chapter 24 prep u med surg 1

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

The nurse is reviewing the lab work of a client diagnosed with infective endocarditis. Which diagnostic study confirms the diagnosis?

Positive blood culture

A client with a recent history of atrial fibrillation has been prescribed warfarin. What action will the nurse take to confirm safe dosing?

Review the client's international normalized ratio (INR).

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 total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD?

An LVAD only supports a failing left ventricle.

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

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant?

Rheumatic fever

The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point?

The treatments include medications, medical devices, surgery, or transplantation.

The nurse is caring for a client who has been diagnosed with aortic stenosis. The client is prescribed digoxin. What is the rationale for the medication?

left ventricular dysfunction

A client is admitted to the hospital with suspected rheumatic endocarditis. What diagnostic test will the nurse anticipate being ordered?

throat culture

A nurse is teaching a client who is awaiting a heart transplant. Which statement indicates the client understands what is required to help minimize rejection?

"I will need to take three different types of medications for the rest of my life to help prevent rejection."

If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected?

mitral valve

During a teaching session, a client who is having a valvuloplasty tomorrow asks the nurse about the difference between a mechanical valve replacement and a tissue valve. What answer from the nurse is correct?

"A mechanical valve is thought to be more durable and so requires replacement less often."

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 can still drink coffee and tea."

The nurse is educating a client about the care related to a new diagnosis of mitral valve prolapse. What statement made by the client demonstrates understanding of the teaching?

"I will avoid caffeine, alcohol, and smoking."

A nurse is caring for a client newly diagnosed with mitral valve prolapse. The health care provider indicates the client has probably had this condition for years. What factor is important for the nurse to consider when teaching the client about valvular disease?

"The client with mitral valve prolapse probably had no health symptoms."

The nurse completes an assessment of a client with mitral regurgitation. What statement represents the appropriate physical finding for a client with this condition?

"The high-pitched blowing sound at the apex is indicative of a systolic murmur."

A nurse and a nursing student are performing a physical assessment of a client with pericarditis. The client has an audible pericardial friction rub on auscultation. When leaving the room, the student asks the nurse what causes the sound. The nurse's best response is which of the following?

"The pericardial surfaces lose their lubricating fluid because of inflammation and rub against each other."

A client with a mechanical valve replacement asks the nurse, "Why do I have to take antibiotics before getting my teeth cleaned?" What is the nurse's best response?

"You are at risk of developing an infection in your heart."

The nurse is preparing to administer warfarin to a client with a mechanical valve replacement. The client's international normalized ratio is 2.7. What action will the nurse take?

Administer the medication as ordered.

A nurse is caring for a client receiving warfarin therapy following a mechanical valve replacement. The client had a prothrombin time and International Normalized Ratio (INR) drawn before breakfast. The laboratory report shows the client's INR reading was 4. What is the nurse's first priority ?

Assess the client for bleeding and notify the health care provider of the results.

The nurse is auscultating the heart sounds of a patient with mitral stenosis. The pulse rhythm is weak and irregular. What rhythm does the nurse expect to see on the electrocardiogram (ECG)?

Atrial fibrillation

The nurse is caring for a client diagnosed with bacterial myocarditis. The client's heart rate is 120-130 beats per minute and blood pressure 158/89 mm Hg. What medications will the nurse administer to treat the client with myocarditis? Select all that apply.

carvedilol amiodarone penicillin

A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)?

Bleeding and infection

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic?

Check regularly for dependent edema

A nurse evaluates a client and suspects pericarditis. What indicator is considered the most characteristic symptom of pericarditis?

Chest pain

A client with a recent myocardial infarction was admitted to the hospital with a new diagnosis of mitral valve regurgitation. Which assessment data obtained by the nurse should be immediately communicated to the health care provider?

Crackles audible throughout the lungs

A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the development of left ventricular failure?

Dyspnea, orthopnea, pulmonary edema

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

A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response?

Group A, beta-hemolytic streptococcus

Which type of graft is used when a heart valve replacement is made of tissue from an animal heart valve?

Heterograft

An adult client with a tentative diagnosis of infective endocarditis is admitted to an acute care facility. The medical history reveals diabetes mellitus, hypertension, and pernicious anemia. The client underwent an appendectomy 20 years earlier and an aortic valve replacement 2 years before this admission. What history finding is a major risk factor for infective endocarditis?

History of aortic valve replacement

A client with endocarditis is being discharged home. What statement indicates effectiveness of client teaching about preventing recurrence of the infection?

I will ask for antibiotics whenever I have dental work done."

Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis?

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 client comes into the emergency department reporting about chest pain that gets worse when taking deep breaths and lying down. After ruling out a myocardial infarction, a nurse would assess for which diagnosis?

Pericarditis

A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client's symptoms may indicate:

cardiomyopathy.

It is important for a nurse to be aware of the normal hemodynamics of blood flow to recognize and understand pathology when it occurs. The nurse should know that incomplete closure of the tricuspid valve results in a backward flow of blood from the:

Right ventricle to the right atrium.

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

The nurse is teaching a client diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without resorting to taking medications. What should the nurse teach the client?

To rest and relax before taking nitroglycerin

A client was admitted to the hospital with a diagnosis of aortic regurgitation. On assessment, what positive indicators for the disease process will the nurse note? Select all that apply.

Visible neck vein pulsations The pulse has a rapid upstroke, then collapses The presence of a diastolic murmur

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?

echocardiogram

A client is diagnosed with infective endocarditis. What laboratory values will the nurse assess? Select all that apply.

elevated erythrocyte sedimentation rate (ESR) elevated white blood cell (WBC) count

The nurse suspects a client has developed pericarditis after a week of cold-like symptoms. Which of the client's signs and symptoms indicate pericarditis?

fever, chest discomfort, and elevated erythrocyte sedimentation rate (ESR)

A nurse reviewing a client's echocardiogram report reads the following statements: "The heart muscle is asymmetrically thickened and the overall size and mass are increased, especially along the septum. The ventricular walls are thickened, reducing the size of the ventricular cavities. Several areas of the myocardium show evidence of scarring." The nurse knows these manifestations are indicative of which type of cardiomyopathy?

hypertrophic

A nurse is teaching a client about mitral stenosis. What is the key teaching point regarding the disruption to the normal flow of blood through the heart due to mitral stenosis?

increased resistance of a narrowed orifice between the left atrium and the left ventricle

The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis?

reports of constant chest pain

The nurse is teaching a school community parent group about heart wellness. What risk factor is a common leading cause for mitral stenosis?

rheumatic fever

A client's chart indicates Virchow's triad. This client is at risk for which complication

thrombophlebitis