VALVULAR HEART DISEASE S1
The nurse provides discharge instructions for a 40-yr-old woman newly diagnosed with cardiomyopathy. Which statement indicates that further teaching is necessary? "I will reduce stress by learning guided imagery." "I will avoid lifting heavy objects." "My family will need to take a CPR course." "I can drink alcohol in moderation."
"I can drink alcohol in moderation." - Patients with cardiomyopathy should avoid alcohol consumption, especially in patients with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as family members learning CPR, are recommended teaching points.
A nurse is caring for a client following insertion of a permanent pacemaker. Which of the following client statements indicates a potential complication of the insertion procedure? "I can't get rid of these hiccups." "I feel dizzy when I stand." "My incision site stings." "I have a headache."
"I can't get rid of these hiccups." - Hiccups can indicate that the pacemaker is stimulating the chest wall or diaphragm, which can occur as a result of a lead wire perforation.
HDL levels should be
>60 mg/dL
A nurse is monitoring a client's ECG monitor and notes the client's rhythm has changed from normal sinus rhythm to supraventricular tachycardia. The nurse should prepare to assist with which of the following interventions? Initiate chest compressions Vagal stimulation Administration of atropine IV Defibrillation
Vagal stimulation - The nurse should identify that vagal stimulation might temporarily convert the client's heart rate to normal sinus rhythm. The nurse should have a defibrillator and resuscitation equipment at the client's bedside because vagal stimulation can cause bradydysrhythmias, ventricular dysrhythmias, or asystole.
Weak peripheral pulses are related to decreased cardiac output resulting from ______-sided heart failure.
left
The nurse should identify that an INR of 2.0 is within the desired reference range of _____ to _____ for a client who has a deep-vein thrombosis and is receiving warfarin to reduce the risk of new clot formation and a stroke.
2.0-3.0
A nurse is reviewing the health record of a client who is being evaluated for possible valvular heartdisease. The nurse should recognize which of the following data as risk factors for this condition? (Selectall that apply.) A. Surgical repair of an atrial septal defect at age 2 years B. Measles infection during childhood C. Hypertension for 5 years D. Weight gain of 10 lb in past year E. Diastolic murmur present
A. CORRECT: A history of congenital malformations is a risk factor for valvular heart disease. B. INCORRECT: Having a streptococcal infection or rheumatic fever during childhood is a risk factorfor valvular heart disease. C. CORRECT: Hypertension places a client at risk for valvular heart disease. D. INCORRECT: A sudden weight gain of 10 lb could indicate fluid collection related to left-sidedvalvular heart disease. E. CORRECT: A murmur indicates turbulent blood flow, which is often due to valvular heart disease.
A nurse is completing the admission physical assessment of client who has a history of mitral valve insufficiency. Which of the following is an expected finding? A. Hoarseness B. Petechiae C. Crackles in lung bases D. Splenomegaly
A. INCORRECT: Hoarseness is an expected finding in a client who has mitral valve stenosis. B. INCORRECT: Petechiae is an expected finding in a client who has infective endocarditis. C. CORRECT: Crackles in the lung bases is an expected finding in a client who has pulmonarycongestion due to mitral valve insufficiency. D. INCORRECT: Hepatomegaly, not splenomegaly, is an expected finding in a client who has left-sidedheart valve damage.
A nurse is completing discharge teaching with a client who had a surgical placement of a mechanical heart valve. Which of the following statements by the client indicates understanding of the teaching? A. "I will be glad to get back to my exercise routine right away." B. "I will have my prothrombin time checked on a regular basis." C. "I will talk to my dentist about no longer needing antibiotics before dental exams." D. "I will continue to limit my intake of foods containing potassium."
A. INCORRECT: The client will be on activity limitation for 6 weeks following surgery for a heartvalve replacement. B. CORRECT: Anticoagulant therapy with warfarin (Coumadin) is necessary for the client followingplacement of a mechanical heart valve. The client's prothrombin time will be checked on aregular basis. C. INCORRECT: Antibiotic therapy is recommended prior to dental work following placement of aheart valve. D. INCORRECT: Dietary recommendations include limiting foods containing sodium.
The patient had 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? Long-term anticoagulation therapy Take β-adrenergic blockers to control palpitations. Exercise plan to increase cardiac tolerance Antibiotic prophylaxis for dental care
Antibiotic prophylaxis for dental care - 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.
A nurse is caring for a client who is 8 hr postoperative following a coronary artery bypass graft (CABG). Which of the following client findings should the nurse report? Mediastinal drainage 100 mL/hr Blood pressure 160/80 mm Hg Temperature 37.1° C (98.8° F) Potassium 4.0 mEq/L
Blood pressure 160/80 mm Hg - The nurse should report an elevated blood pressure following a CABG because increased vascular pressure can cause bleeding at the incision sites.
The patient had myocarditis and is now experiencing fatigue, weakness, palpitations, and dyspnea at rest. The nurse assesses pulmonary crackles, edema, and weak peripheral pulses. Sinoatrial tachycardia is evident on the cardiac monitor. The Doppler echocardiography shows dilated cardiomyopathy. What collaborative and nursing care of this patient should be done to improve cardiac output and the quality of life (select all that apply.)? Control heart failure by enhancing myocardial contractility. Relieve left ventricular outflow obstruction. Improve ventricular filling by reducing ventricular contractility. Improve diastolic filling and the underlying disease process. Decrease preload and afterload.
Control heart failure by enhancing myocardial contractility Decrease preload and afterload. - The patient is experiencing dilated cardiomyopathy. To improve cardiac output and quality of life, drug, nutrition, and cardiac rehabilitation will be focused on controlling heart failure by decreasing preload and afterload and improving cardiac output, which will improve the quality of life. Relief of left ventricular outflow obstruction and improving ventricular filling by reducing ventricular contractility is done for hypertrophic cardiomyopathy. There are no specific treatments for restrictive cardiomyopathy, but interventions are aimed at improving diastolic filling and the underlying disease process.
A 55-yr-old female patient develops acute pericarditis after a myocardial infarction. Which assessment finding indicates a possible complication? Presence of a pericardial friction rub Increased chest pain with deep breathing Decreased blood pressure with tachycardia Distant and muffled apical heart sounds
Decreased blood pressure with tachycardia - Cardiac tamponade is a serious complication of acute pericarditis. Signs and symptoms include narrowed pulse pressure, tachypnea, tachycardia, a decreased cardiac output, and decreased blood pressure. The other symptoms are consistent with acute pericarditis.
A nurse is assessing a client who has dilated cardiomyopathy. Which of the following findings should the nurse expect? Dyspnea on exertion Tracheal deviation Pericardial rub Weight loss
Dyspnea on exertion - The nurse should identify dyspnea on exertion as an expected manifestation of dilated cardiomyopathy. Dyspnea on exertion is due to ventricular compromise and reduced cardiac output.
A nurse is caring for a client who is being treated for heart failure and has a prescription for furosemide. The nurse should plan to monitor for which of the following as an adverse effect of this medication? Shortness of breath Lightheadedness Dry cough Metallic taste
Lightheadedness - Furosemide can cause a substantial drop in blood pressure, resulting in lightheadedness or dizziness.
A nurse is caring for a client who has endocarditis. Which of the following findings should the nurse recognize as a potential complication? Ventricular depolarization Guillain-Barré syndrome Myelodysplastic syndrome Valvular disease
Valvular disease - Valvular disease or damage often occurs as a result of inflammation or infection of the endocardium.
________________ is the isoenzyme specific to the myocardium. Elevated ___________ indicates myocardial muscle injury.
creatine kinase-MB
LDL levels should be
less than 100
The apex of the heart is considered the __________.
point of maximal impulse
Prior history of _______________ makes the patient more susceptible to a second attack after a streptococcal infection. The best prevention is antibiotic prophylaxis for a minimum of 5 years.
rheumatic fever
Dependent edema is a finding related to systemic congestion resulting from _________-sided heart failure.
right
Increased abdominal girth is a finding related to systemic congestion resulting from _______-sided heart failure.
right
Jugular venous neck distention is a finding related to systemic congestion resulting from _______-sided heart failure.
right
Urine output less than 30 mL/hr is a manifestation of ________. Urine output is decreased due to a compensatory decreased blood flow to the kidneys, hypovolemia, or graft thrombosis or rupture.
shock
A 72-yr-old man with a history of aortic stenosis is admitted to the emergency department. He reports severe left-sided chest pressure radiating to the jaw. Which medication, if ordered by the health care provider, should the nurse question? Morphine sulfate Nitroglycerin Aspirin Oxygen
Nitroglycerin - Aspirin, oxygen, nitroglycerin, and morphine sulfate are all commonly used to treat acute chest pain suspected to be caused by myocardial ischemia. However, nitroglycerin should be used cautiously or avoided in patients with aortic stenosis as a significant reduction in blood pressure may occur. Chest pain can worsen because of a drop in blood pressure.
The patient with pericarditis is complaining of chest pain. After assessment, which intervention should the nurse expect to implement to provide pain relief? NSAIDs Corticosteroids Morphine sulfate Protein pump inhibitor
Nonsteroidal antiinflammatory drugs - Nonsteroidal antiinflammatory drugs (NSAIDs) control pain and inflammation. Corticosteroids are reserved for patients already taking corticosteroids for autoimmune conditions and those who do not respond to NSAIDs. Morphine is not necessary. Proton pump inhibitors are used to decrease stomach acid to avoid the risk of gastrointestinal bleeding from the NSAIDs.
Which patients are most at risk for developing infective endocarditis (select all that apply) Older woman with disseminated coccidioidomycosis (valley fever) Adolescent with exertional palpitations and clubbing of fingers Man with complaints of chest pain and shortness of breath Patient with end-stage renal disease on peritoneal dialysis Female with peripheral intravenous site for medication administration Homeless man with history of intravenous drug abuse
Older woman with disseminated coccidioidomycosis (valley fever) Patient with end-stage renal disease on peritoneal dialysis Homeless man with history of intravenous drug abuse - Patients with systemic coccidioidomycosis (valley fever) are at risk of fungal endocarditis. Peritoneal dialysis requires strict sterile technique to prevent peritonitis. Intravenous drug abuse, especially if reusing or sharing needles are at risk of developing sepsis. In addition, risk for infection is increased in the elderly, homeless, and those with chronic illness. Chest pain, shortness of breath, and palpitations may be signs of endocarditis. Clubbing of the fingers indicates long-term hypoxia. Central venous catheters, not peripheral, increase risk to for infective endocarditis.
When caring for a patient with infective endocarditis, the nurse will assess the patient for which vascular manifestations (select all that apply.)? Osler's nodes Subcutaneous nodules Janeway's lesions Splinter hemorrhages Erythema marginatum lesions
Osler's nodes Janeway's lesions Splinter hemorrhages - Osler's nodes, Janeway's lesions, and splinter hemorrhages are all vascular manifestations of infective endocarditis. Subcutaneous nodules and erythema marginatum lesions occur with rheumatic fever.
An 80-yr-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 do or have what done? Percutaneous transluminal balloon valvuloplasty (PTBV) procedure Take nitroglycerin for chest pain. Aortic valve replacement Open commissurotomy (valvulotomy) procedure
Percutaneous transluminal balloon valvuloplasty (PTBV) procedure - The PTBV procedure is best for this older adult patient who is a poor surgery candidate related to the uncontrolled type 1 diabetes mellitus. Aortic valve replacement would probably 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. Open commissurotomy procedure is used for mitral stenosis.
The nurse is teaching a community group about preventing rheumatic fever. What information should the nurse include? Requesting antibiotics before dental surgery for individuals with rheumatoid arthritis Avoidance of respiratory infections in children born with heart defects Prompt recognition and treatment of streptococcal pharyngitis Completion of 4 to 6 weeks of antibiotic therapy for infective endocarditis
Prompt recognition and treatment of streptococcal pharyngitis - The nurse should emphasize the need for prompt and adequate treatment of streptococcal pharyngitis infection, which can lead to the complication of rheumatic fever.
While admitting a patient with pericarditis, the nurse will assess for what manifestations of this disorder? Prolonged PR intervals Clubbing of the fingers Pulsus paradoxus Widened pulse pressure
Pulsus paradoxus - Pericarditis can lead to cardiac tamponade, an emergency situation. Pulsus paradoxus greater than 10 mm Hg is a sign of cardiac tamponade that should be assessed at least every 4 hours in a patient with pericarditis. Prolonged PR intervals occur with first-degree AV block. Widened pulse pressure occurs with valvular heart disease and increased intracranial pressure. Clubbing of fingers may occur in subacute forms of infective endocarditis and valvular heart disease.
The nurse is caring for a patient who received a mechanical aortic valve replacement two years ago. Current lab values include an international normalized ratio (INR) of 1.5, platelet count of 150,000/µL, and hemoglobin of 8.6g/dL. Which nursing action is most appropriate? Report laboratory values to the health care provider. Monitor for signs of bleeding. Assess the vital signs. Start intravenous fluids.
Report laboratory values to the health care provider. - Patients with mechanical valve replacement are placed on anticoagulants and should be in a therapeutic INR range of 2.5 to 3.5. Administration of Coumadin (Warfarin) prolongs clotting time and prevents clot formation on the valve. The low INR would require a call to the healthcare provider for an order increase the medication dose. Vital signs would be unchanged related to the low INR. Intravenous fluids are not indicated. The patient is at risk of forming clots, not bleeding.
A nurse is caring for a client who was admitted for treatment of left-sided heart failure with intravenous loop diuretics and digitalis therapy. The client is experiencing weakness and an irregular heart rate. Which of the following actions should the nurse take first? Obtain the client's current weight. Review serum electrolyte values. Determine the time of the last digoxin dose. Check the client's urine output
Review serum electrolyte values. - Weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte imbalance, an adverse effect of loop diuretics. The first action the nurse should take is to review the client's electrolyte values, particularly the potassium level, because the client is at risk for dysrhythmias from hypokalemia.
A nurse is caring for a client who is receiving heparin therapy and develops hematuria. Which of the following actions should the nurse take if the client's aPTT is 96 seconds? Increase the heparin infusion flow rate by 2 mL/hr. Continue to monitor the heparin infusion as prescribed Request a prothrombin time (PT). Stop the heparin infusion.
Stop the heparin infusion. - The nurse should identify that the client's aPTT is above the critical value and the client is displaying manifestations of bleeding. Therefore, the nurse should discontinue the heparin infusion immediately and notify the provider to reduce the risk of client injury.