Nursing Management: Patients With Structural, Inflammatory, and Infectious Cardiac Disorders
What is the most common cause of mitral stenosis?
Rheumatic endocarditis
A patient with a history of primary hypertension has undergone echocardiography after being referred to a specialist for blood pressure management. The patient's echocardiogram revealed ventricular hypertrophy and a decreased ejection fraction. The nurse who is providing care for this patient should recognize that these findings are characteristic of what valvular disorder?
Aortic stenosis (AS)
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.
During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following?
Decreased cardiac output
A client with aortic regurgitation is admitted to the hospital. Which assessment findings would indicate left ventricular failure?
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND)
The nurse is admitting a patient to the cardiac care unit with complaints of dyspnea on exertion and fatigue. The patient's electrocardiogram (ECG) shows dysrhythmias associated with left ventricular hypertrophy. What diagnostic tool would be the most helpful in diagnosing cardiomyopathy?
Echocardiogram
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?
Echocardiography
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 nurse is caring for a client with aortic stenosis whose compensatory mechanisms of the heart have begun to fail. The nurse will monitor the client carefully for which initial symptoms?
Exertional dyspnea, orthopnea, pulmonary edema
A client is diagnosed with rheumatic endocarditis. What bacterium is the nurse aware causes this inflammatory response?
Group A, beta-hemolytic streptococcus
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 patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea as a result of pulmonary venous hypertension. What valvular disorder would cause pulmonary venous hypertension?
Mitral stenosis
Which valve lies between the right ventricle and the pulmonary artery?
Pulmonic valve
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?
Shortness of breath
Which symptom occurs in the client diagnosed with mitral regurgitation when pulmonary congestion occurs?
Shortness of breath
The nurse is obtaining a history from a client diagnosed with hypertrophic cardiomyopathy. What information obtained from the client is indicative of hypertrophic cardiomyopathy?
a parent has the same disorder
Statistics show an increase in the prevalence of infective endocarditis among older adults. Which factor places older adults at risk for developing infective endocarditis?
increased use of prosthetic valve replacements
A client reports headaches and "just not feeling right," which the client blames on ongoing sleep disturbances. Inspection reveals Janeway lesions on the bottoms of the client's feet. These symptoms may indicate:
infective endocarditis.
One of the most common causes of mitral valve regurgitation in people living in developed countries is
ischemia of the left ventricle.
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.
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 needs to have a cardiac valve replacement. The nurse offers client education about the procedures involved—including the benefits and risks. Which client statement indicates the need for more education?
"I'm anxious because I'll need to have cardiopulmonary bypass."
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."
Following several months of increasing dyspnea on exertion, a 71-year-old woman has been diagnosed with mitral stenosis (MS). The woman is relieved to receive a diagnosis that explains her symptoms but does not completely understand the root of her problem. How can the nurse best explain the woman's health problem?
"The valve in the left side of your heart has become stiff and narrowed, so your heart can't fill with all the blood that your body needs."
A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease?
echocardiogram
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 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
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
When teaching a client with rheumatic carditis and a history of recurrent rheumatic fever, which statement by the client indicates that teaching has been successful?
"I may have to take prophylactic antibiotics for up to 10 years."
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."
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
Which would the nurse stress as a periodic lifelong necessity for a client managing infective endocarditis?
Antibiotic therapy
Which describes a valve used in replacement surgery that is made from the client's own heart valve?
Autograft
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
A patient has been admitted with endocarditis. The patient asks the nurse how the health care provider knows what medicines to order to kill the bacteria. The nurse knows that to find the most appropriate antibiotic treatment, what test would be the most helpful?
Blood cultures
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.
The nurse is caring for a patient diagnosed with pericarditis. What serious complication should this patient be monitored for?
Cardiac tamponade
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 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
A client with mitral stenosis is admitted to the hospital. What assessment findings would indicate right ventricular failure?
Distended jugular veins, pedal edema, nausea
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?
Hypertrophic
In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight, especially along the septum?
Hypertrophic
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."
Recent exacerbation of a patient's mitral valve regurgitation prompted her cardiologist to perform a mitral valve replacement in which the patient received a mechanical valve. In the weeks following the patient's surgery, which of the following blood tests will be most relevant to the patient's potential complications?
International normalized ratio (INR)
A patient with a history of valvular disease has just arrived in the PACU after a percutaneous balloon valvuloplasty. Which intervention should the recovery nurse implement?
Keep the patient's affected leg straight.
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
Incomplete closure of the mitral valve results in backflow of blood from the:
Left ventricle to left atrium
The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation, the educator emphasizes that aortic regurgitation causes what?
Left ventricular hypertrophy
Which nursing intervention should a nurse perform to reduce cardiac workload in a client diagnosed with myocarditis?
Maintain the client on bed rest
Which nursing intervention would reduce cardiac workload in a client with myocarditis?
Maintain the client on bed rest.
Which intervention should the nurse include in the plan of care for a client with valvular heart disease who is experiencing pulmonary congestion?
Rest and sleep in a chair or sit in bed with head elevated
Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch.
Restrictive cardiomyopathy (RCM)
A nurse is conducting a health 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
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
A patient has a diagnosis of dilated cardiomyopathy (DCM) and was admitted 24 hours ago for treatment. Which of the following principles should the nurse integrate into the planning of this patient's care?
The patient will benefit from bed rest in the short term, and activity should be introduced slowly.
A nurse is preparing a teaching plan regarding biological tissue valve replacement. What is a disadvantage of this type of valve replacement?
The valve has to be replaced frequently.
The nurse is teaching a patient diagnosed with aortic stenosis the importance of attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?
To rest and relax before taking nitroglycerin
The nurse understands that which of the following medications will be administered to the client for 6 to 12 weeks following prosthetic porcine valve surgery?
Warfarin
The nurse is discharging a client recently diagnosed with aortic stenosis (AS). What are symptoms associated with aortic stenosis?
angina, syncope, and dyspnea
A nurse is assigned to the medical intensive care unit. The nurse auscultates a water-hammer pulse. What will the sound resemble?
quick, sharp strokes that suddenly collapse
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
A client's chart indicates Virchow's triad. This client is at risk for which complication?
thrombophlebitis
