MS 2 - Chapter 24 Prep U
If a client were to develop rheumatic carditis, which cardiac structure would most likely be affected? mitral valve septum inferior vena cava coronary arteries
mitral valve In rheumatic carditis, cardiac structures that usually are affected include the heart valves (particularly the mitral valve), endocardium, myocardium, and pericardium.
The nurse completes an assessment of a client admitted with pericarditis. What client symptom will the nurse correlate with the diagnosis of pericarditis? dyspnea fatigue lasting more than 1 month reports of constant chest pain elevated ESR and CRP
reports of constant chest pain The most characteristic symptom of pericarditis is chest pain. The pain or discomfort usually remains fairly constant, but it may worsen with deep inspiration and when lying down or turning.
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 mechanical valve is less likely to generate blood clots, so long-term anticoagulation therapy is not required." "Mechanical valves are not always available and are very expensive." "Mechanical valves are used for women of childbearing age."
"A mechanical valve is thought to be more durable and so requires replacement less often." Mechanical valves are thought to be more durable than tissue valves and so require replacement less often. Tissue valves are less likely to generate blood clots and so long-term anticoagulation therapy is not required. Homografts (human valves) are not always available and are very expensive.
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? "I'll enroll in an aerobic exercise program." "I can still drink coffee and tea." "I should increase my fluid intake." "I should eat foods rich in protein."
"I can still drink coffee and tea." The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.
The nurse determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement? "Can I take the antibiotics as a pill now?" "I need a referral to a dietician to understand a low-sodium diet." "I have to call my doctor so I can get antibiotics before seeing the dentist." "If I quit smoking, it will help the endocarditis."
"I have to call my doctor so I can get antibiotics before seeing the dentist." Antibiotic prophylaxis is recommended for high-risk clients immediately before and sometimes after dental procedures.
A client with a confirmed DVT is being discharged from the ED. Which client statement indicates that the client has received proper nursing instruction and understands how to manage this condition? "I need to do my leg exercises five times or more every hour." "I should lie on my side with my knees bent when sleeping." "I need to ice my leg every 2 hours for about 20 minutes." "I should try not to drink too much during the daytime."
"I need to do my leg exercises five times or more every hour." Exercise prevents venous stasis by promoting venous circulation, relieves swelling, and reduces pain. Promoting venous blood flow prevents the formation of thrombi and subsequent potential for emboli in the unaffected extremity.
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." "I will take antibiotics before getting my teeth cleaned." "I can get a tattoo at a local parlor." "I can get my tongue pierced at a store in the shopping mall."
"I will avoid caffeine, alcohol, and smoking." In mitral valve prolapse, if dysrhythmias are documented and cause symptoms, the client is advised to eliminate caffeine and alcohol from the diet and to stop the use of tobacco products.
The nurse instructs a client recovering from mechanical valve replacement surgery. Which client statement indicates that teaching has been effective? "I have a low risk of developing an infection in my heart." "I will not need to take anticoagulant medication every day." "I can play soccer in a week or two." "I will not drive until informed by my health care provider."
"I will not drive until informed by my health care provider." The client receiving from mechanical valve replacement surgery needs to avoid driving a car until informed it is safe to do so. The client will need to avoid contact sports such as soccer until cleared by the health care provider. The client is at risk for developing infective endocarditis and should be instructed on the symptoms to include fever, chills, petechiae, malaise, and weight loss. Anticoagulant medication is needed for life when a mechanical valve is used.
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 mechanical, and it will not deteriorate or need replacing." "The valve is from a tissue donor, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is made from a pig tissue, and I will not need to take any blood-thinning drugs when I am discharged." "The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged."
"The valve is made from my own heart valve, and I will not need to take any blood-thinning drugs when I am discharged." Autografts (i.e., autologous valves) are obtained by excising the client's own pulmonic valve and a portion of the pulmonary artery for use as the aortic valve. Anticoagulation is unnecessary because the valve is the client's own tissue and is not thrombogenic. The autograft is an alternative for children (it may grow as the child grows), women of childbearing age, young adults, clients with a history of peptic ulcer disease, and people who cannot tolerate anticoagulation. Aortic valve autografts have remained viable for more than 20 years.
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 Syncope Dizziness Fatigue
An extra heart sound Often the first and only sign of mitral valve prolapse is identified when a physical examination of the heart reveals an extra heart sound, referred to as a mitral click. Fatigue, dizziness, and syncope are other symptoms of mitral valve prolapse.
Which describes a valve used in replacement surgery that is made from the client's own heart valve? Homograft Xenograft Autograft Allograft
Autograft An example of an autograft is when the surgeon excises the pulmonic valve and uses it for an aortic valve replacement. An allograft, also called a homograft, refers to replacement using human tissue. Xenograft refers to animal tissue used in tissue replacement.
A client with aortic stenosis is reluctant to have valve replacement surgery. A nurse is present when the health care provider talks to the client about a treatment that is less invasive than surgery which will likely relieve some of the client's symptoms. What treatment option has been discussed? Balloon percutaneous valvuloplasty Antibiotic therapy Placement of an autograft valve Placement of a xenograft valve
Balloon percutaneous valvuloplasty Definitive treatment for aortic stenosis is surgical replacement of the aortic valve. Clients who are symptomatic, but not good surgical candidates may benefit from a one or two balloon percutaneous valvuloplasty. Antibiotic therapy will not open the valve. The client does not want to have a valve replacement of any kind.
A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)? Thrombosis and infection Bleeding and wound dehiscence Evisceration Bleeding and infection
Bleeding and infection Possible complications of an aortic balloon valvuloplasty include aortic regurgitation, emboli, ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia, mitral valve damage, infection, and bleeding from the catheter insertion sites.
A client is diagnosed with mitral regurgitation. What does the nurse consider with the mechanics of cardiac hemodynamics? Blood flows backward from the left ventricle into the left atrium during systole. Blood flows backward from the left atrium into the pulmonary system. Blood flows backward from the right ventricle into the right atrium. Blood flows backward from the aorta into the left ventricle.
Blood flows backward from the left ventricle into the left atrium during systole. When the mitral valve leaflets thicken, fibrose, and contract, they cannot close completely. With each heartbeat, blood is forced backward into the left atrium during systole. Regurgitation of blood into the left atrium causes the left atrial pressure to rise.
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for? Decreased venous pressure Left ventricular hypertrophy Hypertension Cardiac tamponade
Cardiac tamponade The inflammatory process of pericarditis may lead to an accumulation of fluid in the pericardial sac (pericardial effusion) and increased pressure on the heart, leading to cardiac tamponade.
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 Dyspnea, distended jugular veins, orthopnea Distended jugular veins, pedal edema, nausea Orthopnea, nausea, pedal edema
Dyspnea, orthopnea, pulmonary edema Signs and symptoms of progressive left ventricular failure include breathing difficulties, such as orthopnea, PND, and pulmonary edema. Distended jugular veins, pedal edema, and nausea are signs and symptoms of right sided heart failure.
The diagnosis of aortic regurgitation (AR) is confirmed by which of the following? Echocardiography Cardiac catheterization Myocardial biopsy Exercise stress testing
Echocardiography Diagnosis is confirmed by echocardiography. Cardiac catheterization is not necessary in most patients with AR. Exercise stress testing will assess functional capacity and symptom response. A myocardial biopsy may be performed to analyze myocardial tissue cells in patients with cardiomyopathy.
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 dairy products and carbonated beverages Decrease the amount of acidic beverages and fruits Eliminate caffeine and alcohol Decrease the amount of sodium and saturated fat
Eliminate dairy products and carbonated beverages To minimize symptoms of mitral valve prolapse, the nurse should instruct the client to avoid caffeine and alcohol.
In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum? Dilated Restrictive Arrhythmogenic right ventricular Hypertrophic
Hypertrophic Because of structural changes, hypertrophic cardiomyopathy had also been called idiopathic hypertrophic subaortic stenosis or asymmetric septal hypertrophy. Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling. Arrhythmogenic right ventricular cardiomyopathy occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.
A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned earlier. What option will the nurse most likely discuss? Left ventricular assist device Chordoplasty Annuloplasty Open commissurotomy
Left ventricular assist device When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. Because of the limited number of organ donors, many clients die waiting. In some cases, a left ventricular assist device is implanted to support the failing heart until a suitable donor becomes available.
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? Administering antiseptic lozenges Obtaining a throat culture Fluid increase to 2500cc Warm, salt water gargling
Obtaining a throat culture When a child has a sore throat and symptoms of a possible infection occur, it is essential that a culture is obtained. A culture can identify group A beta-hemolytic streptococcal infection, which needs to be eliminated with use of an antibiotic. Warm, salt gargles; increasing fluids; and administering antiseptic lozenges are helpful for symptom control. Obtaining a throat culture is a priority.
The nurse is caring for a client with aortic regurgitation. The nurse knows to expect what symptoms during the physical examination? Headache and vomiting Orthopnea and dyspnea Nausea and low urine output Increased urine output
Orthopnea and dyspnea Aortic regurgitation usually manifests as progressive left ventricular failure, resulting from blood flowing backward from the aorta to the left ventricle, and eventually into the lungs. Urine output would be decreased from lower cardiac output. Nausea and vomiting are symptoms of increased gastrointestinal pressure, which would result from right heart failure. Kidney failure could become a problem later if cardiac output became too low, but not initially. CVA and an infarcted bowel would not be caused by mitral regurgitation.
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? Croup Rheumatic fever Severe staphylococcal infection Medullary sponge kidney
Rheumatic fever Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections.
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? Cardiomyopathy Rheumatic fever Pericarditis Mitral stenosis
Rheumatic fever Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and thereby rheumatic heart disease.
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? Pericarditis Cardiomyopathy Mitral stenosis Rheumatic fever
Rheumatic fever Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and thereby rheumatic heart disease.
The nurse is providing discharge teaching for a client with rheumatic endocarditis but no valvular dysfunction. On which nursing diagnosis should the nurse focus her teaching? Risk for infection Impaired gas exchange Chronic pain Impaired memory
Risk for infection Clients with endocarditis have a Risk for infection. The nurse should stress to the client that he'll need to continue antibiotics for a minimum of 5 years and that he'll need to take prophylactic antibiotics before invasive procedures for life. There is no indication that the client has Chronic pain or Impaired memory. Because the client doesn't have valvular damage, Impaired gas exchange doesn't apply.
A nurse is told in report that a patient has aortic stenosis. Which anatomical position should the nurse auscultate to assess the murmur? Erb's point Second intercostal space, left sternal notch Fourth intercostal space, left sternal border Second intercostal space, right sternal notch
Second intercostal space, right sternal notch The second intercostal space, right sternal notch, is the area on the chest where the aorta can best be heard opening and closing. Erb's point allows the nurse to hear the opening and closing of the tricuspid valve. The second intercostal, left sternal notch is where to hear the pulmonic valve. The fourth intercostal space, left sternal border is to assess the tricuspid.
A nurse is caring for a client with acute mitral regurgitation related to an acute myocardial infarction. The nurse knows to monitor the client carefully for symptoms of which initial complication or result? Cerebral vascular accident (CVA) Infarcted bowel Severe heart failure Kidney failure
Severe heart failure Acute mitral regurgitation usually manifests as severe congestive heart failure, resulting from blood flowing backward from the left ventricle to the left atria and eventually into the lungs. Kidney failure could become a problem later if cardiac output is too low, but not initially. CVA and an infarcted bowel would not be caused by mitral regurgitation.
A client with a myocardial infarction develops acute mitral valve regurgitation. The nurse knows to assess for which manifestation that would indicate that the client is developing pulmonary congestion? A loud, blowing murmur Hypertension Shortness of breath Tachycardia
Shortness of breath Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation (e.g., resulting from a myocardial infarction) usually manifests as severe congestive heart failure. Dyspnea, fatigue, and weakness are the most common symptoms. Palpitations, shortness of breath upon exertion, and cough from pulmonary congestion also occur.
The nurse is assessing a client admitted with infective endocarditis. Which manifestation would the nurse expect to find? Raised red rash on the trunk and face Involuntary muscle movements of the extremities Bruising on the palms of the hands and soles of the feet Small painful lesions on the pads of the fingers and toes
Small painful lesions on the pads of the fingers and toes Primary presenting symptoms of infective endocarditis are fever and a heart murmur. In addition small, painful nodules (Osler nodes) may be present in pads of fingers or toes. Irregular red or purple, painless flat macules (Janeway lesions) may be present on palms, fingers, hands, soles, and toes. Hemorrhages with pale centers (Roth spots) caused by emboli may be observed in fundi of the eyes. Splinter hemorrhages (i.e., reddish-brown lines and streaks) may be seen under the proximal half of fingernails and toenails. Petechiae may appear in conjunctiva and mucous membranes. Cardiomegaly, heart failure, tachycardia, or splenomegaly may occur.
A nurse is caring for a client with pericarditis and auscultates a pericardial friction rub. What action does the nurse ask the client to do to distinguish a pericardial friction rub from a pleural friction rub? There is really no question to ask the client to tell the difference. The nurse places the client flat for at least 4 minutes. The nurse has the client stand during auscultation. The nurse asks the client to hold the breath during auscultation.
The nurse asks the client to hold the breath during auscultation. A pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid as a result of inflammation. The audible rub on auscultation is synchronous with the heartbeat. To distinguish between a pleural rub and a pericardial rub, the client should hold the breath. The pericardial rub will continue. Length of auscultation and standing would not assist in distinguishing one kind of rub from the other.
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 drink a glass of milk before taking nitroglycerin To engage in 15 minutes of light exercise before taking nitroglycerin To eat a small meal before taking nitroglycerin To rest and relax before taking nitroglycerin
To rest and relax before taking nitroglycerin The venous dilation that results from nitroglycerin decreases blood return to the heart, thus decreasing cardiac output and increasing the risk of syncope and decreased coronary artery blood flow. The nurse teaches the client about the importance of attempting to relieve the symptoms of angina with rest and relaxation before taking nitroglycerin and to anticipate the potential adverse effects. Exercising, eating, and drinking are not recommended prior to using nitroglycerin.
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? dilated hypertrophic restrictive arrhythmogenic right ventricular
hypertrophic In hypertrophic cardiomyopathy (HCM), the heart muscle asymmetrically increases in size and mass, especially along the septum. It often affects nonadjacent areas of the ventricle. The increased thickness of the heart muscle reduces the size of the ventricular cavities and causes the ventricles to take a longer time to relax after systole. The coronary arteriole walls are also thickened, decreasing the internal diameter of the arterioles. The narrow arterioles restrict the blood supply to the myocardium, causing numerous small areas of ischemia and necrosis. The necrotic areas of the myocardium ultimately fibrose and scar, further impeding ventricular contraction. Because of the structural changes involved, HCM has also been called idiopathic hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).
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? edema angina dyspnea left ventricular dysfunction
left ventricular dysfunction Digoxin may be used to treat left ventricular dysfunction. Diuretics may be used for dyspnea. Nitrates may be prescribed for the treatment of angina, but must be used with caution due to the risk of orthostatic hypotension and syncope.
A nurse is caring for a young female adult client diagnosed with atrial fibrillation who has just had a mitral valve replacement. The client is being discharged with prescribed warfarin. The client mentions to the nurse that she relies on the rhythm method for birth control. What education will be a priority for the nurse to provide to this client? symptoms to report of worsening tachycardia related to atrial fibrillation instructions for using the rhythm method foods to limit (green leafy vegetables) while taking warfarin the high risk for complications if she becomes pregnant while taking warfarin
the high risk for complications if she becomes pregnant while taking warfarin Women of childbearing age should not take warfarin (pregnancy X category) if they plan to become pregnant. There is danger to the placenta and risk for the mother to bleed. The fetus may also be affected. This client should practice a more reliable method of birth control. The rhythm method for birth control is not always accurate. The symptoms of worsening tachycardia are important, but do not correspond to the warfarin therapy. Limiting green leafy vegetables is important with warfarin therapy, but risk for fetal harm is more important.
