Question 1

The nurse is planning care for a client hospitalized with a streptococcal infective endocarditis (IE). Which of the following interventions should the nurse include?

Accepted Answer

Treatment for IE involves 4-6 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 2

The nurse is caring for a client with rheumatic fever who has subcutaneous nodules, erythema marginatum, and polyarthritis. Which of the following nursing diagnoses best reflects these findings?

Accepted Answer

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

Question 3

Which of the following techniques should the nurse use to assess the client with pericarditis for the presence of a pericardial friction rub?

Accepted Answer

Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. Because dyspnea is one clinical manifestation of pericarditis, the nurse should time the friction rub with the pulse rather than ask the client to stop breathing during auscultation. Friction rubs are not typically low pitched or rumbling and are not confined to systole.
Rubs are not assessed by palpation.

Question 4

The nurse is caring for a client with infective endocarditis of the tricuspid valve. Which of the following findings should the nurse plan to monitor for the presence of endocarditis in the client?

Accepted Answer

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

Question 5

The nurse is caring for a client with acute dyspnea and is diagnosed with dilated cardiomyopathy. Which of the following information should the nurse include when teaching the client about management of this disorder?

Accepted Answer

The client 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 clients with good adherence to therapy may have recurrent episodes of heart failure. The client is instructed to avoid alcoholic beverages. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a client with hypertrophic cardiomyopathy).

Question 6

The nurse is caring for a client who has had recent cardiac surgery and develops pericarditis, with symptoms of chest pain at a level 6 (0-10 scale) with deep breathing. Which of the following prescribed PRN medications should the nurse administer?

Accepted Answer

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

Question 7

Which of the following actions should the community health nurse include when planning ways to decrease the incidence of rheumatic fever?

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. Education about monitoring temperature will not decrease the incidence of rheumatic fever.

Question 8

The nurse is admitting a client with possible acute pericarditis. Which of the following diagnostic assessments should the nurse plan to teach the client about?

Accepted Answer

Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the client has evidence of sepsis. Cardiac catheterization is not a diagnostic procedure for pericarditis. Electrolyte levels are not helpful in making a diagnosis of pericarditis.

Question 9

The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge concerning long-term management of rheumatic fever when a client who is recovering from rheumatic fever says which of the following statements?

Accepted Answer

Clients with a history of rheumatic fever are more susceptible to a second episode. The other client statements are correct and would not support the nursing diagnosis of ineffective health maintenance.

Question 10

The nurse is obtaining a health history from a client with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which of the following questions by the nurse is best?

Accepted Answer

Dental procedures place the client 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 11

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the client with infective endocarditis (IE). Which of the following findings support this diagnosis?

Accepted Answer

Decreased renal perfusion caused by inadequate cardiac output will lead to poor 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 12

The nurse is caring for a client with aortic stenosis and establishes a nursing diagnosis of acute pain related to decreased coronary blood flow. Which of the following interventions is best?

Accepted Answer

Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The client 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 client has atrial fibrillation.

Question 13

The nurse is assessing a client with infective endocarditis (IE). Which of the following findings should the nurse expect to assess?

Accepted Answer

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

Question 14

The nurse is providing discharge teaching for a client with mitral valve prolapse (MVP) without valvular regurgitation. Which of the following client statements indicate that teaching has been effective?

Accepted Answer

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

Question 15

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a client with acute pericarditis. Which of the following actions is best for the nurse to implement?

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 respirations tends to increase pericardial pain. Opioids are not very effective at controlling pain caused by acute inflammatory conditions and are usually ordered PRN. The client would receive scheduled doses of a nonsteroidal anti-inflammatory drug (NSAID).

Question 16

The nurse is caring for a client who is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the client, which of the following informationshould the nurse include?

Accepted Answer

Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this client. Mechanical valves are durable and last longer than 5 years. All valve repair procedures are palliative, not curative, and require lifelong health care. Biological valves do not activate the immune system, and immuno-suppressive therapy is not needed.

Question 17

Cardiac tamponade is suspected in a client who has acute pericarditis. Which of the following actions should the nurse implement to assess for the presence of pulsus paradoxus?

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 18

The nurse is conducting postoperative teaching with a client who had a mitral valve replacement with a mechanical valve. Which of the following information should the nurse include in the teaching plan?

Accepted Answer

Anticoagulation therapy with warfarin is needed for a client 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 risk for clots on the valve. Mechanical valves are durable and would last longer than 7-10 years. Monitoring of the radial pulse is not necessary after valve replacement.

Question 19

The nurse is conducting an admission health history with a client with possible rheumatic fever. Which of the following questions is most pertinent to ask?

Accepted Answer

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

Question 20

The nurse is assessing a client with mitral valve stenosis and hypoxemia. Which of the following findings should the nurse expect to assess?

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.

Quiz 39: Nursing Management Inflammatory and Structural Heart Disorders

The nurse is planning care for a client hospitalized with a streptococcal infective endocarditis (IE) . Which of the following interventions should the nurse include?