aorta into the left ventricle. c) Right ventricle into the right atrium. d) Left atrium into the pulmonary system.
a. Left ventricle into the left atrium during systole. Explanation: When the mitral valve leaflets thicken, fibrose, and contract, they cannot close completely. With each heartbeat, blood is forced backward into the left atrium during systole. Regurgitation of blood into the left atrium causes left atrial pressure to rise.
The nurse is caring for a client with aortic regurgitation. The nurse knows to expect which of the following symptoms on physical examination? a) Orthopnea and dyspnea b) Headache and vomiting c) Nausea and low urine output d) Increased urine output
a. Orthopnea and dyspnea Explanation: Aortic regurgitation usually manifests as progressive left ventricular failure, resulting from blood flowing backward from the aorta to the left ventricle, and eventually into the lungs. Urine output would be decreased from lower cardiac output. Nausea and vomiting are symptoms of increased gastrointestinal pressure, which would result from right heart failure. Kidney failure could become a problem later if cardiac output became too low, but not initially. CVA and an infarcted bowel would not be caused by mitral regurgitation.
Following the assessment of a patient with suspected pericarditis, the nursing student would determine which of the following findings to be most characteristic? a) Reports of constant chest pain b) Fatigue lasting more than 1 month c) Elevated ESR and CRP d) Dyspnea
a. Reports of constant chest pain Explanation: The most characteristic symptom of pericarditis is chest pain. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning. Other signs may include a mild fever, increased WBC count, anemia, and an elevated ESR or C-reactive protein level. Dyspnea and other signs and symptoms of heart failure may occur.
The nurse assessing a patient with pericardial effusion at 0800 notes the apical pulse is 74 and the BP is 140/92. At 1000, the patient has neck vein distention, the apical pulse is 72, and the BP is 108/92. Which action would the nurse implement first? a) Stay with the patient, use a calm voice, and ask for assistance via call light. b) Place the patient in the left lateral recumbent position. c) Administer morphine by intravenous push slowly. d) Notify the health care provider immediately.
a. Stay with the patient, use a calm voice, and ask for assistance via call light. Explanation: The nurse stays with the patient and continues to assess and record signs and symptoms while intervening to decrease patient anxiety. The pulse pressure is narrowing, and the patient is experiencing neck vein distention, indicative of rising central venous pressure. After reaching assistance via the call light from the patient's beside, the nurse notifies the physician immediately and prepares to assist with diagnostic echocardiography and pericardiocentesis. A left lateral recumbent position is used when administering enemas. Morphine would be given to someone who may be experiencing a myocardial infarction, not cardiac tamponade.
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? a) The high risk for complications if she becomes pregnant while taking warfarin b) Foods to limit (green leafy vegetables) while taking warfarin c) Symptoms to report of worsening tachycardia related to atrial fibrillation d) Instructions for using the rhythm method
a. The high risk for complications if she becomes pregnant while taking warfarin Explanation: Women of childbearing age should not take warfarin (pregnancy X category) if they plan to become pregnant. There is danger to the placenta and risk for the mother to bleed. The fetus may also be affected. This client should practice a more reliable method of birth control.
The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery? a) Warfarin b) Digoxin c) Furosemide d) Aspirin
a. Warfarin Explanation: To reduce the risk of thrombosis in patients with porcine or bovine tissue valves, warfarin is required for 6 to 12 weeks, followed by aspirin therapy. Furosemide would not be given for 6 to 12 weeks following this type of surgery. Digoxin may be used for the treatment of arrhythmias, but not just for 6 to 12 weeks.
A 62-year-old female who is 2 weeks CABG returns to her cardiologist due to new symptoms, including heaviness in her chest and pain between her breasts. She reports that leaning forward decreases the pain. The cardiologist admits her to the hospital to rule out pericarditis. Which of the following is a contributing cause to pericarditis? Select all that apply. a) Pneumonia b) Chest trauma c) Cardiac surgery d) Tuberculosis e) Myocarditis
b, c, d, e • Cardiac surgery • Tuberculosis • Myocarditis • Chest trauma Explanation: Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or MI (heart attack) or develops after cardiac surgery.
During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. Which of the following answers from the nurse is correct information? a) "Mechanical valves are used for women of childbearing age." b) "A mechanical valve is thought to be more durable and so requires replacement less often." c) "Mechanical valves are not always available and are very expensive." d) "A mechanical valve is less likely to generate blood clots, so long-term anticoagulation therapy is not required."
b. "A mechanical valve is thought to be more durable and so requires replacement less often." Explanation: Mechanical valves are thought to be more durable than tissue valves and so require replacement less often. Tissue valves are less likely to generate blood clots and so long-term anticoagulation therapy is not required. Homografts (human valves) are not always available and are very expensive.
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? a) "The great vessels rub against the pericardium with each heart beat." b) "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." c) "The layers of the heart become loose from each other and rub together with each heart beat." d) "The lung surfaces lose their lubrication and rub against the myocardium with each heart beat."
b. "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other." Explanation: A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid due to inflammation. The rub is audible on auscultation and is synchronous with the heartbeat. The layers of the heart never become loose from each other. The great vessels are not in contact with the inside of the pericardium, where the inflammation is located. The lungs have nothing to do with a pericardial friction rub.
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. a) 3.0 b) 3.8 c) 2.6 d) 3.4
b. 3.8 Explanation: Coumadin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5 to maintain adequate anticoagulation. Levels below 2 to 2.5 can result in insufficient anticoagulation and levels greater than 3.5 can result in dangerous and prolonged anticoagulation.
The diagnosis of aortic regurgitation (AR) is confirmed by which of the following? a) Myocardial biopsy b) Echocardiography c) Exercise stress testing d) Cardiac catheterization
b. Echocardiography Explanation: Diagnosis is confirmed by echocardiography. Cardiac catheterization is not necessary in most patients with AR. Exercise stress testing will assess functional capacity and symptom response. A myocardial biopsy may be performed to analyze myocardial tissue cells in patients with cardiomyopathy.
For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations? a) Angina b) Left ventricular dysfunction c) Dyspnea d) Edema
b. Left ventricular dysfunction Explanation: Digoxin may be used to treat left ventricular dysfunction, and diuretics may be used for dyspnea. Nitrates may be prescribed for the treatment of angina, but must be used with caution due to the risk of orthostatic hypotension and syncope.
Part of the continued management of a patient with infective endocarditis is assessment for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign? a) Patterns of petechiae on the chest b) Red or purple macules found on the palms of the hands c) Erythematosus modules on the pads of the fingers d) Splinter hemorrhages seen under the fingernails
b. Red or purple macules found on the palms of the hands Explanation: Janeway lesions are painless, red or purple macules found on the palms and soles.
Which type of graft is utilized when a heart valve replacement is made of tissue from an animal heart valve? a) Allograft b) Xenograft c) Homograft d) Autograft
b. Xenograft Explanation: Xenograft refers to replacement of tissue from animal tissue. An autograft is a heart valve replacement made from the patient's own heart valve. Allograft refers to replacement using human tissue and is a synonym for homograft. Homograft refers to replacement using human tissue and is a synonym for allograft.
Following a coronary artery bypass graft, a client begins having chest "fullness" and anxiety. The nurse suspects cardiac tamponade and prints a lead II electrocardiogram (ECG) strip for interpretation. In looking at the strip, the change in the QRS complex that would most support her suspicion is: a) widening complex. b) amplitude decrease. c) narrowing complex. d) amplitude increase.
b. amplitude decrease. Explanation: An amplitude decrease would support the nurse's suspicion because fluid surrounding the heart, such as in cardiac tamponade, suppresses the amplitude of the QRS complexes on an ECG. Narrowing and widening complexes as well as an amplitude increase aren't expected findings on the ECG of an individual with cardiac tamponade.
A patient has an admitting diagnosis of acute left-sided infective endocarditis. The nurse instructs the patient that the best diagnostic test to confirm this diagnosis is a) transesophageal echocardiogram b) blood cultures c) urinalysis d) complete blood count
b. blood cultures Explanation: A definitive diagnosis is made when a micro-organism is found in two separate blood cultures. All others mentioned may contribute to the diagnosis but are not the most definitive
Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply. a) Decreased C-reactive protein b) Elevated erythrocyte sedimentation rate (ESR) c) Elevated white blood cell (WBC) count d) Elevated c-reactive protein e) Decreased sedimentation rate
c, d, b • Elevated white blood cell (WBC) count • Elevated c-reactive protein • Elevated erythrocyte sedimentation rate (ESR) Explanation: Abnormal findings include anemia, elevated WBC counts, elevated ESR, and elevated c-reactive protein
The nurse determines that a 49-year-old client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? a) "If I quit smoking, it will help the endocarditis." b) "I need a referral to a dietician to understand a low-sodium diet." c) "I have to call my doctor so I can get antibiotics before seeing the dentist." d) "Can I take the antibiotics as a pill now?"
c. "I have to call my doctor so I can get antibiotics before seeing the dentist." Explanation: Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after dental procedures.
The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)? a) First-degree atrioventricular block b) Sinus dysrhythmia c) Atrial fibrillation d) Ventricular tachycardia
c. Atrial fibrillation Explanation: In mitral stenosis, the pulse is weak and often irregular because of atrial fibrillation (caused by strain on the atrium).
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a) Hypertension b) Left ventricular hypertrophy c) Cardiac tamponade d) Decreased venous pressure
c. Cardiac tamponade Explanation: The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade
An asymptomatic patient questions the nurse about mitral regurgitation and inquires about continuing exercises. Which of the following is the most appropriate nursing response? a) Take ample rest after exercise b) Avoid any type of exercise c) Continue exercising until mild symptoms develop d) Avoid strenuous exercise
c. Continue exercising until mild symptoms develop Explanation: Exercise is not limited until mild symptoms develop. It is not important for an asymptomatic patient to avoid exercise and to take ample rest after exercise.
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? a) Dizziness, nausea, diarrhea b) Syncope, fever, vomiting c) Exertional dyspnea, orthopnea, pulmonary edema d) Nausea, vomiting, exertional fatigue
c. Exertional dyspnea, orthopnea, pulmonary edema Explanation: When symptoms develop, clients with aortic stenosis usually first have exertional dyspnea, caused by increased pulmonary venous pressure from left heart failure. Orthopnea, paroxysmal nocturnal dyspnea, dizziness, and pulmonary edema may also occur. Nausea and vomiting may be signs of gastrointestinal congestion, but would be related to right heart failure, which does not occur initially with aortic stenosis.
A patient who has had a recent myocardial infarction develops pericarditis and complains of level 6 (on a scale of 0-10) chest pain with deep breathing. Which of these ordered pro re nata (PRN) medications will be the most appropriate for the nurse to administer? a) Morphine sulfate 6 mg IVP every 2-4 hours b) Fentanyl 2 mg intravenous pyelogram (IVP) every 2-4 hours c) Ibuprofen (Motrin) 800 mg po every 8 hours d) Acetaminophen (Tylenol) 650 mg per os (po) every 4 hours
c. Ibuprofen (Motrin) 800 mg po every 8 hours Explanation: Pain associated with pericarditis is caused by inflammation, thus nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.
What medication order would the nurse question for a patient being treated for pericarditis? a) Colchicine b) Ibuprofen c) Indocin d) Prednisone
c. Indocin Explanation: Analgesic medications and NSAIDs such as aspirin or ibuprofen (Motrin) may be prescribed for pain relief during the acute phase of pericarditis. These agents also hasten reabsorption of fluid in patients with rheumatic pericarditis. Indomethacin (Indocin) is contraindicated because it may decrease coronary blood flow. Colchicine (Colcrys) or corticosteroids (e.g., prednisone) may be prescribed if the pericarditis is severe or if the patient does not respond to NSAIDs. Colchicine also may be used instead of NSAIDs during the acute phase
A physician has scheduled a client with mitral stenosis for mitral valve replacement. Which condition may arise as a complication of mitral stenosis? a) Left ventricular hypertrophy b) Left-sided heart failure c) Pulmonary hypertension d) Myocardial ischemia
c. Pulmonary hypertension Explanation: Mitral stenosis, or severe narrowing of the mitral valve, impedes blood flow through the stenotic valve, increasing pressure in the left atrium and pulmonary circulation. These problems may lead to low cardiac output, pulmonary hypertension, oedema, and right-sided (not left-sided) heart failure. Other potential complications of mitral stenosis include mural thrombi, pulmonary hemorrhage, and embolism to vital organs. Myocardial ischemia may occur in a client with coronary artery disease. Left ventricular hypertrophy is a potential complication of aortic stenosis.
A nursing student is assigned to the medical intensive care unit for the first time. The nurse preceptor asks the student to listen to a water-hammer pulse. The nursing student knows that the sound will resemble which of the following? a) Mitral click b) High-pitched blowing sound at the apex c) Quick, sharp strokes that suddenly collapse d) Low-pitched diastolic murmur at the apex
c. Quick, sharp strokes that suddenly collapse Explanation: With the water-hammer (Corrigan's) pulse, the pulse strikes the palpating finger with a quick, sharp stroke and then suddenly collapses.
Which of the following symptoms occurs in the patient diagnosed with mitral regurgitation when pulmonary congestion occurs? a) Hypertension b) Tachycardia c) Shortness of breath d) A loud, blowing murmur
c. Shortness of breath Explanation: If pulmonary congestion occurs, the patient with mitral regurgitation develops shortness of breath. A loud, blowing murmur often is heard throughout ventricular systole at the heart's apex. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.
A patient with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which of the following manifestations that would indicate that the patient is developing pulmonary congestion? a) Hypertension b) A loud, blowing murmur c) Shortness of breath d) Tachycardia
c. Shortness of breath Explanation: Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue and weakness are the most common symptoms. Palpitations, shortness of breath on exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the heart's apex. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.
A female client in the general practice group where you practice nursing has a history of rheumatic fever as a child. Which of the following instructions should you provide before she has any dental work done? a) Take steroids. b) Avoid any kind of activities. c) Take prophylactic antibiotics. d) Take aspirin.
c. Take prophylactic antibiotics. Explanation: Clients with a history of rheumatic fever are susceptible to infective endocarditis and should be asked to take prophylactic antibiotics before any invasive procedure, including dental work. Steroids are used to suppress the inflammatory response. Clients with a history of rheumatic fever are susceptible to infective endocarditis and should be asked to take prophylactic antibiotics before any invasive procedure, including dental work. Aspirin is an anticoagulant and usedto control the formation of blood clots around heart valves. Clients with a history of rheumatic fever should be asked to take prophylactic antibiotics before any invasive procedure, including dental work. Many clients cannot appreciate the danger of the disease without seeing external signs of the damage. The nurse gently but firmly reminds the client to limit activity. However, clients should take prophylactic antibiotics before any invasive procedure, including dental work.
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: a) Atrial hypertrophy. b) Pulmonary circulation congestion. c) The increased resistance of a narrowed orifice between the left atrium and the left ventricle. d) Inadequate left ventricle filling.
c. The increased resistance of a narrowed orifice between the left atrium and the left ventricle. Explanation: Left atrial pressure increases because of the slowed blood flow into the LV through the narrowed orifice. The left atrium dilates and hypertrophies because of the increased blood volume. Pulmonary venous pressure rises, and the circulation becomes congested. As a result, the RV and right atrium become enlarged. Eventually, the ventricle fails. (
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: a) notify the next shift to hold the daily 5 p.m. dose of warfarin. b) give the client an I.M. vitamin K injection and notify the physician of the results. c) 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. d) call the physician to request an increase in the warfarin dose.
c. 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. Explanation: For a client taking warfarin following a valve replacement, the INR should be between 2 and 3.5. The nurse should notify the physician of an elevated INR level and communicate assessment data regarding possible bleeding. The nurse shouldn't administer medication such as warfarin or vitamin K without a physician's order. The nurse should notify the physician before holding a medication scheduled to be administered during another shift.
A nurse is teaching a patient about valve replacement surgery. Which statement by the patient indicates an understanding of the benefit of an autograft replacement valve? a) "The valve is mechanical, and it will not deteriorate or need replacing." b) "The valve is from a tissue donor, and I will not need to take any blood thinning drugs with I am discharged." c) "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." d) "The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged."
d. "The valve is made from my own heart valve, and I will not need to take any blood thinning drugs when I am discharged." Explanation: Autografts (i.e., autologous valves) are obtained by excising the patient's own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the patient's own tissue and is not thrombogenic. The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, patients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.
A nurse is caring for four clients on the cardiac unit. Which client has the greatest risk for contracting infective endocarditis? a) A client with a history of repaired ventricular septal defect b) A client 1 day post coronary stent placement c) A client with hypertrophic cardiomyopathy d) A client 4 days postoperative after mitral valve replacement
d. A client 4 days postoperative after mitral valve replacement Explanation: Having prosthetic cardiac valves places the client at high risk for infective endocarditis. Hypertrophic cardiomyopathy and repaired ventricular septal defects are moderate risks for infective endocarditis. Coronary stent placement isn't a risk factor for infective endocarditis.
The nurse is preparing to administer warfarin (Coumadin), an oral anticoagulant, to a patient with a mechanical valve replacement. The patient's INR is 2.7. Which action should the nurse take? a) Prepare to administer Vitamin K. b) Hold the medication and notify the HCP. c) Asses the patient for abnormal bleeding. d) Administer the medication as ordered.
d. Administer the medication as ordered. Explanation: Patients with mechanical valve replacements who take warfarin (Coumadin) usually have individualized target international normalized ratios (INRs) between 2.0 and 3.5. The nurse would give the medication as ordered.
While assessing a patient with pericarditis, the nurse cannot auscultate a friction rub. Which action should the nurse implement? a) Document that the pericarditis has resolved. b) Notify the health care provider. c) Prepare to insert a unilateral chest tube. d) Ask the patient to lean forward and listen again.
d. Ask the patient to lean forward and listen again. Explanation: The most characteristic sign of pericarditis is a creaky or scratchy friction rub heard most clearly at the left lower sternal border. Having the patient lean forward and to the left uses gravity to force the heart nearer to the chest wall, which allows the friction rub to be heard. These assessment data are not life-threatening and do not require a call to the health care provider. The nurse should try multiple times to auscultate the friction rub before deciding that the rub is gone. Chest tubes are not the treatment of choice for not hearing friction rubs
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis? a) Dyspnea b) Uncontrolled restlessness c) Fatigue lasting more than 1 month d) Constant chest pain
d. Constant chest pain Explanation: The most characteristic symptom of pericarditis is chest pain, although pain also may be located beneath the clavicle, in the neck, or in the left trapezius (scapula) region. Pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.
A client is admitted to the hospital with aortic stenosis. Which of the following assessment findings would indicate the development of left ventricular failure? a) Dyspnea, distended jugular veins, orthopnea b) Distended jugular veins, pedal edema, nausea c) Orthopnea, nausea, pedal edema d) Dyspnea, orthopnea, pulmonary edema
d. Dyspnea, orthopnea, pulmonary edema Explanation: Signs and symptoms of progressive left ventricular failure include breathing difficulties, such as orthopnea, PND, and pulmonary edema. Distended jugular veins, pedal edema, and nausea are signs and symptoms of right sided heart failure.
A patient complaining of heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. In order to relieve the symptoms, the nurse should teach the patient which of the following dietary interventions? a) Eliminate dairy products and carbonated beverages. b) Decrease the amount of sodium and saturated fat. c) Decrease the amount of acidic beverages and fruits. d) Eliminate caffeine and alcohol
d. Eliminate caffeine and alcohol Explanation: To minimize symptoms of mitral valve prolapse, the nurse should instruct the patient to avoid caffeine and alcohol. The nurse encourages the patient to read product labels, particularly on over-the-counter products such as cough medicine, because these products may contain alcohol, caffeine, ephedrine and adrenaline, which may produce arrhythmias and other symptoms. The nurse also explores possible diet, activity, sleep, and other lifestyle factors that may correlate with symptoms
The nurse obtains a health history from a patient with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask? a) Do you live with any domesticated animals in your home? b) Do you have a family history of endocarditis? c) Have you recently vacationed outside of the United States? d) Have you been to the dentist recently?
d. Have you been to the dentist recently? Explanation: Invasive procedures, particularly those involving mucosal surfaces (e.g., those involving manipulation of gingival tissue or periapical regions of teeth), can cause a bacteremia, which rarely lasts more than 15 minutes. However, if a patient has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator [ICD]), bacteremia can cause bacterial endocarditis.
A 30-year-old male client presents at the clinic complaints of a headache and "just not feeling right," which he blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of his feet. The nurse is aware that these symptoms may indicate which of the following? a) Myocarditis b) Dilated cardiomyopathy c) Rheumatic fever d) Infective endocarditis
d. Infective endocarditis Explanation: Subacute endocarditis infections progress insidiously over weeks to months with vague manifestations, such as headache, malaise, fatigue, and sleep disturbances. Small, painless, red-blue macular lesions or Janeway lesions may appear on the palms of the hands and soles of the feet. Janeway lesions and the client's other symptoms indicate that the client may have infective endocarditis. Clients with myocarditis may complain of sharp stabbing or squeezing chest discomfort that resolves upon sitting up. Janeway lesions may indicate that the client has infective endocarditis. Clients with dilated cardiomyopathy are likely to experience fatigue and leg swelling and may also have palpitations and chest pain. Janeway lesions may indicate that the client may have infective endocarditis.
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? a) Prone b) Semi-Fowler's c) Supine d) Leaning forward while sitting
d. Leaning forward while sitting Explanation: The nurse should encourage the client to lean forward, because this position causes the heart to pull away from the diaphragmatic pleurae of the lungs, helping relieve chest pain caused by pericarditis. The semi-Fowler's, supine, and prone positions don't cause this pulling-away action and therefore don't relieve chest pain associated with pericarditis.
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? a) Infarcted bowel b) Kidney failure c) Cerebral vascular accident (CVA) d) Severe heart failure
d. Severe heart failure Explanation: Acute mitral regurgitation usually manifests as severe congestive heart failure, resulting from blood flowing backward from the left ventricle to the left atria and eventually into the lungs. Kidney failure could become a problem later if cardiac output is too low, but not initially. CVA and an infarcted bowel would not be caused by mitral regurgitation.
Which of the following symptoms occurs in the patient diagnosed with mitral regurgitation when pulmonary congestion occurs? a) Tachycardia b) A loud, blowing murmur c) Hypertension d) Shortness of breath
d. Shortness of breath Explanation: If pulmonary congestion occurs, the patient with mitral regurgitation develops shortness of breath. A loud, blowing murmur often is heard throughout ventricular systole at the heart's apex. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.
A nurse is preparing a teaching plan regarding biological tissue valve replacement. Which of the following identifies a disadvantage of this type of valve replacement? a) There is a low incidence of thromboembolism. b) The patient's infections are easier to treat. c) The patient must take lifelong anticoagulant therapy. d) The valve has to be replaced frequently.
d. The valve has to be replaced frequently. Explanation: Biological valves deteriorate and need to be replaced frequently. They do not necessitate accompanying anticoagulant therapy. Infections are easier to treat and the risk of thromboembolism is lower as compared with mechanical valves.
