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

Question 1

A patient with chronic mitral regurgitation states,"I am always so tired." Which factor should the nurse identify as contributing to this patient's fatigue?

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

Answer 1

Decreased cardiac output

Question 2

The nurse is reviewing care for a group of patients.Which patient with a heart valve disorder should the nurse identify as being susceptible to developing the complication of fluid volume excess?

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

Answer 2

A 68-year-old female on digoxin (Lanoxin)

Question 3

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 should the nurse do?

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

Answer 3

Notify registered nurse (RN).

Question 4

The nurse is reinforcing discharge instructions to a patient who has a mitral valve prolapse.What information should be included?

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

Question 5

The nurse is providing discharge teaching for a patient with mitral stenosis.What should the nurse include in this 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) "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."
D) "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."

Question 6

The nurse is monitoring a patient with aortic stenosis and notes crackles in the lungs and a cough.Which complication should the nurse suspect is occurring in this patient?

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

Question 7

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.Which diagnostic test should the nurse anticipate scheduling for the patient?

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

Question 8

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

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

Question 9

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

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

Question 10

The nurse is contributing to a patient's plan of care.Which statement 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 breathing sounds, no edema or weight gain
C) States ability to comply with therapeutic regimen
D) Verbalizes definition of disorder and manifestations

Question 11

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

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

Question 12

The nurse is collecting data from a patient who has mitral stenosis.For which condition should the nurse assess in the patient's history?

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

Question 13

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

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

Question 14

A patient with mitral regurgitation asks what the health problem means.What should the nurse explain to the patient?

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

Question 15

A patient is diagnosed with chronic aortic regurgitation.Which procedure should the nurse anticipate being prescribed for this patient?

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

Question 16

While collecting data on a patient with aortic stenosis the nurse monitors for signs of heart failure.What is the nurse monitoring for heart failure as a complication of aortic stenosis?

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

Question 17

The nurse is reinforcing teaching provided to a patient with aortic regurgitation on how to reduce cardiac workload.Which patient statement indicates that teaching has been effective?

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

Question 18

The nurse is evaluating care provided to a patient with the nursing diagnosis of activity intolerance because of aortic regurgitation.Which outcome indicates that care has been effective?

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

Question 19

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 20

The nurse is reinforcing teaching provided to a patient with aortic stenosis.Which statement indicates that the patient correctly understands what happens in aortic stenosis?

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

Question 21

A healthy postoperative patient who has been on bedrest for 3 days suddenly develops 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) Perform a bilateral Homans' test.
B) Give a narcotic for pain as ordered.
C) Ensure physician is notified immediately.
D) Reassure the patient that everything is fine.

Question 22

The nurse is reviewing the prothrombin time (PT)value for a patient prescribed warfarin (Coumadin).The laboratory's prothrombin time range is 9 to 11 seconds.What would be the therapeutic time for the patient?

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

Question 23

A patient is diagnosed with cardiomyopathy.What should the nurse identify as a potential risk for this patient?

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

Question 24

The nurse is caring for a patient who develops a fever and reports right calf pain with a reddened and swollen calf.Which action 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 25

The nurse is reinforcing teaching provided to a patient with strep throat.Which statement indicates that the patient understands the complication that can occur 2 to 3 weeks after this health problem?

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

Question 26

The nurse is collecting data on a patient recovering from a hysterectomy who is experiencing left calf tenderness.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 actions should the nurse recommend for this patient's plan of care?

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

Question 27

The nurse is collecting data from a patient 3 days after a motor vehicle crash in which the patient hit the steering wheel.The data reveal symptoms of pericarditis.Which finding indicates the presence of pericarditis?

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

Question 28

The home health nurse is visiting a patient with cardiomyopathy who lives alone and is prescribed anticoagulant therapy.Which observation indicates that the patient requires more teaching?

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

Question 29

The nurse reinforces teaching provided to a patient prescribed 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 feel fine, so I do not need to wear a Medic-Alert bracelet anymore."
D) "I care for my teeth very well, brushing them with a hard brush and flossing daily."

Question 30

The nurse reinforces teaching provided to a patient with mitral stenosis.Which patient statement indicates that the teaching has been effective?

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

Question 31

A patient with mitral stenosis is prescribed a preoperative antibiotic.Which patient statement indicates an understanding for taking this medication?

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

Question 32

A patient with acute pericarditis 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) Provide anti-inflammatory medication as ordered.
D) Have the patient cough and deep breathe hourly while awake.

Question 33

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

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

Question 34

The nurse is collecting data from a patient.Which approach should the nurse use to determine the presence of a Homan's sign?

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 35

The nurse is caring for a patient with pericarditis.Which type of medication should the nurse expect to be prescribed for the patient?

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

Question 36

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

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

Question 37

A patient with a deep vein thrombosis receiving a heparin infusion and warfarin (Coumadin)therapy develops bleeding gums.What action should the nurse take?

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

Question 38

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

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

Question 39

A patient with aortic stenosis is being treated for heart failure.Which medication order should the nurse question?

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

Question 40

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

Question 41

A patient is scheduled for cardiac surgery for placement of a mechanical valve.Which patient statement indicates correct understanding of characteristics of mechanical valves used for cardiac valve replacement? (Select all that apply.)

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

Question 42

The nurse identifies the diagnosis of decreased cardiac output for a patient with a cardiac valve disorder.Which interventions should the nurse include in this patient's plan of care? (Select all that apply.)

A) Provide oxygen as prescribed.
B) Maintain fluid restriction of 1000 mL.
C) Elevate the head of the bed 45 degrees.
D) Encourage frequent periods of bedrest.
E) Assess vital signs and oxygen saturation.

Question 43

The nurse has been caring for a patient experiencing a reduction in cardiac output.Which findings indicate that interventions are effective,and the patient is improving? (Select all that apply.)

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

Question 44

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 information should be included in the patient's teaching plan? (Select all that apply.)

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

Question 45

The nurse is preparing to administer warfarin (Coumadin)to a patient.Which laboratory value should the nurse review before administering this medication?

A) Bleeding time
B) Fibrinogen level
C) Partial thromboplastin time
D) INR

Question 46

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.How many tablets should the nurse administer to the patient?

Question 47

A patient who is taking digoxin (Lanoxin)is diagnosed with myocarditis.For which effect should the nurse monitor the patient?

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

Question 48

The nurse suspects that a patient recovering from valve replacement surgery is experiencing an infection.Which findings did the nurse use to come to this conclusion? (Select all that apply.)

A) Cloudy urine
B) Lung crackles
C) Incisional pain
D) Elevated temperature
E) Yellow-green sputum

Question 49

A postoperative patient suddenly develops dyspnea,tachypnea,restlessness,and chest pain.Which complication should the nurse suspect is occurring in this patient?

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

Question 50

A patient recovering from valve replacement surgery has a low cardiac output.Which laboratory tests should the nurse identify as a possible cause for this patient's problem? (Select all that apply.)

A) Low serum sodium level
B) Low serum calcium level
C) Low serum magnesium level
D) Elevated serum glucose level
E) Elevated serum potassium level

Question 51

The nurse is reviewing the medical histories for a group of patients.Which patients should receive prophylactic antibiotics to prevent infective endocarditis (IE)? (Select all that apply.)

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

Question 52

A patient is admitted for treatment of aortic stenosis.What findings should the nurse expect when collecting data from this patient? (Select all that apply.)

A) Chest pain
B) Orthopnea
C) Heart murmur
D) Dyspnea on exertion
E) Oxygen saturation 80%

Question 53

The nurse is monitoring a patient with pericarditis.What health problem is this patient at risk for developing?

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

Question 54

A patient is being admitted to the intensive care unit after cardiac surgery.Which nursing actions should the nurse include in this patient's plan of care? (Select all that apply.)

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

Question 55

A patient recovering from cardiac surgery complains of discomfort when turning and moving in bed.What should the nurse encourage the patient perform when making position changes?

A) Hold the breath
B) Splint with a pillow
C) Bend the knees to the chest
D) Lift the head off of the bed

Question 56

The nurse is contributing to a patient's plan of care for a patient who has an elevated INR.Which nursing diagnosis should the nurse recommend receive priority in the patient's care plan?

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

Question 57

The nurse caring for patients on the cardiac unit reviews the standards related to deep vein thrombosis prophylaxis.Which approach should the nurse recognize as being the most effective to prevent the development of deep vein thrombosis?

A) Using bilateral thigh-high stockings throughout hospitalization
B) Using low molecular weight heparin given subcutaneously daily
C) Using bilateral leg compression devices while the patient is in bed
D) Using a combination of pharmacological and compression interventions