N123 Chp 37 Inflammatory and Structural Cardiac Disease

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 bracelet." 2 "I will take antibiotics when I have my teeth extracted." 3 "Valve surgery has completely cured my disease." 4 "I will start a vigorous aerobic exercise program." 5 "I should go to the doctor if I have a respiratory infection."

1, 2, 5 It is advisable for this patient to wear a Medic Alert bracelet 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. Also, valve surgery only relieves the symptoms and does not cure the disease; therefore, regular follow-up is important to monitor the disease progression. 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 ordered by the health care provider. Text Reference - p. 826

A nurse is planning the discharge teaching for a patient with cardiomyopathy. What instructions should be present in the plan? Select all that apply. 1 Avoid alcohol. 2 Restrict fluids. 3 Drink more coffee. 4 Balance activity and rest periods. 5 Consume food products with high sodium content.

1, 4 A patient with cardiomyopathy should avoid alcohol, because it may increase blood pressure and can have adverse effects on the heart. Balance between activities and rest is essential to decrease systemic valvular resistance. Dehydration can increase systemic valvular resistance, which may result in obstruction to the forward flow of blood. Therefore, it is important to drink six to eight glasses of water every day to avoid dehydration. Coffee should be avoided, because it contains caffeine, which is a stimulant. It is important to follow a low-sodium diet, because it helps prevent water retention in the body. Text Reference - p. 830

Which heart sound indicates aortic valve stenosis by its absence, in a patient with valvular heart disease? 1 Absence of S1 2 Absence of S2 3 Absence of S3 4 Absence of S4

2 Aortic stenosis occurs as the 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. Text Reference - p. 821

The nurse is caring for a patient with valvular heart disease who experiences atrial dysrhythmias. Which type of medication does the nurse anticipate in the prescription? 1 Nitrates 2 Positive inotropes 3 Calcium channel blockers 4 Angiotensin-converting enzyme (ACE) inhibitors

3 Atrial dysrhythmia is an irregular heartbeat that occurs in the atrium. Calcium channel blockers dilate arteries by reducing calcium flux into the cells, which increases myocardial oxygen supply and prevents atrial dysrhythmias. Nitrates and ACE inhibitors are vasodilators that are used in the treatment of heart failure. Positive inotropes are used to treat heart failure in patients with valvular heart disease. Text Reference - p. 824

The nurse is preparing a discharge teaching plan for a patient admitted with restrictive cardiomyopathy. Which instruction should the nurse include in the teaching plan for the patient? 1 Follow a normal sodium diet. 2 Drink three to four glasses of water daily. 3 Maintain a reasonable weight and avoid large meals. 4 Learn and practice cardiopulmonary resuscitation.

3 The patient should maintain a reasonable weight and avoid large meals. The patient should follow a low-sodium diet and read all product labels for sodium content. The patient should drink six to eight glasses of water a day unless fluids are restricted. The caregiver and not the patient should learn and practice cardiopulmonary resuscitation because of the potential for sudden cardiac arrest in the patient. Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess. Text Reference - p. 829

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 Maintain bed rest. 2 Administer nitrates for chest pain. 3 Avoid caffeine or ephedrine. 4 Keep the patient hydrated. 5 Prescribe β-adrenergic blockers to control palpitations.

3, 4, 5 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. Text Reference - p. 822

What is the clinical use of a multiple gated acquisition (MUGA) scan? 1 It helps determine ejection fraction. 2 It helps detect conduction disturbances. 3 It helps determine the effectiveness of dilated cardiomyopathy. 4 It helps detect infectious organisms in the heart tissue.

1 A multiple gated acquisition nuclear scan determines ejection fraction. Ejection fraction less than 20 percent is associated with a 50 percent mortality rate within a year. Conduction disorders like tachycardia, bradycardia, and dysrhythmias are diagnosed by electrocardiogram. Endomyocardial biopsy at the right side of the heart helps identify infectious organisms in heart tissue. Doppler echocardiography helps evaluate the effectiveness of dilated cardiomyopathy. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 828

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

1 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. Text Reference - p. 827

A patient is admitted to the hospital with a diagnosis of aortic valve stenosis. Which manifestation should the nurse expect when taking the health history? 1 Angina 2 Fatigue 3 Dyspnea 4 Weakness

1 Angina is one of the classic triad of manifestations that occurs on exertion in aortic valve stenosis. Angina occurs when the myocardial oxygen demand of the hypertrophied left ventricle exceeds oxygen supply. Fatigue, dyspnea, and weakness are clinical manifestations of chronic mitral valve regurgitation. Text Reference - p. 823

A patient is admitted to the hospital with a diagnosis of acute mitral valve regurgitation. What is the priority nursing intervention? 1 Auscultate the lung sounds. 2 Observe for bloody sputum. 3 Palpate lower extremity edema. 4 Assess for water-hammer pulse.

1 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. Water-hammer pulse is a manifestation of chronic, severe aortic valve regurgitation. Text Reference - p. 822

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

1 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. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 821

The nurse auscultates an irregular, rapid heart rate in a patient with mitral valve prolapse. Which medication does the nurse expect will be prescribed? 1 Propranolol 2 Atorvastatin 3 Trimetazidine 4 Isosorbide dinitrate

1 Palpitations are fast, hard, and irregular heartbeats. Propranolol is a β-adrenergic blocker that slows the heart rate by acting on the β-adrenergic receptors located on the heart cells. Atorvastatin is a statin, used primarily to treat elevated blood cholesterol levels and reduce the risk of cardiovascular disease. Trimetazidine is an anti-ischemic medication that improves glucose control and improves cardiac function in dilated cardiomyopathy. Isosorbide dinitrate is used to prevent angina attacks by dilating blood vessels. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 822

Which type of valvular heart disease occurs in patients that abuse drugs intravenously? 1 Tricuspid stenosis 2 Pulmonic stenosis 3 Aortic valve stenosis 4 Mitral valve stenosis

1 Tricuspid stenosis is the disease of the tricuspid valve that occurs in patients who abuse drugs intravenously or who have had rheumatic fever. Pulmonic stenosis is congenital. Aortic valve stenosis occurs due to rheumatic fever. Mitral valve stenosis occurs due to rheumatic heart disease. Text Reference - p. 823

What should be included in the teachings of a patient with rheumatic fever to prevent acquired rheumatic valve disease? Select all that apply. 1 Watch for symptoms of valvular heart disease. 2 Take prophylactic antibiotic therapy and practice hygienic measures. 3 Avoid exercise. 4 Drink more coffee. 5 Wear a Medic Alert bracelet.

1, 2 The patient with rheumatic fever should be taught about the symptoms of valvular heart disease. This is done to provide early medical treatment to the patient and alert him. It is necessary to take prophylactic antibiotic therapy 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 it. Text Reference - p. 820

A patient with aortic valve stenosis is receiving nitroglycerin. Which statements from the nurse indicate an understanding about the medication? Select all that apply. 1 "It is given to treat angina." 2 "It can cause hypotension." 3 "It can worsen chest pain." 4 "It is a drug of choice in mitral valve prolapse." 5 "It is given to control heart palpitations."

1, 2, 3 Nitroglycerin is used with caution in patients with aortic valve stenosis to treat angina. This is because it can significantly reduce blood pressure and worsen chest pain due to a decrease in preload and a drop in blood pressure. The drug causes hypotension through dilation of blood vessels. It is not recommended in mitral valve prolapse, because the chest pain in mitral valve prolapse does not respond to antianginal treatment. Also, nitroglycerin is not administered for controlling palpitations. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. Text Reference - p. 821

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

1, 2, 3 The nurse should instruct the patient to avoid strenuous activity and dehydration, because these may increase systemic valvular resistance, which may lead to obstruction to 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 obstruction of blood flow from the heart. Vigorous leg exercises should be avoided, because they can lead to an increase in systemic vascular resistance. Text Reference - p. 829

The nurse is assessing a 69-year-old patient during a regular follow-up visit. The patient has progressive valvular disease caused by rheumatic fever. Which interventions would be appropriate for the nurse to perform? Select all that apply. 1 Ensure ongoing prophylaxis 2 Encourage planned rest periods 3 Encourage persistent physical exercise 4 Monitor effectiveness of medication 5 Explain the need for mechanical valve replacement

1, 2, 4 When assessing a patient with progressive valvular disease caused by rheumatic fever, the nurse should ensure ongoing prophylaxis to prevent recurrence. The nurse should encourage the patient to plan rest periods and should monitor 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 biological valve replacement rather than mechanical valve replacement, because the latter involves higher risk of bleeding from anticoagulants. Text Reference - p. 826

A nurse is planning the discharge teaching for a patient with valvular heart disease. What instructions should the nurse include in the plan? Select all that apply. 1 Avoid cigarettes. 2 Take planned rest periods. 3 Continue with aerobic exercises. 4 Continue with daily activities as before. 5 Undergo regular cardiac assessments.

1, 2, 5 Consumption of tobacco should be strictly avoided, because it stimulates the heart. Rest periods should be planned to avoid exertion. Regular cardiac assessment helps to monitor the disease progress and 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 patient should not continue aerobic exercises, because these are strenuous. It is necessary to conserve energy; therefore, modifications should be made in daily activities. Complex activities should be broken into simpler steps for easy execution. Text Reference - p. 826

A patient seeks information about the advantages of minimally invasive valvuloplasty surgery. What should the nurse say to explain the procedure to the patient? Select all that apply. 1 "It involves a shorter period of stay in the hospital." 2 "It can lead to postoperative atrial fibrillation." 3 "It is associated with a higher risk of sternal infection." 4 "It may require a blood transfusion." 5 "It is associated with less pain."

1, 2, 5 Minimally invasive valvuloplasty surgery involves a ministernotomy. 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 due to the surgery on the valves but is less common than with open surgical valvuloplasty. Because the procedure is minimally invasive, there is less postoperative pain. The procedure carries a lesser risk of sternal infection due to the small incision. Also, fewer blood transfusions are needed compared to open valvuloplasty because the blood loss is typically minimal. Text Reference - p. 825

An older adult is scheduled to undergo percutaneous transluminal balloon valvuloplasty. What information should the nurse provide to the patient before the procedure? Select all that apply. 1 It has few complications. 2 It is performed in an operating room. 3 Long-term results are similar to surgical commissurotomy. 4 The procedure is difficult but has good results. 5 It requires a surgical incision.

1, 3 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. Text Reference - p. 824

The nurse is caring for a patient with dilated cardiomyopathy who receives a prescription for trimetazidine therapy. What are the desired outcomes of the therapy? Select all that apply. 1 Improved glucose control 2 Reduction in dysrhythmias 3 Improved cardiac function 4 Decreased atrial fibrillation 5 Reduction in the risk of embolization

1, 3 Trimetazidine is a metabolic modulator that improves glucose control and improves cardiac function in patients with dilated cardiomyopathy. Dysrhythmias are reduced with antidysrhythmics, such as amiodarone. Atrial fibrillation is reduced with the use of digitalis. Anticoagulant therapy helps in reducing the risk of embolization. Test-Taking Tip: Recall the category of trimetazidine, its therapeutic effects, mechanism of action, this helps in selecting the correct answer. Text Reference - p. 828

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

1, 5 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 atypical chest pain. Cognitive perceptual pattern understands how a patient perceives and responds to sensory input. Angina and chest pain indicates 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 receptors. Asking the patient about fainting, dizziness, and orthopnea helps in assessing the activity-exercise functional health pattern. Text Referen

What assessment findings does the nurse expect when caring for a patient with mitral valve stenosis? Select all that apply. 1 Stroke 2 Seizures 3 Chest pain 4 Hoarseness 5 Palpitations

1,2 Emboli result in the buildup of cellular waste and carbon dioxide, leading to damage to the cells and neurons. The damage to heart cells will result in stroke, and damage to neurons will cause nervous system disorders such as seizures or epilepsy. Chest pain results from decreased cardiac output and coronary perfusion. Atrial enlargement on the laryngeal nerve results in hoarseness. Palpitations result from atrial fibrillation. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 821

The nurse conducts a complete physical assessment on a patient admitted with infective endocarditis. Which finding is significant? 1 Respiratory rate of 18 and heart rate of 90 2 Regurgitant murmur at the mitral valve area 3 Heart rate of 94 and capillary refill time of two seconds 4 Point of maximal impulse palpable in fourth intercostal space

2 A regurgitant murmur of the aortic or mitral valves would indicate valvular disease, which is a complication of endocarditis. Respiratory rate of 18 and heart rate of 90, heart rate of 94 and capillary refill time of two seconds, and point of maximal impulse palpable in fourth intercostal space are within normal limits. Text Reference - p. 811

A patient with valvular heart disease is found to have pulmonic stenosis. Which conservative therapy does the nurse expect in the patient's prescription? 1 Annuloplasty 2 Balloon valvuloplasty 3 Mitral commissurotomy 4 Sapien Transcatheter Heart Valve (THV)

2 Balloon valvuloplasty or percutaneous transluminal balloon valvuloplasty (PTBV) is beneficial in patients with pulmonic stenosis. Annuloplasty is the reconstruction of annulus that is beneficial in patients with mitral or tricuspid regurgitation. Mitral commissurotomy or valvulotomy is used in patients with pure mitral stenosis. Sapien Transcatheter Heart Valve (THV) is beneficial in patients with atrial stenosis. Text Reference - p. 824

Which diagnostic study is used to diagnose mitral valve prolapse? 1 Ultrasound 2 Echocardiogram 3 Electrocardiogram 4 Cardiac catheterization

2 Echocardiogram is the diagnostic study that is used to diagnose mitral valve prolapse. All echocardiograms are done in two or three dimensions. Echocardiogram is used to monitor 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. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 822

What reason does the nurse suspect for observing hemoptysis while caring for a patient with mitral valve stenosis? 1 Atrial fibrillation 2 Pulmonary hypertension 3 Decreased cardiac output 4 Atrial enlargement pressing on the laryngeal nerve

2 Pulmonary hypertension causes hemoptysis or bleeding in the lungs and the coughing up of blood due to 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 due to atrial enlargement pressing on the laryngeal nerve in patients with mitral valve prolapse. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 821

Which type of cardiomyopathy impairs diastolic filling and stretch? 1 Dilated cardiomyopathy 2 Restrictive cardiomyopathy 3 Takotsubo cardiomyopathy 4 Hypertrophic cardiomyopathy

2 Restrictive cardiomyopathy, the least common type of cardiomyopathy, impairs diastolic filling and stretch. Dilated cardiomyopathy involves diffuse inflammation and rapid degeneration of myocardial fibers. Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome. Hypertrophic cardiomyopathy involves asymmetric hypertrophy without ventricular dilation. Text Reference - p. 829

The nurse assessing a patient with mitral valve stenosis finds symptoms primarily associated with what cardiac change? 1 Diminished cardiac output 2 Improper emptying of the left atrium 3 Increased pressure in the left ventricle 4 Inadequate filling of the right ventricle

2 The mitral valve prevents backward flow into the pulmonary vein. If the valve does not close, pulmonary circulation is compromised and the left atrium will not empty. Decreased cardiac output may be influenced by mitral valve stenosis; however, it would be more related to mitral valve regurgitation. Increased left ventricular pressure may be seen with aortic stenosis. Inadequate filling of the right ventricle may be due to atrial fibrillation or atrial flutter. Text Reference - p. 821

The patient has a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement? 1 Long-term anticoagulation therapy 2 Antibiotic prophylaxis for dental care 3 Exercise plan to increase cardiac tolerance 4 β-adrenergic blockers to control palpitations

2 The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Long-term anticoagulation therapy is not used with biologic valve replacement unless the patient has atrial fibrillation. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement. Text Reference - p. 820

A patient with a cardiovascular disorder reports severe chest pain radiating to the neck and arms. Assessment findings include scratching, grating, and high-pitched sounds at the lower sternal border of the chest. The nurse recognizes that the findings are indicative of what complications? Select all that apply. 1 Subacute nodules 2 Pericardial effusion 3 Cardiac tamponade 4 Rheumatic endocarditis 5 Chronic rheumatic carditis

2, 3 Severe chest pain radiating to the neck, arms, and shoulders indicate acute pericarditis. Pericardial friction rub is scratching, grating, and high-pitched sounds heard at the lower sternal border of the chest; this condition is associated with patients who have acute endocarditis. Pericardial effusion is one of the complications of acute pericarditis; it is associated with buildup of fluid in the pericardium. Cardiac tamponade is another complication of acute pericarditis; this develops due to an increase in pericardial effusion volume. 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. Test-Taking Tip: When answering this question, it may be useful to understand that the patient has pericardial friction rub. Text Reference - p. 815

A patient is admitted to the hospital with a diagnosis of valvular heart disease. What tests would be done to monitor the progression of the disease? Select all that apply. 1 Chest x-ray 2 Transesophageal echocardiography 3 Doppler color-flow imaging 4 Echocardiogram 5 Real-time 3-D echocardiography

2, 3 Transesophageal echocardiography and Doppler color-flow imaging help to diagnose and monitor progression of valvular disease. A chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Echocardiogram identifies heart rate and rhythm, ischemia, or ventricular hypertrophy. Real-time 3-D echocardiography helps to assess mitral valve and congenital heart diseases. Text Reference - p. 823

While auscultating a patient who underwent trauma, the nurse auscultates a quick, strong heartbeat that collapses immediately. The patient has severe dyspnea and describes the chest pain as 8 out of 10 on the pain scale. Which condition does the nurse suspect? 1 Aortic stenosis (AS) 2 Mitral valve stenosis 3 Aortic regurgitation (AR) 4 Mitral valve regurgitation

3 A quick, strong beat that collapses immediately is known as water-hammer pulse. Water-hammer pulse, dyspnea, and chest pain due to 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. Text Reference - p. 823

Which medication is prescribed to decrease preload in patients with dilated cardiomyopathy? 1 Captopril 2 Metoprolol 3 Furosemide 4 Spironolactone

3 Furosemide is a diuretic that decreases preload in patients with dilated cardiomyopathy. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that reduces afterload. Metoprolol is an adrenergic blocker that controls neurohormonal stimulation in patients with heart failure. Spironolactone is a diuretic that controls neurohormonal stimulation in patients with heart failure. Text Reference - p. 828

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

3 Histologic confirmation of myocarditis is 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. 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. Nuclear scans, echocardiography, and magnetic resonance imaging (MRI) are used to assess cardiac function. Text Reference - p. 818

A patient had mitral valve replacement surgery two months ago, and has been receiving warfarin therapy. The patient is in the clinic today to have blood work drawn, and the international normalized ratio (INR) results for today's visit are 3.1. The nurse anticipates taking which action? 1 Instruct the patient to stop taking the warfarin until INR levels are at a lower level. 2 Prepare to administer vitamin K injections because the INR level is elevated dangerously. 3 Inform the patient that there will be no changes in the warfarin dose because the INR is at a therapeutic level. 4 Instruct the patient regarding the new prescription for a higher dose of warfarin because the INR is not at a therapeutic level.

3 International normalized ratio (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. Text Reference - p. 826

The nurse has finished a teaching session with a patient who has acute rheumatic fever (RF). Which statement 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 get back my strength." 4 "I can have a heating pad placed on my painful knees if needed."

3 Promoting optimal rest (not promoting exercise) is essential to reduce 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. Teach the patient that completing the full course of antibiotics is vital to successful treatment. Another priority nursing goal is relief of joint pain. Position painful joints for comfort and in proper alignment. Heat may be applied and salicylates or NSAIDs administered for joint pain. Text Reference - p. 820

Which diagnostic study is used to assess congenital heart disease in a patient? 1 Chest x-ray 2 Doppler color-flow imaging 3 Real time 3-D echocardiography 4 Computerized tomography scan

3 Real-time 3-D echocardiography is used to assess mitral valve defects and congenital heart disease. Chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Doppler color-flow imaging and transesophageal echocardiography help diagnose and monitor valvular heart disease progression. Computerized tomography scan with contrast gold helps diagnose aortic disorders. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 823

A nurse is performing discharge teaching for a patient with dilated cardiomyopathy. Which patient statement indicates a need for further teaching? 1 "I will report shortness of breath to my health care provider." 2 "My family members will learn cardiopulmonary resuscitation." 3 "Surgery is a possible treatment option to relieve my symptoms." 4 "Alternate periods of rest with required activities of daily living."

3 Surgery is not a possible treatment option for dilated cardiomyopathy. Surgery for hypertrophic cardiomyopathy is a possible treatment option to improve the patient's symptoms. Discharge teaching includes reporting shortness of breath to the health care provider to assess possible worsening of heart failure. Also, family members and caregiver(s) are encouraged to learn cardiopulmonary resuscitation because ventricular dysrhythmias associated with dilated cardiomyopathy are a common cause of sudden cardiac death. Alternating periods of rest with activity is needed to reduce the workload of the heart. Text Reference - p. 828

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

4 Anorexia, weight loss, edema, dyspnea, and distention of neck veins indicate chronic constrictive pericarditis, which results from scarring due to 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. Text Reference - p. 817

While assessing a patient's medical history, the nurse notices loss of elasticity of the pericardial sac. Which condition does the nurse suspect in this patient? 1 Pericarditis 2 Pericardiectomy 3 Pericardiocentesis 4 Chronic constrictive pericarditis

4 Chronic constrictive pericarditis results from scarring, with fibrin deposition and loss of elasticity of the pericardial sac. Inflammation of the pericardial sac is termed pericarditis. A pericardiectomy is a procedure that involves complete resection of the pericardium through median sternotomy with the use of cardiopulmonary bypass. Pericardiocentesis is a procedure usually performed for pericardial effusion with acute cardiac tamponade, purulent pericardiasis, and suspected neoplasm. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. Text Reference - p. 817

While performing right-sided heart catheterization on a patient with dilated cardiomyopathy, the primary health care provider performs an endomyocardial biopsy. What does the nurse recall as the rationale for the biopsy? 1 To rule out cardiomegaly 2 To determine eosinophilic fasciitis 3 To confirm coronary artery disease 4 To identify infectious organisms in heart failure

4 Endomyocardial biopsy along with right-sided heart catheterization is used to identify infectious organisms in heart tissue in patients with cardiomyopathy. Chest x-ray is used to rule out cardiomegaly. A multiple gated acquisition (MUGA) nuclear scan is used to determine eosinophilic fasciitis. Cardiac catheterization is used to confirm coronary artery disease. Text Reference - p. 828

Which complication occurs due to obstruction to aortic outflow during increased activity? 1 Angina 2 Fatigue 3 Dyspnea 4 Syncope

4 Syncope occurs 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 due to increased left ventricular diastolic pressure. Text Reference - p. 829

An 80-year-old patient with uncontrolled type 1 diabetes mellitus is diagnosed with aortic stenosis. When conservative therapy is no longer effective, the nurse knows that the patient will need to consider what procedure? 1 Aortic valve replacement 2 Nitroglycerin for chest pain 3 Open commissurotomy (valvulotomy) procedure 4 Percutaneous transluminal balloon valvuloplast (PTBV) procedure

4 The PTBV procedure is best for this older adult patient with uncontrolled type 1 diabetes mellitus who is a poor surgery candidate. Aortic valve replacement probably would not be tolerated well by this patient, although it may be done if the PTBV fails and the diabetes is controlled in the future. Nitroglycerin is used cautiously for chest pain, because it can reduce blood pressure and worsen chest pain in patients with aortic stenosis. The open commissurotomy procedure is used for mitral stenosis. Text Reference - p. 823

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

4 The nurse assessing a patient with chronic aortic regurgitation would find a strong, quick beat that collapses immediately, known as water-hammer pulse. Heart sounds may include a soft or absent S1, S3, or S4 and a soft, high-pitched diastolic murmur. Low-pitched diastolic murmur and loud accentuated S1 are observed in mitral valve stenosis. An S3 gallop is found in patients with chronic mitral valve regurgitation. Text Reference - p. 821

The nurse is auscultating the heart sounds for a patient with valvular heart disease. Which of these assessment findings may indicate mitral valve regurgitation? Select all that apply. 1 A systolic murmur 2 A soft S1 heart sound 3 A prominent S4. heart sound 4 A diminished S2 heart sound 5 Audible third heart sound (S3) 6 A loud holosystolic murmur at the apex radiating to the left axilla.

5, 6 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. 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. Text Reference - p. 822