NURS 24 EXAM 3 CHAPTER 28

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 The most significant risk factor for mitral stenosis is rheumatic fever, which gradually causes the mitral valve leaflets to thicken and can result in leaflet fusion. Risk factors for aortic regurgitation are infective endocarditis, Marfan syndrome, and a dissecting aortic aneurysm.

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 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." The patient should take antibiotics for dental procedures that involve manipulation of gingival tissue or the periapical area of the teeth or perforation of the oral mucosa. Exceptions include routine anesthetic injections through noninfected tissue, placement of orthodontic brackets, loss of deciduous teeth, bleeding from trauma to the lips or oral mucosa, dental x-rays, adjustment of orthodontic appliances, and placement of removable prosthodontic or orthodontic appliances.

The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask?

"Have you been to the dentist recently?"

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 determines that a client recently diagnosed with subacute bacterial endocarditis understands discharge teaching upon which client statement?

"I have to call my doctor so I can get antibiotics before seeing the dentist."

A client 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."

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 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."

A patient has received a heterograft for a tricuspid valve replacement. What statement made by the patient demonstrates understanding of the valve replacement?

"I will not take long-term anticoagulation because I want to get pregnant."

A nurse working at a pediatric clinic is teaching a group of parents. A parent asks the nurse if it is okay to let the young child recover from a sore throat naturally, rather than bringing the child to the clinic for diagnosis and treatment. What is the nurse's best response?

"It may be streptococcal sore throat. Rheumatic heart disease can be prevented with early treatment."

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 pericardial friction rub occurs when the pericardial surfaces lose their lubricating fluid due to inflammation. The rub is audible on auscultation and is synchronous with the heartbeat. The layers of the heart never become loose from each other. The great vessels are not in contact with the inside of the pericardium, where the inflammation is located. The lungs have nothing to do with a pericardial friction rub.

A client who had a prosthetic valve replacement was taking warfarin to reduce the risk of postoperative thrombosis. The client visited the nurse at a clinic once a week. What INR level would alert the nurse to notify the health care provider?

3.8 Warfarin patients usually have individualized target international normalized ratios (INRs) between 2 to 3.5 to maintain adequate anticoagulation. Levels below 2 to 2.5 can result in insufficient anticoagulation and levels greater than 3.5 can result in dangerous and prolonged anticoagulation.

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 plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide

Alternate active periods with rest periods

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 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 would the nurse stress as a lifelong necessity for a client managing infective endocarditis?

Antibiotic therapy

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.

When a patient is taking an immunosuppressant following heart transplantation, the nurse would determine which of the following as the MOST important intervention?

Assess vital signs every 4 hours.

A nurse plans to have an education session with a client who has cardiomyopathy and the client's spouse about ways to decrease the sense of powerlessness. What action by the nurse will provide this information?

Assist the client in identifying life areas over which the client still has control.

Which describes a valve used in replacement surgery that is made from the client's own heart valve?

Autograft

Which behavior indicates to the nurse that the cardiac client's level of anxiety has increased?

Avoids answering questions regarding status

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 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)?

Bleeding and infection

The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?

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

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

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

Check regularly for dependent edema

A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition?

Chronic alcohol use

The nurse determines that a patient has a characteristic symptom of pericarditis. What symptom does the nurse recognize as significant for this diagnosis?

Constant chest pain

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 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

A nurse is conducting a heath history on a client with a primary diagnosis of mitral stenosis. Which disorder reported by the client is the most common cause of mitral stenosis?

Rheumatic endocarditis

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 Acute rheumatic fever, which occurs most often in school-age children, may develop after an episode of group A beta-hemolytic streptococcal pharyngitis (Chart 28-2). Clients with rheumatic fever may develop rheumatic heart disease as evidenced by a new heart murmur, cardiomegaly, pericarditis, and heart failure.

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

Heterograft Heterograft, also called bioprosthesis, refers to replacement of tissue from animal tissue, usually pigs but also cows or horses. An autograft is a heart valve replacement made from the client's own heart valve. Allograft refers to replacement using human tissue and is a synonym for homograft.

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 scaring." The nurse knows these manifestations are indicative of which type of cardiomyopathy?

Hypertronic

In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?

Hypertrophic

A client who suffered blunt chest trauma in a motor vehicle accident reports chest pain during deep inspiration. On auscultation, the nurse detects a pericardial friction rub — a classic sign of acute pericarditis. To relieve this chest pain, which position should the nurse encourage the client to assume?

Leaning forward while sitting

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

Maintain the client on bed rest. The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing. Bed rest also helps decrease myocardial damage and the complications of myocarditis. The nurse should administer supplemental oxygen to relieve tachycardia that may develop from hypoxemia. If the client has a fever, the nurse should administer a prescribed antipyretic along with independent nursing measures such as minimizing layers of bed linen, promoting air circulation and evaporation of perspiration, and offering oral fluids. The nurse should elevate the client's head to promote maximal breathing potential.

A nurse is caring for a client diagnosed with a mitral valve prolapse who is asymptomatic. What will nurse expect to be ordered for this client?

No treatment No treatment is required for asymptomatic clients. If symptoms develop, management is aimed at symptomatic control. Beta blockers such as metoprolol and calcium channel blockers such as diltiazem may be used to relieve chest pain and palpitations. Heparin sodium will not be needed for anticoagulation.

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 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

Which mitral valve condition generally produces no symptoms?

Prolapse

A client with infective endocarditis is assessed by the nurse for the presence of Janeway lesions. On inspection, the nurse recognizes these lesions by identifying which characteristic sign?

Red or purple macules found on the palms of the hands

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 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?

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.

Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs?

Shortness of breath If pulmonary congestion occurs, the client with mitral regurgitation develops shortness of breath. A loud, blowing murmur often is heard throughout ventricular systole at the apex of the heart. Hypertension may develop when reduced cardiac output triggers the renin-angiotensin-aldosterone cycle. Tachycardia is a compensatory mechanism when stroke volume decreases.

A client with infective endocarditis of a prosthetic mitral valve returns to the emergency department with a second episode of left-sided weakness and visual changes. What collaborative management will the nurse expect for this client?

Surgical valve replacement

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?

The nurse asks the client to hold the breath during auscultation.

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

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

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

Throat culture Rheumatic fever is a preventable disease. Diagnosing and effectively treating streptococcal pharyngitis can prevent rheumatic fever and, therefore, rheumatic heart disease. If signs and symptoms of streptococcal pharyngitis are present, a throat culture is necessary to make an accurate diagnosis. An electrophysiology study will confirm abnormal heart rhythms. An electrocardiogram will monitor heart rhythm disturbances, not diagnose the endocarditis. A complete blood count will not confirm the endocarditis diagnosis, but will add information for treatment.

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

Thrombophlebitis Virchow's triad refers to venous stasis (slowed circulation), altered blood coagulation, and trauma to the vein, and predisposes clients to thrombosis and thrombophlebitis. The diagnosis of Virchow's triad indicates the client already presents with venous stasis. The diagnosis of Virchow's triad indicates the client already presents with altered blood coagulation. Postphlebitic syndrome is a vascular complication that may occur for up to 5 years after the initial episode with thrombophlebitis. This client does not yet have thrombophlebitis, so is not at risk for postphlebitic syndrome.

The nurse caring for a client with cardiomyopathy plans to have an education session with the client and the client's spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload?

When resting, sit up with the legs down to pool blood in the legs. Many clients find that sitting up with their legs down is more comfortable than lying in bed. This position is helpful in pooling venous blood in the periphery and reducing preload. Laying flat in bed impairs respiratory efforts due to abdominal contents pushing against the lungs. This client must be on a low sodium cardiac diet to avoid fluid retention. It is impossible to avoid all physical and emotional stress.

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 The classic signs and symptoms of pericarditis include fever, positional chest discomfort, nonspecific ST-segment elevation, elevated ESR, and pericardial friction rub. Low urine output secondary to left ventricular dysfunction lethargy, anorexia, heart failure and pitting edema, result from acute renal failure.

A nurse is teaching a client about mitral stenosis and the effect on blood flow in the heart. What is teaching point of the disruption to the normal flow of blood through the heart from the mitral stenosis?

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

The nurse is caring for a client diagnosed with aortic stenosis prescribed digoxin. What clinical manifestation will be the rationale for the medication?

left ventricular dysfunction

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 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. Other signs may include a mild fever, increased WBC count, anemia, and an elevated ESR or C-reactive protein level. Dyspnea and other signs and symptoms of heart failure may occur.

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?

the high risk for complications if she becomes pregnant while taking warfarin

The nurse is providing discharge teaching to a client with recurrent endocarditis. What prevention strategies will be included with the teaching? Select all that apply.

use a nail clipper for fingernail care report recurrent fever lasting longer than 7 days to the health care provider notify dentist of the history of endocarditis with any planned dental procedures