Deck 28: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders

Question 1

A patient with mitral stenosis exhibits new symptoms of a dysrhythmia. Based on the pathophysiology of this disease process, the nurse would expect the patient to exhibit what heart rhythm?

A) Ventricular fibrillation (VF)
B) Ventricular tachycardia (VT)
C) Atrial fibrillation
D) Sinus bradycardia

Answer 1

Atrial fibrillation

Question 2

A patient who has undergone a valve replacement with a mechanical valve prosthesis is due to be discharged home. During discharge teaching, the nurse should discuss the importance of antibiotic prophylaxis prior to which of the following?

A) Exposure to immunocompromised individuals
B) Future hospital admissions
C) Dental procedures
D) Live vaccinations

Answer 2

Dental procedures

Question 3

A patient with hypertrophic cardiomyopathy $(\mathrm{HCM})$ has been admitted to the medical unit. During the nurses admission interview, the patient states that she takes over-the-counter water pills on a regular basis. How should the nurse best respond to the fact that the patient has been taking diuretics?

A) Encourage the patient to drink at least 2 liters of fluid daily.
B) Increase the patients oral sodium intake.
C) Inform the care provider because diuretics are contraindicated.
D) Ensure that the patients fluid balance is monitored vigilantly.

Answer 3

Inform the care provider because diuretics are contraindicated.

Question 4

The critical care nurse is caring for a patient who is receiving cyclosporine postoperative heart transplant. The patient asks the nurse to remind him what this medication is for. How should the nurse best respond?

A) Azathioprine decreases the risk of thrombus formation.
B) Azathioprine ensures adequate cardiac output.
C) Azathioprine increases the number of white blood cells.
D) Azathioprine minimizes rejection of the transplant.

Question 5

A patient with a history rheumatic heart disease knows that she is at risk for bacterial endocarditis when undergoing invasive procedures. Prior to a scheduled cystoscopy, the nurse should ensure that the patient knows the importance of taking which of the following drugs?

A) Enoxaparin (Lovenox)
B) Metoprolol (Lopressor)
C) Azathioprine (Imuran)
D) Amoxicillin (Amoxil)

Question 6

A patient with pericarditis has just been admitted to the CCU. The nurse planning the patients care should prioritize what nursing diagnosis?

A) Anxiety related to pericarditis
B) Acute pain related to pericarditis
C) Ineffective tissue perfusion related to pericarditis
D) Ineffective breathing pattern related to pericarditis

Question 7

A patient newly admitted to the telemetry unit is experiencing progressive fatigue, hemoptysis, and dyspnea. Diagnostic testing has revealed that these signs and symptoms are attributable to pulmonary venous hypertension. What valvular disorder should the nurse anticipate being diagnosed in this patient?

A) Aortic regurgitation
B) Mitral stenosis
C) Mitral valve prolapse
D) Aortic stenosis

Question 8

The nurse is caring for a patient with mitral stenosis who is scheduled for a balloon valvuloplasty. The patient tells the nurse that he is unsure why the surgeon did not opt to replace his damaged valve rather than repairing it. What is an advantage of valvuloplasty that the nurse should cite?

A) The procedure can be performed on an outpatient basis in a physicians office.
B) Repaired valves tend to function longer than replaced valves.
C) The procedure is not associated with a risk for infection.
D) Lower doses of antirejection drugs are required than with valve replacement.

Question 9

The nurse is reviewing the echocardiography results of a patient who has just been diagnosed with dilated cardiomyopathy (DCM). What changes in heart structure characterize DCM?

A) Dilated ventricles with atrophy of the ventricles
B) Dilated ventricles without hypertrophy of the ventricles
C) Dilation and hypertrophy of all four heart chambers
D) Dilation of the atria and hypertrophy of the ventricles

Question 10

A patient has been admitted to the medical unit with signs and symptoms suggestive of endocarditis. The physicians choice of antibiotics would be primarily based on what diagnostic test?

A) Echocardiography
B) Blood cultures
C) Cardiac aspiration
D) Complete blood count

Question 11

A community health nurse is presenting an educational event and is addressing several health problems, including rheumatic heart disease. What should the nurse describe as the most effective way to prevent rheumatic heart disease?

A) Recognizing and promptly treating streptococcal infections
B) Prophylactic use of calcium channel blockers in high-risk populations
C) Adhering closely to the recommended child immunization schedule
D) Smoking cessation

Question 12

A patient with mitral valve prolapse is admitted for a scheduled bronchoscopy to investigate recent hemoptysis. The physician has ordered gentamicin to be taken before the procedure. What is the rationale for this?

A) To prevent bacterial endocarditis
B) To prevent hospital-acquired pneumonia
C) To minimize the need for antibiotic use during the procedure
D) To decrease the need for surgical asepsis

Question 13

The nurse is admitting a patient with complaints of dyspnea on exertion and fatigue. The patients ECG shows dysrhythmias that are sometimes associated with left ventricular hypertrophy. What diagnostic tool would be most helpful in diagnosing cardiomyopathy?

A) Cardiac catheterization
B) Arterial blood gases
C) Echocardiogram
D) Exercise stress test

Question 14

The nurse is preparing a patient for cardiac surgery. During the procedure, the patients heart will be removed and a donor heart implanted at the vena cava and pulmonary veins. What procedure will this patient undergo?

A) Orthotopic transplant
B) Xenograft
C) Heterotropic transplant
D) Homograft

Question 15

A patient is undergoing diagnostic testing for mitral stenosis. What statement by the patient during the nurses interview is most suggestive of this valvular disorder?

A) I get chest pain from time to time, but it usually resolves when I rest.
B) Sometimes when Im resting, I can feel my heart skip a beat.
C) Whenever I do any form of exercise I get terribly short of breath.
D) My feet and ankles have gotten terribly puffy the last few weeks.

Question 16

The nurse is caring for a patient who is scheduled to undergo mechanical valve replacement. Patient education should include which of the following?

A) Use of patient-controlled analgesia
B) Long-term anticoagulant therapy
C) Steroid therapy
D) Use of IV diuretics

Question 17

The staff educator is presenting a workshop on valvular disorders. When discussing the pathophysiology of aortic regurgitation the educator points out the need to emphasize that aortic regurgitation causes what?

A) Cardiac tamponade
B) Left ventricular hypertrophy
C) Right-sided heart failure
D) Ventricular insufficiency

Question 18

The nurse is creating a plan of care for a patient with a cardiomyopathy. What priority goal should underlie most of the assessments and interventions that are selected for this patient?

A) Absence of complications
B) Adherence to the self-care program
C) Improved cardiac output
D) Increased activity tolerance

Question 19

An older adult patient has been diagnosed with aortic regurgitation. What change in blood flow should the nurse expect to see on this patients echocardiogram?

A) Blood to flow back from the aorta to the left ventricle
B) Obstruction of blood flow from the left ventricle
C) Blood to flow back from the left atrium to the left ventricle
D) Obstruction of blood from the left atrium to left ventricle

Question 20

A patient who has undergone valve replacement surgery is being prepared for discharge home. Because the patient will be discharged with a prescription for warfarin (Coumadin), the nurse should educate the patient about which of the following?

A) The need for regularly scheduled testing of the patients International Normalized Ratio (INR)
B) The need to learn to sleep in a semi-Fowlers position for the first 6 to 8 weeks to prevent emboli
C) The need to avoid foods that contain vitamin $\mathrm{K}$
D) The need to take enteric-coated ASA on a daily basis

Question 21

A nurse is planning discharge health education for a patient who will soon undergo placement of a mechanical valve prosthesis. What aspect of health education should the nurse prioritize in anticipation of discharge?

A) The need for long-term antibiotics
B) The need for 7 to 10 days of bed rest
C) Strategies for preventing atherosclerosis
D) Strategies for infection prevention

Question 22

A patient with mitral valve stenosis is receiving health education at an outpatient clinic. To minimize the patients symptoms, the nurse should teach the patient to do which of the following?

A) Eat a high-protein, low-carbohydrate diet.
B) Avoid activities that cause an increased heart rate.
C) Avoid large crowds and public events.
D) Perform deep breathing and coughing exercises.

Question 23

A patient is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the patients most recent laboratory results, the nurse should prioritize assessment of which of the following?

A) Sodium
B) AST, ALT, and bilirubin
C) White blood cell differential
D) BUN

Question 24

A patient has been admitted with an aortic valve stenosis and has been scheduled for a balloon valvuloplasty in the cardiac catheterization lab later today. During the admission assessment, the patient tells the nurse he has thoracolumbar scoliosis and is concerned about lying down for any extended period of time. What is a priority action for the nurse?

A) Arrange for an alternative bed.
B) Measure the degree of the curvature.
C) Notify the surgeon immediately.
D) Note the scoliosis on the intake assessment.

Question 25

A patient is a candidate for percutaneous balloon valvuloplasty, but is concerned about how this procedure will affect her busy work schedule. What guidance should the nurse provide to the patient?

A) Patients generally stay in the hospital for 6 to 8 days.
B) Patients are kept in the hospital until they are independent with all aspects of their care.
C) Patients need to stay in the hospital until they regain normal heart function for their age.
D) Patients usually remain at the hospital for 24 to 48 hours.

Question 26

A patient has been diagnosed with a valvular disorder. The patient tells the nurse that he has read about numerous treatment options, including valvuloplasty. What should the nurse teach the patient about valvuloplasty?

A) For some patients, valvuloplasty can be done in a cardiac catheterization laboratory.
B) Valvuloplasty is a dangerous procedure, but it has excellent potential if it goes well.
C) Valvuloplasty is open heart surgery, but this is very safe these days and normally requires only an overnight hospital stay.
D) Its prudent to get a second opinion before deciding to have valvuloplasty.

Question 27

The patient has just returned to the floor after balloon valvuloplasty of the aortic valve and the nurse is planning appropriate assessments. The nurse should know that complications following this procedure
Include what? Select all that apply.

A) Emboli
B) Mitral valve damage
C) Ventricular dysrhythmia
D) Atrial-septal defect
E) Plaque formation

Question 28

The nurse is caring for a patient with right ventricular hypertrophy and consequently decreased right ventricular function. What valvular disorder may have contributed to this patients diagnosis?

A) Mitral valve regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Mitral valve stenosis

Question 29

The cardiac nurse is caring for a patient who has been diagnosed with dilated cardiomyopathy (DCM). Echocardiography is likely to reveal what pathophysiological finding?

A) Decreased ejection fraction
B) Decreased heart rate
C) Ventricular hypertrophy
D) Mitral valve regurgitation

Question 30

A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy?

A) Dilated cardiomyopathy (DCM).
B) Arrhythmogenic right ventricular cardiomyopathy (ARVC)
C) Hypertrophic cardiomyopathy (HCM)
D) Restrictive or constrictive cardiomyopathy (RCM)

Question 31

The nurse is teaching a patient diagnosed with aortic stenosis appropriate strategies for attempting to relieve the symptom of angina without drugs. What should the nurse teach the patient?

A) To eat a small meal before taking nitroglycerin
B) To drink a glass of milk before taking nitroglycerin
C) To engage in 15 minutes of light exercise before taking nitroglycerin
D) To rest and relax before taking nitroglycerin

Question 32

A patient has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment?

A) Heart transplantation
B) Balloon valvuloplasty
C) Cardiac catheterization
D) Stent placement

Question 33

A patient has undergone a successful heart transplant and has been discharged home with a medication regimen that includes cyclosporine and tacrolimus. In light of this patients medication regimen, what nursing diagnosis should be prioritized?

A) Risk for injury
B) Risk for infection
C) Risk for peripheral neurovascular dysfunction
D) Risk for unstable blood glucose

Question 34

The nurse is caring for a patient with acute pericarditis. What nursing management should be instituted to minimize complications?

A) The nurse keeps the patient isolated to prevent nosocomial infections.
B) The nurse encourages coughing and deep breathing.
C) The nurse helps the patient with activities until the pain and fever subside.
D) The nurse encourages increased fluid intake until the infection resolves.

Question 35

A patient who has recently recovered from a systemic viral infection is undergoing diagnostic testing for myocarditis. Which of the nurses assessment findings is most consistent with myocarditis?

A) Sudden changes in level of consciousness (LOC)
B) Peripheral edema and pulmonary edema
C) Pleuritic chest pain
D) Flulike symptoms

Question 36

The nurse on the hospitals infection control committee is looking into two cases of hospital-acquired infective endocarditis among a specific classification of patients. What classification of patients would be at greatest risk for hospital-acquired endocarditis?

A) Hemodialysis patients
B) Patients on immunoglobulins
C) Patients who undergo intermittent urinary catheterization
D) Children under the age of 12

Question 37

The nurse is caring for a recent immigrant who has been diagnosed with mitral valve regurgitation. The nurse should know that in developing countries the most common cause of mitral valve regurgitation is what?

A) A decrease in gamma globulins
B) An insect bite
C) Rheumatic heart disease and its sequelae
D) Sepsis and its sequelae

Question 38

Most individuals who have mitral valve prolapse never have any symptoms, although this is not the case for every patient. What symptoms might a patient have with mitral valve prolapse? Select all that apply.

A) Anxiety
B) Fatigue
C) Shoulder pain
D) Tachypnea
E) Palpitations

Question 39

A cardiac surgery patients new onset of signs and symptoms is suggestive of cardiac tamponade. As a member of the interdisciplinary team, what is the nurses most appropriate action?

A) Prepare to assist with pericardiocentesis.
B) Reposition the patient into a prone position.
C) Administer a dose of metoprolol.
D) Administer a bolus of normal saline.

Question 40

The nurse is auscultating the breath sounds of a patient with pericarditis. What finding is most consistent with this diagnosis?

A) Wheezes
B) Friction rub
C) Fine crackles
D) Coarse crackles