Complex Ch 28: CV 1
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) The valve has to be replaced frequently. b) There is a low incidence of thromboembolism. c) The patient's infections are easier to treat. d) The patient must take lifelong anticoagulant therapy.
Answer: A 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. (page 777)
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? a) Rheumatic fever b) Croup c) Medullary sponge kidney d) Severe staphylococcal infection
Answer: A Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures. (page 786)
The nurse is obtaining a history from a patient diagnosed with hypertrophic cardiomyopathy. What information obtained from the patient is indicative of this form of cardiomyopathy? a) A parent has the same disorder b) A long-standing history of hypertension c) A history of amyloidosis d) A history of alcoholism
Answer: A Hypertrophic cardiomyopathy (HCM) is a rare autosomal dominant condition, occurring in men, women, and children (often detected after puberty) with an estimated prevalence rate of 0.05% to 0.2% of the population in the United States (Sander, 2011). Echocardiograms may be performed every year from 12 to 18 years of age and then every 5 years from 18 to 70 years of age in susceptible individuals (i.e., those with a family history of HCM) (Sander, 2011).
A 6-year-old female client is admitted to the pediatrics unit due to suspected rheumatic fever. Aggressive antibiotic therapy and comfort measures have been instituted to minimize the long-lasting effects of the systemic inflammation. If the client were to develop rheumatic carditis, which cardiac structure would most likely be affected? a) Mitral valve b) Inferior vena cava c) Septum d) Coronary arteries
Answer: A In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium. In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium. In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium. In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium. (page 772)
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) Have you been to the dentist recently? b) Do you live with any domesticated animals in your home? c) Have you recently vacationed outside of the United States? d) Do you have a family history of endocarditis?
Answer: A 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. (page 787)
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) An extra heart sound b) Dizziness c) Fatigue d) Syncope
Answer: A 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. (page 771)
A nurse plans to have an education session with a client who has cardiomyopathy and the client's spouse about ways to decrease the sense of powerlessness. Which of the following actions by the nurse will provide this information? a) Assist the client in identifying life areas over which she still has control. b) Encourage the client to occasionally have foods not on her low-sodium diet. c) Encourage the client to try to forget about things in life that she has lost. d) Change the subject quickly if the client brings up the things in life she has lost.
Answer: A The client should be assisted to identify the things in life that she has lost. The nurse will then assist the client to identify the amount of control that she still has (eg, low-sodium food choices, medication schedule). The nurse should never encourage the client to forget what she has lost or change the subject if a client wants to talk about something. The nurse should encourage this discussion. It is important that the client adhere closely to a low-sodium diet. The nurse should encourage this adherence and never suggest otherwise. (page 786)
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? a) Cardiac tamponade b) Decreased venous pressure c) Hypertension d) Left ventricular hypertrophy
Answer: A 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 (see Chapter 29). Taylor's note: pericarditis is inflammation of the sac around the heart, which squeezes the heart. If you talk about tamping something down, it's stomping on it until it's smushed flat. Tamping dirt during construction, for example. So cardiac TAMPonade is when the heart is being stomped on. The inflammation of the pericardium does a pretty good job stomping on the heart itself. (page 791)
Which of the following nursing interventions should a nurse perform when a patient with cardiomyopathy receives a diuretic? a) Check for dependent edema regularly b) Maintain bed rest c) Administer oxygen d) Unrestricted physical activity
Answer: A The nurse should monitor for dependent edema regularly if the patient with cardiomyopathy receives a diuretic. Oxygen is administered either continuously or when dyspnea or dysrhythmias develop. Bed rest is not necessary. The nurse should ensure that the patient's activity level is reduced and should sequence any activity that is slightly exertional between periods of rest. (page 781)
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
Answer: A 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. (page 805)
A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? a) Staphylococcus aureus b) Group A, beta-hemolytic streptococcus c) Pseudomonas aeruginosa d) Serratia marcescens
Answer: B Acute rheumatic fever, which occurs most often in school-age children, may develop after an episode of group A beta-hemolytic streptococcal pharyngitis (Chart 28-2). Patients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure. (page 786)
Which of the following describes a valve used in replacement surgery that is made from the patient's own heart valve? a) Homograft b) Autograft c) Allograft d) Xenograft
Answer: B 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. (page 778)
The nurse determines that a 49-year-old client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? a) "Can I take the antibiotics as a pill now?" b) "I have to call my doctor so I can get antibiotics before seeing the dentist." c) "I need a referral to a dietician to understand a low-sodium diet." d) "If I quit smoking, it will help the endocarditis."
Answer: B Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after dental procedures. (page 787)
The nurse is caring for a client with aortic regurgitation. The nurse knows to expect which of the following symptoms on physical examination? a) Headache and vomiting b) Orthopnea and dyspnea c) Increased urine output d) Nausea and low urine output
Answer: B 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. (page 801)
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? a) Ineffective thermoregulation b) Decreased cardiac output c) Risk for deficient fluid volume d) Risk for peripheral neurovascular dysfunction
Answer: B Decreased cardiac output is an appropriate nursing diagnosis for a client with HCM because the hypertrophied cardiac muscle decreases the effectiveness of the heart's contraction, decreasing cardiac output. Heart failure may complicate HCM, causing fluid volume excess; therefore, the nursing diagnosis of Risk for deficient fluid volume isn't applicable. Ineffective thermoregulation and Risk for peripheral neurovascular dysfunction are inappropriate because HCM doesn't cause these problems. (page 785)
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) call the physician to request an increase in the warfarin dose. b) 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. c) give the client an I.M. vitamin K injection and notify the physician of the results. d) notify the next shift to hold the daily 5 p.m. dose of warfarin.
Answer: B 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. (page 779)
A patient with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the patient for which of the following manifestations? a) Tachypnea and dyspnea b) Anorexia and confusion c) Edema and orthopnea d) Abdominal pain and diarrhea
Answer: B Patients with RCM have increased sensitivity to digoxin, and the nurse must anticipate that low doses will be prescribed and assess for digoxin toxicity. The most common manifestations of digoxin toxicity are gastrointestinal (anorexia, nausea, and vomiting), cardiac (rhythm disturbances and heart block), and central nervous system (CNS) disturbances (confusion, headache, weakness, dizziness, and blurred or yellow vision). (page 785)
A patient comes to the clinic with complaints of 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 of the following preventable diseases? a) Mitral stenosis b) Rheumatic fever c) Pericarditis d) Cardiomyopathy
Answer: B Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease. (page 787)
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: a) "I will always be on antibiotic therapy." b) "I will ask for antibiotics whenever I have dental work done." c) "I will start an antibiotic when I am exposed to anyone with infections." d) "I am going to take an aspirin a day to prevent lesions around my valve."
Answer: B The patient should take antibiotics for dental procedures that involve manipulation of gingival tissue or the periapical area of the teeth or perforation of the oral mucosa. Exceptions include routine anesthetic injections through noninfected tissue, placement of orthodontic brackets, loss of deciduous teeth, bleeding from trauma to the lips or oral mucosa, dental x-rays, adjustment of orthodontic appliances, and placement of removable prosthodontic or orthodontic appliances. (page 787)
Which of the following is the most common complication of prosthetic valves? a) Arrhythmias b) Thromboembolism c) Infection d) Hemolysis
Answer: B Thromboembolism is the most common complication of prosthetic valves and long-term anticoagulation with warfarin is initiated 48 hours after surgery. Overall, patients are at risk for thromboembolism, infection, arrhythmias, and hemolysis. (page 777)
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) Decrease the amount of sodium and saturated fat. b) Eliminate caffeine and alcohol c) Eliminate dairy products and carbonated beverages. d) Decrease the amount of acidic beverages and fruits.
Answer: B 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. (page 771)
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? a) Administering antiseptic lozenges b) Obtaining a throat culture c) Warm, salt water gargling d) Fluid increase to 2500cc
Answer: B When a child has a sore throat and symptoms of a possible infection occur, it is essential that a culture is obtained. A culture can identify group A beta-hemolytic streptococcal infection, which needs to be eliminated with use of an antibiotic. Warm, salt gargles; increasing fluids; and administering antiseptic lozenges are helpful for symptom control. Obtaining a throat culture is a priority. (page 787)
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) Age b) History of diabetes mellitus c) History of aortic valve replacement d) Race
Answer: C 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. (page 789)
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 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 a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged."
Answer: C 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. (page 778)
A nurse caring for a patient with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which of the following patient behaviors would indicate to the nurse that the patient's level of anxiety has decreased? a) The patient is resting in bed watching TV. b) The patient answers questions about physical status with no problem. c) The patient eagerly awaits visits from family. d) The patient is able to discuss the prognosis freely.
Answer: D As anxiety decreases, patients will be able to discuss prognosis freely, verbalize fears and concerns, and participate in support groups. (page 786)
Which of the following is a term used to describe the splitting or separating of fused cardiac valve leaflets? a) Chordoplasty b) Valvuloplasty c) Commissurotomy d) Annuloplasty
Answer: C Commissurotomy is the splitting or separating of fused cardiac valve leaflets. Annuloplasty is a repair of a cardiac valve's outer ring. Chordoplasty is repair of the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle. Valvuloplasty is a repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty. Taylor's note: this question is easy if you remember that "-plasty" is the suffix for a repair of something. A nose job is called a rhinoplasty. The suffix "-otomy" means to cut into something. Lobotomy is cutting into the frontal lobe. Tracheotomy is cutting into the trachea. Since the question asks about cutting apart fused valves, the only answer that makes sense is the one ending in "-otomy." (page 776)
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) CT scan b) Chest x-ray c) Echocardiogram d) Cardiac cauterization
Answer: C 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. (page 791)
A 45-year-old male client with a confirmed DVT is being discharged from the ED. Which of the following client statements indicates that the client has received proper nursing instruction and understands how to manage his condition? a) "I should try not to drink too much during the daytime." b) "I should lie on my side with my knees bent when sleeping." c) "I need to do my leg exercises five times or more every hour." d) "I need to ice my leg every 2 hours for about 20 minutes."
Answer: C Exercise prevents venous stasis by promoting venous circulation, relieves swelling, and reduces pain. Promoting venous blood flow prevents the formation of thrombi and subsequent potential for emboli in the unaffected extremity. Bending the knees is contraindicated for a client with DVT because it interferes with venous circulation and may increase the size of the existing clot or contribute to the formation of additional thrombi. Clients with DVT should apply warm, moist compresses to the area of discomfort because warmth dilates blood vessels, improves circulation, and relieves swelling, all of which relieve discomfort; moist heat is more comforting than dry heat. Adequate fluid volume dilutes blood cells in plasma and reduces the risk for platelet aggregation. (page 847)
The nurse is caring for a client following cardiac valve replacement. Which nursing action is correct when obtaining a Homan's sign to screen for thrombophlebitis? a) Assess the pulse on the dorsal aspect of the foot b) Rotation of the knee noting pain c) Dorsiflexion of the foot noting calf pain d) Adduction of the lower extremity
Answer: C The correct action to obtain a Homan's sign is to dorsiflex the foot noting calf pain. Heat, redness, and swelling also develops along the length of the vein. The other options are part of a circulation and musculoskeletal assessment but not the action for a Homan's sign. (page 847)
A patient is admitted with suspected cardiomyopathy. What diagnostic test would be most helpful with the identification of this disorder? a) Cardiac catheterization b) Phonocardiogram c) Echocardiogram d) Serial enzyme studies
Answer: C The echocardiogram is one of the most helpful diagnostic tools for cardiomyopathy because the structure and function of the ventricles can be observed easily. Taylor's note: Also, it's the least invasive of the options listed (except phonocardiogram maybe but who even knows what that is). Generally for something not emergent, pick the least invasive option! (page 781)
Following the assessment of a patient with suspected pericarditis, the nursing student would determine which of the following findings to be most characteristic? a) Fatigue lasting more than 1 month b) Elevated ESR and CRP c) Reports of constant chest pain d) Dyspnea
Answer: C 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. (page 791)
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) Supine b) Semi-Fowler's c) Leaning forward while sitting d) Prone
Answer: C 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. (page 791)
Which valve lies between the right ventricle and the pulmonary artery? a) Chordae tendineae b) Mitral c) Pulmonic d) Tricuspid
Answer: C The pulmonic valve is a semilunar valve located between the right ventricle and the pulmonary artery. The tricuspid valve is an atrioventricular valve located between the right atrium and right ventricle. The mitral valve is an atrioventricular valve located between the left atrium and left ventricle. Chordae tendineae anchor the valve leaflets to the papillary muscle and ventricular wall. (page 770)
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 lung surfaces lose their lubrication and rub against the myocardium with each heart beat." c) "The layers of the heart become loose from each other and rub together with each heart beat." d) "The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."
Answer: D 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. (page 819)
In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? a) Arrhythmogenic right ventricular cardiomyopathy b) Restrictive c) Dilated d) Hypertrophic
Answer: D Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH). Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue. (page 780)
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) Tachycardia d) Shortness of breath
Answer: D 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. (page 772)
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? a) Risk for peripheral neurovascular dysfunction b) Risk for deficient fluid volume c) Ineffective thermoregulation d) Decreased cardiac output
Answer: D Decreased cardiac output is an appropriate nursing diagnosis for a client with HCM because the hypertrophied cardiac muscle decreases the effectiveness of the heart's contraction, decreasing cardiac output. Heart failure may complicate HCM, causing fluid volume excess; therefore, the nursing diagnosis of Risk for deficient fluid volume isn't applicable. Ineffective thermoregulation and Risk for peripheral neurovascular dysfunction are inappropriate because HCM doesn't cause these problems. (page 785)
A nurse is conducting a heath history on a patient with a primary diagnosis of mitral stenosis. Which of the following disorders reported by the patient is the most common cause of mitral stenosis? a) Congestive heart failure b) Myocardial infarction c) Atrial fibrillation d) Rheumatic endocarditis
Answer: D Mitral stenosis is most often caused by rheumatic endocarditis, which progressively thickens the mitral valve leaflets and chordate tendineae. Leaflets often fuse together. Eventually, the mitral valve orifice narrows and progressively obstructs blood flow into the ventricle. (page 772)
A patient comes to the clinic with complaints of 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 of the following preventable diseases? a) Mitral stenosis b) Cardiomyopathy c) Pericarditis d) Rheumatic fever
Answer: D Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease. (page 787)
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) Distended jugular veins, pedal edema, nausea b) Dyspnea, distended jugular veins, orthopnea c) Orthopnea, nausea, pedal edema d) Dyspnea, orthopnea, pulmonary edema
Answer: D 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. Taylor's note: if you remember that Left and Lung both start with an L, you can remember that left-sided heart failure affects the lungs. (page 773)
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
Answer: D 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. (page 787)
Which of the following nursing interventions should a nurse perform to reduce cardiac workload in a patient diagnosed with myocarditis? a) Administer a prescribed antipyretic b) Elevate the patient's head c) Administer supplemental oxygen d) Maintain the patient on bed rest
Answer: D The nurse should maintain the patient on bed rest to reduce cardiac workload and promote healing. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the patient has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures like minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the patient's head to promote maximal breathing potential. (page 790)
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) Place the patient in the left lateral recumbent position. b) Administer morphine by intravenous push slowly. c) Notify the health care provider immediately. d) Stay with the patient, use a calm voice, and ask for assistance via call light.
Answer: D 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. (page 820)
The nurse understands that which of the following medications will be administered for 6 to 12 weeks following prosthetic porcine valve surgery? a) Furosemide b) Aspirin c) Digoxin d) Warfarin
Answer: D 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. (page 779)
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? a) Open commissurotomy b) Annuloplasty c) Chordoplasty d) Left ventricular assist device
Answer: D When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Because of the limited number of organ donors, many clients die waiting. In some cases, a left ventricular assist device is implanted to support the failing heart until a suitable donor becomes available. The other three choices have to do with failing valves and valve repairs. (page 809)
A nursing student is caring for a client with end-stage cardiomyopathy. The client's spouse asks the student to clarify one of the last treatment options available that the physician mentioned. After checking with the primary nurse, the student would most likely discuss which of the following? a) Valvuloplasty b) Xenograft tissue valve c) Annuloplasty d) Heart transplantation
Answer: D When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. The other three choices have to do with failing valves and valve repairs. (page 781)
