MED/SURG2: Chapter 36

The nurse recognizes that interventions for a patient with dilated cardiomyopathy focus on controlling heart failure (HF). Which medications are prescribed decrease preload, to assist with this goal? Select all that apply.

-Furosemide -Nitroglycerin -

The nurse recalls that which are the main characteristics of hypertrophic cardiomyopathy (CMP)? Select all that apply.

-Impaired diastole -Massive ventricular hypertrophy -Rapid, forceful contraction of the left ventricle

A patient is scheduled for a percutaneous transluminal balloon valvuloplasty. What information should the nurse provide to the patient before the procedure? Select all that apply.

-It has few complications -Long-term results are similar to surgical commissurotomy

The nurse is caring for a patient with Takotsubo cardiomyopathy. What information should the nurse provide to the patient about this disease? Select all that apply.

-It is more common in menopausal women -The clinical findings are similar to acute coronary syndrome. -The clinical findings are similar to acute coronary syndrome.

The nurse provides information about side effects of digoxin to a nursing student. What should the nurse include? Select all that apply.

-It may cause toxicity. -It may result in dysrhythmias

A patient has been admitted with acute pericarditis. How should the nurse care for this patient? Select all that apply.

-Provide an overbed table -Tell the patient to avoid alcohol. -Administer antiinflammatory medications

What supportive measures should the nurse implement when providing care to a patient with myocarditis? Select all that apply.

-Providing a quiet environment -Spacing activity and rest periods -Placing the patient in semi-Fowler's position -Keep the patient and caregiver informed about the therapeutic plan

The nurse assesses a patient with infective endocarditis and expects what clinical manifestations? Select all that apply.

-Roth's spots -Osler's nodes -Janeway's lesions

The nurse cares for a patient with infective endocarditis (IE) and expects what assessment findings? Select all that apply.

-Tachycardia -Peripheral edema -Retinal hemorrhages

A patient that has undergone valve replacement takes warfarin. The patient asks the nurse why regular international normalized ratio (INR) tests are prescribed. What explanation should the nurse give to emphasize the importance of this test? Select all that apply.

-To determine proper dosage -To determine adequacy of therapy

A patient is admitted with suspected myocarditis. Which test is considered most diagnostic for this illness?

Endomyocardial biopsy

A patient is suspected of having hypertrophic cardiomyopathy (CMP). The nurse anticipates a prescription for what primary diagnostic study?

Echocardiogram

The nurse provides education to a patient with infective endocarditis related to home care management. Which statement made by the patient indicates the need for further teaching?

"I should be aware that fever and fatigue are normal."

The nurse provides discharge teaching for a patient with a diagnosis of subacute infective endocarditis. Which statement made by the patient indicates the need for further teaching?

"I will receive a prescription for antibiotics that I will take by mouth."

Which statement made by the nurse to a patient with cardiomyopathy regarding home care instructions needs correction?

"Increase your caffeine consumption."

The nurse is providing discharge education to a patient with dilated cardiomyopathy (CMP). Which patient statement indicates the need for further teaching?

"Most patients with this diagnosis respond well to treatment."

A patient with group A streptococcal pharyngitis states, "I do not want to take the antibiotics that have been prescribed." How should the nurse respond?

"Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease."

The nurse is assessing a patient with mitral valve stenosis. Which findings are likely during the nursing examination? Select all that apply.

-Exertional dyspnea -Fatigue and palpitations -Low-pitched diastolic murmur at the apex

A patient has been diagnosed with mitral valve prolapse. What should be included in the treatment plan of the patient? Select all that apply.

-Fluid restriction -Avoiding caffeine or ephedrine -β-adrenergic blockers to control palpitations

The nurse provides teaching to a patient with acute rheumatic fever (RF). Which statement made by the patient indicates a need for further education?

"Exercise is important to help me regain my strength."

While reviewing the diagnostic reports of a patient with hypertrophic cardiomyopathy, the nurse notes an abnormal, irregular, and rapid heartbeat and left ventricular outflow obstruction. Which medications may be beneficial to the patient? Select all that apply.

-Digitalis -Verapamil -Metoprolol

A patient is admitted to a hospital with a possible diagnosis of hypertrophic cardiomyopathy. The nurse anticipates that which diagnostic tests will be performed? Select all that apply.

-Echocardiogram -Cardiac catheterization

The nurse assesses a 70-year-old patient during a follow-up visit. The patient has progressive valvular disease caused by rheumatic fever. Which interventions are appropriate for the nurse to perform? Select all that apply.

-Encourage planned rest periods -Ensure ongoing prophylactic therapy -Evaluate the effectiveness of medication.

The nurse is caring for a patient admitted to a health care facility with acute pericarditis. Which interventions should the nurse perform? Select all that apply.

-Ensure that the patient is kept on bed rest -Keep the head of the bed raised to 45 degrees -Administer antiinflammatory drugs with milk or food

Which questions are appropriate for the nurse to ask to assess the cognitive-perceptual patterns of a patient diagnosed with valvular heart disease? Select all that apply.

-"Do you experience angina?" -"Do you experience atypical chest pain?

The nurse conducts a health history interview of a patient who is diagnosed with infective endocarditis. Which questions are appropriate for the nurse to include when assessing the patient's cognitive-perceptual pattern? Select all that apply.

-"Do you have a headache? -Do you experience chest pain? -"Do you experience abdominal pain

A patient has undergone surgery for a valve replacement. Which statements indicate that the patient understands the instructions from the nurse? Select all that apply.

-"I should wear a Medic Alert device." -"I will need to take antibiotics when I have my teeth extracted." -"I should contact my health care provider if I have a respiratory infection."

A patient seeks information about the advantages of minimally invasive valvuloplasty surgery. What should the nurse say to explain the procedure to the patient? Select all that apply.

-"It is associated with less pain." -"It can lead to postoperative atrial fibrillation -"It involves a shorter length of stay in the hospital."

The nurse is assessing a patient for pericardial friction rub related to myocarditis. The nurse should perform the steps of the assessment in what order?

-Assist the patient to lean forward -Place the stethoscope at the lower left sternal border of the chest -Ask the patient to hold his or her breath -Repeat several times

The nurse is auscultating the heart sounds of a patient with valvular heart disease. Which assessment findings may indicate mitral valve regurgitation? Select all that apply.

-Audible third heart sound (S3) -A loud holosystolic murmur at the apex radiating to the left axilla

The nurse is planning discharge teaching for a patient with cardiomyopathy. What instructions should be included in the plan? Select all that apply.

-Avoid alcohol -Balance activity and rest periods -Avoid vigorous isometric exercises.

The nurse should include which instructions when teaching a patient with mitral valve prolapse about self-care? Select all that apply.

-Avoid caffeine -Avoid ephedrine in over-the-counter medications -Immediately report shortness of breath, fatigue, and palpitations

The nurse is planning discharge teaching for a patient with valvular heart disease. What instructions should the nurse include in the plan? Select all that apply.

-Avoid cigarettes -Take planned rest periods. -Limit activities that cause fatigue -Undergo regular cardiac assessments.

A nurse is caring for a patient with hypertrophic cardiomyopathy. What measures should be included in planning the care for this patient? Select all that apply.

-Avoid dehydration -Avoid strenuous activity -Encourage elevation of the feet

The nurse identifies a group of patients who have a high risk of developing infective endocarditis. What instructions should be included when teaching the patients about the prevention of infective endocarditis? Select all that apply.

-Avoid overexertion -Visit a dentist regularly -Avoid people with cold and flu symptoms

A patient with a transplanted heart has developed heart valve disease. What should the nurse include in the patient teaching? Select all that apply.

-Avoid strenuous physical exercise -Notify the health care provider for planned dental work -If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed.

A patient with atrial fibrillation has been scheduled to undergo biologic valve replacement surgery. What should the nurse tell the patient about the benefits of a biologic valve versus a mechanical valve? Select all that apply.

-Biologic valves lower the risk of tissue rejection -Biologic valves do not require anticoagulation therapy.

A patient with infective endocarditis is being discharged from the health care facility. What should the nurse teach the patient and caregiver about nursing care at home? Select all that apply.

-Continue follow-up care -Take antibiotics as scheduled -Avoid people with an upper respiratory tract infection

The nurse assesses a patient and suspects acute mitral valve regurgitation (MR). Which symptoms support the nurse's suspicion? Select all that apply.

-Cool extremities -Thready, peripheral pulses

The nurse is measuring a patient's pulsus paradoxus. The first Korotkoff sound during expiration is noted at 115 mm Hg, and the reading at which sounds are heard throughout the respiratory cycle is noted at 84 mm Hg. What is the amount of paradox? Record the answer using a whole number. ______

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The nurse assesses a patient with valvular heart disease. The nurse recalls that the absence of what heart sound is indicative of aortic valve stenosis?

Absence of S2

A patient reports severe chest pain radiating to the neck and arms. Assessment findings include a scratching, grating, and high-pitched sound at the lower sternal border of the chest. The nurse recognizes the presence of the hallmark finding of what condition?

Acute pericarditis

Which is a secondary cause of restrictive cardiomyopathy?

Amyloidosis

Which category of medication helps reduce afterload in patients with heart failure?

Angiotensin-converting enzyme (ACE) inhibitors

While performing an admission assessment, the nurse notes Janeway's lesions on a patient's fingertips, palms, soles of feet, and toes. The nurse suspects what diagnosis?

Infective endocarditis

A patient with a history of rheumatic fever is diagnosed with mitral valve stenosis. The patient is scheduled for prosthetic valve replacement surgery. The nurse should inform the patient that what protective mechanism will be implemented after the surgery?

Antibiotic prophylaxis for dental manipulation involving the gums of the teeth

What is the nursing priority for a patient with rheumatic fever?

Antibiotic therapy

While auscultating a patient who underwent trauma, the nurse auscultates a quick, strong heartbeat that collapses immediately. The patient has severe dyspnea and describes the chest pain as 8 out of 10 on the pain scale. Which condition does the nurse suspect?

Aortic valve regurgitation

A patient is admitted to the hospital with a diagnosis of acute mitral valve regurgitation. What is the priority nursing intervention?

Auscultate the lung sounds

Which type of murmur is observed in patients with chronic aortic valve regurgitation?

Austin Flint murmur

The nurse is caring for an older patient that is diagnosed with pulmonic stenosis. The nurse anticipates that which type of conservative therapy may be prescribed?

Balloon valvuloplasty

The nurse reviews laboratory test results for a patient with acute infective endocarditis. Which test result is significant for determining the plan of treatment?

Blood cultures

The nurse assessing a patient with mitral valve stenosis will likely find symptoms primarily associated with what cardiac change?

Reduced lung compliance

The nurse is caring for a patient with valvular heart disease who experiences atrial dysrhythmias. The nurse anticipates a prescription for which type of medication?

Calcium channel blocker

A patient that is receiving treatment for acute pericarditis reports a new onset of chest pain. The nurse assesses the patient and notes confusion, anxiety, and restlessness. The nurse suspects what complication?

Cardiac tamponade

A patient reports anorexia, weight loss, edema, and dyspnea on exertion. Upon physical examination, the nurse finds jugular venous distention. What type of cardiovascular inflammation does the nurse suspect the patient is experiencing?

Chronic constrictive pericarditis

While reviewing a patient's medical record, the nurse notices loss of elasticity of the pericardial sac. Which condition does the nurse suspect in this patient?

Chronic constrictive pericarditis

The nurse assesses a patient with infective endocarditis and expects that if petechiae are observed, they will be found in what location of the body?

Conjunctivae

A patient with an inflammation of the pericardial sac secondary to systemic lupus erythematosus (SLE). The nurse anticipates that which therapy will be prescribed?

Corticosteroid therapy

Which type of surgical therapy utilizes cardiopulmonary bypass?

Direct vision procedure

Which medication is prescribed to decrease preload in patients with dilated cardiomyopathy?

Furosemide

The nurse is caring for a patient with infective endocarditis and should monitor for which complication that occurs due to pulmonary emboli?

Hemoptysis

After assessing a patient with rheumatic fever, the nurse documents Sydenham's chorea in the patient's medical record. Which assessment finding led the nurse to document this condition?

Involuntary movements of the face and limbs

Which statement is true regarding hypertrophic cardiomyopathy?

It involves impaired diastole

While assessing a patient with cardiovascular disorder, the nurse observes flat, small, painless, red spots on the soles of the feet and palms of the hands. The nurse recognizes that the findings meet the definition of what condition?

Janeway's lesions

A patient with infective endocarditis is admitted to the health care facility. The nurse is aware that primary lesions of infective endocarditis can cause emboli. Which organ may be affected by the process of embolization due to right-sided heart lesions?

Lungs

The nurse is preparing a discharge teaching plan for a patient admitted with restrictive cardiomyopathy. Which instruction should the nurse include in the plan?

Maintain a reasonable weight and avoid large meals

The nurse performs an international normalized ratio (INR) blood study for a patient two months after the patient underwent mitral valve replacement surgery. The patient has been receiving warfarin therapy since the surgery. The INR value is 3.1. The nurse should take what action?

Maintain the patient at the same warfarin dose

The nurse finds diastolic murmurs in a patient who says, "I'm finding it hard to breathe, and sometimes I cough up blood." What condition does the nurse suspect?

Mitral valve stenosis

A patient's assessment findings include peripheral edema, distended neck veins, and lung crackles. What diagnosis does the nurse anticipate?

Myocarditis

What is a noninfectious cause of pericarditis?

Myxedema

The patient with pericarditis reports chest pain. The nurse recognizes that which intervention will help provide pain relief?

Nonsteroidal antiinflammatory drugs (NSAIDs)

The nurse is assessing a patient with a pacemaker during a follow-up visit. The patient has red, painful, tender, pea-sized lesions on the fingertips and toes. How should the nurse document this finding?

Osler's nodes

An 80-year-old patient who is a poor surgery candidate is diagnosed with aortic stenosis. The nurse anticipates that what procedure will likely be recommended?

Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

The nurse expects what assessment finding in a patient diagnosed with acute pericarditis?

Pericardial friction rub

The nurse reviews the medical record of a patient newly diagnosed with infective endocarditis (IE). The nurse identifies that it is essential to notify the primary health care provider about which finding?

Positive results of a blood culture

The echocardiography report of a patient with infective endocarditis (IE) indicates the presence of a vegetative mass in the right ventricle. The nurse recalls that what complication could result from this condition?

Pulmonary embolization

A patient with mitral valve stenosis presents with hemoptysis. The nurse suspects that the symptom is caused by what?

Pulmonary hypertension

While assessing a patient with pericarditis, the nurse expects to observe what manifestation of the disorder?

Pulsus paradoxus

Which diagnostic study is used to assess congenital heart disease in a patient?

Real time 3-D echocardiography

Which diagnostic study is used to diagnose mitral valve prolapse?

Real-time 3-D echocardiography

Which type of cardiomyopathy impairs diastolic filling and stretch?

Restrictive cardiomyopathy

The nurse conducts a complete physical assessment on a patient admitted with suspected infective endocarditis (IE). Which diagnostic finding is indicative of the disorder?

Retinal hemorrhages

The nurse recalls that which heart disease involves the inflammation of all layers of the heart?

Rheumatic fever

The nurse reviews the assessment findings of a patient with febrile illness and suspects that the patient is experiencing what condition?

Rheumatic fever (RF)

A patient that is hospitalized with acute pericarditis reports severe, sharp chest pain. To increase patient comfort, the nurse should encourage the patient to assume which position?

Sit up and lean forward

The nurse is assessing a patient with rheumatic fever in the outpatient unit of a health care facility. For which condition should the nurse assess the patient?

Subcutaneous nodules over all bony surfaces

What is a major central nervous system (CNS) manifestation of rheumatic fever (RF)?

Sydenham's chorea

Which complication occurs due to obstruction to aortic outflow during increased activity?

Syncope

The ECG (electrocardiogram) of a postmenopausal woman reporting chest pain reveals an elevated ST segment, and the laboratory test reports indicate elevated cardiac biomarkers. Which condition does the nurse suspect?

Takotsubo cardiomyopathy

A multiple gated acquisition (MUGA) scan has been prescribed to a patient with cardiac problems to determine what?

The patient's ejection fraction (EF)

A patient with suspected infective endocarditis (IE) is scheduled for cardiac catheterization. The nurse recognizes that the purpose of the test for this patient is what?

To evaluate valve function

What is the therapeutic role of digoxin in treating myocarditis?

To improve myocardial contractility

Which diagnostic study helps detect the presence of vegetation on the heart valves in a patient with endocarditis?

Transesophageal echocardiogram

Which type of valvular heart disease occurs almost exclusively in patients that abuse drugs intravenously?

Tricuspid stenosis

A patient with infective endocarditis is scheduled for a transesophageal echocardiogram (TEE). The nurse recalls that the test is performed to detect what?

Vegetations on the heart valves

It is determined that a patient with advanced dilated cardiomyopathy (CMP) is not a candidate for heart transplantation. The nurse anticipates a prescription for what treatment?

Ventricular assist device (VAD)

The nurse is assessing a patient with chronic aortic regurgitation in the emergency unit of a health care facility. The nurse expects to find which heart sound?

Water-hammer pulse

While auscultating a patient who underwent trauma, the nurse auscultates a quick, strong heartbeat that collapses immediately. The patient has severe dyspnea and describes the chest pain as 8 out of 10 on the pain scale. Which condition does the nurse suspect?

aortic valve regurgitation

The nurse auscultates an irregular, rapid heart rate in a patient with mitral valve prolapse. Which type of medication does the nurse expect will be prescribed?

β-blocker