Question 1

The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE).Which question by the nurse is most appropriate?

Accepted Answer

Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis (IE).Myocardial infarction (MI),immunizations,and a family history of endocarditis are not risk factors for IE.

Question 2

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale)chest pain with deep breathing.Which ordered PRN medication will be the most appropriate for the nurse to give?

Accepted Answer

The pain associated with pericarditis is caused by inflammation,so nonsteroidal antiinflammatory drugs (NSAIDs)(e.g.,ibuprofen)are most effective.Opioid analgesics are usually not used for the pain associated with pericarditis.

Question 3

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis.Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?

Accepted Answer

Long-term anticoagulation therapy is needed after mechanical valve replacement,and this would restrict decisions about career and childbearing in this patient.Mechanical valves are durable and last longer than biologic valves.All valve repair procedures are palliative,not curative,and require lifelong health care.Biologic valves do not activate the immune system,and immunosuppressive therapy is not needed.

Question 4

During discharge teaching with a 68-year-old patient who had a mitral valve replacement with a mechanical valve,the nurse instructs the patient on the

Accepted Answer

Anticoagulation with warfarin (Coumadin)is needed for a patient with mechanical valves to prevent clotting on the valve.This will require frequent international normalized ratio (INR)testing.Daily aspirin use will not be effective in reducing the risk for clots on the valve.Monitoring of the radial pulse is not necessary after valve replacement.Patients should resume activities of daily living as tolerated.

Question 5

When caring for a patient with infective endocarditis of the tricuspid valve,the nurse should monitor the patient for the development of

Accepted Answer

Embolization from the tricuspid valve would cause symptoms of pulmonary embolus.Flank pain,changes in mental status,and splenomegaly would be associated with embolization from the left-sided valves.

Question 6

While caring for a patient with aortic stenosis,the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow.A priority nursing intervention for this patient would be to

Accepted Answer

Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain.The patient with aortic stenosis requires higher preload to maintain cardiac output,so nitroglycerin and measures to decrease venous return are contraindicated.Anticoagulation is not recommended unless the patient has atrial fibrillation.

Question 7

The nurse suspects cardiac tamponade in a patient who has acute pericarditis.To assess for the presence of pulsus paradoxus,the nurse should

Accepted Answer

Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle.The other methods described would not be useful in determining the presence of pulsus paradoxus.

Question 8

During the assessment of a 25-year-old patient with infective endocarditis (IE),the nurse would expect to find

Accepted Answer

New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure.Substernal chest discomfort,rashes,and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.

Question 9

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis.The priority intervention by the nurse for this problem is to

Accepted Answer

Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis.Forcing fluids will not decrease the inflammation or pain.Taking deep breaths will tend to increase pericardial pain.Opioids are not very effective at controlling pain caused by acute inflammatory conditions and are usually ordered PRN.The patient would receive scheduled doses of a nonsteroidal antiinflammatory drug (NSAID).

Question 10

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE)based on which assessment finding(s)?

Accepted Answer

Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output.Petechiae,fever,chills,and diaphoresis are symptoms of IE,but are not caused by decreased cardiac output.An increase in pulse rate of 15 beats/minute is normal with exercise.

Question 11

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy.Which information will the nurse plan to teach the patient about managing this disorder?

Accepted Answer

The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms.Because dilated cardiomyopathy does not respond well to therapy,even patients with good compliance with therapy may have recurrent episodes of heart failure.Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy).The patient with terminal or end-stage cardiomyopathy may consider heart transplantation.

Question 12

When caring for a patient with mitral valve stenosis,it is most important that the nurse assess for

Accepted Answer

The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs,resulting in hypoxemia and dyspnea.The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia.

Question 13

When developing a community health program to decrease the incidence of rheumatic fever,which action would be most important for the community health nurse to include?

Accepted Answer

The incidence of rheumatic fever is decreased by treatment of streptococcal infections with antibiotics.Family history is not a risk factor for rheumatic fever.There is no immunization that is effective in decreasing the incidence of rheumatic fever.Teaching about monitoring temperature will not decrease the incidence of rheumatic fever.

Question 14

While caring for a 23-year-old patient with mitral valve prolapse (MVP)without valvular regurgitation,the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to

Accepted Answer

Use of stimulant medications should be avoided by patients with MVP because these may exacerbate symptoms.Daily aspirin and restricted physical activity are not needed by patients with mild MVP.Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.

Question 15

A patient is admitted to the hospital with possible acute pericarditis.The nurse should plan to teach the patient about the purpose of

Accepted Answer

Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis.Blood cultures are not indicated unless the patient has evidence of sepsis.Cardiac catheterization and 24-hour Holter monitor is not a diagnostic procedure for pericarditis.

Question 16

The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge regarding long-term management of rheumatic fever when a 30-year-old recovering from rheumatic fever without carditis says which of the following?

Accepted Answer

Patients with a history of rheumatic fever are more susceptible to a second episode.Patients with rheumatic fever without carditis require prophylaxis until age 20 and for a minimum of 5 years.The other patient statements are correct and would not support the nursing diagnosis of ineffective health maintenance.

Question 17

The nurse is admitting a patient with possible rheumatic fever.Which question on the admission health history will be most pertinent to ask?

Accepted Answer

Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection.Although illicit IV drug use should be discussed with the patient before discharge,it is not a risk factor for rheumatic fever,and would not be as pertinent when admitting the patient.Family history is not a risk factor for rheumatic fever.Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.

Question 18

A patient with rheumatic fever has subcutaneous nodules,erythema marginatum,and polyarthritis.Based on these findings,which nursing diagnosis would be most appropriate?

Accepted Answer

The patient's joint pain will lead to difficulty with activity.The skin lesions seen in rheumatic fever are not open or pruritic.Although acute joint pain will be a problem for this patient,joint inflammation is a temporary clinical manifestation of rheumatic fever and is not associated with permanent joint changes.

Question 19

When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE),which intervention is a priority for the nurse to include?

Accepted Answer

Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in order to eradicate the bacteria,which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC)line.Rest periods and limiting physical activity to a moderate level are recommended during the treatment for IE.Oral antibiotics are not effective in eradicating the infective bacteria that cause IE.Blood cultures,rather than antibody levels,are used to monitor the effectiveness of antibiotic therapy.

Question 20

To assess the patient with pericarditis for evidence of a pericardial friction rub,the nurse should

Accepted Answer

Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border.The nurse should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a pleural friction rub.Friction rubs are not typically low pitched or rumbling and are not confined to systole.Rubs are not assessed by palpation.

Quiz 37: Nursing Management: Inflammatory and Structural Heart Disorders

The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE) .Which question by the nurse is most appropriate?

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing.Which ordered PRN medication will be the most appropriate for the nurse to give?