Deck 39: Nursing Management: Inflammatory and Structural Heart Disorders

Question 1

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

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) Position the patient in a Fowler's position,leaning forward on a padded overbed table.
D) Consult with the physician to provide patient-controlled analgesia with a narcotic analgesic.

Answer 1

Position the patient in a Fowler's position,leaning forward on a padded overbed table.

Question 2

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

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

Answer 2

The patient complains of chest pain associated with ambulation.

Question 3

During the assessment of a patient with IE,what would the nurse expect to find?

A) A new regurgitant murmur
B) Splinter hemorrhages of the lips
C) Dyspnea and a dry,hacking cough
D) Substernal chest pain and pressure

Answer 3

A new regurgitant murmur

Question 4

A patient hospitalized with a streptococcal IE tells the nurse that the physician said treatment would require 4 to 6 weeks of antibiotic therapy and says she needs to get back to work as soon as possible.In advising the patient about the expected regimen for IE,what should the nurse explain about the treatment?

A) After 2 weeks of IV antibiotic therapy,she may be discharged with oral antibiotics to take for another 4 weeks.
B) Hospitalization for 4 to 6 weeks will be necessary to prevent a relapse while she receives IV antibiotic therapy.
C) She may be able to receive outpatient IV antibiotic therapy with home nursing care if complications do not develop.
D) She will be able to return to work as soon as her fever subsides if she does not develop any symptoms of heart failure.

Question 5

The physician writes the following admitting orders for a patient with suspected IE who has fever and chills: ceftriaxone (Rocephin)1.0 g intravenous (IV)piggyback every 12 hours,aspirin for a temperature above 38.9°C,blood cultures ? 3,complete blood count,and electrocardiogram (ECG).When admitting the patient,to which of the following orders should the nurse give the highest priority?

A) Scheduling the ECG
B) Initiating the intravenous (IV)antibiotic
C) Obtaining the blood cultures
D) Administering the antipyretic agent

Question 6

A 22-year-old patient with rheumatic fever has subcutaneous nodules,erythema marginatum,and polyarthritis of multiple joints.What would the nurse document as an appropriate nursing diagnosis based on these findings?

A) Activity intolerance related to fatigue and arthralgia
B) Risk for infection related to open skin lesions
C) Risk for impaired skin integrity related to pruritus and scratching
D) Risk for impaired physical mobility related to permanent joint fixation

Question 7

A patient is admitted to the hospital with possible acute pericarditis.The nurse explains to the patient that to confirm a diagnosis of acute pericarditis,the physician will most likely use which of the following tests?

A) Multiple ECGs
B) Daily blood cultures
C) Cardiac catheterization
D) Fluid obtained by pericardiocentesis

Question 8

While obtaining a nursing history from a 23-year-old man with rheumatic fever,what information related by the patient does the nurse recognize as the most significant?

A) Has used illicit IV drugs within the last 3 months
B) Has been unemployed for 6 months and has been eating poorly
C) Suffered chest trauma with a fractured rib during a fight 2 weeks ago
D) Has had a recent sore throat

Question 9

A patient who is hospitalized with IE develops sharp left flank pain and hematuria.The nurse notifies the physician,recognizing that these symptoms may indicate which of the following complications?

A) Bacterial colonization in the kidneys
B) Vegetative embolization to the kidneys
C) Septicemia resulting in decreased glomerular blood flow
D) Hemolysis of red blood cells by hemolytic microorganisms

Question 10

To assess the patient with pericarditis for the presence of a pericardial friction rub,the nurse should undertake which of the following actions?

A) Place the diaphragm of the stethoscope at the lower left sternal border of the chest.
B) Ask the patient to stop breathing during auscultation to distinguish the sound from a pleural rub.
C) Use the diaphragm of the stethoscope to listen for a rumbling,low-pitched sound that occurs during systole.
D) Palpate the precordial area with the tips of the fingers to detect a vibration that occurs with each cardiac contraction.

Question 11

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

A) Subtract one third of the diastolic BP from the systolic BP.
B) Auscultate for a pericardial friction rub that increases in volume during inspiration.
C) Evaluate the rhythm of the pulse in relation to the patient's inspiration and expiration.
D) Note the first Korotkoff sound occurring during both inspiration and expiration while deflating the blood pressure cuff.

Question 12

The nurse suspects the development of cardiac tamponade in a patient with acute pericarditis on finding which of the following data?

A) Blood pressure 166/96 mm Hg
B) Jugular vein distension (JVD)to the level of the jaw
C) A pulsus paradoxus of 8 mm Hg
D) Level 6 chest pain on a 10-point scale with deep inspiration

Question 13

While caring for a patient with mitral valve prolapse with mild valvular regurgitation,the nurse determines that discharge teaching has been effective when the patient tells the nurse that she will do which of the following?

A) Take one aspirin a day to prevent embolization.
B) Limit her physical activity to avoid stressing her heart valves.
C) Schedule an appointment with her doctor every 6 months.
D) Discuss the diagnosis of mitral valve prolapse with the dentist.

Question 14

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

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

Question 15

The community health nurse involved in programs to prevent rheumatic fever knows that which of the following interventions is the most important to decrease the incidence of the disease?

A) Immunizing susceptible groups of people with streptococcal vaccine
B) Providing prophylactic antibiotics to people with a family history of rheumatic fever
C) Teaching people to seek medical diagnosis and treatment for streptococcal pharyngitis
D) Promoting hygienic measures to prevent the transmission of streptococcal infections

Question 16

The nurse establishes the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge concerning long-term management of rheumatic fever when a patient recovering from rheumatic endocarditis makes which of the following remarks?

A) "I will have to take prophylactic monthly antibiotic injections for at least 5 years."
B) "I should see my physician if I develop excessive fatigue or difficulty breathing."
C) "I will need to let my dentist know that I have had this rheumatic fever."
D) "I will be immune to further episodes of rheumatic fever after this infection."

Question 17

Which pulse pattern would the nurse expect to diagnose on assessment of a patient who has mitral valve regurgitation?

A) Bounding radial pulse
B) Irregular radial pulse
C) Thready peripheral pulses
D) Absent peripheral pulses

Question 18

During assessment of a patient with mitral valve stenosis,which findings would the nurse recognize are characteristic of the pressure gradient differences occurring with mitral valve stenosis?

A) Angina and syncope
B) Dyspnea and hemoptysis
C) JVD and peripheral edema
D) Hypotension and paroxysmal nocturnal dyspnea

Question 19

A 21-year-old female student is scheduled for an open mitral valve commissurotomy for treatment of a mitral stenosis resulting from rheumatic endocarditis when she was a child.Which factor supports the choice of valve repair over valve replacement in this patient?

A) No artificial valves are available yet to replace mitral valves.
B) Valve repair has a lower operative mortality rate than does valve replacement.
C) Biological replacement valves necessitate long-term immunosuppressive therapy.
D) Long-term anticoagulation is necessary with mechanical valve replacement.

Question 20

A patient is admitted to hospital with a diagnosis of myocarditis.The nurse knows that early cardiac manifestations will appear approximately how long after viral infection?

A) 24 to 48 hours
B) 3 to 5 days
C) 7 to 10 days
D) 2 to 3 weeks

Question 21

During postoperative teaching with a patient who has had a mitral valve replacement with a mechanical valve,what should the nurse instruct the patient about?

A) The need to avoid high-voltage electrical fields
B) The need for anticoagulation therapy for the duration of the valve
C) The probability that the valve will need to be replaced in 7 to 10 years
D) The need to check the pulse daily to determine the functioning of the valve

Question 22

Which information obtained by the nurse when assessing a patient admitted with mitral valve stenosis should be communicated to the physician immediately?

A) The patient has a loud diastolic murmur all across the precordium.
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 4+ peripheral edema in both legs.

Question 23

Which of the following is the primary symptom of mitral stenosis?

A) Tachypnea
B) Exertional dyspnea
C) Atrial fibrillation
D) Hemoptysis

Question 24

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

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

Question 25

Which of the following is the hallmark finding in a patient with acute pericarditis?

A) Severe sharp chest pain.
B) Pericardial friction rub.
C) Referred pain to the trapezius muscle.
D) Dyspnea

Question 26

A patient who has developed acute pulmonary edema is hospitalized and diagnosed with dilated cardiomyopathy.Which information will the nurse plan to include when teaching the patient about management of this disorder?

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

Question 27

What is the term for flat,painless,small red spots on the palms and soles of a patient who has IE?

A) Osler's nodes
B) Roth's spots
C) Janeway's lesions
D) Palmar surface paradoxus

Question 28

A patient who has had recent cardiac surgery develops pericarditis and complains of severe chest pain with deep breathing.Which of these ordered as-needed medications should the nurse administer?

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