Ch. 28 PrepU
The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?
"Have you been to the dentist recently?"
The nurse determines that a 49-year-old client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?
"I have to call my doctor so I can get antibiotics before seeing the dentist."
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
Which of the following would be inconsistent as a lifestyle change directive for the patient diagnosed with heart failure?
Push fluids
Which of the following is an action of the intra-aortic balloon pump (IABP)?
Reduction of left ventricular afterload
A patient is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response? Group A, beta-hemolytic streptococcus Serratia marcescens Pseudomonas aeruginosa Staphylococcus aureus
Group A, beta-hemolytic streptococcus
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."
A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. Which of the following instructions would provide that information?
Alternate active periods with rest periods.
Which would the nurse stress as a lifelong necessity for a client managing infective endocarditis?
Antibiotic therapy
The nurse is assessing a patient and feels a pulse with quick, sharp strokes that suddenly collapse. The nurse knows that this type of pulse is diagnostic for which disorder?
Aortic regurgitation
The nurse is caring for a client who is diagnosed with aortic stenosis, but is reluctant to have surgery for valve replacement. The nurse is present when the physician talks to the client about a treatment that is less invasive than surgery, but that will likely relieve some of the client's symptoms. Later, the client asks the nurse to review with her spouse the treatment offered. What does the nurse talk about with the spouse?
Balloon percutaneous valvuloplasty
Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic?
Check regularly for dependent edema
When evaluating a patient suspected of having pericarditis, the nurse documents the description of which indicator that is considered the most characteristic symptom? Dyspnea Fatigue Chest pain Orthopnea
Chest pain
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?
Decreased cardiac output
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?
Heart transplantation
In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?
Hypertrophic
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:
I will ask for antibiotics whenever I have dental work done."
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? Left ventricular assist device Open commissurotomy Annuloplasty Chordoplasty
Left ventricular assist device
For patients diagnosed with aortic stenosis, digoxin would be ordered for which of the following clinical manifestations? Left ventricular dysfunction Edema Dyspnea Angina
Left ventricular dysfunction
In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?
Leg edema
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
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?
Shortness of breath
Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs? A loud, blowing murmur Shortness of breath Hypertension Tachycardia
Shortness of breath
Which is a potassium-sparing diuretic used in the treatment of heart failure (HF)?
Spironolactone
A client has a history of rheumatic fever as a child. Which instructions should be provided before the client has any dental work done?
Take prophylactic antibiotics.
Which signs and symptoms accompany a diagnosis of pericarditis?
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
Which valve lies between the right ventricle and the pulmonary artery?
Pulmonic valve
A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity?
Potassium level of 2.8 mEq/L
During a teaching session, a client who is having a valuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. Which of the following answers from the nurse is correct information?
"A mechanical valve is thought to be more durable and so requires replacement less often."
A nurse is teaching a client who is having a valuloplasty tomorrow. The client asks what the advantage is for having a tissue valve replacement instead of a mechanical valve. The correct answer by the nurse is which of the following? "A tissue valve is thought to be more durable and so requires replacement less often." "A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required." "A tissue valve does not deteriorate as easily as mechanical valves." "A tissue valve does not become infected as easily as mechanical valves."
"A tissue valve is less likely to generate blood clots, and so long-term anticoagulation therapy is not required."
An asymptomatic client questions the nurse about mitral regurgitation and inquires about continuing exercises. Which is the most appropriate response by the nurse? "Continue exercising until mild symptoms develop." "Take ample rest after exercise." "Avoid strenuous exercise." "Avoid any type of exercise."
"Continue exercising until mild symptoms develop."
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? "I'll enroll in an aerobic exercise program." "I can still drink coffee and tea." "I should increase my fluid intake." "I should eat foods rich in protein."
"I can still drink coffee and tea."
A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition?
"I need to do my leg exercises five times or more every hour."
A patient who had a prosthetic valve replacement was taking Coumadin to reduce the risk of postoperative thrombosis. He visited the nurse practitioner at the Coumadin clinic once a week. Select the INR level that would alert the nurse to notify the health care provider.
3.8
The nurse is auscultating the heart of a client diagnosed with mitral valve prolapse. Which is often the first and only manifestation of mitral valve prolapse?
An extra heart sound
The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart?
Echocardiogram
The nurse is caring for a client with aortic regurgitation. The nurse knows to expect which of the following symptoms on physical examination?
Orthopnea and dyspnea
A patient hospitalized for 10 days with subacute infective endocarditis is afebrile and has no signs of heart damage. Discharge with outpatient antibiotic therapy for 2 to 6 weeks is anticipated. During discharge planning with the patient, it is MOST important for the nurse to
Assess the patient's home environment in terms of family assistance and adequacy.
Which describes a valve used in replacement surgery that is made from the client's own heart valve?
Autograft
The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis?
Constant chest pain
Which medication reverses digitalis toxicity?
Digoxin immune FAB
A client is admitted to the hospital with aortic stenosis. Which of the following assessment findings would indicate the development of left ventricular failure?
Dyspnea, orthopnea, pulmonary edema
A client is admitted to the hospital with possible acute pericarditis and pericardial effusion. The nurse knows to prepare the client for which diagnostic test to confirm the client's diagnosis? Cardiac cauterization Computed tomography Chest x-ray Echocardiography
Echocardiography
The diagnosis of aortic regurgitation (AR) is confirmed by which of the following?
Echocardiography
Which of the following lab values would be seen in the patient diagnosed with infective endocarditis? Select all that apply. Elevated c-reactive protein Elevated erythrocyte sedimentation rate (ESR) Elevated white blood cell (WBC) count Decreased sedimentation rate Decreased C-reactive protein
Elevated white blood cell (WBC) count Elevated c-reactive protein Elevated erythrocyte sedimentation rate (ESR)
A client reporting heart palpitations is diagnosed with atrial fibrillation caused by mitral valve prolapse. To relieve the symptoms, the nurse should teach the client which dietary intervention?
Eliminate caffeine and alcohol
Which signs and symptoms accompany a diagnosis of pericarditis? Low urine output secondary to left ventricular dysfunction fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR) Lethargy, anorexia, and heart failure Pitting edema, chest discomfort, and nonspecific ST-segment elevation
Fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)
The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience?
Gradual unexplained weight gain
Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve?
Heterograft
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?
History of aortic valve replacement
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? Leaning forward while sitting Semi-Fowler's Supine Prone
Leaning forward while sitting
The nurse working in the medical intensive care unit has a patient admitted with mitral stenosis. The nurse knows that the pathophysiology of mitral stenosis is consistent with some of the following. Choose all that apply. Left ventricular failure Aortic stenosis Left atrial hypertrophy Aortic regurgitation
Left atrial hypertrophy
Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis? Administer supplemental oxygen Elevate the client's head Maintain the client on bed rest Administer a prescribed antipyretic
Maintain the client on bed rest
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?
Obtaining a throat culture
A physician has scheduled a client with mitral stenosis for mitral valve replacement. Which condition may arise as a complication of mitral stenosis? Myocardial ischemia Left ventricular hypertrophy Left-sided heart failure Pulmonary hypertension
Pulmonary hypertension
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?
The high risk for complications if she becomes pregnant while taking warfarin
A nurse caring for a patient with mitral stenosis understands that the initial cause of disruption to the normal flow of blood through the heart is due to:
The increased resistance of a narrowed orifice between the left atrium and the left ventricle.
The nurse documents pitting edema in the bilateral lower extremities of the client. What does this documentation mean?
There is excess fluid volume in the interstitial space in areas affected by gravity.
A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing
decompensated heart failure with pulmonary edema.
A nurse caring for a client with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which behavior would indicate to the nurse recognizes that the client's level of anxiety has decreased when the client
is able to discuss the prognosis freely.
If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected? inferior vena cava coronary arteries septum mitral valve
mitral valve
A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client?
nausea and vomiting
