Deck 39: Nursing Management Inflammatory and Structural Heart Disorders

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?

A)Monitor laboratories for streptococcal antibodies.
B)Arrange for insertion of a long-term IV catheter.
C)Encourage the client to get regular aerobic exercise.
D)Teach the importance of completing all oral antibiotics.

Answer 1

Arrange for insertion of a long-term IV catheter.

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?

A)Activity intolerance related to physical deconditioning (arthralgia)
B)Risk for infection as evidenced by immunosupression
C)Chronic pain related to injury agent (permanent joint fixation)
D)Risk for impaired skin integrity evidenced by pressure over bony prominence

Answer 2

Activity intolerance related to physical deconditioning (arthralgia)

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?

A)Auscultate with the stethoscope diaphragm at the lower left sternal border.
B)Listen for a rumbling, low-pitched, systolic sound over the left anterior chest.
C)Feel the precordial area with the palm of the hand to detect vibration with cardiac contraction.
D)Ask the client to stop breathing during auscultation to distinguish the sound from a pleural friction rub.

Answer 3

Auscultate with the stethoscope diaphragm at the lower left sternal border.

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?

A)Dyspnea
B)Flank pain
C)Hemiparesis
D)Splenomegaly

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?

A)Elevating the legs above the heart will help relieve angina.
B)No more than two alcoholic drinks daily are recommended.
C)Careful adherence to diet and medication regimen will prevent heart failure.
D)Notify the health care provider about any symptoms of heart failure.

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?

A)Fentanyl 2 mg IV
B)Morphine sulphate 6 mg IV
C)Ibuprofen 800 mg PO
D)Acetaminophen 650 mg PO

Question 7

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

A)Immunize susceptible groups in the community with streptococcal vaccine.
B)Teach community members to seek treatment for streptococcal pharyngitis.
C)Educate about the importance of monitoring temperature when infections occur.
D)Provide prophylactic antibiotics to people with a family history 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?

A)Electrolyte levels
B)Echocardiography
C)Daily blood cultures
D)Cardiac catheterization

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?

A)"I will need to have monthly antibiotic injections for 10 years or longer."
B)"I will need to take Aspirin or ibuprofen to relieve my joint pain."
C)"I will call the doctor if I develop excessive fatigue or difficulty breathing."
D)"I will be immune to further episodes of rheumatic fever after this infection."

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?

A)"Have you been to the dentist lately?"
B)"Do you have a history of a heart attack?"
C)"Is there a family history of endocarditis?"
D)"Have you had any recent immunizations?"

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?

A)Fever, chills, and diaphoresis
B)Urine output less than 30 mL/hour
C)Petechiae of the buccal mucosa and conjunctiva
D)Increase in pulse rate of 15 beats/minute with activity

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?

A)Promote rest to decrease myocardial oxygen demand.
B)Educate the client about the need for anticoagulant therapy.
C)Teach the client to use sublingual nitroglycerin for chest pain.
D)Elevate the head of the bed 60 degrees to decrease venous return.

Question 13

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

A)A new regurgitant murmur
B)A pruritic rash on the trunk
C)Involuntary muscle movement
D)Substernal chest pain and pressure

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?

A)Plan to take antibiotics before any dental appointments
B)Limit physical activity to avoid stressing the heart valves.
C)Take one Aspirin a day to prevent embolization from the valve.
D)Avoid use of over-the-counter (OTC) medications that contain stimulant drugs.

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?

A)Force fluids to 3 000 mL/day to decrease fever and inflammation.
B)Teach about deep, slow respirations to control the pain.
C)Remind the client to ask for the opioid pain medication every 4 hours.
D)Position the client in Fowler's position, leaning forward on the overbed table.

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?

A)Biological replacement valves require the use of immuno-suppressive drugs.
B)Mechanical mitral valves require replacement approximately every 5 years.
C)Lifelong anticoagulant therapy is needed after mechanical valve replacement.
D)Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty.

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?

A)Check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration.
B)Note when Korotkoff sounds are audible during both inspiration and expiration.
C)Auscultate for a pericardial friction rub that increases in volume during inspiration.
D)Subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).

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?

A)Use of daily Aspirin for anticoagulation
B)Correct method for taking the radial pulse
C)Need for frequent laboratory blood testing
D)Possibility of valve replacement in 7-10 years

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?

A)"Have you had a recent sore throat?"
B)"Are you using any illegal IV drugs?"
C)"Do you have any family history of congenital heart disease?"
D)"Can you recall having any chest injuries in the last few weeks?"

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?

A)Diastolic murmur
B)Peripheral edema
C)Right upper quadrant tenderness
D)Complaints of shortness of breath

Question 21

Which of the following prescriptions written by the health care provider for a client admitted with infective endocarditis (IE) and a fever should the nurse implement first?

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

Question 22

The nurse is assessing a client who has mitral valve regurgitation. Which of the following findings should be communicated to the health care provider immediately?

A)4+ peripheral edema in both legs
B)Crackles audible to the lung apices
C)A palpable thrill felt over the left anterior chest
D)A loud systolic murmur all across the precordium

Question 23

Which of the following assessment data obtained by the nurse when assessing a client with acute pericarditis should be reported immediately to the health care provider?

A)Pulsus paradoxus 8 mm Hg
B)Blood pressure (BP) of 166/96
C)Jugular vein distension (JVD) to the level of the jaw
D)Level 6 (0-10 scale) chest pain with deep inspiration

Question 24

The nurse is conducting discharge teaching about the need for prophylactic antibiotics when having dental procedures. This teaching would be provided to a client with which of the following diagnoses?

A)Acute myocardial infarction
B)Exacerbation of heart failure
C)Mechanical mitral valve replacement
D)Rheumatic fever after a streptococcal infection.

Question 25

The nurse is taking a health history from a 24-year-old client with hypertrophic cardiomyopathy (HC). Which of the following information obtained by the nurse is most relevant?

A)The client reports using cocaine once at age 16.
B)The client has a history of a recent upper respiratory infection.
C)The client's 29-year-old brother had a sudden cardiac arrest.
D)The client has a family history of coronary artery disease.

Question 26

Which of the following findings in a client with infective endocarditis (IE) is most important for the nurse to communicate to the health care provider?

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

Question 27

Which of the following assessment information obtained by the nurse for a client with aortic stenosis is most important to report to the health care provider?

A)The client complains of chest pain associated with ambulation.
B)A loud systolic murmur is audible along the right sternal border.
C)A thrill is palpable at the 2nd intercostal space, right sternal border.
D)The point of maximum impulse (PMI) is at the left midclavicular line.

Question 28

The nurse is caring for a client who had an acute myocardial infarction (MI) 3 days prior and has symptoms of stabbing chest pain that increases with deep breathing. Which of the following actions should the nurse take first?

A)Auscultate the heart sounds.
B)Check the client's oral temperature.
C)Notify the client's health care provider.
D)Give the ordered acetaminophen.