PrepU CH. 19
The nurse determines that teaching has been effective when a client diagnosed with chronic stable angina states:
"Angina may result from exertional activity or emotional stress and be relieved within minutes by rest or by nitroglycerin."
Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?
Emotional stress
The nurse is assessing a client for early signs of constrictive pericarditis. The most likely manifestation would be:
Ascites
What is the most important factor in myocardial oxygen demand?
Heart rate
A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess.
Mucous membranes
Exudate in the pericardial cavity is a characteristic of which cardiac condition?
Pericardial effusion
A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:
"Aspirin will help prevent blood clotting."
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?
"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."
A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client?
"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
The nurse is teaching a patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which of the following statements by the patient shows that the patient understands this condition?
"I should report episodes of dizziness or fainting."
A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis?
"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising."
On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds:
"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."
A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be:
"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."
During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?
20 to 40 minutes
Which client should most benefit from treatment with antithrombin agents?
57-year-old client who has recently been diagnosed with unstable angina
Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?
A hypercyanotic attack brought on by periods of stress
The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD?
Atherosclerosis
ST-elevated myocardial infarction is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?
Action decreases metabolic demands of the heart.
What is the most common identifiable cause of secondary cardiomyopathy?
Alcohol abuse
Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?
An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?
At the apex of the heart
A client is admitted to the intensive care unit suspected of having infective endocarditis. Which of the following tests is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client?
Blood culture
A patient with mitral valve regurgitation and left heart failure reports shortness of breath and fatigue with activities of daily living. Which of the following instructions by the nurse will be ineffective in reducing these symptoms?
Elevating legs for 20 minutes daily
A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?
Cardiac tamponade
A nurse educator explains a type of cardiac condition as "a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilation and often lead to cardiovascular death or progressive heart failure." Which condition fits this definition?
Cardiomyopathy
The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?
Constrictive pericarditis
When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?
Conversion from aerobic to anaerobic metabolism
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics?
Echocardiogram, blood cultures, temperature
A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?
Decreased level of consciousness
A client with heart failure has just had an automatic defibrillator installed in her chest wall. When the nurse is performing follow-up assessments in the coming months, which finding is most likely the result of a complication?
Fever and diaphoresis
A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which of the following reasons? Select all that apply.
For its vasodilatation effect To relieve coronary pain
The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?
Genetic
Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?
Have the client sit up and lean forward.
A community health nurse is conducting a seminar at a local church group on health and wellness. Which of the following does she tell the group is the leading cause of death in the United States?
Heart disease
The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them is the most important factor in myocardial oxygen demand?
Heart rate
A 31-year-old African-American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?
Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:
History of cigarette smoking and elevated blood pressure
A 17-year-old athlete died suddenly during a track meet and it was subsequently determined that he had heart disease. Which condition was the most likely cause of his heart failure?
Hypertrophic cardiomyopathy
A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?
Hypertrophic cardiomyopathy
Cardiomyopathies are classified as either primary or secondary. The primary cardiomyopathies are further classified as genetic, mixed, or acquired. Which of the following are genetically based? (Select all that apply.)
Hypertrophic cardiomyopathy Left ventricular noncompaction
The nursing student has learned in his class that coronary artery disease (CAD) is heart disease caused by which of the following?
Impaired coronary blood flow
Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)?
Increased aortic pressure
A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process?
Infective endocarditis
A client who has just been diagnosed with mitral valve stenosis tells the nurse that he has heard of the disease but he does not know anything about it. He asks the nurse what it means. What would be the nurse's best response?
It is a defect of the mitral valve which causes obstruction of blood flow.
While studying the heart the nursing instructor teaches about pericarditis. Which of the following does she tell the student best defines this disease?
It is an inflammatory process.
The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?
Kussmaul sign
A nurse assesses a patient with normal biomarkers who reports angina. Which of the following additional manifestations are late signs of aortic stenosis? Select all that apply.
One with an ejection fraction of 25% and atrial fibrillation
The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states that blood is shunted from the:
Left side of the heart to the right side of the heart
A client is admitted for observation due to abnormal heart sounds, pulmonary congestion, nocturnal paroxysmal dyspnea, and orthopnea. Upon auscultation a low-pitched, rumbling murmur, best heard at the apex of the heart, is also heard. Which condition does the client likely have?
Mitral valve stenosis
Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever and rheumatic heart disease. This occurs through what phenomenon?
Molecular mimicry
The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?
Morphine
Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply.
Muffled heart tones. Narrowed pulse pressure. Low BP—84/60
When the electrocardiogram (ECG) of a patient in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta adrenergic blocker. Which of the following factors in the patient's history will cause the nurse to withhold medication? Select all that apply.
Myocardial infarction caused by cocaine use • Third-degree heart block • Shock
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.
Myocardial infarction prevention
A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:
Onset of STEMI
Five hours after presenting to the emergency department with substernal chest pain, a patient's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. Which of the following is the nurse's interpretation of these results?
Patient is currently experiencing an MI.
A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?
Pericardial effusion
The nurse working on the cardiac floor identifies which of the following to be the initial treatment of choice for small pericardial effusions and mild cardiac tamponade?
Pericardiocentesis
A client is seen in the emergency room with complaints of sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?
Pericarditis
A nurse is caring for a patient with a new diagnosis of rheumatic fever. Which of the following is the highest priority goal of treatment during the acute phase?
Prevent cardiac complications
A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:
Prompt diagnosis and treatment of streptococcal infections
A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?
Prompt diagnosis of streptococcal infections with a throat culture
The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?
Propranolol, a β-Adrenergic blocker.
The health care provider is preparing to assess a client who has been diagnosed with hypertrophic cardiomyopathy. The provider anticipates the assessment data will include:
Reduced chamber size
A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client?
Rheumatic fever
A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?
See the doctor for evaluation immediately.
The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. What test is not used in the diagnosis of angina?
Serum biochemical markers
A nurse preparing education on managing the risk factors for coronary artery disease (CAD) will stress which information? Select all that apply.
Smoking cessation techniques Identification of high cholesterol foods Importance of exercise on managing hypertension Signs and symptoms of type 2 diabetes mellitus
An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication?
Systemic emboli, especially to brain.
The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:
T-wave changes
Which of the following patients is at the greatest risk of developing rheumatic heart disease?
Teenager with untreated strep throat
The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?
The disabling effects that result from involvement of heart valves
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?
The most common cause is a staph infection.
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:
The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.
In infective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood. What are the possible systemic effects of these vegetative lesions?
They can fragment and cause cerebral emboli.
Which serum biomarker is highly specific for myocardial tissue?
Troponin
A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?
Troponin assays
A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?
Troponin level
A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this patient about diagnosing a valvular defect?
Valvular defects usually are detected through cardiac auscultation.
The nursing instructor when teaching about disorders of cardiac function informs the students that all people presenting with ST-segment elevation myocardial infarction (STEMI) should be assessed for reperfusion therapy as quickly as possible. Reperfusion therapy includes which of the following? Select all that apply.
a) Percutaneous coronary intervention (PCI) c) Coronary artery bypass grafting (CABG) d) Fibrinolytic therapy
A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His cervical lymph nodes are swollen, and he moves stiffly because his joints hurt. Throat cultures show infection with group A streptococci. This child is at high risk for:
mitral valve stenosis.
Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?
Β-Adrenergic-blocking drugs
When a client suffers from a pericardial effusion which of the following are considered to be factors that will influence what effects it will have on cardiac function? Select all that apply.
• Amount of fluid • Rapidity with which it accumulates • The elasticity of the pericardium