ch 23,24,26
The nurse is monitoring the prothrombin time (PT) of a client taking anticoagulant therapy. Which of the following values would the nurse consider normal? 1.5 2.5 3.5 4.5
2.5 Explanation: When the PT is reported as an international normalized ratio, the normal range is 2.0 to 3.0.
A client with a history of rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the client knows the importance of taking which of the following drugs? Enoxaparin Metoprolol Azathioprine Amoxicillin
Amoxicillin Explanation: Although rare, bacterial endocarditis may be life threatening. A key strategy is primary prevention in high-risk clients (i.e., those with rheumatic heart disease, mitral valve prolapse, or prosthetic heart valves). Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after certain procedures. Amoxicillin is the drug of choice. None of the other listed drugs is an antibiotic.
The nurse is taking the radial pulse of a client with a suspected valvular disorder. The pulse is very strong, with quick, sharp beats followed by a sudden collapse of force. What condition would the nurse suspect in the client? Aortic stenosis Aortic regurgitation Mitral valve prolapse Mitral stenosis
Aortic regurgitation Explanation: In aortic regurgitation, the radial pulse may be very strong, with quick, sharp beats followed by a sudden collapse of force, a characteristic called a water-hammer pulse or Corrigan's pulse.
A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)? Thrombosis and infection Bleeding and wound dehiscence Bleeding and infection Evisceration
Bleeding and infection Explanation: Possible complications of an aortic balloon valvuloplasty include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, infection, and bleeding from the catheter insertion sites.
A patient with pericarditis has been admitted to the CCU. The nurse caring for the patient knows that the most common clinical manifestation of pericarditis is what? Palpitations Chest pain Burning sensation in chest Pounding heart rate
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. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.
The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? "I need a referral to a dietician to understand a low-sodium diet." "I have to call my doctor so I can get antibiotics before seeing the dentist." "Can I take the antibiotics as a pill now?" "If I quit smoking, it will help the endocarditis."
"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.
A client is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the client? "Clients generally stay in the hospital for 6 to 8 days." "Clients are kept in the hospital until they are independent with all aspects of their care." "Clients need to stay in the hospital until they regain normal heart function for their age." "Clients usually remain at the hospital for 24 to 48 hours."
"Clients usually remain at the hospital for 24 to 48 hours." Explanation: After undergoing percutaneous balloon valvuloplasty, the patient usually remains in the hospital for 24 to 48 hours. Prediagnosis levels of heart function are not always attainable and the patient does not need to be wholly independent prior to discharge.
The nurse is interviewing a client who presents to the clinic with symptoms of aortic regurgitation. When taking the client's medical history, the nurse will ask which question that may be related to the cause of the client's present symptoms? "Were you a long-distance runner at any time?" "Did you work in the coal industry in the past?" "Have you previously taken medication to help you lose weight?" "Have you ever lived in a house that required treatment for mold?"
"Have you previously taken medication to help you lose weight?" Explanation: The incidence of aortic regurgitation is believed to have increased in recent years as a result of the use of a drug combination that was used at one time to assist in weight loss. A number of researchers have indicated that the use of these drugs have led to an increase in valvular disorders.
The nurse is caring for a client with mitral valve prolapse and would like to use complementary therapy to treat some of the symptoms if possible. What is the nurse's best response to the client? "You will feel better much sooner if you will just take medications." "If you have chest pain, you can lie on the floor and place your legs straight against a wall." "Shortness of breath can be relieved by breathing more rapidly to get more oxygen in your lungs." "If you feel your heart is beating too fast, lie down as quickly as you can so your heart will relax."
"If you have chest pain, you can lie on the floor and place your legs straight against a wall." Explanation: A complementary treatment for the chest pain associated with mitral valve prolapse is to lie flat and place the legs at a 90-degree angle for 3-5 minutes. Shortness of breath can best be treated by instructing the client to breathe deeply and slowly and then exhale through pursed lips. When tachycardia occurs, the client should increase activity to eliminate the need for extra, ineffective heart beats. The client isn't interested in medication at this time so it doesn't need to be discussed.
The nurse is weighing the client with a valvular disorder daily at the same time, with similar clothing, on the same scale. In 24 hours, the client shows a weight gain of 4 lbs. How much fluid would the nurse estimate that the client is retaining? Fill in the blank with a number
2 Explanation: A weight gain of 2 lb or more in 24 hours suggests fluid retention equal to 1 L. A 4-lb weight gain would be the equivalent of 2 L.
A nurse is teaching a client about valve replacement surgery. Which statement by the client indicates an understanding of the benefit of an autograft replacement valve? "The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is from a tissue donor, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is mechanical, and it will not deteriorate or need replacing.
"The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged." Explanation: Autografts (i.e., autologous valves) are obtained by excising the client'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 client'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, clients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.
To be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction (MI)? 30 minutes 60 minutes 9 days 6 to 12 months
60 minutes Explanation: The 60-minute interval is known as "door-to-balloon time" in which a PTCA can be performed on a client with a diagnosed MI. The 30-minute interval is known as "door-to-needle time" for the administration of thrombolytics after MI. The time frame of 9 days refers to the time until the onset of vasculitis after administration of streptokinase for thrombolysis in a client with an acute MI. The 6- to 12-month time frame refers to the time period during which streptokinase will not be used again in the same client for acute MI.
The nurse is assessing a patient two days postoperatively who is suspected of having deep vein obstruction. The patient is complaining of pain in the left lower extremity and there is a 2-cm difference in the right and left leg circumference. What intervention can the nurse provide to promote arterial flow to the lower extremities? Administer a diuretic to decrease the edema in the left lower extremity. Assist with active range-of-motion (ROM) exercises to the left lower extremity. Apply cool compresses to the left lower extremity. Apply a heating pad to the patient's abdomen.
Apply a heating pad to the patient's abdomen. Explanation: Nursing interventions may involve applications of warmth to promote arterial flow and instructions to the patient to avoid exposure to cold temperatures, which causes vasoconstriction. Adequate clothing and warm temperatures protect the patient from chilling. If chilling occurs, a warm bath or drink is helpful. A hot water bottle or heating pad may be applied to the patient's abdomen, causing vasodilation throughout the lower extremities.
A 79-year-old man is admitted to the medical unit with digital gangrene. The man states that his problems first began when he stubbed his toe going to the bathroom in the dark. In addition to this trauma, the nurse should suspect that the client has a history of what health problem? Raynaud phenomenon Coronary artery disease Arterial insufficiency Varicose veins
Arterial insufficiency Explanation: Arterial insufficiency may result in gangrene of the toe (digital gangrene), which usually is caused by trauma. The toe is stubbed and then turns black. Raynaud disease, CAD and varicose veins are not the usual causes of digital gangrene in the elderly.
A client reports chest pain and heavy breathing when exercising or when stressed. Which is a priority nursing intervention for the client diagnosed with coronary artery disease? Assess chest pain and administer prescribed drugs and oxygen Assess blood pressure and administer aspirin It is not important to assess the client or to notify the physician Assess the client's physical history
Assess chest pain and administer prescribed drugs and oxygen Explanation: The nurse assesses the client for chest pain and administers the prescribed drugs that dilate the coronary arteries. The nurse administers oxygen to improve the oxygen supply to the heart. Assessing blood pressure or the client's physical history does not clearly indicate that the client has CAD. The nurse does not administer aspirin without a prescription from the physician.
A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? Assess the client's level of pain and administer prescribed analgesics. Assess the client's level of anxiety and provide emotional support. Prepare the client for pulmonary artery catheterization. Ensure that the client's family is kept informed of the client's status.
Assess the client's level of pain and administer prescribed analgesics. Explanation: The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and family members should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? Cardiac tamponade Decreased venous pressure Hypertension Left ventricular hypertrophy
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 (see Chapter 29).
The nurse is aware that the following finding is often the earliest indication of mitral stenosis: Changes in heart sounds Hypertension Weight gain Dizziness
Changes in heart sounds Explanation: Changes in heart sounds may be the earliest indication of mitral valve stenosis. S1 may be extremely loud if the cusps are fused, or muffled or absent if the cusps have calcified and are immobile. A murmur, described as sounding like a rumbling underground train, can be heard at the heart's apex, especially when the client assumes a left lateral position.
Most people who have mitral valve prolapse never have any symptoms. Other patients with the diagnosis of mitral valve prolapsed do have symptoms. What symptoms might a patient have with mitral valve prolapse? (Mark all that apply.) Chest pain Fatigue Shoulder pain Hyperpnea Palpitations
Chest pain Fatigue Palpitations Explanation: Most people who have mitral valve prolapse never have symptoms. A few have symptoms of chest pain, fatigue, shortness of breath, lightheadedness, dizziness, syncope, palpitations, and anxiety. Fatigue may occur regardless of activity level and amount of rest or sleep. Shortness of breath is not correlated with activity levels or pulmonary function. Atrial or ventricular dysrhythmias may produce the sensation of palpitations, but palpitations have been reported while the heart has been beating normally. Chest pain, which is often localized to the chest, is not correlated with activity and may last for days. Anxiety may be a response to the symptoms; however, some patients report anxiety as the only symptom. Hyperpnea and shoulder pain are not symptoms of mitral valve prolapse.
A patient has been diagnosed with fused mitral leaflets, causing a backward flow of blood. What type of procedure does the nurse know is commonly performed for this type of problem? Annuloplasty Commissurotomy Valve replacement Chordoplasty
Commissurotomy Explanation: The most common valvuloplasty procedure is commissurotomy. Each valve has leaflets; the site where the leaflets meet is called the commissure. Leaflets may adhere to one another and close the commissure (i.e., stenosis). Less commonly, leaflets fuse in such a way that in addition to stenosis, the leaflets also are prevented from closing completely, resulting in backward flow of blood (i.e., regurgitation). A commissurotomy is the procedure performed to separate the fused leaflets.
A client who is postoperative day 1 following a CABG has produced 20 mL of urine in the past 3 hours and the nurse has confirmed the patency of the urinary catheter. What is the nurse's most appropriate action? Document the client's low urine output and monitor closely for the next several hours. Contact the dietitian and suggest the need for increased oral fluid intake. Contact the client's health care provider and continue to assess fluid balance and renal function. Increase the infusion rate of the client's IV fluid to prompt an increase in renal function.
Contact the client's health care provider and continue to assess fluid balance and renal function. Explanation: Nursing management includes accurate measurement of urine output. An output of <0.5 mL/kg/h may indicate hypovolemia or renal insufficiency. Prompt referral is necessary. IV fluid replacement may be indicated, but is beyond the independent scope of the dietitian or nurse.
A client has a several-year history of asymptomatic mitral valve regurgitation, inquires about continuing regular exercise. Which response should the nurse provide? Continue exercise until mild symptoms develop. Take ample rest after exercise. Avoid any type of exercise. Avoid strenuous exercises.
Continue exercise until mild symptoms develop. Explanation: Exercise is not limited in mitral valve regurgitation until mild symptoms develop.
The nurse is caring for a client with aortic regurgitation for which the health care provider has prescribed a beta-blocker. The nurse should know that a client with which other disorder will require frequent assessments due to this medication? Peripheral neuropathy Frequent upper respiratory infections Diabetes mellitus Multiple sclerosis
Diabetes mellitus Explanation: Beta blockers can cause an increase in blood sugar so clients with diabetes mellitus who have been prescribed beta blockers will need extra blood sugar monitoring. Beta blockers do not affect the symptoms associated with peripheral neuropathy, URIs, or multiple sclerosis.
A patient on the cardiac unit asks the nurse what the first symptoms of mitral stenosis are. When discussing the clinical manifestations of mitral stenosis with this patient, it would be important for the nurse to emphasize what? Palpable arterial pulsations New murmur Difficulty breathing Mitral click
Difficulty breathing Explanation: The first symptom of mitral stenosis is often breathing difficulty (dyspnea) on exertion as a result of pulmonary venous hypertension. Patients with mitral stenosis are likely to show progressive fatigue as a result of low cardiac output. Palpable arterial pulsations are present in aortic regurgitation. A mitral click is present in patients with mitral valve prolapse. When a new murmur in patients with a systemic infection is found, infectious endocarditis would be suspected.
Which is a characteristic of arterial insufficiency? Diminished or absent pulses Superficial ulcer Aching, cramping pain Pulses are present but may be difficult to palpate
Diminished or absent pulses Explanation: A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses.
A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis? Cardiac cauterization Computed tomography Echocardiography Chest x-ray
Echocardiography Explanation: Echocardiography is useful in detecting the presence of pericardial effusions associated with pericarditis. An echocardiogram may detect inflammation, pericardial effusion, tamponade, and heart failure. It may help confirm the diagnosis.
The patient has just returned to the floor after a balloon valvuloplasty. The nurse caring for the patient knows that complications following this procedure include what? (Mark all that apply.) Embolization Mitral regurgitation Myocardial infarction Coarctation of the aorta Plaque formation
Embolization Mitral regurgitation Myocardial infarction Explanation: Complications, although rare, include mitral regurgitation, residual atrial-septal defect, perforation of the left ventricle, embolization, and MI.
When discussing angina pectoris secondary to atherosclerotic disease with a client, the client asks why he tends to experience chest pain when he exerts himself. The nurse should describe which of the following phenomena? Exercise increases the heart's oxygen demands. Exercise causes vasoconstriction of the coronary arteries. Exercise shunts blood flow from the heart to the mesenteric area. Exercise increases the metabolism of cardiac medications.
Exercise increases the heart's oxygen demands. Explanation: Physical exertion increases the myocardial oxygen demand. If the client has arteriosclerosis of the coronary arteries, then blood supply is diminished to the myocardium. Exercise does not cause vasoconstriction or interfere with drug metabolism. Exercise does not shunt blood flow away from the heart.
A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? Group A, beta-hemolytic streptococcus Pseudomonas aeruginosa Serratia marcescens Staphylococcus aureus
Group A, beta-hemolytic streptococcus Explanation: 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). Clients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure.
When being assessed by her new nurse practitioner, a woman states that she has had Raynaud's disease for many years, a problem that occasionally affects her quality of life. When performing health education surrounding this problem, what should the nurse emphasize? Teaching the woman about atherosclerosis and its role in Raynaud's disease Teaching the woman about the correct use of anticoagulants Helping the woman identify and avoid the specific triggers of her problem Teaching the woman the signs and symptoms of deep vein thrombosis
Helping the woman identify and avoid the specific triggers of her problem Explanation: With appropriate patient teaching and lifestyle modifications, Raynaud's disease is generally benign and self-limiting. The patient is instructed to avoid the stimuli (eg, cold, tobacco) that provoke vasoconstriction. Raynaud's is not caused by atherosclerosis, and it is not a risk factor for DVT. Anticoagulants do not address the signs, symptoms, or etiology of the disease.
A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy? Dilated cardiomyopathy (DCM). Arrhythmogenic right ventricular cardiomyopathy (ARVC) Hypertrophic cardiomyopathy (HCM) Restrictive or constrictive cardiomyopathy (RCM)
Hypertrophic cardiomyopathy (HCM) Explanation: With HCM, cardiac arrest (i.e., sudden cardiac death) may be the initial manifestation in young people, including athletes. DCM, ARVC, and RCM are not typically present in younger adults who appear otherwise healthy.
The nurse is creating a plan of care for a client with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this client? Absence of complications Adherence to the self-care program Improved cardiac output Increased activity tolerance
Improved cardiac output Explanation: The priority nursing diagnosis of a client with cardiomyopathy would include improved or maintained cardiac output. Regardless of the category and cause, cardiomyopathy may lead to severe heart failure, lethal dysrhythmias, and death. The pathophysiology of all cardiomyopathies is a series of progressive events that culminate in impaired cardiac output. Absence of complications, adherence to the self-care program, and increased activity tolerance should be included in the care plan, but they do not have the priority of improved cardiac output.
Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? Increased abdominal and back pain Decreased pulse rate and blood pressure Retrosternal back pain radiating to the left arm Elevated blood pressure and rapid respirations
Increased abdominal and back pain Explanation: Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.
The nurse is caring for an adult patient who had symptoms of unstable angina during admission to the hospital. The most appropriate nursing diagnosis for the discomfort associated with angina is what? Deficient knowledge about underlying disease and methods for avoiding complications Anxiety related to fear of death Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Noncompliance related to failure to accept necessary lifestyle changes
Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Explanation: Ineffective cardiopulmonary tissue perfusion describes the symptoms of discomfort associated with angina. Deficient knowledge describes the patient awareness of disease process and treatment. Anxiety identifies psychological effects of angina, while noncompliance is related to a patient's resistance to changing behaviors/patterns necessary to treat and manage the disease.
A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? Impaired gas exchange related to increased blood flow Excess fluid volume related to peripheral vascular disease Risk for injury related to edema Ineffective peripheral tissue perfusion related to venous congestion
Ineffective peripheral tissue perfusion related to venous congestion Explanation: Ineffective peripheral tissue perfusion related to venous congestion takes highest priority because venous inflammation and clot formation impede blood flow in a client with DVT. Impaired gas exchange related to increased blood flow is incorrect because impaired gas exchange is related to decreased, not increased, blood flow. Excess fluid volume related to peripheral vascular disease is inappropriate because there's no evidence that this client has an excess fluid volume. Risk for injury related to edema may be warranted but is secondary to ineffective tissue perfusion.
The nurse is taking a health history on a new patient. The patient reports experiencing pain in the left lower leg and foot when walking, but claims that the pain is relieved with rest. The nurse notes that the patient's left lower leg is slightly edematous and hairless. What should the nurse suspect that the patient may be experiencing? Coronary artery disease (CAD) Intermittent claudication Arterial embolus Raynaud's disease
Intermittent claudication Explanation: A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise. The nurse would not yet conclude that the patient has CAD, an arterial embolus, or Raynaud's disease.
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophsiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what? Cardiac tamponade Left ventricular enlargement Right-sided heart failure Ventricular insufficiency
Left ventricular enlargement Explanation: Aortic regurgitation eventually causes left ventricular enlargement (hypertrophy). In aortic regurgitation, blood from the aorta returns to the left ventricle during diastole in addition to the blood normally delivered by the left atrium. The left ventricle dilates, trying to accommodate the increased volume of blood. Aortic regurgitation does not cause cardiac tamponade, right-sided heart failure, or ventricular insufficiency.
The nurse is caring for a patient who is scheduled for a balloon valvuloplasty. The nurse recalls that balloon valvuloplasty is most commonly used for which valvular heart disease? Aortic regurgitation Mitral valve prolapse Mitral stenosis Mitral regurgitation
Mitral stenosis Explanation: Balloon valvuloplasty is most commonly used for patients diagnosed with mitral stenosis or aortic valve stenosis in elderly patients. For patients with mitral regurgitation, rotation of the great vessels, and thoracolumbar scoliosis, balloon valvuloplasty is contraindicated.
A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea as a result of pulmonary venous hypertension. What valvular disorder would cause pulmonary venous hypertension? Aortic regurgitation Mitral stenosis Mitral valve prolapse Aortic stenosis
Mitral stenosis Explanation: The first symptom of mitral stenosis is often dyspnea on exertion as a result of pulmonary venous hypertension. Symptoms usually develop after the valve opening is reduced by one-third to one-half its usual size. Patients are likely to show progressive fatigue as a result of low cardiac output. The enlarged left atrium may create pressure on the left bronchial tree, resulting in a dry cough or wheezing. Patients may expectorate blood (ie, hemoptysis) or experience palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and repeated respiratory infections. Pulmonary venous hypertension is not caused by aortic regurgitation, mitral valve prolapse, or aortic stenosis.
Mary Seaver is admitted to the pediatrics unit where you practice nursing. She was admitted by her pediatrician 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 Mary were to develop rheumatic carditis, which cardiac valve most likely would be affected? Mitral valve Pulmonic valve Tricuspid valve Aortic valve
Mitral valve Explanation: Cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium.
An adult client is admitted to the ED with chest pain. The client states that he had unrelieved chest pain for approximately 20 minutes before coming to the hospital. To minimize cardiac damage, the nurse should expect to administer which of the following interventions? Thrombolytics (fibrinolytics), oxygen administration, and nonsteroidal anti-inflammatories Morphine sulphate, oxygen, and bed rest Oxygen and beta-adrenergic blockers Bed rest, albuterol nebulizer treatments, and oxygen
Morphine sulphate, oxygen, and bed rest Explanation: The client with suspected MI should immediately receive supplemental oxygen, aspirin, nitroglycerin, and morphine. Morphine sulphate reduces preload and decreases workload of the heart, along with increased oxygen from oxygen therapy and bed rest. With decreased cardiac demand, this provides the best chance of decreasing cardiac damage. NSAIDs and beta-blockers are not normally indicated. Albuterol, which is a medication used to manage asthma and respiratory conditions, will increase the heart rate.
Which medical treatment should be administered to treat intermittent claudication? Analgesics Warfarin (Coumadin) Heparin Pentoxifylline (Trental)
Pentoxifylline (Trental) Explanation: Pentoxifylline decreases blood viscosity, increases red blood cell flexibility, and improves flow through small vessels. Analgesics are administered for pain relief. Warfarin and heparin are anticoagulants.
A cardiac surgery client's new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurse's most appropriate action? Prepare to assist with pericardiocentesis. Reposition the client into a prone position. Administer a dose of metoprolol as prescribed. Administer a bolus of normal saline as prescribed.
Prepare to assist with pericardiocentesis. Explanation: Cardiac tamponade requires immediate pericardiocentesis. Beta-blockers and fluid boluses will not relieve the pressure on the heart and prone positioning would likely exacerbate symptoms.
A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease? Recognizing and promptly treating streptococcal infections Prophylactic use of calcium channel blockers in high-risk populations Adhering closely to the recommended child immunization schedule Smoking cessation
Recognizing and promptly treating streptococcal infections Explanation: Group A streptococcus can cause rheumatic heart fever, resulting in rheumatic endocarditis. Being aware of signs and symptoms of streptococcal infections, identifying them quickly, and treating them promptly, are the best preventative techniques for rheumatic endocarditis. Smoking cessation, immunizations, and calcium channel blockers will not prevent rheumatic heart disease.
What is the primary reason that the nurse monitors urine output in the client with a valvular disorder of the heart? Renal output reflects the heart's ability to perfuse the renal arteries. Urinary output is a reflection of the effectiveness of valvuloplasty procedures. Urine output will show any lingering signs of infection that may have contributed to the valve problem. The client's kidneys will directly affect the pumping of the heart.
Renal output reflects the heart's ability to perfuse the renal arteries.
Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. Hypertrophic cardiomyopathy (HCM) Restrictive cardiomyopathy (RCM) Dilated cardiomyopathy (DCM) Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Restrictive cardiomyopathy (RCM) Explanation: RCM may be associated with amyloidosis (amyloid, a protein substance, is deposited within cells) and other such infiltrative diseases. However, the cause is idiopathic in most cases. Hypertrophic cardiomyopathy occurs when the heart muscle asymmetrically increases in size and mass, especially along the septum. Dilated cardiomyopathy is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. Arrhythmogenic right ventricular cardiomyopathy occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.
A nurse is conducting a heath history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis? Rheumatic endocarditis Congestive heart failure Atrial fibrillation Myocardial infarction
Rheumatic endocarditis Explanation: 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.
A client comes to the clinic reporting fever, chills, and sore throat and is diagnosed with streptococcal pharyngitis. A nurse knows that early diagnosis and effective treatment is essential to avoid which preventable disease? Rheumatic fever Mitral stenosis Cardiomyopathy Pericarditis
Rheumatic fever Explanation: Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and thereby rheumatic heart disease.
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? Risk for infection Chronic pain Impaired gas exchange Impaired memory
Risk for infection Explanation: Clients with endocarditis have a Risk for infection. The nurse should stress to the client that he'll need to continue antibiotics for a minimum of 5 years and that he'll need to take prophylactic antibiotics before invasive procedures for life. There is no indication that the client has Chronic pain or Impaired memory. Because the client doesn't have valvular damage, Impaired gas exchange doesn't apply.
A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? A loud, blowing murmur Hypertension Shortness of breath Tachycardia
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 upon exertion, and cough from pulmonary congestion also occur. A loud, blowing murmur often is heard throughout ventricular systole at the apex of the heart. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.
The nurse is assessing a client who recently began experiencing dizziness and weakness. The nurse will note which manifestation on the cardiac assessment which is suggestive of aortic stenosis? Split S2 sound and the PMI is displaced laterally from its usual location Split S1 sound and an inability to locate the PMI on the client's chest S3 and S4 identified with a normal PMI Normal heart sounds and a PMI that is displaced to the right of the sternum
Split S2 sound and the PMI is displaced laterally from its usual location Explanation: Clients with aortic stenosis will have a split S2 sound and because of ventricular enlargement, heart pulsations are displaced laterally or distally on the chest wall from the usual PMI. On auscultation, S4 may be heard but not S3.
Diagnostic testing reveals a backflow of blood in the client's left ventricle from the left atrium. The nurse is aware that the patient is suffering from a defect in which valve? Mitral Aortic Bicuspid Pulmonic
The mitral valve separates the left atrium and left ventricle. This malfunction allows the backflow of blood due to a defect in the mitral valve. The tricuspid valve separates the right atrium and right ventricle. The pulmonic valve separates the right ventricle and pulmonary artery. The aortic valve separates the left ventricle and aorta.
A patient with coronary artery disease (CAD) is having a cardiac catheterization. What indicator is present for the patient to have a coronary artery bypass graft (CABG)? The patient has compromised left ventricular function. The patient has had angina longer than 3 years. The patient has at least a 70% occlusion of a major coronary artery. The patient has an ejection fraction of 65%.
The patient has at least a 70% occlusion of a major coronary artery. Explanation: For a patient to be considered for CABG, the coronary arteries to be bypassed must have approximately a 70% occlusion (60% if in the left main coronary artery).
A client has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The health care provider's choice of antibiotics would be primarily based on what diagnostic test? Echocardiography Blood cultures Cardiac aspiration Full blood count
To help determine the causative organisms and the most effective antibiotic treatment for the client, blood cultures are taken. A CBC can help establish the degree and stage of infection, but not the causative microorganism. Echocardiography cannot indicate the microorganisms causing the infection. "Cardiac aspiration" is not a diagnostic test.
A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gater area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? Arterial insufficiency Venous insufficiency Neither venous nor arterial insufficiency Trauma
Venous insufficiency Explanation: Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.
A client has had a 12-lead ECG completed as part of an annual physical examination. The nurse notes an abnormal Q wave on an otherwise unremarkable ECG. The nurse recognizes that this finding indicates an old MI. an evolving MI. variant angina. a cardiac dysrhythmia.
an old MI. Explanation: An abnormal Q wave may be present without ST-segment and T-wave changes, which indicates an old, not acute, MI.
A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD? ankle-brachial index exercise electrocardiography electron beam computed tomography photoplethysmography
ankle-brachial index Explanation: The client's symptoms indicate possible peripheral artery disease (PAD). The ankle-brachial index is a simple, noninvasive test used for this diagnosis. An exercise electrocardiography may be ordered for a client with possible CAD. An EBCT is a radiologic test that produces x-rays of the coronary arteries using an electron beam. It is used to diagnose for CAD. Clients with suspected venous insufficiency will undergo photoplethysmography, a diagnostic test that measures light that is not absorbed by hemoglobin and consequently is reflected back to the machine.
A client with no history of cardiac problems is undergoing diagnostics for a cardiac valvular condition. The cardiologist has indicated that the client has had this particular valvular condition from birth, and the recent onset of symptoms is attributed to age. What disorder is causing the client difficulty? aortic stenosis aortic hypertrophy mitral stenosis mitral regurgitation
aortic stenosis Explanation: In older adults without predisposing cardiac conditions, aortic stenosis is an age-related degenerative change from progressive calcium deposits in valve cells. In older adults without predisposing cardiac conditions, narrowing of the aortic valve is an age-related degenerative change from progressive calcium deposits in valve cells. Clients who have had rheumatic carditis are more likely to develop mitral stenosis. Mitral regurgitation is associated with rheumatic carditis and mitral valve prolapse.
A client with CAD thinks diltiazem (Cardizem) has been causing nausea. Diltiazem (Cardizem) is categorized as which type of drug? calcium-channel blocker beta-adrenergic blocker nitrate diuretic
calcium-channel blocker Explanation: Calcium-channel blocking agents may be used to treat CAD as well, although research has shown that they may be less beneficial than beta-adrenergic blocking agents. Diltiazem (Cardizem) is an example of a calcium-channel blocker.
The public health nurse is participating in a health fair and interviews a client with a history of hypertension, who is currently smoking one pack of cigarettes per day. The client denies any of the most common manifestations of CAD. The nurse should expect the focuses of CAD treatment to be: drug therapy and smoking cessation. diet and drug therapy. diet therapy only. diet therapy and smoking cessation.
diet therapy and smoking cessation. Explanation: Due to the absence of symptoms, dietary therapy would likely be selected as the first-line treatment for possible CAD. Drug therapy would be determined based on a number of considerations and diagnostics findings, but would not be directly indicated. Smoking cessation is always indicated, regardless of the presence or absence of symptoms.
A client with suspected mitral valve stenosis is undergoing diagnostic testing. The earliest indication of this client's valvular disorder was most likely changes in: heart sounds. diastolic blood pressure. heart rate. heart rhythm.
heart sounds. Explanation: Changes in heart sounds may be the earliest indication of mitral valve stenosis. S1 may be extremely loud if the cusps are fused or muffled, or absent if the cusps have calcified and are immobile. A murmur, described as sounding like a rumbling underground train, can be heard at the heart's apex, especially when the client assumes a left lateral position. In mitral valve stenosis, the systolic BP is low from reduced cardiac output.
A client is undergoing diagnostics for a cardiac disorder. As a child, she had rheumatic fever and her recent pregnancy seems to have exacerbated her fatigue and dyspnea after exertion. After a thorough examination, the cardiologist schedules the client for a corrective procedure. What is her expected diagnosis? mitral stenosis mitral regurgitation aortic stenosis aortic regurgitation
mitral stenosis Explanation: It may take 20 to 40 years for a client who has had rheumatic fever to develop mitral stenosis. At that time, clients report fatigue and dyspnea after slight exertion. Symptoms become disabling approximately 10 years after onset; they are accentuated when unusual demands are placed on the heart (e.g., fever, emotional stress, pregnancy). Mitral regurgitation is associated with rheumatic carditis and mitral valve prolapse. Aortic stenosis, a narrowing of the aortic valve, is an age-related degenerative change from progressive calcium deposits in valve cells. Aortic regurgitation may be a consequence of various disorders such as rheumatic carditis, endocarditis, syphilis, age-related stretching of the proximal aorta, and systemic inflammatory conditions.
The chest radiograph of a client who is experiencing fatigue and dyspnea after slight exertion reveals an enlarged left atrium and mitral valve calcification. The findings most likely indicate: mitral stenosis. aortic regurgitation. aortic stenosis. mitral regurgitation.
mitral stenosis. Explanation: In mitral stenosis, the mitral valve cannot open completely, leading to incomplete emptying of the left atrium. The left atrium enlarges because it has to contract more forcibly to empty. Aortic regurgitation occurs when the aortic valve does not close tightly and blood can leak backward. A chest radiograph reveals heart enlargement, and the aortic valve appears dilated. Aortic stenosis is a narrowing of the opening in the aortic valve when the valve cusps become stiff and rigid. Ventricular enlargement is evident on a chest radiograph. Mitral regurgitation occurs when the mitral valve does not close completely. Chest radiography shows enlarged chambers on the left side of the heart.
