Deck 36: Inflammatory and Structural Heart Disorders

Question 1

A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of

A)blood cultures.
B)echocardiography.
C)cardiac catheterization.
D)24-hour Holter monitor.

Answer 1

echocardiography.

Question 2

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?

A)A heart transplant should be scheduled as soon as possible.
B)Elevating the legs above the heart will help relieve dyspnea.
C)Careful compliance with diet and medications will prevent heart failure.
D)Notify the health care provider about symptoms such as shortness of breath.

Answer 2

Notify the health care provider about symptoms such as shortness of breath.

Question 3

The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus,the nurse should

A)subtract the diastolic blood pressure from the systolic blood pressure.
B)note when Korotkoff sounds are auscultated during both inspiration and expiration.
C)check the electrocardiogram (ECG) for variations in rate during the respiratory cycle.
D)listen for a pericardial friction rub that persists when the patient is instructed to stop breathing.

Answer 3

note when Korotkoff sounds are auscultated during both inspiration and expiration.

Question 4

To assess the patient with pericarditis for evidence of a pericardial friction rub,the nurse should

A)listen for a rumbling, low-pitched, systolic murmur over the left anterior chest.
B)auscultate with the diaphragm of the stethoscope on the lower left sternal border.
C)ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub.
D)feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction.

Question 5

During the assessment of a young adult patient with infective endocarditis (IE),the nurse would expect to find

A)substernal chest pressure.
B)a new regurgitant murmur.
C)a pruritic rash on the chest.
D)involuntary muscle movement.

Question 6

The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history focuses on a pertinent risk factor for rheumatic fever?

A)"Do you use any illegal IV drugs?"
B)"Have you had a recent sore throat?"
C)"Have you injured your chest in the last few weeks?"
D)"Do you have a family history of congenital heart disease?"

Question 7

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

A)teach the patient to take deep, slow breaths to control the pain.
B)force fluids to 3000 mL/day to decrease fever and inflammation.
C)provide a fresh ice bag every hour for the patient to place on the chest.
D)place the patient in Fowler's position, leaning forward on the overbed table.

Question 8

While caring for a 23-yr-old patient with mitral valve prolapse (MVP)without valvular regurgitation,the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to

A)take antibiotics before any dental appointments.
B)limit physical activity to avoid stressing the heart.
C)avoid over-the-counter (OTC) drugs that contain stimulants.
D)take an aspirin a day to prevent clots from forming on the valve.

Question 9

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE)based on which assessment finding(s)?

A)Fever, chills, and diaphoresis
B)Urine output less than 30 mL/hr
C)Petechiae on the inside of the mouth and conjunctiva
D)Increase in heart rate of 15 beats/minute with walking

Question 10

A patient with rheumatic fever has subcutaneous nodules,erythema marginatum,and polyarthritis. The patient reports that discomfort in the joints prevents favorite activities such as taking a daily walk and working on sewing projects. Based on these findings,which nursing diagnosis statement would be appropriate?

A)Activity intolerance related to arthralgia
B)Anxiety related to permanent joint fixation
C)Altered body image related to polyarthritis
D)Social isolation related to pain and swelling

Question 11

During discharge teaching with an older patient who had a mitral valve replacement with a mechanical valve,the nurse must instruct the patient on the

A)use of daily aspirin for anticoagulation.
B)correct method for taking the radial pulse.
C)need for frequent laboratory blood testing.
D)need to avoid any physical activity for 1 month.

Question 12

While caring for a patient with aortic stenosis,the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. An appropriate nursing intervention for this patient would be to

A)promote rest to decrease myocardial oxygen demand.
B)teach the patient about the need for anticoagulant therapy.
C)teach the patient to use sublingual nitroglycerin for chest pain.
D)raise the head of the bed 60 degrees to decrease venous return.

Question 13

When caring for a patient with infective endocarditis of the tricuspid valve,the nurse should monitor the patient for the development of

A)flank pain.
B)splenomegaly.
C)shortness of breath.
D)mental status changes.

Question 14

When developing a community health program to decrease the incidence of rheumatic fever,which action should the community health nurse include?

A)Vaccinate high-risk groups in the community with streptococcal vaccine.
B)Teach community members to seek treatment for streptococcal pharyngitis.
C)Teach about the importance of monitoring temperature when sore throats occur.
D)Teach about prophylactic antibiotics to those with a family history of rheumatic fever.

Question 15

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale)chest pain with deep breathing. Which prescribed PRN medication will be the most appropriate for the nurse to give?

A)Fentanyl 1 mg IV
B)IV morphine sulfate 4 mg
C)Oral ibuprofen (Motrin) 600 mg
D)Oral acetaminophen (Tylenol) 650 mg

Question 16

When caring for a patient with mitral valve stenosis,it is most important that the nurse assess for

A)diastolic murmur.
B)peripheral edema.
C)shortness of breath on exertion.
D)right upper quadrant tenderness.

Question 17

The home health nurse is visiting a 30-yr-old patient recovering from rheumatic fever without carditis. The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge regarding long-term management of rheumatic fever when the patient makes which statement?

A)"I will need prophylactic antibiotic therapy for 5 years."
B)"I can take aspirin or ibuprofen (Motrin) to relieve my joint pain."
C)"I will be immune to future episodes of rheumatic fever after this infection."
D)"I should call the health care provider if I am fatigued or have difficulty breathing."

Question 18

A 21-yr-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?

A)Biologic valves will require immunosuppressive drugs after surgery.
B)Mechanical mitral valves need to be replaced sooner than biologic valves.
C)Lifelong anticoagulant therapy is needed after mechanical valve replacement.
D)Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

Question 19

The nurse obtains a health history from an older patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most focused on identifying a risk factor for IE?

A)"Do you have a history of a heart attack?"
B)"Is there a family history of endocarditis?"
C)"Have you had any recent immunizations?"
D)"Have you had dental work done recently?"

Question 20

When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE),which intervention is most appropriate for the nurse to include?

A)Arrange for placement of a long-term IV catheter.
B)Monitor labs for levels of streptococcal antibodies.
C)Teach the importance of completing all oral antibiotics.
D)Encourage the patient to begin regular aerobic exercise.

Question 21

Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider?

A)Pulsus paradoxus 8 mm Hg
B)Blood pressure (BP) of 168/94 mm Hg
C)Jugular venous distention (JVD) to jaw level
D)Level 6 (0 to 10 scale) chest pain with a deep breath

Question 22

The nurse is caring for a patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider?

A)The patient complains of chest pressure when ambulating.
B)A loud systolic murmur is heard along the right sternal border.
C)A thrill is palpated at the second intercostal space, right sternal border.
D)The point of maximum impulse (PMI) is at the left midclavicular line.

Question 23

Two days after an acute myocardial infarction (MI),a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first?

A)Auscultate the heart sounds.
B)Check the patient's temperature.
C)Give the PRN acetaminophen (Tylenol).
D)Notify the patient's health care provider.

Question 24

Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are most effective?

A)Assess for the presence of a paradoxical pulse.
B)Monitor for changes in the patient's sedimentation rate.
C)Assess for the presence of jugular venous distention (JVD).
D)Check the electrocardiogram (ECG) for ST segment changes.

Question 25

The nurse is obtaining a health history from a 24-yr-old patient with hypertrophic cardiomyopathy (CMP). Which information obtained by the nurse is most important?

A)The patient has a history of a recent upper respiratory infection.
B)The patient has a family history of coronary artery disease (CAD).
C)The patient reports using cocaine a "couple of times" as a teenager.
D)The patient's 29-yr-old brother died from a sudden cardiac arrest.

Question 26

The nurse is caring for a patient with mitral regurgitation. Referring to the figure below,where should the nurse listen to best hear a murmur typical of mitral regurgitation?

A)1
B)2
C)3
D)4

Question 27

After receiving information about four patients during change-of-shift report,which patient should the nurse assess first?

A)Patient with acute pericarditis who has a pericardial friction rub
B)Patient who has just returned to the unit after balloon valvuloplasty
C)Patient who has hypertrophic cardiomyopathy and a heart rate of 116
D)Patient with a mitral valve replacement who has an anticoagulant scheduled

Question 28

The nurse will plan discharge teaching about prophylactic antibiotics before dental procedures for which patient?

A)Patient admitted with a large acute myocardial infarction
B)Patient being discharged after an exacerbation of heart failure
C)Patient who had a mitral valve replacement with a mechanical valve
D)Patient being treated for rheumatic fever after a streptococcal infection

Question 29

The nurse is caring for a 64-yr-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately?

A)The patient has 4+ peripheral edema.
B)The patient has diffuse bilateral crackles.
C)The patient has a loud systolic murmur across the precordium.
D)The patient has a palpable thrill felt over the left anterior chest.

Question 30

Which assessment finding in a patient who is admitted with infective endocarditis (IE)is most important to communicate to the health care provider?

A)Generalized muscle aching
B)Sudden onset right flank pain
C)Janeway's lesions on the palms
D)Temperature 100.7°F (38.1°C)

Question 31

Which admission order written by the health care provider for a patient admitted with infective endocarditis (IE)and a fever would be a priority for the nurse to implement?

A)Administer ceftriaxone 1 g IV.
B)Order blood cultures drawn from two sites.
C)Give acetaminophen (Tylenol) PRN for fever.
D)Arrange for a transesophageal echocardiogram.

Question 32

After receiving change-of-shift report on four patients,which patient should the nurse assess first?

A)Patient with rheumatic fever who has sharp chest pain with a deep breath
B)Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg
C)Patient with infective endocarditis who has a murmur and splinter hemorrhages
D)Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

Question 33

Which statement by a patient with restrictive cardiomyopathy indicates that the nurse's discharge teaching about self-management has been effective?

A)"I will avoid taking aspirin or other antiinflammatory drugs."
B)"I can restart my exercise program that includes hiking and biking."
C)"I will need to limit my intake of salt and fluids even in hot weather."
D)"I will take antibiotics before my teeth are cleaned at the dental office."

Question 34

The nurse is assessing a patient with myocarditis before giving the scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider?

A)Leukocytosis
B)Irregular pulse
C)Generalized myalgia
D)Complaint of fatigue

Question 35

Which action could the nurse delegate to unlicensed assistive personnel (UAP)trained as electrocardiogram (ECG)technicians working on the cardiac unit?

A)Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome.
B)Obtain a list of herbal medications used at home while admitting a new patient with pericarditis.
C)Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy.
D)Watch the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.