Deck 23: Nursing Care of Patients With Valvular, Inflammatory, and Infectious Cardiac or Venous Disorders

Question 1

The nurse is contributing to the care plan of a patient with aortic stenosis. Which of these outcomes would support a favorable response for the nursing diagnosis of activity intolerance?

A)Clear breath sounds, no edema or weight gain
B)Vital signs within normal limits during self-care
C)Verbalizes knowledge of disorder
D)States willingness to comply with therapeutic regimen

Answer 1

Vital signs within normal limits during self-care

Question 2

The nurse is caring for a patient who has aortic stenosis. During data collection, which of these manifestations would indicate to the nurse that the patient is experiencing myocardial oxygen deficiency?

A)Jugular vein distention
B)Sacral edema
C)Angina
D)Pericardial friction rub

Answer 2

Angina

Question 3

Which outcome would the nurse recognize as evidence for meeting the desired outcome for a patient with aortic regurgitation and a nursing diagnosis of activity intolerance?

A)Completed activities of daily living with assistance
B)Engaged in desired daily and social activities
C)Reported no longer participates in gardening hobby
D)Stated maintained bedrest to reduce fatigue

Answer 3

Engaged in desired daily and social activities

Question 4

A patient who has aortic stenosis develops severe dyspnea and chest pain. What should the nurse do now?

A)Give nitroglycerin.
B)Obtain vital signs.
C)Encourage the patient to sleep.
D)Raise the head of the bed.

Question 5

A patient with chronic mitral regurgitation states, "I am always so tired." The nurse recognizes which of the following factors is most likely contributing to the fatigue?

A)Decreased cardiac output
B)Heart murmur
C)Pulmonary congestion
D)Coughing

Question 6

During data collection for a patient after cardiac surgery, the nurse notes that chest tube drainage has increased and is now greater than 200 mL per hour. What intervention should take priority?

A)Recheck drainage every 30 minutes.
B)Notify registered nurse.
C)Recheck vital signs in 30 minutes.
D)Monitor oxygen saturation.

Question 7

The nurse is contributing to a patient's plan of care. Which of the following is a desired outcome for the nursing diagnosis of Deficient Knowledge related to a new medical diagnosis of mitral valve prolapse?

A)Exhibits less fatigue during self-care
B)Clear breath sounds, no edema or weight gain
C)Verbalizes definition of disorder and manifestations
D)States ability to comply with therapeutic regimen

Question 8

The nurse is reinforcing teaching for a patient with aortic regurgitation on how to reduce cardiac workload. Which of these, if stated by a patient, indicates to the nurse correct understanding of these interventions?

A)"Lie flat when in bed."
B)"Eat three large meals daily."
C)"Elevate the legs hourly."
D)"Alternate activity with rest."

Question 9

The nurse is reinforcing discharge instructions to a patient who has a mitral valve prolapse. Which of the following should be included?

A)"You may have a possible need for prophylactic antibiotics."
B)"Begin a home aerobic exercise program."
C)"Cough and deep breathe hourly when awake."
D)"Perform hourly leg exercises if lying down."

Question 10

The nurse is caring for a patient who has a valvular problem. The patient states the doctor is ordering something that measures the pressures in the patient's heart. The nurse anticipates scheduling an appointment for which of the following?

A)Chest radiograph
B)Cardiac catheterization
C)Echocardiogram
D)Electrocardiogram

Question 11

The nurse is contributing to the plan of care for a patient who has aortic stenosis. The nurse understands that during data collection, monitoring for signs of heart failure should be done. Heart failure occurs as a complication of aortic stenosis due to which of the following?

A)Cardiac workload is increased from reduced cardiac output.
B)Cardiac workload is increased from increased cardiac output.
C)Cardiac workload is decreased from reduced cardiac output.
D)Cardiac workload is decreased from increased cardiac output.

Question 12

Which of the following individuals with a heart valve disorder is susceptible to developing the complication of fluid volume excess?

A)An 18-year-old female taking warfarin (Coumadin)
B)A 27-year-old male on atenolol (Tenormin)
C)A 44-year-old male taking amoxicillin (Amoxil)
D)A 68-year-old female on digoxin (Lanoxin)

Question 13

The nurse is collecting data for a patient who has mitral stenosis. Which condition would the nurse likely document was reported in the patient's history?

A)Rheumatoid arthritis
B)Meningitis
C)Rheumatic fever
D)Scarlet fever

Question 14

The nurse reinforced teaching for a patient with aortic stenosis. Which of these, if stated by a patient, indicates to the nurse correct understanding of what happens in aortic stenosis?

A)"There is backflow of blood into the right ventricle."
B)"There is backflow of blood into the left ventricle."
C)"There is impaired emptying of the right ventricle."
D)"There is impaired emptying of the left ventricle."

Question 15

Which of these, if stated by a patient, indicates to the nurse correct understanding of the treatment of choice for chronic aortic regurgitation?

A)Valvular commissurotomy
B)Medication therapy
C)Valvular annuloplasty
D)Surgical valve replacement

Question 16

The nurse is monitoring a patient with aortic stenosis and notes crackles in the lungs and a cough. The nurse would be correct in recognizing that the patient has most likely developed which of these complications?

A)Heart failure
B)Rheumatic fever
C)Pneumonia
D)Hypertension

Question 17

The nurse is contributing to a patient's plan of care. During medication administration, which medication would the nurse understand as being prescribed to treat a patient with aortic stenosis who has symptoms of heart failure?

A)Heparin
B)Bumetanide (Bumex)
C)Digitalis
D)Warfarin (Coumadin)

Question 18

The nurse is providing discharge teaching for a patient with mitral stenosis. Which of the following statements should be included in the teaching?

A)"The medications you will be taking make your blood thicker, so you are at risk for small clots to form."
B)"It is important that you increase your fluid intake and take iron supplements so that your body can make enough blood for your heart to pump around."
C)"Because of your heart condition, the blood flow through your heart is slower and blood may tend to pool in certain areas, which might allow tiny clots to form."
D)"Your blood is rushing through your heart so fast that it may not give your heart enough oxygen and you may have something called angina, or heart pain."

Question 19

The nurse is reinforcing teaching for a patient who has had a mechanical valve replacement. What should be taught regarding safety during warfarin (Coumadin) therapy?

A)Wear Medic-Alert identification.
B)Increase intake of green leafy vegetables.
C)Keep yearly blood test appointments.
D)Use a straight razor when shaving.

Question 20

The nurse is reinforcing teaching for a patient diagnosed with mitral valve regurgitation who asks, "What does that really mean?" Which of the following statements would the nurse include in the teaching?

A)"There is backflow of blood into the right atrium."
B)"There is backflow of blood into the left atrium."
C)"There is impaired emptying of the right atrium."
D)"There is impaired emptying of the left atrium."

Question 21

While monitoring a patient with cardiomyopathy, the nurse understands the patient is at risk for which of the following complications?

A)Angina
B)Myocardial infarction
C)Heart failure
D)Pericarditis

Question 22

The nurse is reinforcing teaching to a patient with thrombophlebitis. Which diagnostic test would the nurse explain is used to confirm thrombophlebitis?

A)Arterial Doppler ultrasonography
B)Chest radiograph
C)Intravenous pyelogram
D)Duplex venous scanning

Question 23

The nurse is contributing to a patient's plan of care. Which positioning would the nurse recommend for a patient with a left deep vein thrombosis?

A)Elevate left leg above heart level.
B)Elevate right leg above heart level.
C)Elevate both legs above heart level.
D)Elevate head above level of legs.

Question 24

The nurse is collecting data for a patient. The nurse would check for Homans' sign by which of these methods?

A)Observing the calf and thigh color bilaterally
B)Listening with a Doppler to posterior bilateral tibial pulses
C)Measuring the patient's calf and thigh circumference bilaterally
D)Dorsiflexing the patient's foot sharply and asking if calf pain occurs

Question 25

The nurse reinforced teaching for a patient with mitral stenosis. Which statement by the patient indicates that the teaching has been effective?

A)"There is a backflow of blood into the lower left chamber of the heart."
B)"There is a narrowing of the blood vessel that brings blood into the heart."
C)"The right side of the heart is not pumping effectively."
D)"The top chamber on the left side of the heart doesn't empty all of the way."

Question 26

The home health nurse is visiting a patient with cardiomyopathy who lives alone and is taking anticoagulant therapy. Which of these observations indicate that the patient requires more teaching?

A)The patient is wearing elastic stockings and slippers.
B)The patient has a soft-bristle toothbrush in the bathroom.
C)The patient has a bottle of acetaminophen on the counter.
D)The patient has a straight razor on the bathroom sink.

Question 27

The nurse reinforced teaching for a patient with strep throat. Which of these, if stated by a patient, indicates to the nurse correct understanding of complications that can occur 2 to 3 weeks after an episode of strep throat?

A)"Rheumatic heart disease."
B)"Rheumatic fever."
C)"Cardiomyopathy."
D)"Pericarditis."

Question 28

The nurse is contributing to a plan of care for a patient who has acute pericarditis. The patient has a nursing diagnosis of Pain related to the inflammatory process. What nursing action should the nurse recommend?

A)Restrict fluids to 500 mL per day.
B)Teach the patient to take shallow, rapid breaths.
C)Have the patient cough and deep breathe hourly while awake.
D)Provide anti-inflammatory medication as ordered.

Question 29

The nurse is caring for a patient with pericarditis. Which type of medication would the nurse expect to administer to the patient?

A)Anti-inflammatory medication
B)Beta blocker
C)Antihypertensive
D)Calcium channel blocker

Question 30

A patient with aortic stenosis is being treated for heart failure. Which of the following medications would the nurse question?

A)Heparin
B)Bumetanide (Bumex)
C)Digoxin (Lanoxin)
D)Warfarin (Coumadin)

Question 31

Which of these would the nurse recognize as a therapeutic prothrombin time (PT) value for a patient on warfarin (Coumadin) when the laboratory's normal prothrombin time range is 9 to 11 seconds?

A)12.5 seconds
B)17 seconds
C)30 seconds
D)26 seconds

Question 32

A healthy postoperative patient who has been on bedrest for 3 days develops sudden dyspnea, tachypnea, restlessness, and chest pain. The patient says, "I feel as if something is going to happen to me." What should the nurse do?

A)Ensure physician is notified immediately.
B)Perform a bilateral Homans' test.
C)Give a narcotic for pain as ordered.
D)Reassure the patient that everything is fine.

Question 33

The nurse is caring for a patient with a deep vein thrombosis who is receiving intravenous heparin. The nurse should monitor which of these laboratory tests specifically for the effects of the heparin?

A)Bleeding time
B)PT
C)PTT
D)Platelets

Question 34

The nurse reinforced teaching for a patient taking an anticoagulant for atrial fibrillation due to valvular disease. Which statement by the patient indicates that the teaching has been effective?

A)"I will have monthly blood tests done."
B)"I can take aspirin for my frequent headaches."
C)"I care for my teeth very well, brushing them with a hard brush and flossing daily."
D)"I feel fine, so I do not need to wear a Medic-Alert bracelet anymore."

Question 35

The nurse is collecting data on a patient who had a hysterectomy 2 days ago and reports tenderness in her left calf. Data include the following: left calf 17.5 inches; right calf 14 inches; left thigh 32 inches; right thigh 28 inches; shiny, warm, and reddened left leg. Which of these actions should be recommended for the plan of care by the nurse?

A)Maintain bedrest.
B)Encourage ambulation daily.
C)Place antiembolism stocking on left leg.
D)Place antiembolism stocking on both legs.

Question 36

The nurse is collecting data for a patient 3 days after an automobile accident, in which the patient hit the steering wheel. The data reveal symptoms of pericarditis. Which of these findings are indicative of pericarditis?

A)Pain on expiration
B)Pericardial friction rub
C)Jugular vein distention
D)Crackles in lung bases

Question 37

The nurse is caring for a patient who develops a fever and reports right calf pain with a reddened and swollen calf. Which of these actions should the nurse take?

A)Massage the affected calf.
B)Place ice on the affected calf.
C)Place elastic stocking on right leg.
D)Measure bilateral calf circumference daily.

Question 38

A patient who has a deep vein thrombosis is receiving a heparin drip and warfarin (Coumadin) therapy. The patient's gums bled during oral care. What action should the nurse take?

A)Turn off the heparin drip immediately.
B)Offer the patient a saline mouth rinse.
C)Notify the registered nurse.
D)Tell the patient to gargle with mouthwash.

Question 39

The nurse is giving a patient who has mitral stenosis a preoperative antibiotic. Which of these, if stated by a patient, indicates to the nurse correct understanding of why the antibiotic is necessary?

A)"To prevent infection of the surgical incision."
B)"To prevent postoperative pneumonia."
C)"To prevent a bacterial infection in the heart."
D)"To prevent an increase in body temperature."

Question 40

A patient with a history of mitral valve replacement surgery is instructed to take prophylactic antibiotics before a scheduled root canal. Which of the following indicates to the nurse that teaching has been effective?

A)"If I develop a fever in the next week or so, I need to call my doctor right away."
B)"Endocarditis causes rapid weight gain so I need to weigh myself every day for a full week."
C)"If I notice any ankle edema, I should lower my salt intake."
D)"I know I need to call my doctor if I notice a dry cough."

Question 41

Which of these, if stated by a patient, indicates to the nurse correct understanding of characteristics of mechanical valves used for cardiac valve replacement? (Select all that apply.?

A)"They do not require lifelong anticoagulant therapy."
B)"They are durable."
C)"They create turbulent blood flow."
D)"They require donors."
E)"They may be preferred if anticoagulation is a concern."
F)"They can be placed during balloon angioplasty."

Question 42

While monitoring a patient with pericarditis, the nurse recognizes that the patient is at risk for cardiac tamponade if which of the following occurs?

A)Cardiac output decreases more than 10%.
B)Cardiac workload increases by 15%.
C)Emboli begin to form.
D)Pericardial sac fluid increases.

Question 43

Which of the following nursing actions should the nurse plan for a patient returning from the intensive care unit after cardiac surgery? (Select all that apply.?

A)Connect the patient to a cardiac monitor.
B)Place the patient in a cool environment.
C)Assist in head-to-toe data collection.
D)Palpate chest and neck for signs of crepitus.
E)Note any patient shivering.
F)Assess breath sounds every shift.

Question 44

Before the nurse administers warfarin (Coumadin) to a patient, which of these laboratory values should be checked?

A)Bleeding time
B)International normalized ratio
C)Partial thromboplastin time
D)Fibrinogen level

Question 45

While caring for patients on the cardiac unit, the nurse reviews the standards related to deep vein thrombosis prophylaxis. The nurse recognizes that research supports which of the following approaches of care as most effective?

A)Prophylaxis using low molecular weight heparin given subcutaneously daily
B)Prophylaxis using bilateral leg compression devices while the patient is in bed
C)Prophylaxis using bilateral thigh-high stockings throughout hospitalization
D)Prophylaxis using a combination of pharmacological and compression interventions
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 46

The nurse is contributing to a patient's plan of care for a patient who has an elevated international normalized ratio (INR). Which of these nursing diagnoses should the nurse recommend receive priority in the patient's care plan?

A)Acute Pain
B)Ineffective Breathing Pattern
C)Risk for Injury
D)Risk for Infection

Question 47

A patient with obstructive hypertrophic cardiomyopathy is being released from the hospital and is to continue treatment with atenolol (Tenormin) and disopyramide (Norpace) at home. Which of the following should be included in the patient's teaching plan? (Select all that apply.?

A)Eat small meals.
B)Have one alcoholic drink per day.
C)Participate in sports, such as tennis.
D)Drink fluids to remain hydrated.
E)Plan activities in small amounts.
F)Check the pulse daily before taking medications.Completion
Complete each statement.

Question 48

A patient with aortic stenosis experiencing angina and syncope is prescribed 0.25 mg of digoxin (Lanoxin). The nurse has available digoxin, 0.125 mg tablet. The nurse should give the patient ________________tablet(s).

Question 49

The nurse recognizes that which of the following individuals should receive prophylactic antibiotics to prevent infective endocarditis (IE)? (Select all that apply.?

A)A 56-year-old with a history of mitral valve prolapse scheduled for routine dental cleaning
B)A 68-year-old with a history of atrial fibrillation scheduled for a root canal
C)A 71-year-old with a history of infective endocarditis scheduled for a tooth extraction
D)A 76-year-old with a history of cardiac valve repair scheduled for a colonoscopy
E)A 69-year-old with a history of congenital heart disease who is having an abscess drained
F)A 55-year-old with a history of angina scheduled for arthroscopic knee surgery

Question 50

A postoperative patient who develops sudden dyspnea, tachypnea, restlessness, and chest pain is most likely experiencing which of these complications?

A)Myocardial infarction
B)Pulmonary edema
C)Respiratory arrest
D)Pulmonary embolus

Question 51

The nurse is caring for a patient who is on digoxin (Lanoxin). With myocarditis, the nurse is aware that which of these effects occurs with digoxin administration?

A)Increased inflammation
B)Decreased inflammation
C)Increased risk of toxicity
D)Decreased risk of toxicity

Question 52

Which of the following findings in a patient with decreased cardiac output would the nurse recognize as indicating that interventions are effective, and the patient is improving? (Select all that apply.?

A)Temperature 98.6°F (37°C), respirations 16/min, blood pressure 110/75 mm Hg, pulse 75 beats/min)
B)Urine output greater than 30 mL/hour
C)Cool pale extremities with diminished peripheral pulses
D)Less shivering
E)Clear lung sounds
F)Pulse oximeter reading 96%