Ch 36 inflammatory disorders, Valvular disorders

Which clinical manifestations would the nurse expect to find when assessing a patient with infective endocarditis? Select all that apply. 1 Roth's spots 2 Osler's nodes 3 Aschoff's bodies 4 Janeway's lesions 5 Sydenham's chorea

1 Roth's spots 2 Osler's nodes 4 Janeway's lesions

The nurse is providing discharge education to a patient with dilated cardiomyopathy (CMP). Which patient statement indicates the need for further teaching? 1 "I may need to start taking a diuretic." 2 "I may be given a prescription for nitroglycerin." 3 "Most people with this diagnosis respond well to treatment." 4 "I should alternate periods of rest with activities of daily living.

3 "Most people with this diagnosis respond well to treatment." Dilated CMP does not respond well to therapy, and patients experience multiple episodes of heart failure (HF). Diuretics and nitrates decrease preload and may be prescribed. Alternating periods of rest with activity is needed to reduce the workload of the heart.

To prevent infection after an aneurysm repair the nurse should take which action? Monitor peripheral pulses for changes Administer broad spectrum antibiotics as prescribed Insert a nasogastric tube for decompression Infuse IV fluids to maintain normal BP

Administer broad spectrum antibiotics as prescribed

A client with rheumatic fever reports angina, syncope and dyspnea on exertion. What condition do you suspect? Mitral valve stenosis Aortic valve stenosis Mitral valve regurgitation Aortic valve regurgitation

Aortic valve stenosis

A client reports fever, arthralgias, & red pea sized lesions on the toes. What risk factors for IE will you assess for? Age 65 years and younger History of alcoholism Presence of mechanical valve Recent myocardial infarction

Presence of mechanical valve

What assessment finding might the nurse observe on a client with a stable abdominal aortic aneurysm? Pulsating abdominal mass Grey Turner's Sign Dyspnea Hoarseness

Pulsating abdominal mass

To prevent IE after valve surgery, the client should take antibiotics before what procedures? Echocardiogram Removal of teeth Foley catheter insertion Flu vaccination

Removal of teeth

A client presents with a new diagnosis of MVP. What abnormal heart sound do you expect? Pericardial friction rub Diastolic murmur Systolic murmur Prominent S4

Systolic murmur

A patient is admitted to the hospital with a possible diagnosis of hypertrophic cardiomyopathy. Which diagnostic tests will the nurse expect to be prescribed? Select all that apply. 1 Echocardiogram 2 Complete blood count 3 Cardiac catheterization 4 Doppler color-flow imaging 5 Transesophageal echocardiography

1 Echocardiogram 3 Cardiac catheterization The echocardiogram is the primary tool used in confirming hypertrophic cardiomyopathy because it demonstrates wall-motion abnormalities and diastolic dysfunction. Cardiac catheterization helps to clarify how well the heart chambers are pumping and will show any leakage in the valves. It is also used in diagnosing as well as guiding the treatment of hypertrophic cardiomyopathy. A complete blood count will not help in diagnosis. Transesophageal echocardiography and Doppler color-flow imaging are usually not required to confirm the diagnosis. These tests are appropriate for diagnosing valvular heart diseases.

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. 1 Encourage planned rest periods. 2 Ensure ongoing prophylactic therapy. 3 Encourage persistent physical exercise. 4 Evaluate the effectiveness of medication. 5 Recommend a mechanical valve replacement

1 Encourage planned rest periods. 2 Ensure ongoing prophylactic therapy. 4 Evaluate the effectiveness of medication. When assessing a patient with progressive valvular disease caused by rheumatic fever, the nurse should encourage the patient to plan rest periods, ensure ongoing prophylaxis to prevent recurrence, and evaluate the effectiveness of medication. The patient should avoid persistent physical exercise to prevent fatigue and dyspnea; instead, the patient should have an appropriate exercise plan to increase cardiac tolerance. It is preferable for patients over 65 years of age to undergo biologic valve replacement rather than mechanical valve replacement because the latter involves a higher risk of bleeding from anticoagulants.

The nurse provides care for a patient with hypertrophic cardiomyopathy. The nurse identifies that which medications are appropriate to be included in the patient's treatment plan? Select all that apply. 1 Metoprolol 2 Verapamil 3 Amiodarone 4 Diuretic 5 Nitrate

1 Metoprolol 2 Verapamil 3 Amiodarone 4 Diuretic Goals of care for a patient with hypertrophic cardiomyopathy are to improve ventricular filling by reducing ventricular contractility and relieving left ventricular outflow obstruction. These can be achieved with β-blocker (e.g., metoprolol) or calcium channel blocker (e.g., verapamil) therapy. Drug therapy for cardiomyopathy also includes antidysrhythmics, angiotensin-converting enzyme (ACE) inhibitors, and diuretics. Amiodarone or sotalol (Betapace) are effective antidysrhythmic drugs. Nitrates such as isosorbide dinitrate should not be used for patients with hypertrophic cardiomyopathy as they may aggravate underlying pathophysiological issues.

Which heart sound is diminished or inaudible in a patient with aortic valve stenosis? 1 S1 2 S2 3 S3 4 S4

2 S2 Aortic stenosis occurs as a result of rheumatic fever and is characterized by a diminished or absent S2. A diminished or absent S1, S3, or S4 is associated with aortic valve regurgitation.

The nurse reviews a list of potential candidates for valve replacement surgery. Which patients are more likely to receive a biologic valve than a mechanical valve? Select all that apply. 1 A 20-year-old man 2 A 67-year-old man 3 A 35-year-old man 4 A 12-year-old boy 5 A 32-year-old woman

2 A 67-year-old man 5 A 32-year-old woman In a 67-year-old man, durability is less important than the side effects of anticoagulant therapy, such as the risk of bleeding from anticoagulants. Hence, a biologic valve is preferred. The 32-year-old woman is of childbearing age and cannot take anticoagulant therapy, which is required after mechanical valve replacement. Taking long-term anticoagulant therapy may increase the risk of bleeding during future pregnancies; therefore she would be considered for a biologic valve. Biologic valves are less durable than mechanical valves. A 20-year-old man, 35-year-old man, and 12-year-old boy are all younger patients; hence, a mechanical valve is best for them because of its durability.

Which intervention would the nurse perform for a patient with rheumatic fever? 1 Encouraging joint mobility 2 Administering antibiotic therapy 3 Teaching about anticoagulation therapy 4 Applying ice packs to painful joints

2 Administering antibiotic therapy Patients with a history of rheumatic fever frequently require ongoing antibiotic therapy. A priority nursing goal is the relief of joint pain, not the optimization of joint mobility. Anticoagulation is not indicated in this patient population. Heat should be applied to painful joints.

Which heart disease involves the inflammation of all layers of the heart? 1 Pericarditis 2 Rheumatic fever 3 Infective endocarditis 4 Rheumatic heart disease

2 Rheumatic fever Rheumatic fever is an acute inflammatory condition that involves the inflammation of the endocardium, pericardium, and myocardium. Pericarditis is the inflammation of the pericardial sac. Infective endocarditis is the infection of the endocardium. Caused by rheumatic fever, rheumatic heart disease involves scarring and deformity of the heart valves.

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. Which condition would the nurse suspect? 1 Subacute nodules 2 Acute pericarditis 3 Rheumatic endocarditis 4 Chronic rheumatic carditis

2 Acute pericarditis Severe chest pain radiating to the neck, arms, and shoulders indicates acute pericarditis. A pericardial friction rub is a scratching, grating, and high-pitched sound heard at the lower sternal border of the chest; this condition is associated with patients who have acute endocarditis. Subacute nodules are small, firm, painless, and hard swellings over the knees, elbows, and wrists associated with rheumatic fever. Rheumatic endocarditis and chronic rheumatic carditis are complications associated with rheumatic fever.

The nurse is assessing for the presence of pulsus paradoxus for a patient with suspected cardiac tamponade. Which calculation using the assessment data in the patient's medical record reflects the amount of this patient's paradox? 1 8 mm Hg 2 28 mm Hg 3 10 mm Hg 4 58 mm Hg

2 28 mm Hg The steps to measure pulsus paradoxus include the following:1. Position the patient in a semirecumbent position.2. Have patient breathe normally.3. Using a manually operated BP cuff, measure systolic BP.4. Inflate BP cuff at least 20 mm Hg above systolic BP and slowly deflate until the first Korotkoff sounds are heard only during expiration.5. Deflate cuff slowly until sounds are heard throughout the respiratory cycle (inspiration and expiration) and note the pressure.6. Determine the difference between the measurements taken in steps 4 and 5. This will equal the amount of paradox.For this patient, sounds are heard on expiration at 110 mm Hg. Sounds heard throughout cycle at -82 mm Hg. The amount of paradox is 28 mm Hg. The difference is normally 10 mm Hg, and cardiac tamponade may be present. Overall BP measurement, RR, HR, PP, and BP measurement at which sounds are heard on inspiration are not used to measure pulsus paradoxus.

The nurse is assessing a patient with chronic aortic regurgitation in the emergency unit of a health care facility. Which finding would the nurse expect? 1 S3 gallop 2 Water-hammer pulse 3 Loud, accentuated S1 4 Low-pitched diastolic murmur

2 Water-hammer pulse The nurse assessing a patient with chronic aortic regurgitation would find a strong, quick beat that collapses immediately, known as a water-hammer pulse. An S3 gallop is found in patients with chronic mitral valve regurgitation. Heart sounds may include a soft or absent S1, S3, or S4 and a soft, high-pitched diastolic murmur. A low-pitched diastolic murmur and loud accentuated S1 are observed in mitral valve stenosis.

A patient has inflammation of the pericardial sac secondary to systemic lupus erythematosus (SLE). Which therapy is likely to be prescribed? 1 Salicylates 2 Antibiotics 3 Corticosteroids 4 Nonsteroidal antiinflammatory drugs (NSAIDs)

3 Corticosteroids Inflammation of the pericardial sac indicates pericarditis; corticosteroid therapy is reserved for patients with pericarditis secondary to SLE. Salicylate therapy is beneficial to patients with rheumatic fever. Antibiotic therapy is used in the treatment of bacterial pericarditis. NSAID therapy is used to control pain and inflammation in patients with pericarditis.

A patient with valvular heart disease is hospitalized. Which diagnostic tests are likely to be prescribed to monitor disease progression? Select all that apply. 1 Chest x-ray 2 Electrocardiogram (ECG) 3 Doppler color-flow imaging 4 Real-time three-dimensional (3-D) echocardiography 5 Transesophageal echocardiography

3 Doppler color-flow imaging 5 Transesophageal echocardiography Transesophageal echocardiography and Doppler color-flow imaging help to diagnose and monitor the progression of valvular disease. A chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. An ECG identifies heart rate, rhythm, and any ischemia or ventricular hypertrophy. Real-time 3-D echocardiography helps to assess mitral valve and congenital heart diseases.

Which medications would be used to decrease preload in a patient with cardiomyopathy? Select all that apply. 1 Captopril 2 Metoprolol 3 Furosemide 4 Nitroglycerin 5 Low-molecular-weight heparin

3 Furosemide 4 Nitroglycerin Furosemide and nitroglycerin decrease preload. Captopril reduces afterload. Metoprolol controls the neurohormonal stimulation that occurs with heart failure. Anticoagulation therapy reduces the risk for systemic embolization from clots that form in the heart chambers.

Which type of surgical therapy requires a cardiopulmonary bypass? 1 Annuloplasty 2 Closed procedure 3 Open valvuloplasty 4 Balloon valvuloplasty

3 Open valvuloplasty An open valvuloplasty is a surgical therapy that involves the use of a cardiopulmonary bypass. Annuloplasty is the reconstruction of the annulus of a valve, and it does not require a cardiopulmonary bypass. A closed procedure requires the insertion of a transventricular dilator through the left ventricular apex into the mitral valve. A balloon valvuloplasty involves threading a balloon-tipped catheter from the femoral artery or vein into the stenotic valve.

Which diagnostic study would be used to assess congenital heart disease? 1 Chest x-ray 2 Doppler color-flow imaging 3 Real-time three-dimensional (3-D) echocardiography 4 CT scan

3 Real-time three-dimensional (3-D) echocardiography Real-time 3-D echocardiography is used to assess mitral valve defects and congenital heart disease. A chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Doppler color-flow imaging and transesophageal echocardiography help diagnose and monitor the progression of valvular heart disease. A CT scan with contrast helps diagnose aortic disorders.

The nurse provides education about home care management to a patient with infective endocarditis. Which statement by the patient indicates the need for further teaching? 1 "I should wear elastic compression stockings." 2 "I should cough and deep breathe every two hours." 3 "I should perform range-of-motion exercises daily." 4 "I should be aware that fever and fatigue are normal."

4 "I should be aware that fever and fatigue are normal.". A patient with infective endocarditis should not consider fever and fatigue as normal and should notify the primary health care provider if these symptoms persist. The patient should wear elastic compression stockings and cough every two hours to prevent the complications of immobility. Patients with infective endocarditis should perform range-of-motion exercises to reduce problems related to reduced mobility.

A patient has been diagnosed with mitral valve prolapse. What should be included in the treatment plan of the patient? Select all that apply. 1 Fluid restriction 2 Maintain bed rest 3 Nitrates for chest pain 4 Avoiding caffeine or ephedrine 5 β-adrenergic blockers to control palpitations

4 Avoiding caffeine or ephedrine 5 β-adrenergic blockers to control palpitations A patient with mitral valve prolapse should avoid caffeine or ephedrine because these can exacerbate the symptoms. The patient should also be kept hydrated to maintain hemodynamic stability. β-adrenergic blockers should be prescribed for palpitations and chest pain. Inactivity may cause stasis of blood; hence, bed rest is not recommended. The patient with mitral valve prolapse does not respond to antianginal treatment such as nitrates when administered for chest pain.

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? 1 Annuloplasty 2 Aortic valve replacement 3 Open commissurotomy (valvulotomy) procedure 4 Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

4 Percutaneous transluminal balloon valvuloplasty (PTBV) procedure The PTBV procedure is generally indicated for an older patient who is a poor surgery candidate. Annuloplasty is an option for patients with mitral or tricuspid regurgitation. An open commissurotomy procedure is used for mitral stenosis. Valve replacement may be required for mitral, aortic, tricuspid, and occasionally pulmonic valve disease.

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. 1 An Austin-Flint murmur 2 A soft S1 heart sound 3 A prominent S4 heart sound 4 A diminished S2 heart sound 5 An audible third heart sound (S3) 6 A loud apical holosystolic murmur radiating to the left axilla

5 An audible third heart sound (S3) 6 A loud apical holosystolic murmur radiating to the left axilla Auscultation of heart sounds in the presence of mitral valve regurgitation reveals an audible third heart sound (S3), even with normal left ventricular function, because of increased left ventricular volume. The murmur is a loud holosystolic murmur at the apex radiating to the left axilla. An Austin-Flint murmur is a result of aortic regurgitation, originating at the mitral valve when blood enters simultaneously from both the aorta and the left atrium. A systolic murmur, a soft S1 heart sound, a prominent S4 heart sound, and a diminished S2 heart sound are found upon assessment of aortic valve stenosis.

A client with MVP reports a history of CP & palpitations. What intervention should the nurse anticipate? Administer SL PRN Nitroglycerin tablets Position the client leaning forward in Fowler's position Transfer client immediately to OR for valve surgery Educate on need for Beta-Blocker use to manage symptoms

Educate on need for Beta-Blocker use to manage symptoms

A client with myocarditis survives Sudden Cardiac Death. What interventions do you anticipate? Drug therapy with long acting oral nitroglycerin Permanent pacemaker (PPM) implantation Implantable Cardiac-Defibrillator (ICD) insertion Educating family on need for lifelong oxygen therapy

Implantable Cardiac-Defibrillator (ICD) insertion

The mitral valve is found between what parts of the heart? Right atrium and right ventricle Right ventricle and lungs Left atrium and left ventricle Left ventricle and aorta

Left atrium and left ventricle

Which statement by the client who is getting an aortic valve replacement requires additional teaching? My new tissue value will require lifelong anticoagulation therapy I chose a mechanical valve because they are more durable and I am young Warfarin will increase my risk of bleeding complications My INR will be monitored and should be between 2.5 and 3.5

My new tissue value will require lifelong anticoagulation therapy

Which questions are appropriate to assess the cognitive-perceptual pattern of a patient diagnosed with valvular heart disease? Select all that apply. 1 "Do you experience angina?" 2 "Do you experience fainting?" 3 "Do you experience dizziness?" 4 "Do you experience orthopnea?" 5 "Do you experience chest pain?"

1 "Do you experience angina?" 5 "Do you experience chest pain?" While assessing the effect of valvular heart disease on a patient's cognitive-perceptual pattern, it is appropriate to ask if the patient has angina and chest pain. The cognitive-perceptual pattern indicates how a patient perceives and responds to sensory input. Angina and chest pain indicate the presence of an effect on nociceptors that send signals to the brain and spinal cord. The sensation is known by the sensation-generating mechanism defined by the modality of the receptors. Asking the patient about fainting, dizziness, and orthopnea helps in assessing the activity-exercise functional health pattern.

The nurse conducts a health history interview of a patient who is diagnosed with infective endocarditis. Which questions would the nurse include when assessing the patient's cognitive-perceptual pattern? Select all that apply. 1 "Do you have a headache?" 2 "Do you experience chills?" 3 "Do you have night sweats?" 4 "Do you experience chest pain?" 5 "Do you experience abdominal pain?"

1 "Do you have a headache?" 4 "Do you experience chest pain?" 5 "Do you experience abdominal pain?" While assessing the effect of infective endocarditis on a patient's cognitive-perceptual pattern, the appropriate questions to ask are related to the patient's history of headache, chest pain, abdominal pain, and muscle tenderness. Asking the patient about the occurrence of chills helps to assess the patient's nutritional-metabolic pattern. Asking the patient about night sweats will help to assess sleep-rest patterns in the patient.

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. 1 "I should wear a Medic Alert device." 2 "I will start a vigorous aerobic exercise program." 3 "Valve surgery has completely cured my disease." 4 "I will need to take antibiotics when I have my teeth extracted." 5 "I should contact my health care provider if I have a respiratory infection."

1 "I should wear a Medic Alert device." 4 "I will need to take antibiotics when I have my teeth extracted." 5 "I should contact my health care provider if I have a respiratory infection." It is advisable for this patient to wear a Medic Alert device to provide information in case of an emergency. Antibiotic prophylaxis prior to invasive dental procedures (such as extraction) is necessary to prevent endocarditis. Respiratory infections should be treated with antibiotics because some microorganisms may damage the valves of the heart. Strenuous physical exercise should be avoided because the valve may be unable to accommodate the associated increase in cardiac output. The extent of physical exercise should be prescribed by the health care provider. Valve surgery only relieves the symptoms and does not cure the disease; therefore regular follow-up is important to monitor the disease progression.

The nurse provides discharge teaching for a patient who has subacute infective endocarditis. Which statement made by the patient indicates the need for further teaching? 1 "I will make sure to plan rest periods during any of my activities." 2 "I will receive a prescription for antibiotics that I will take by mouth." 3 "Fatigue, malaise, or chills might indicate a recurrence of the infection." 4 "Before I schedule a dentist appointment, I will tell my health care provider."

1 "I will make sure to plan rest periods during any of my activities." IV, not oral, antibiotic therapy is the prescribed treatment for subacute infective endocarditis. Rest periods during activities will decrease the cardiac workload. Fatigue, malaise, or chills are signs and symptoms that may indicate recurrent infection. Prophylactic antibiotic therapy is needed before dental procedures to reduce the risk of recurrent infective endocarditis.

A patient seeks information about the advantages of minimally invasive valvuloplasty surgery over open surgical valvuloplasty. Which information would the nurse provide? Select all that apply. 1 "It is associated with less pain." 2 "There is a higher risk of sternal infection." 3 "It requires a shorter length of stay in the hospital." 4 "Postoperative atrial fibrillation is less common." 5 "It is more likely that a postoperative blood transfusion will be needed."

1 "It is associated with less pain. 3 "It requires a shorter length of stay in the hospital." 4 "Postoperative atrial fibrillation is less common." Minimally invasive valvuloplasty surgery involves a mini-sternotomy. Because the procedure is minimally invasive, there is less postoperative pain. Hence, there is a shorter hospital stay because a small surgical wound takes less time to heal. Postoperative atrial fibrillation is reported in this procedure as a result of the surgery on the valves but is less common than with an open surgical valvuloplasty. The procedure carries a lesser risk of sternal infection because of the small incision. Also, fewer blood transfusions are needed compared with an open valvuloplasty because the blood loss is typically minimal.

Which condition is a secondary cause of restrictive cardiomyopathy? 1 Amyloidosis 2 Aortic stenosis 3 Muscular dystrophy 4 Coronary artery disease

1 Amyloidosis Amyloidosis is the deposition of a protein, amyloid, that can lead to restrictive cardiomyopathy as a result of the buildup of amyloid deposits in the heart affecting its shape and function. Aortic stenosis causes hypertrophic cardiomyopathy. Muscular dystrophy and coronary heart disease cause dilated cardiomyopathy.

Which assessment would reveal the most common problem patients experience in acute mitral valve regurgitation? 1 Auscultate the lung sounds. 2 Observe for bloody sputum. 3 Assess for a water-hammer pulse. 4 Palpate the lower extremities for edema.

1 Auscultate the lung sounds. Auscultation of the lung sounds is the priority nursing intervention in acute mitral valve regurgitation. In acute mitral valve regurgitation, there is a rapid increase in left atrial pressure and volume, which leads to pulmonary congestion, resulting in pulmonary edema and possible cardiogenic shock. Hemoptysis can occur with mitral valve stenosis, not acute mitral valve regurgitation. Lower extremity edema is a manifestation of tricuspid stenosis. A water-hammer pulse is a manifestation of chronic, severe aortic valve regurgitation.

The nurse is planning discharge teaching for a patient with cardiomyopathy. Which instructions would be included in the plan? Select all that apply. 1 Avoid alcohol. 2 Balance activity and rest periods. 3 Drink two to four glasses of water a day. 4 Avoid vigorous isometric exercises. 5 Consume food products with high sodium content

1 Avoid alcohol. 2 Balance activity and rest periods. 4 Avoid vigorous isometric exercises. A patient with cardiomyopathy should avoid alcohol because it may increase BP and can have adverse effects on the heart. A balance between activities and rest is essential to decrease systemic valvular resistance. Dehydration can increase systemic valvular resistance, which may result in obstruction of the forward flow of blood. Therefore it is important to drink six to eight glasses of water every day to avoid dehydration. Patients should avoid heavy lifting or vigorous isometric exercises. It is important to follow a low-sodium diet because it helps prevent water retention.

Which instructions would the nurse include when teaching a patient with mitral valve prolapse about self-care? Select all that apply. 1 Avoid caffeine. 2 Avoid all exercise. 3 Avoid heavy lifting or isometric exercises. 4 Avoid ephedrine in over-the-counter medications. 5 Use antibiotics prophylactically prior to a procedure. 6 Immediately report shortness of breath, fatigue, and palpitations

1 Avoid caffeine. 4 Avoid ephedrine in over-the-counter medications. .6 Immediately report shortness of breath, fatigue, and palpitations Avoiding caffeine and ephedrine will help prevent heart palpitations. The nurse will teach a patient with mitral valve prolapse to immediately report shortness of breath, fatigue, palpitations, or other symptoms such as anxiety to the healthcare provider, or if necessary, activate the emergency response system. The patient is encouraged to begin or maintain an exercise program to maintain optimal health. Instructing a patient to avoid heavy lifting or isometric exercises is reserved for patients with a symptomatic or pathologic cardiac condition, such as cardiomyopathy. The use of antibiotics prior to a procedure is not necessary with mitral valve prolapse.

A nurse is caring for a patient with hypertrophic cardiomyopathy. Which measures would be included in planning the care for this patient? Select all that apply. 1 Avoid dehydration. 2 Avoid strenuous activity. 3 Encourage elevation of the feet. 4 Administer nitroglycerin for chest pain. 5 Ask the patient to do vigorous leg exercises.

1 Avoid dehydration. 2 Avoid strenuous activity. 3 Encourage elevation of the feet. The nurse should instruct the patient with hypertrophic cardiomyopathy to avoid strenuous activity and dehydration because these may increase systemic valvular resistance, which may lead to obstruction of the forward flow of the heart. Elevation of the feet while resting helps to improve the volume of blood returning to the heart. The use of vasodilators such as nitroglycerin to relieve chest pain can actually worsen the patient's condition by decreasing venous return. It can further increase the obstruction of blood flow from the heart. Vigorous leg exercises should be avoided because they can lead to an increase in systemic vascular resistance.

A patient is suspected of having hypertrophic cardiomyopathy (CMP). Which primary diagnostic study would the nurse expect to explain to the patient? 1 Echocardiogram 2 Heart catheterization 3 Nuclear stress testing 4 Electrocardiogram (ECG)

1 Echocardiogram The echocardiogram is the primary diagnostic tool used to confirm hypertrophic cardiomyopathy. An electrocardiogram will reveal dysrhythmias associated with the ventricle. Heart catheterization and nuclear stress testing may also be helpful in diagnosing and treating hypertrophic cardiomyopathy, but the echocardiogram will be the first choice of test.

The nurse identifies a group of patients who have a high risk of developing infective endocarditis. Which instructions would be included when teaching the patients about the prevention of infective endocarditis? Select all that apply. 1 Avoid overexertion. 2 Visit a dentist regularly. 3 Undergo immunotherapy. 4 Remain on complete bed rest. 5 Avoid people with cold and flu symptoms.

1 Avoid overexertion. 2 Visit a dentist regularly. 5 Avoid people with cold and flu symptoms. Patients who have a high risk of developing infective endocarditis should not overexert themselves because this can increase the cardiac workload. Such patients should plan rest periods before and after activities to avoid excessive fatigue. Dental hygiene is very important in preventing infective endocarditis. Regular visits to the dentist would help in maintaining good oral hygiene, thus preventing infection. Contact with people having cold or flu-like symptoms should be avoided to prevent infection. Modulating the immune response contributes little to the development of endocarditis. Therefore immunotherapy is not the treatment of choice.

The nurse is planning discharge teaching for a patient with valvular heart disease. Which instructions would the nurse include in the plan? Select all that apply. 1 Avoid tobacco. 2 Take planned rest periods. 3 Limit activities that cause fatigue. 4 Exercise vigorously for 30 minutes/day. 5 Undergo regular cardiac assessments.

1 Avoid tobacco. 2 Take planned rest periods. 3 Limit activities that cause fatigue. 5 Undergo regular cardiac assessments. Tobacco use should be strictly avoided because it stimulates the heart. Rest periods should be planned to avoid exertion. Activities that cause fatigue or dyspnea should be limited. Regular cardiac assessment helps to monitor the disease progress and the effectiveness of the treatment provided. The patient should be advised to avoid strenuous physical activities because damaged valves may not be able to properly cope with the increased cardiac output demand.

The nurse reviews the laboratory test results for a patient with acute infective endocarditis. Which test result is significant for determining the plan of treatment? 1 Blood cultures 2 C-reactive protein 3 White blood cell count 4 Erythrocyte sedimentation rate

1 Blood cultures A significant laboratory test for making the diagnosis of acute infective endocarditis is blood cultures. The collection of two blood cultures will be positive in more than 90% of patients. The C-reactive protein, white blood cell count, and erythrocyte sedimentation rate laboratory tests are more significant in monitoring the patient's response to antibiotic treatment.

The nurse is caring for a patient with acute pericarditis. Which assessment findings reflect a serious complication of this condition? Select all that apply. 1 Chest pain 2 Bradycardia 3 Peripheral edema 4 Pulsus paradoxus 5 Narrowed pulse pressure 6 Jugular venous distention

1 Chest pain 4 Pulsus paradoxus 5 Narrowed pulse pressure 6 Jugular venous distention Cardiac tamponade is a serious complication of pericarditis. Cardiac tamponade develops as the pericardial effusion increases in volume, resulting in compression of the heart. The speed of fluid accumulation affects the severity of the clinical manifestations. The patient with cardiac tamponade may report chest pain and is often confused, anxious, and restless. As the compression of the heart increases, there is decreased cardiac output (CO), muffled heart sounds, and a narrowed pulse pressure. The patient develops tachypnea and tachycardia. The neck veins usually are markedly distended because of the increased jugular venous pressure, and pulsus paradoxus is present. Pulsus paradoxus is a decrease in systolic BP during inspiration that is exaggerated in cardiac tamponade. Bradycardia and peripheral edema are not assessment findings associated with cardiac tamponade.

A patient with hypertrophic cardiomyopathy has an abnormal, irregular, and rapid heartbeat and left ventricular outflow obstruction. Which medications may be beneficial to the patient? Select all that apply. 1 Digitalis 2 Verapamil 3 Metoprolol 4 Nitroglycerin 5 Isosorbide dinitrate

1 Digitalis 2 Verapamil 3 Metoprolol An abnormal, irregular, and rapid heartbeat indicates atrial fibrillation. Digitalis decreases automaticity at the atrioventricular (AV) node, which prolongs the effective refractory period of the AV node tissue, resulting in slowing the conduction velocity through the node. Verapamil is a calcium channel blocker that is used in the reduction of ventricular filling in patients with asymmetric septal hypertrophy (ASH). Metoprolol is a β-adrenergic receptor blocker (β-blocker) that reduces ventricular filling. Vasodilators such as isosorbide dinitrate, which contain nitroglycerin, may worsen the chest pain by decreasing venous return and further increasing obstruction of blood flow from the heart.

The nurse anticipates that what will be included in the treatment plan of a patient with myocarditis who has hypotension and a low ejection fraction? Select all that apply. Which interventions would be included in the treatment plan for a patient with myocarditis who has hypotension and a low ejection fraction? Select all that apply. 1 Digoxin 2 Anticoagulation therapy 3 IV milrinone 4 Immunosuppressive agents 5 IV nitroprusside

1 Digoxin 2 Anticoagulation therapy 4 Immunosuppressive agents A patient with myocarditis and hypotension will have a low ejection fraction, which may result in a thrombus formation. Digoxin improves myocardial contractility and reduces the heart rate. Anticoagulation therapy reduces the risk of thrombus formation from blood stasis. Myocarditis is considered an autoimmune disorder; therefore immunosuppressive agents should be administered to reduce myocardial inflammation. IV milrinone and IV nitroprusside reduce afterload and should not be given if hypotension is present.

A patient is admitted with myocarditis with accompanying heart failure. The nurse will expect to initiate which pharmacologic treatments? Select all that apply. A patient who has myocarditis is admitted with accompanying heart failure. Which types of medications will the nurse expect to administer? Select all that apply. 1 Diuretics 2 β-Adrenergic receptor blockers (β-blockers) 3 Anticoagulants 4 Angiotensin-converting enzyme (ACE) inhibitors 5 Nonsteroidal antiinflammatory drugs (NSAIDs)

1 Diuretics 2 β-Adrenergic receptor blockers (β-blockers) 3 Anticoagulants 4 Angiotensin-converting enzyme (ACE) inhibitors The treatment for myocarditis consists of managing associated heart symptoms. Diuretics reduce fluid volume and decrease preload. β-Blockers and ACE inhibitors are used if the heart is enlarged or to treat heart failure. If hypotension is not present, IV medications such as nitroprusside and milrinone reduce afterload and improve cardiac output (CO) by decreasing systemic vascular resistance. Anticoagulation therapy reduces the risk of clot formation from blood stasis in patients with a low ejection fraction (EF). NSAIDs are not used in the treatment of myocarditis.

The nurse reviews the laboratory reports of a patient with acute pericarditis. The electrocardiogram report shows an elevated ST segment. Which laboratory abnormalities would the nurse expect to find in this patient? Select all that apply. 1 Elevated troponin levels 2 Decreased hemoglobin count 3 Elevated white blood cell count 4 Elevated C-reactive protein (CRP) 5 Decreased erythrocyte sedimentation rate (ESR)

1 Elevated troponin levels 3 Elevated white blood cell count 4 Elevated C-reactive protein (CRP) Troponin levels are increased with the elevation of the ST segment, which indicates concurrent myocardial damage. Leukocytosis commonly occurs because of inflammation. Elevated CRP is a common laboratory finding in acute pericarditis. It is caused by the inflammation of the pericardial sac. A decreased hemoglobin count is not associated with acute pericarditis. The ESR is elevated as a result of inflammation of the pericardial sac.

The nurse reviews the laboratory reports of a patient with myocarditis. Which laboratory findings are expected? Select all that apply. 1 Elevated viral titers 2 Moderate leukocytosis 3 Decreased level of troponin 4 Elevated C-reactive protein (CRP) levels 5 Decreased erythrocyte sedimentation rate (ESR)

1 Elevated viral titers 2 Moderate leukocytosis 4 Elevated C-reactive protein (CRP) levels Myocarditis refers to the focal or diffuse inflammation of the myocardium. Viral titers are elevated because of the presence of the virus in the myocardial tissue causing cellular damage and necrosis of the myocardial tissue. Mild to moderate leukocytosis may be present as a result of the inflammation. CRP levels may be elevated because of the inflammation. Troponin is a myocardial marker; hence, the level of troponin will be elevated. The ESR is also elevated because it is an inflammatory marker.

The nurse is caring for a patient admitted to a health care facility with acute pericarditis. Which interventions would the nurse perform? Select all that apply. 1 Ensure that the patient is kept on bed rest. 2 Ensure that the patient is supine at all times. 3 Elevate the head of the bed at mealtime only. 4 Keep the head of the bed raised to 45 degrees. 5 Administer antiinflammatory drugs with milk or food.

1 Ensure that the patient is kept on bed rest 4 Keep the head of the bed raised to 45 degrees. 5 Administer antiinflammatory drugs with milk or food.

Which assessment findings would the nurse expect in a patient with infective endocarditis (IE)? Select all that apply. 1 Fever 2 Bradypnea 3 Bradycardia 4 Weight loss 5 Retinal hemorrhage

1 Fever 4 Weight loss 5 Retinal hemorrhage The manifestations of IE are nonspecific and can involve multiple organ systems. Most patients have a fever. Other symptoms include chills, weakness, malaise, fatigue, and anorexia. Patients may have arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache, clubbing of the fingers, and retinal hemorrhages. Bradycardia is not a symptom of IE. The patient will experience tachypnea, not bradypnea.

A patient is scheduled for a percutaneous transluminal balloon valvuloplasty. Which information would the nurse provide to the patient before the procedure? Select all that apply. 1 It has few complications. 2 It requires a surgical incision. 3 It is performed in an operating room. 4 The procedure is difficult but has good results. 5 The results are similar to surgical commissurotomy.

1 It has few complications. 5 The results are similar to surgical commissurotomy. Percutaneous transluminal balloon valvuloplasty is an alternative treatment for patients with valvular disease. It is an easy procedure with few complications because the approach for the procedure is transcutaneous; therefore it is a minimally invasive procedure. The long-term results are similar to those of surgical commissurotomy with regard to the function of the repaired valve. The surgery is performed in a cardiac catheterization laboratory and not in an operating room. The procedure is not difficult and does not require a surgical incision.

The nurse is caring for a patient who has Takotsubo cardiomyopathy. Which information would the nurse provide to the patient about this disease? Select all that apply. 1 It is more common in menopausal women. 2 It causes permanent impairment of cardiac function. 3 The clinical findings are similar to acute coronary syndrome. 4 It does not reflect any changes in the electrocardiogram (ECG). 5 Cardiac angiography shows no significant coronary artery disease.

1 It is more common in menopausal women. 3 The clinical findings are similar to acute coronary syndrome. 5 Cardiac angiography shows no significant coronary artery disease. Takotsubo cardiomyopathy is an acute stress-related syndrome. It is commonly observed in menopausal women. The clinical findings are the same as in acute coronary syndrome. Cardiac angiography shows no significant coronary artery disease. Normal cardiac function returns days or weeks after supportive therapy. It is often accompanied by chest pain; the ST segment in the ECG is elevated, along with an increase in the cardiac enzyme levels.

The nurse hears a diastolic murmur in a patient who says, "I'm finding it hard to breathe, and sometimes I cough up blood." Which condition would the nurse suspect? 1 Mitral valve stenosis 2 Aortic valve stenosis 3 Mitral valve prolapse 4 Aortic valve regurgitation

1 Mitral valve stenosis Coughing up of blood from the bronchi, larynx, or lungs is known as hemoptysis, and difficulty breathing is dyspnea. Hemoptysis, dyspnea, and diastolic murmurs indicate mitral valve stenosis. Aortic valve stenosis is characterized by angina, dyspnea, syncope, and left ventricular failure. Mitral valve prolapse is an abnormality of the mitral valve leaflets and the papillary muscles that involves dysrhythmias, ventricular tachycardia, palpitations, light-headedness, and dizziness. Aortic valve regurgitation is associated with abrupt dyspnea, chest pain, left ventricular failure, and cardiogenic shock.

A patient's assessment findings include peripheral edema, distended neck veins, and lung crackles. Which condition would the nurse suspect? 1 Myocarditis 2 Polyarthritis 3 Aortic valve stenosis 4 Rheumatic heart disease

1 Myocarditis Peripheral edema (swollen limbs), jugular vein distention (distended neck veins), and crackling heart sounds indicate myocarditis. Polyarthritis is a manifestation of rheumatic fever and is characterized by swelling, redness, and tenderness of the knees, ankles, elbows, and wrists. Aortic valve stenosis is characterized by angina, syncope, dyspnea, heart failure, and the absence of S2. Rheumatic heart disease is a chronic condition that results from rheumatic fever; it is associated with scarring and deformity of the heart valves.

Which condition is classified as a noninfectious cause of pericarditis? 1 Myxedema 2 Lyme disease 3 Rheumatic fever 4 Ankylosing spondylitis

1 Myxedema Myxedema is swelling of the skin and underlying tissues, giving a waxy consistency, and is typical of patients with underactive thyroid glands; it is a noninfectious cause of pericarditis. Lyme disease is an infectious cause of pericarditis. Rheumatic fever and ankylosing spondylitis are hypersensitive or autoimmune causes of pericarditis.

A patient has been admitted with acute pericarditis. Which interventions would the nurse plan for this patient? Select all that apply. 1 Provide an overbed table. 2 Tell the patient to avoid alcohol. 3 Administer antiinflammatory medications. 4 Discontinue the use of proton pump inhibitors. 5 Keep the patient in a Trendelenburg position.

1 Provide an overbed table. 2 Tell the patient to avoid alcohol. 3 Administer antiinflammatory medications. A sitting position with an overbed table helps in reducing the pain associated with acute pericarditis. The patient should be instructed to avoid alcohol to prevent gastrointestinal bleeding. Antiinflammatory medicines should be administered for pain relief. The patient should not be placed in a Trendelenburg position; instead, the head of the bed should be elevated to 45 degrees. A proton pump inhibitor may be given to reduce stomach acid.

Which finding would the nurse expect to observe in a patient who has a complication of pericarditis? 1 Pulsus paradoxus 2 Clubbing of the fingers 3 Prolonged PR intervals 4 Widened pulse pressure

1 Pulsus paradoxus Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every four hours in a patient with pericarditis. Clubbing of the fingers may occur in subacute forms of infective endocarditis and valvular heart disease. Prolonged PR intervals occur with first-degree atrioventricular (AV) block. A widened pulse pressure occurs with valvular heart disease.

Which physiologic change causes the primary symptoms of mitral valve stenosis? 1 Reduced pulmonary compliance 2 Inadequate filling of the right ventricle 3 Increased pressure in the left ventricle 4 Decreased pulmonary vascular pressure

1 Reduced pulmonary compliance The primary symptom of mitral stenosis is exertional dyspnea caused by reduced lung compliance. Increased pulmonary vascular pressure results from increased left atrial pressure and volume increase. Increased left ventricular pressure may be seen with aortic stenosis. Inadequate filling of the right ventricle may be a result of atrial fibrillation or atrial flutter.

The nurse is administering digoxin to a patient who has myocarditis. For which adverse effects will the nurse monitor the patient? Select all that apply. 1 Toxicity 2 Dysrhythmias 3 Increased heart rate 4 Thrombus formation 5 Decreased myocardial contractility

1 Toxicity 2 Dysrhythmias In the case of a patient with myocarditis, the heart has increased sensitivity to dysrhythmias. Therefore digoxin should be used with caution. Myocarditis also predisposes the patient to digoxin toxicity. Digoxin reduces the heart rate and improves myocardial contractility. It is not associated with thrombus formation.

Which type of valvular heart disease occurs almost exclusively in patients who have rheumatic fever after IV drug abuse? 1 Tricuspid stenosis 2 Pulmonic stenosis 3 Aortic valve stenosis 4 Mitral valve stenosis

1 Tricuspid stenosis Tricuspid stenosis is a disease of the tricuspid valve that occurs in patients who abuse IV drugs or who have had rheumatic fever. Pulmonic stenosis is congenital. Aortic valve stenosis occurs as a result of rheumatic fever. Mitral valve stenosis occurs as a result of rheumatic heart disease.

A patient with a pericardial effusion has acute cardiac tamponade. The nurse is preparing the patient for a scheduled pericardiocentesis. Which interventions are appropriate to include in the patient's plan of care? Select all that apply. 1 Maintain NPO status. 2 Administer dopamine. 3 Administer volume expanders. 4 Discontinue all anticoagulant drugs. 5 Explain that the procedure is noninvasive.

2 Administer dopamine. 3 Administer volume expanders. 4 Discontinue all anticoagulant drugs. It is important to administer inotropic agents, such as dopamine, and volume expanders to provide hemodynamic support. Anticoagulant drugs should be discontinued because this may increase the risk of bleeding. Keeping the patient NPO is not necessary. During a pericardiocentesis, a needle is inserted into the pericardial space to remove fluid for analysis, meaning that this is an invasive procedure.

Which type of murmur is observed in patients with chronic aortic valve regurgitation? 1 Diastolic murmur 2 Austin Flint murmur 3 Holosystolic murmur 4 Loud midsystolic murmur

2 Austin Flint murmur An Austin Flint murmur occurs in patients with chronic aortic valve regurgitation. Mitral valve stenosis involves diastolic murmur. Holosystolic murmur occurs in patients with mitral valve prolapse. Loud midsystolic murmur occurs in patients with tricuspid and pulmonic stenosis.

Which rationale explains why a patient with dilated cardiomyopathy would be scheduled for an endomyocardial biopsy? 1 Rule out cardiomegaly 2 Identify infectious organisms 3 Determine eosinophilic fasciitis 4 Confirm coronary artery disease

2 Identify infectious organisms Endomyocardial biopsy, along with right-sided heart catheterization, is used to identify infectious organisms in the heart tissue in patients with cardiomyopathy. A chest x-ray is used to rule out cardiomegaly. A multigated acquisition (MUGA) nuclear scan is used to determine eosinophilic fasciitis. Cardiac catheterization is used to confirm coronary artery disease.

A patient with a transplanted heart has developed heart valve disease. Which instructions would the nurse include in patient teaching? Select all that apply. 1 Avoid pregnancy. 2 Avoid strenuous physical exercise. 3 Notify the health care provider before planned dental work. 4 If the valve disease was caused by rheumatic fever, antibiotics will be prescribed. 5 If on anticoagulation therapy, the international normalized ratio (INR) will need to be checked annually.

2 Avoid strenuous physical exercise. 3 Notify the health care provider before planned dental work. 4 If the valve disease was caused by rheumatic fever, antibiotics will be prescribed. Patients should avoid strenuous physical exercise because damaged valves may not handle the increased cardiac output (CO) demand. Any planned invasive or dental work requires the patient to notify the health care provider. If the valve disease was caused by rheumatic fever, prophylactic antibiotics will be prescribed. Pregnancy is not contraindicated; however, prophylactic antibiotic therapy may be administered to prevent endocarditis. If on anticoagulation therapy, the INR will need to be checked regularly (more frequently than just annually).

The nurse is caring for an older patient who is diagnosed with pulmonic stenosis. Which type of conservative therapy may be prescribed? 1 Annuloplasty 2 Balloon valvuloplasty 3 Mitral commissurotomy 4 SAPIEN Transcatheter Heart Valve (THV)

2 Balloon valvuloplasty Balloon valvuloplasty or percutaneous transluminal balloon valvuloplasty (PTBV) is generally indicated for older adults and for those who are poor surgery candidates. PTBV is used for mitral, tricuspid, and pulmonic stenosis. Annuloplasty is the reconstruction of the annulus and is beneficial in patients with mitral or tricuspid regurgitation. Mitral commissurotomy or valvulotomy is used in patients with pure mitral stenosis. The SAPIEN THV is beneficial in patients with atrial stenosis.

A patient receiving treatment for acute pericarditis reports a new onset of chest pain. The nurse assesses the patient and notes confusion, anxiety, and restlessness. Which complication would the nurse suspect? 1 Monoarthritis 2 Cardiac tamponade 3 Sydenham's chorea 4 Chronic rheumatic carditis

2 Cardiac tamponade A major complication that may result from acute pericarditis is cardiac tamponade. It develops as the pericardial effusion increases in volume. This results in compression of the heart. The patient with cardiac tamponade may report chest pain and is often confused, anxious, and restless. Monoarthritis is a manifestation of rheumatic fever and involves joint swelling, heat, redness, tenderness, and limitation of motion. Sydenham's chorea is a manifestation of rheumatic fever and is characterized by involuntary movements of the face and limbs. Chronic rheumatic carditis results from changes in valvular structure that may occur months to years after an episode of rheumatic fever.

A patient with infective endocarditis is being discharged from the health care facility. Which information would the nurse teach the patient and caregiver about home care? Select all that apply. 1 Avoid exercise. 2 Continue follow-up care. 3 Ensure complete bed rest. 4 Take antibiotics as scheduled. 5 Avoid people with upper respiratory tract infections.

2 Continue follow-up care. 4 Take antibiotics as scheduled. 5 Avoid people with upper respiratory tract infections. The nurse should explain to the patient the importance of good follow-up care, good nutrition, and early treatment of infections. The patient should continue to receive antibiotics as scheduled, and the caregiver should observe the patient for any adverse drug reaction. The nurse should teach the patient to avoid people with infection, especially upper respiratory tract infection. The patient may ambulate and perform moderate activity without exertion. The patient should take periods of rest between activities. The patient should be assisted in performing range-of-motion (ROM) exercises to prevent problems with reduced mobility.

A patient is diagnosed with dilated cardiomyopathy. Which cardiac actions would the health team plan to alter through specific interventions? Select all that apply. 1 Improving diastolic filling 2 Decreasing preload and afterload 3 Improving myocardial contractility 4 Relieving left ventricular outflow obstruction 5 Improving ventricular filling by reducing ventricular contractility

2 Decreasing preload and afterload 3 Improving myocardial contractility The patient is experiencing dilated cardiomyopathy. Interventions should be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility are the goals for hypertrophic cardiomyopathy. Interventions aimed at improving diastolic filling are associated with restrictive cardiomyopathy.

A patient is admitted with suspected myocarditis. Which test is considered most diagnostic for this illness? 1 Echocardiogram 2 Endomyocardial biopsy 3 Electrocardiogram (ECG) 4 Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels

2 Endomyocardial biopsy Histologic confirmation of myocarditis is done through an endomyocardial biopsy. A biopsy done during the first six weeks of acute illness is most diagnostic. This is the period in which lymphocytic infiltration and myocyte damage are present. Nuclear scans, echocardiography, and MRI are used to assess cardiac function. The ECG changes for a patient with myocarditis are often nonspecific but may reflect associated pericardial involvement (e.g., diffuse ST-segment changes). Dysrhythmias and conduction disturbances may be present. Laboratory findings are often inconclusive. They may include mild to moderate leukocytosis and atypical lymphocytes, increased ESR and CRP levels, elevated levels of myocardial markers such as troponin, and elevated viral titers. The virus is generally present in tissue and pericardial fluid samples only during the initial 8 to 10 days of illness.

The nurse is assessing a patient with mitral valve stenosis. Which findings are likely during the nursing examination? Select all that apply. 1 Syncope 2 Exertional dyspnea 3 Nausea and vomiting 4 Fatigue and palpitations 5 Low-pitched diastolic murmur at the apex

2 Exertional dyspnea 4 Fatigue and palpitations 5 Low-pitched diastolic murmur at the apex Exertional dyspnea is caused by reduced lung compliance in mitral stenosis. Fatigue and palpitations are present because of atrial fibrillation. A low-pitched diastolic murmur is best heard at the apex using the stethoscope. Syncope, nausea, and vomiting are not seen in patients with mitral stenosis.

Which clinical sign is associated with phrenic nerve compression as a result of pericardial effusion? 1 Cough 2 Hiccups 3 Dyspnea 4 Hoarseness of voice

2 Hiccups Pericardial effusion can cause compression of nearby structures. Phrenic nerve compression causes hiccups. In pericardial effusion, cough and dyspnea occur as a result of compression of the pulmonary tissue. Hoarseness of the voice is caused by compression of the laryngeal nerve.

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. Which action would the nurse take? 1 Prepare to administer a vitamin K injection. 2 Maintain the patient at the same warfarin dose. 3 Request a prescription for a higher dose of warfarin. 4 Instruct the patient to stop taking warfarin until the INR level decreases.

2 Maintain the patient at the same warfarin dose INR values of 2.5 to 3.5 are therapeutic for patients with mechanical valves, so it is not necessary to change the dose. The patient should not stop taking the warfarin or take a higher dose. Vitamin K is the antidote for warfarin, and it is not necessary to take because the INR is in a therapeutic range..

The nurse is assessing a patient with a pacemaker during a follow-up visit. The patient has red, painful, tender, pea-size lesions on the fingertips and toes. How would the nurse document this finding? 1 Roth's spots 2 Osler's nodes 3 Janeway's lesions 4 Splinter hemorrhages

2 Osler's nodes The nurse should document this finding as Osler's nodes. Osler's nodes are red or purple, tender, pea-size lesions on the fingertips and toes that are vascular manifestations of infective endocarditis. Other vascular manifestations include splinter hemorrhages, Janeway's lesions, and Roth's spots. Splinter hemorrhages are black longitudinal streaks in the nail beds. Janeway's lesions are flat, painless, small, red spots on the palms and soles. Roth's spots are hemorrhagic retinal lesions that are revealed by funduscopic examination.

Which findings aid in confirming the diagnosis of rheumatic fever? Select all that apply. 1 Presence of albuminuria 2 Presence of polyarthralgia 3 Decreased hemoglobin count 4 Presence of subcutaneous nodules 5 Positive throat culture for group A streptococci

2 Presence of polyarthralgia 4 Presence of subcutaneous nodules 5 Positive throat culture for group A streptococci A positive throat culture indicates evidence of group A streptococcal infection. Polyarthralgia is also a common finding in rheumatic fever. Subcutaneous nodules are associated with severe carditis and are observed in patients with rheumatic fever. Albuminuria is a clinical sign of renal dysfunction and is not associated with rheumatic fever. The hemoglobin count may be unaffected in rheumatic fever.

Which supportive measures would the nurse implement when providing care to a patient with myocarditis? Select all that apply. 1 Allowing for frequent visitors 2 Providing a quiet environment 3 Spacing activity and rest periods 4 Placing the patient in the semi-Fowler's position 5 Keep the patient and caregiver informed about the therapeutic plan

2 Providing a quiet environment 3 Spacing activity and rest periods 4 Placing the patient in the semi-Fowler's position 5 Keep the patient and caregiver informed about the therapeutic plan The nurse should implement measures to decrease the cardiac workload. These include providing a quiet environment, spacing activity and rest periods, and placing the patient in the semi-Fowler's position. Keeping the patient and caregiver informed about the therapeutic plan will decrease anxiety. To provide for a restful environment, visitors should be restricted. This also helps to minimize the risk of infection.

Which condition is the likely cause of the hemoptysis in a patient with mitral valve stenosis? 1 Atrial fibrillation 2 Pulmonary hypertension 3 Decreased cardiac output 4 Laryngeal nerve compression

2 Pulmonary hypertension Pulmonary hypertension causes hemoptysis or bleeding in the lungs and the coughing up of blood as a result of increased pressure in the pulmonary circulation. Atrial fibrillation in patients with mitral valve prolapse results in fatigue and palpitations. Decreased cardiac output results in chest pain in patients with mitral valve prolapse. Hoarseness occurs as a result of atrial enlargement pressing on the laryngeal nerve in patients with mitral valve prolapse.

Which finding is consistent with rheumatic fever? 1 Black longitudinal streaks in the nail beds 2 Subcutaneous nodules over all bony surfaces 3 Petechiae in the conjunctivae, lips, buccal mucosa, and palate 4 Painful, tender, red or purple, pea-size lesions on the fingertips or toes

2 Subcutaneous nodules over all bony surfaces When assessing the patient with rheumatic fever, the nurse should inspect the patient's skin for subcutaneous nodules by palpating over all bony surfaces and along the extensor tendons of the hands and feet. Patients with infective endocarditis are assessed for petechiae in the conjunctivae, lips, buccal mucosa, and palate; Osler's nodes are painful, red or purple, pea-size lesions found on the fingertips or toes; and splinter hemorrhages are black longitudinal streaks that may occur in the nail beds.

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. A patient who has undergone valve replacement takes warfarin. The patient asks the nurse why regular international normalized ratio (INR) tests are prescribed. Which explanation would the nurse give to emphasize the importance of this test? Select all that apply. 1 To prevent endocarditis 2 To determine the proper dosage 3 To determine the patency of the valves 4 To determine the adequacy of therapy 5 To examine the durability of the valves

2 To determine the proper dosage 4 To determine the adequacy of therapy The INR must be checked regularly if the patient is on anticoagulation therapy to determine the proper dosage. A high or low INR may require the dose to be adjusted. The INR is also tested to determine the adequacy of anticoagulation. If the anticoagulant is not adequate, blood clots may form. If anticoagulation is more than adequate, there is an increased risk of bleeding. The test cannot prevent endocarditis or determine the patency or durability of valves.

A patient with pharyngitis is suspected to have rheumatic fever. Which interventions will be included in the patient's plan of care? Select all that apply. 1 Cold fomentation for painful joints 2 Treatment for streptococcal pharyngitis 3 Relief of joint pain as a priority nursing goal 4 Discontinuation of antibiotics if there is symptomatic relief 5 Administering nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain

2 Treatment for streptococcal pharyngitis 3 Relief of joint pain as a priority nursing goal 5 Administering nonsteroidal antiinflammatory drugs (NSAIDs) for joint pain Adequate treatment of streptococcal pharyngitis prevents the initial attack of rheumatic fever. A priority nursing goal is the relief of joint pain. NSAIDs can be given to relieve pain in the joints. Completing the full course of antibiotics is important for successful treatment. Heat needs to be applied to painful joints because cold fomentation may lead to stiffness.

It is determined that a patient who has advanced dilated cardiomyopathy (CMP) is not a candidate for heart transplantation. Which treatment is likely to be prescribed? 1 Atrioventricular pacemaker 2 Ventricular assist device (VAD) 3 Ventriculomyotomy and myectomy surgery 4 Percutaneous transluminal septal myocardial ablation

2 Ventricular assist device (VAD) Patients with dilated cardiomyopathy may benefit from nondrug therapies. A VAD allows the heart to rest and recover from acute heart failure. It also may serve as a bridge to heart transplantation. Additionally, cardiac resynchronization therapy and an implantable cardioverter-defibrillator are used in appropriate patients. Atrioventricular pacemaker, ventriculomyotomy and myectomy surgery, and percutaneous transluminal septal myocardial ablation are appropriate for hypertrophic cardiomyopathy.

The nurse provides teaching to a patient with acute rheumatic fever (RF). Which statement made by the patient indicates a need for further education? 1 "I will receive ibuprofen for my joint pain." 2 "I will need to take antibiotics to stop the infection." 3 "Exercise is important to help me regain my strength." 4 "I can have a heating pad placed on my painful knees if needed."

3 "Exercise is important to help me regain my strength." Promoting optimal rest (not promoting exercise) is essential to reduce the cardiac workload and the body's metabolic needs. The primary goals of managing a patient with RF are to (1) control and remove the infecting organism; (2) prevent cardiac complications; and (3) relieve joint pain, fever, and other symptoms. Administer salicylates, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids as prescribed, and monitor fluid intake as appropriate. Administer antibiotics as prescribed to treat the streptococcal infection. Another priority nursing goal is the relief of joint pain. Heat may be applied and salicylates or NSAIDs administered for joint pain.

A patient with group A streptococcal pharyngitis states, "I do not want to take the antibiotics that have been prescribed." Which response would the nurse provide? 1 "You may not want to take the antibiotics, but you will be sorry if you do not." 2 "You will not feel well if you do not take the medicine and get over this infection." 3 "Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease." 4 "If you don't take the medication, you may have complications of the infection, such as loss of balance."

3 "Without treatment, you could get rheumatic fever (RF), which can lead to rheumatic heart disease." RF is not common because of the effective use of antibiotics to treat streptococcal infections. Without treatment, RF can occur and lead to rheumatic heart disease, especially in young adults. Saying that the patient will not feel well or that the patient will be sorry if the antibiotics are not taken is threatening to the patient and inappropriate for the nurse to say. The complications of RF do not include loss of balance.

A patient involved in a motor vehicle crash is brought to the emergency department. The nurse auscultates a quick, strong heartbeat that collapses immediately. The patient has severe dyspnea and describes chest pain as 8 out of 10 on the pain scale. Which condition would the nurse suspect? 1 Aortic valve stenosis 2 Mitral valve stenosis 3 Aortic valve regurgitation 4 Mitral valve regurgitation

3 Aortic valve regurgitation A quick, strong beat that collapses immediately is known as a water-hammer pulse. A water-hammer pulse, dyspnea, and chest pain as a result of trauma indicate aortic regurgitation (AR). Aortic stenosis (AS) is characterized by angina, exertional dyspnea, syncope, and left ventricular failure. Mitral valve stenosis involves exertional dyspnea, hoarseness, hemoptysis, chest pain, and seizures. Mitral valve regurgitation is associated with weakness, fatigue, palpitations, and dyspnea.

Which assessment finding is the most common symptom associated with hypertrophic cardiomyopathy (CMP)? 1 Fatigue 2 Angina 3 Dyspnea 4 Syncope

3 Dyspnea The most common symptom is dyspnea, caused by an elevated left ventricular diastolic pressure. Fatigue occurs because of the resistant decrease in cardiac output (CO) and in exercise-induced flow obstruction. Angina can occur and is most often caused by the increased left ventricular mass or compression of the small coronary arteries by the hypertrophic ventricular myocardium. Syncope most often is caused by an increase in obstruction to aortic outflow during increased activity.

While performing an admission assessment, the nurse notes Janeway's lesions on a patient's fingertips, palms, soles of the feet, and toes. Which condition would the nurse suspect? 1 Acute kidney injury 2 Myocardial infarction 3 Infective endocarditis 4 Chronic thrombophlebitis

3 Infective endocarditis Clinical manifestations of infective endocarditis include Janeway's lesions (flat, painless, small, red spots), which may be seen on the fingertips, palms, soles of the feet, and toes. Clinical manifestations of acute kidney injury, myocardial infarction, and chronic thrombophlebitis will not include Janeway's lesions.

Which assessment finding would lead the nurse to document Sydenham's chorea in the patient's medical record? 1 Inflammation of the joints 2 Red or purple pea-size lesions on the toes 3 Involuntary movements of the face and limbs 4 Bright pink, nonpruritic, maplike macular lesions

3 Involuntary movements of the face and limbs Sydenham's chorea is a major manifestation of rheumatic fever; it is characterized by involuntary movements of the face and limbs, muscle weakness, and speech and gait disturbances. Inflammation of the joints indicates monoarthritis or polyarthritis. Osler's nodes are red or purple pea-size lesions on the toes observed in patients with infective endocarditis. Bright pink, nonpruritic, maplike macular lesions on the trunk indicate subacute nodules in patients with rheumatic fever.

Which assessment findings would the nurse expect when caring for a patient with mitral valve stenosis? Select all that apply. 1 Syncope 2 Orthopnea 3 Palpitations 4 Atrial fibrillation 5 Exertional dyspnea

3 Palpitations 4 Atrial fibrillation 5 Exertional dyspnea The overloaded left atrium places the patient at risk for atrial fibrillation. Palpitations and dyspnea on exertion may also occur. Syncope occurs with mitral valve prolapse. Orthopnea occurs with aortic valve regurgitation.

Which assessment finding would the nurse expect in a patient diagnosed with acute pericarditis? 1 Pulsus paradoxus 2 Muffled heart sounds 3 Pericardial friction rub 4 Narrowed pulse pressure

3 Pericardial friction rub The hallmark finding in acute pericarditis is a pericardial friction rub. Muffled heart sounds, pulsus paradoxus, and a narrowed pulse pressure are findings associated with cardiac tamponade, not acute pericarditis.

Which diagnostic study is used to diagnose mitral valve prolapse? 1 Electrocardiogram 2 Cardiac catheterization 3 Real-time three-dimensional (3-D) echocardiography 4 CT scan of the chest with contrast

3 Real-time three-dimensional (3-D) echocardiography An echocardiogram is a diagnostic study that is used to diagnose mitral valve prolapse. All echocardiograms are done in two or three dimensions. An echocardiogram is used to monitor the progression of valvular heart disease. An electrocardiogram is used to identify heart rate, rhythm, ischemia, or ventricular hypertrophy. Cardiac catheterization is used to detect pressure changes in the cardiac chambers. A CT scan of the chest with contrast is the gold standard for evaluating aortic disorders.

The nurse reviews the assessment findings of a patient with febrile illness. Which condition would the nurse suspect the patient is experiencing? 1 Myocarditis 2 Heart failure 3 Rheumatic fever (RF) 4 Infectious endocarditis

3 Rheumatic fever (RF) These assessment findings suggest the presence of RF. Major criteria for RF include carditis (with a heart murmur), cardiac enlargement, monoarthritis or polyarthritis, Sydenham's chorea, erythema marginatum, and subcutaneous nodules over joint areas. Minor criteria include clinical findings of fever and polyarthralgia. Laboratory findings: erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, C-reactive protein (CRP); evidence of Group A streptococcal infection as indicated by: Antistreptolysin-O titer, positive throat culture, positive rapid antigen test for group A streptococci. ECG findings: prolonged PR interval. The findings are not consistent with myocarditis, heart failure, or infectious endocarditis.

The nurse is assessing a patient diagnosed with pericarditis. Which characteristics of chest pain are likely in this patient? Select all that apply. 1 Pain is reduced by lying down. 2 Pain worsens with deep exhalation. 3 Severe, sharp pain is felt in the chest. 4 Pain may radiate to the neck, arms, or left shoulder. 5 Rapid, shallow breathing helps to avoid the chest pain.

3 Severe, sharp pain is felt in the chest. 4 Pain may radiate to the neck, arms, or left shoulder. 5 Rapid, shallow breathing helps to avoid the chest pain. Pain related to pericarditis can be described as a severe, sharp pain in the chest that may radiate to the neck, arms, or left shoulder. Patients with pericarditis usually have a rapid, shallow breathing pattern because this helps them to avoid chest pain. The chest pain is aggravated by lying down and is relieved with an erect posture. Chest pain worsens with deep inspiration.

A patient hospitalized with acute pericarditis reports severe, sharp chest pain. Which position would the nurse encourage the patient to use? 1 Flat on back 2 Semi-Fowler's 3 Sitting up and leaning forward 4 Lying down and bending the knees

3 Sitting up and leaning forward The chest pain associated with acute pericarditis often is relieved when the patient sits up and leans forward. Lying supine makes the pain worse. The semi-Fowler's position and lying down with the knees bent do not relieve the chest pain associated with acute pericarditis.

The nurse cares for a patient with infective endocarditis (IE) and expects what assessment findings? Select all that apply. 1 Bradycardia 2 Bradypnea 3 Tachycardia 4 Peripheral edema 5 Retinal hemorrhages

3 Tachycardia 4 Peripheral edema 5 Retinal hemorrhages Assessment findings in a patient with infective endocarditis may include peripheral edema, retinal hemorrhage, and tachycardia. Bradycardia is not a symptom of IE, and the patient will experience tachypnea, not bradypnea.

The electrocardiogram (ECG) 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? 1 Dilated cardiomyopathy 2 Restrictive cardiomyopathy 3 Takotsubo cardiomyopathy 4 Hypertrophic cardiomyopathy

3 Takotsubo cardiomyopathy Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome and is commonly observed in postmenopausal women. Dilated cardiomyopathy is characterized by a reduced capacity to exercise, dyspnea at rest, and orthopnea. Restrictive cardiomyopathy involves orthopnea, angina, palpitations, and syncope. Hypertrophic cardiomyopathy is characterized by fatigue, exertional dyspnea, syncope, and angina.

A patient with atrial fibrillation has been scheduled to undergo biologic valve replacement surgery. Which information would the nurse tell the patient about the benefits of a biologic valve? Select all that apply. 1 They do not leak. 2 There is no risk of endocarditis. 3 They have a low risk of tissue rejection. 4 Anticoagulation therapy is not required. 5 They are more durable than mechanical valves.

3 They have a low risk of tissue rejection. 4 Anticoagulation therapy is not required. Biologic valves are made from bovine, porcine, or human tissues. Therefore they have a low risk of eliciting an immune response and tissue rejection. Because they have low thrombogenicity, they do not require anticoagulation therapy, unlike mechanical valves. However, biologic valves may tend to leak or cause endocarditis, similarly to mechanical valves. Biologic valves are less durable than mechanical valves.

The nurse auscultates an irregular, rapid heart rate in a patient with mitral valve prolapse. Which type of medication would the nurse expect to be prescribed? 1 Statin 2 Nitrate 3 β-Adrenergic receptor blocker (β-blocker) 4 Anti-ischemic

3 β-Adrenergic receptor blocker (β-blocker) Palpitations are fast, hard, and irregular heartbeats. Propranolol is an example of a β-blocker that slows the heart rate by acting on the β-adrenergic receptors located on the heart cells. A statin, such as atorvastatin, is used primarily to treat elevated blood cholesterol levels and reduce the risk of cardiovascular disease. A nitrate, such as isosorbide dinitrate, is used to prevent angina attacks by dilating the blood vessels. An anti-ischemic medication, such as trimetazidine, improves glucose control and improves cardiac function in dilated cardiomyopathy.

Which category of medication helps reduce afterload in patients with heart failure? 1 Opioids 2 Antidysrhythmic drugs 3 β-Adrenergic receptor blockers (β-blockers) 4 Angiotensin-converting enzyme (ACE) inhibitors

4 Angiotensin-converting enzyme (ACE) inhibitors ACE inhibitors block angiotensin II and dilate both arteries and veins. ACE inhibitors reduce arterial pressure and afterload in patients with heart failure by causing vasodilation. Opioids such as morphine decrease cardiac workload by lowering myocardial O2 consumption, reducing contractility, and decreasing the BP and heart rate. Antidysrhythmic drugs are used to suppress abnormal rhythms such as atrial fibrillation and atrial flutter. β-Blockers suppress the neurohormonal stimulation that occurs in patients with heart failure.

A patient with a history of rheumatic fever is diagnosed with mitral valve stenosis and scheduled for prosthetic valve replacement surgery. Which intervention will be added to the plan of care after the surgery? 1 Exercise plan to increase cardiac tolerance 2 β-Adrenergic receptor blockers (β-blockers) to control palpitations 3 Immunosuppressive therapy to prevent rejection 4 Antibiotic prophylaxis for dental cleanings or care

4 Antibiotic prophylaxis for dental cleanings or care The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement. Immunosuppressive therapy is not necessary.

A patient reports anorexia, weight loss, edema, and dyspnea on exertion. Upon physical examination, the nurse finds jugular venous distention. Which type of cardiovascular inflammation would the nurse suspect the patient is experiencing? 1 Myocarditis 2 Infective endocarditis 3 Rheumatic endocarditis 4 Chronic constrictive pericarditis

4 Chronic constrictive pericarditis Anorexia, weight loss, edema, dyspnea, and distention of the neck veins indicate chronic constrictive pericarditis, which results from scarring from the loss of elasticity of the pericardium. Myocarditis is the inflammation of the myocardium, characterized by fever, fatigue, myalgia, dyspnea, and lymphadenopathy. Infective endocarditis is characterized by fever, malaise, anorexia, abdominal discomfort, and clubbing of the fingers. Rheumatic endocarditis is characterized by inflammation in the joints, resulting in painful deformity and immobility.

In which body location would the nurse expect to find petechiae on a patient with infective endocarditis? 1 Toes 2 Nail beds 3 Fingertips 4 Conjunctivae

4 Conjunctivae Petechiae are manifestations of infective endocarditis that result from fragmentation and microembolization of vegetative lesions. Petechiae occur on the conjunctivae, buccal mucosa, palate, and lips and over the ankles, feet, and antecubital and popliteal areas. Janeway's lesions occur on toes and fingertips. Splinter hemorrhages occur in the nail beds.

While reviewing a patient's medical record, the nurse notices a loss of elasticity of the pericardial sac. Which condition would the nurse suspect? 1 Pericarditis 2 Pericardiectomy 3 Pericardiocentesis 4 Constrictive pericarditis

4 Constrictive pericarditis Chronic constrictive pericarditis results from scarring, with fibrin deposition and loss of elasticity of the pericardial sac. Inflammation of the pericardial sac is pericarditis. A pericardiectomy is a procedure that involves the complete resection of the pericardium through a median sternotomy with the use of a cardiopulmonary bypass. Pericardiocentesis is a procedure usually performed for pericardial effusion with acute cardiac tamponade, purulent pericarditis, and suspected neoplasm.

Which goal does the administration of digoxin support in treating myocarditis? 1 Decrease preload 2 Treat an enlarged heart 3 Increase cardiac output 4 Improve myocardial contractility

4 Improve myocardial contractility Myocarditis is the diffuse inflammation of the myocardium. Digoxin improves myocardial contractility and reduces the heart rate. Diuretics reduce the fluid volume and decrease the preload. Angiotensin-converting enzyme (ACE) inhibitors reduce the afterload and treat the enlarged heart associated with myocarditis. IV medications like nitroprusside reduce afterload and improve cardiac output by decreasing systemic vascular resistance.

Which intervention will help provide pain relief for the patient with pericarditis? 1 Corticosteroids 2 Morphine sulfate 3 Proton pump inhibitor 4 Nonsteroidal antiinflammatory drugs (NSAIDs)

4 Nonsteroidal antiinflammatory drugs (NSAIDs) NSAIDs will control pain and inflammation. Corticosteroids are reserved for patients already taking them for autoimmune conditions or those who do not respond to NSAIDs. Morphine, an opioid, is not necessary or specific for this type of pain. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of gastrointestinal bleeding from the NSAIDs.

An 80-year-old patient who is a poor surgery candidate is diagnosed with severe aortic stenosis. Which procedure for aortic stenosis can be done without surgically opening the chest? 1 Annuloplasty 2 Aortic valve replacement 3 Open commissurotomy (valvulotomy) 4 Percutaneous transluminal balloon valvuloplasty (PTBV)

4 Percutaneous transluminal balloon valvuloplasty (PTBV) The PTBV procedure is generally indicated for an older patient who is a poor surgery candidate, and it is accomplished in the cardiac catheterization lab without open surgery. Annuloplasty is an option for patients with mitral or tricuspid regurgitation. An open commissurotomy procedure is used for mitral stenosis. Valve replacement via open surgery may be required for mitral, aortic, tricuspid, and occasionally pulmonic valve disease.

The nurse reviews the medical record of a patient newly diagnosed with infective endocarditis (IE). Which finding is essential to report to the primary health care provider? 1 Recent dental procedure 2 Patient reports of fatigue 3 Results of the echocardiogram 4 Positive results of a blood culture

4 Positive results of a blood culture Positive results of a blood culture of a patient diagnosed with IE indicate that the causative organism is not susceptible to the ordered antibiotic. This needs to be communicated immediately so that the proper antibiotic can be administered. The information regarding the recent dental procedure is obtained with the history of the patient and is not a priority to report to the health care provider. Fatigue is an expected symptom of IE. An echocardiogram is a diagnostic tool for IE.

The echocardiography report of a patient with infective endocarditis (IE) indicates the presence of a vegetative mass in the right ventricle. Which complication could result from this condition? 1 Liver embolization 2 Renal embolization 3 Cerebral embolization 4 Pulmonary embolization

4 Pulmonary embolization Vegetations are the primary lesions of IE that stick to the endocardium of the heart. Vegetations occurring in the right side of the heart could dislodge and then occlude the pulmonary artery, causing a pulmonary embolism. Vegetations occurring in the left side of the heart can dislodge and cause an embolism in the brain, liver, kidneys, and spleen. This can lead to renal, liver, or cerebral embolization.

Which type of murmur is observed in patients with chronic aortic valve regurgitation? 1 Holosystolic murmur 2 Loud midsystolic murmur 3 Low-pitched diastolic murmur 4 Soft, high-pitched diastolic murmur

4 Soft, high-pitched diastolic murmur An Austin-Flint murmur (soft, high-pitched diastolic) occurs in patients with chronic aortic valve regurgitation. Mitral valve stenosis involves a diastolic murmur. A holosystolic murmur occurs in patients with mitral valve prolapse. A loud midsystolic murmur occurs in patients with tricuspid and pulmonic stenosis.

Which complication of hypertrophic cardiomyopathy occurs as a result of obstructed aortic outflow during increased activity? 1 Angina 2 Fatigue 3 Dyspnea 4 Syncope

4 Syncope Syncope occurs in hypertrophic cardiomyopathy when blood flow is obstructed and is insufficient to meet the demands associated with activity. Increased left ventricular muscle mass by the hypertrophic ventricular myocardium will result in angina. A decrease in cardiac output and in exercise-induced flow obstruction leads to fatigue. Dyspnea occurs as a result of increased left ventricular diastolic pressure.

Which diagnostic study detects the presence of vegetation on the heart valves of a patient with infectious endocarditis? 1 Chest x-ray 2 Electrocardiogram 3 Cardiac catheterization 4 Transesophageal echocardiogram

4 Transesophageal echocardiogram Transesophageal echocardiogram and two- or three-dimensional transthoracic echocardiograms help detect vegetation on the heart valves of a patient with infectious endocarditis. The presence of vegetation on the heart valves cannot be detected by chest x-ray, cardiac catheterization, or electrocardiography. A chest x-ray can help to identify gross cardiac changes, blood vessels can be examined by cardiac catheterization, and an electrocardiogram can identify cardiac rhythm changes.

A patient with infective endocarditis is scheduled for a transesophageal echocardiogram (TEE). What would the test be expected to detect? 1 Cardiomegaly 2 Cardiac dysrhythmias 3 Atrioventricular block 4 Vegetations on the valves

4 Vegetations on the valves A TEE is used to detect vegetations on the heart valves. A chest x-ray is used to detect cardiomegaly. An electrocardiograph is used to detect cardiac dysrhythmias in patients with pericarditis. An electrocardiogram (ECG) detects first- or second-degree atrioventricular (AV) block.

Which instruction would the nurse include when teaching a patient with rheumatic fever about how to prevent acquired rheumatic valve disease? Select all that apply. 1 Avoid exercise. 2 Drink more coffee. 3 Wear a Medic Alert bracelet. 4 Watch for symptoms of heart valve disease. 5 Prophylactic antibiotic therapy will be prescribed.

4 Watch for symptoms of heart valve disease. 5 Prophylactic antibiotic therapy will be prescribed. The patient with rheumatic fever should be taught the symptoms of valvular heart disease. This is done to provide early medical treatment to the patient. Prophylactic antibiotic therapy is necessary to prevent endocarditis. The patient should be taught to practice hygiene measures to prevent contracting any infection. Avoiding exercise and drinking more coffee will not prevent rheumatic valve disease. Coffee contains caffeine, which can have adverse effects on the heart. Wearing a Medic Alert bracelet is recommended after valve surgery but is not required to prevent valvular disease.

Which condition is a major central nervous system (CNS) manifestation of rheumatic fever (RF)? 1 Aschoff's bodies 2 Pulsus paradoxus 3 Dressler syndrome 4 Sydenham's chorea

4 Sydenham's chorea Sydenham's chorea is a major CNS manifestation of rheumatic fever. It is characterized by involuntary movements of the face and limbs, muscle weakness, and speech and gait disturbances. Aschoff's bodies are nodules formed by a reaction to inflammation upon swelling and destruction of collagen fibers; these are not CNS manifestations. Pulsus paradoxus is an abnormally large decrease in the systolic BP during inspiration and is observed in patients with pericarditis. Dressler syndrome is late pericarditis that occurs four to six weeks after a myocardial infarction.

Which statement made by the nurse to a patient with cardiomyopathy regarding home care instructions requires correction? 1 "Follow a low-sodium diet." 2 "Avoid over-the-counter diet pills." 3 "Increase your caffeine consumption." 4 "Report increased fatigue to your health care provider."

Caffeine contains stimulants that stimulate the heart, which results in irregular heart rhythms. Therefore patients with cardiomyopathy should avoid caffeine. The patient should consume a low-sodium diet. The patient should avoid diet pills because they may contain stimulants. The patient should report increased fatigue to the health care provider.

The nurse is assessing a patient for a pericardial friction rub related to myocarditis. In which order would the nurse perform the steps of the assessment? 1. Place the stethoscope at the lower left sternal border of the chest. 2. Assist the patient to lean forward. 3. Repeat several times. 4. Ask the patient to hold his or her breath briefly.

Correct1.Assist the patient to lean forward. Correct2.Place the stethoscope at the lower left sternal border of the chest. Correct3.Ask the patient to hold his or her breath briefly. Correct4.Repeat several times The nurse helps the patient to lean forward, and the stethoscope is placed at the lower left sternal border of the chest. The patient should be asked to hold his or her breath to distinguish a pericardial friction rub from a pleural friction rub. The process may be repeated several times to identify a pericardial friction rub because pericardial friction rubs are often intermittent and short-lived.

Which information in the patient's history indicates an increased risk for infection of the endocardial layer of the heart? 1 Myxedema 2 Marfan's syndrome 3 Hodgkin's lymphoma 4 Postpericardiotomy syndrome

Infection of the endocardial layer of the heart indicates infective endocarditis. Marfan's syndrome is a genetic disorder that affects the connective tissue and is a risk factor for infective endocarditis. Myxedema and Hodgkin's lymphoma are noninfectious causes of pericarditis. Postpericardiotomy syndrome is a hypersensitive or autoimmune cause of pericarditis.

A patient with a cardiovascular disorder has flat, small, painless, red spots on the soles of the feet and palms of the hands. Which term is used for these findings? 1 Roth's spots 2 Osler's nodes 3 Janeway's lesions 4 Splinter hemorrhages

Janeway's lesions Flat, small, painless, red spots on the soles and palms indicate Janeway's lesions, which are observed in patients with infective endocarditis. Roth's spots are hemorrhagic lesions on the retina. Osler's nodes are painful, tender, purple or red, pea-size lesions observed on the toes and fingertips of patients with infective endocarditis. Splinter hemorrhages are black longitudinal streaks that occur in the nail beds of patients with infective endocarditis.

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 paradoxus? Record the answer using a whole number. ____ mm Hg

The difference between the pressure at which the first Korotkoff sound during expiration is noted and the pressure at which sound throughout the respiratory cycle is noted is the amount of paradoxus (115 mm Hg - 84 mm Hg = 31 mm Hg).