Deck 37: Nursing Management: Inflammatory and Structural Heart Disorders

Question 1

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

A) electrolyte levels.
B) echocardiography.
C) daily blood cultures.
D) cardiac catheterization.

Answer 1

echocardiography.

Question 2

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

A) a new regurgitant murmur.
B) a pruritic rash on the trunk.
C) involuntary muscle movement.
D) substernal chest pain and pressure.

Answer 2

a new regurgitant murmur.

Question 3

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient, which information will the nurse include?

A) Biologic replacement valves require the use of immunosuppressive drugs.
B) Mechanical mitral valves require replacement approximately every 5 years.
C) Lifelong anticoagulant therapy is needed after mechanical valve replacement.
D) Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty.

Answer 3

Lifelong anticoagulant therapy is needed after mechanical valve replacement.

Question 4

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

A) force fluids to 3000 mL/day to decrease fever and inflammation.
B) teach the patient to take deep, slow respirations to control the pain.
C) remind the patient to ask for the opioid pain medication every 4 hours.
D) position the patient in Fowler's position, leaning forward on the overbed table.

Question 5

A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. An appropriate nursing diagnosis based on these findings is

A) activity intolerance related to arthralgia.
B) risk for infection related to open skin lesions.
C) chronic pain related to permanent joint fixation.
D) risk for impaired skin integrity related to pruritus.

Question 6

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

A) Monitor labs for streptococcal antibodies.
B) Arrange for insertion of a long-term IV catheter.
C) Encourage the patient to get regular aerobic exercise.
D) Teach the importance of completing all oral antibiotics.

Question 7

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

A) "Have you been to the dentist lately?"
B) "Do you have a history of a heart attack?"
C) "Is there a family history of endocarditis?"
D) "Have you had any recent immunizations?"

Question 8

A patient admitted with acute dyspnea is diagnosed with dilated cardiomyopathy. Which information will the nurse include when teaching the patient about management of this disorder?

A) Elevating the legs above the heart will help relieve angina.
B) No more than two alcoholic drinks daily are recommended.
C) Careful compliance with diet and medications will prevent heart failure.
D) Notify the doctor about any symptoms of heart failure such as shortness of breath.

Question 9

While caring for a 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

A) plan to take antibiotics before any dental appointments.
B) limit physical activity to avoid stressing the heart valves.
C) take 1 aspirin a day to prevent embolization from the valve.
D) avoid use of over-the-counter ( OTC ) medications that contain stimulant drugs.

Question 10

During postoperative teaching with a patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient regarding the

A) use of daily aspirin for anticoagulation.
B) correct method for taking the radial pulse.
C) need for frequent laboratory blood testing.
D) possibility of valve replacement in 7 to 10 years.

Question 11

A patient who has had recent cardiac surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer?

A) Fentanyl 2 mg IV
B) IV morphine sulfate 6 mg
C) Oral ibuprofen (Motrin) 800 mg
D) Oral acetaminophen (Tylenol) 650 mg

Question 12

While obtaining an admission health history from a patient with possible rheumatic fever, which question will be most pertinent to ask?

A) "Have you had a recent sore throat?"
B) "Are you using any illegal IV drugs?"
C) "Do you have any family history of congenital heart disease?"
D) "Can you recall having any chest injuries in the last few weeks?"

Question 13

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

A) auscultate with the stethoscope diaphragm at the lower left sternal border.
B) listen for a rumbling, low-pitched, systolic sound over the left anterior chest.
C) feel the precordial area with the palm of the hand to detect vibration with cardiac contraction.
D) ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub.

Question 14

Which action will the community health nurse include when planning ways to decrease the incidence of rheumatic fever?

A) Immunize susceptible groups in the community with streptococcal vaccine.
B) Teach community members to seek treatment for streptococcal pharyngitis.
C) Educate about the importance of monitoring temperature when infections occur.
D) Provide prophylactic antibiotics to people with a family history of rheumatic fever.

Question 15

Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should

A) check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration.
B) note when Korotkoff sounds are audible during both inspiration and expiration.
C) auscultate for a pericardial friction rub that increases in volume during inspiration.
D) subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).

Question 16

While caring for a patient with aortic stenosis, the nurse establishes a nursing diagnosis of acute pain related to decreased coronary blood flow. An appropriate intervention by the nurse is to

A) promote rest to decrease myocardial oxygen demand.
B) educate the patient about the need for anticoagulant therapy.
C) teach the patient to use sublingual nitroglycerin for chest pain.
D) elevate the head of the bed 60 degrees to decrease venous return.

Question 17

The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge concerning long-term management of rheumatic fever when a 30-year-old recovering from rheumatic fever says,

A) "I will need to have monthly antibiotic injections for 10 years or longer."
B) "I will need to take aspirin or ibuprofen (Motrin) to relieve my joint pain."
C) "I will call the doctor if I develop excessive fatigue or difficulty breathing."
D) "I will be immune to further episodes of rheumatic fever after this infection."

Question 18

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

A) fever, chills, and diaphoresis.
B) urine output less than 30 mL/hr.
C) petechiae of the buccal mucosa and conjunctiva.
D) increase in pulse rate of 15 beats/minute with activity.

Question 19

When caring for the patient with infective endocarditis of the tricuspid valve, the nurse will plan to monitor the patient for

A) dyspnea.
B) flank pain.
C) hemiparesis.
D) splenomegaly.

Question 20

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

A) diastolic murmur.
B) peripheral edema.
C) right upper quadrant tenderness.
D) complaints of shortness of breath.

Question 21

Which assessment finding in a patient who is hospitalized with infective endocarditis ( IE ) is most important to communicate to the health care provider?

A) Generalized muscle aching
B) Sudden onset left flank pain
C) Janeway's lesions on the palms
D) Temperature 100.5° F ( 38.1° C )

Question 22

Which assessment information obtained by the nurse for a patient with aortic stenosis would be most important to report to the health care provider?

A) The patient complains of chest pain associated with ambulation.
B) A loud systolic murmur is audible along the right sternal border.
C) A thrill is palpable at the 2nd intercostal space, right sternal border.
D) The point of maximum impulse (PMI) is at the left midclavicular line.

Question 23

The nurse will plan discharge teaching about the need for prophylactic antibiotics when having dental procedures for the patient who

A) was admitted with a large acute myocardial infarction.
B) is being discharged after an exacerbation of heart failure.
C) has had a mitral valve replacement with a mechanical valve.
D) has been treated for rheumatic fever after a streptococcal infection.

Question 24

A few days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first?

A) Auscultate the heart sounds.
B) Check the patient's oral temperature.
C) Notify the patient's health care provider.
D) Give the ordered acetaminophen (Tylenol).

Question 25

The nurse is taking a health history from a 24-year-old patient with hypertrophic cardiomyopathy ( HC ). Which information obtained by the nurse is most relevant?

A) The patient reports using cocaine once at age 16.
B) The patient has a history of a recent upper respiratory infection.
C) The patient's 29-year-old brother has had a sudden cardiac arrest.
D) The patient has a family history of coronary artery disease ( CAD ).

Question 26

Which information obtained by the nurse when assessing a patient admitted with mitral valve regurgitation should be communicated to the health care provider immediately?

A) The patient has 4+ peripheral edema in both legs.
B) The patient has crackles audible to the lung apices.
C) The patient has a palpable thrill felt over the left anterior chest.
D) The patient has a loud systolic murmur all across the precordium.

Question 27

Which of the following assessment data obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider?

A) Pulsus paradoxus 8 mm Hg
B) Blood pressure ( BP ) of 166/96
C) Jugular vein distention ( JVD ) to the level of the jaw
D) Level 6 ( 0 to 10 scale ) chest pain with deep inspiration

Question 28

Which of these prescriptions written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever should the nurse implement first?

A) Order blood cultures drawn from two sites.
B) Give acetaminophen (Tylenol) PRN for fever.
C) Administer ceftriaxone (Rocephin) 1 g IV.
D) Obtain a transesophageal echocardiogram.